Radiofrequency ablation within the first intercoccygeal disk for coccygodynia: a case report.

Pain Practice

2011 May-Jun; 11(3): 278-81.

Scemama P (1), Shaparin N(2), Kaufman A, Dua S(3).

1 Department of Medicine, Morristown Memorial Hospital, Morristown, New Jersey

2 Department of Anesthesiology/Division of Pain Management, UMDNJ-New Jersey Medical School, Newark, New Jersey

3 Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, U.S.A.

Abstract

Interventional procedures for coccydynia (coccygodynia) are limited. This is a case report of long-term improvement following radiofrequency ablation (RFA) within the 1st intercoccygeal disk. Case Presentation: A 44-year-old female presented with a 1 year history of coccydynia following a fall. Examination under fluoroscopy localized her pain at the disk between the 1st and 2nd coccygeal vertebrae. Provocation with needle entry reproduced the patient's pain, and the 1st intercoccygeal disk was injected with 40 mg of methylprednisolone. This gave the patient excellent relief for about 3 weeks. The procedure was repeated at 4 weeks, providing with the same response. Decision was then made to proceed with RFA. Her symptoms were reproduced in response to stimulation at 50 Hz with 0.9 V, and stimulation at 2 Hz at 2 V did not result in any motor stimulation. RFA was then carried out at 70C for 80 seconds, followed by injection of 20 mg of methylprednisolone. The patient's Numeric Rating Scale pain score decreased from 9/10 to 3/10 after the RFA. She had about 70% relief for about 6 months. Discussion: There is evidence that intercoccygeal disks can be a source of coccydynia. Immunohistochemistry has shown mechanoreceptors in intercoccygeal disks, and coccygeal discography has been shown to reproduce coccygeal pain. Intercoccygeal disk injection is described as a therapeutic option in the literature. Because various RFA techniques have been successfully used for intervertebral diskogenic pain, the decision was made to attempt RFA at the 1st intercoccygeal disk with resultant significant long-term improvement.

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