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Case series
Coccygeoplasty: preliminary experience with this new alternative treatment of refractory coccydynia in patients with coccyx hypermobility
  1. Luigi Manfre1,
  2. Inês Gil2,
  3. Tiago Baptista3,4,
  4. Pedro Calvão Pires5,
  5. Aldo Eros de Vivo1,
  6. Salvador Masala6,
  7. Ronil V Chandra7,8,
  8. Gennaro D'Anna9,
  9. Joshua A Hirsch10
  1. 1 Department of Radiology, IOM Mediterranean Oncology Institute, Viagrande, Italy
  2. 2 Department of Neuroradiology, Centro Hospitalar do Algarve EPE, Faro, Portugal
  3. 3 Department of Neuroradiology, Oxford University Hospitals NHS Trust, Oxford, UK
  4. 4 Department of Neuroradiology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
  5. 5 Department of Neuroradiology, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
  6. 6 Department of Diagnosis Imaging Interventional Radiology and Clinical Pathology, Ospedale San Giovanni Battista, Roma, Italy
  7. 7 Department of Interventional Neuroradiology, Monash Health, Clayton, Victoria, Australia
  8. 8 Department of Image, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
  9. 9 Department of Radiology, IRCCS Istituto Clinico Humanitas, Rozzano, Italy
  10. 10 NeuroEndovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Inês Gil, Department of Neuroradiology, Centro Hospitalar do Algarve EPE, Faro, Portugal; inesgilalmeida{at}


Background Coccydynia has many causes, including fracture, subluxation, and hypermobility of sacrococcygeal segments. Existing treatments are limited in their effectiveness. Coccygeoplasty (CP) is a relatively new, minimally invasive treatment that appears to address this difficult clinical challenge.

Objective To describe clinical results at the time of the procedure and at 3- and 12-months' follow-up of patients with coccydynia related to subluxation and coccyx hypermobility treated with the CP technique. Additionally, to determine if there is any correlation between the final imaging and clinical results at 3- and 12-months' follow-up.

Methods A prospectively maintained database was used, and all patients who underwent CP for chronic coccydynia between January 2005 and October 2018 were retrospectively reviewed. All the patients had painful hypermobility (greater than 25°) with anterior flexion confirmed on radiological imaging. Alternative causes of coccydynia were excluded using CT and MRI. Procedures were performed under local anesthesia with combined fluoroscopic and CT guidance. Clinical follow-up was performed at two time points: 3 and 12 months after treatment using the Visual Analogue Scale (VAS).

Results Twelve patients were treated in a single center. No procedural complications occurred. At 3- and 12-months' follow-up, the majority (75%) of patients had significantly lower VAS scores than at baseline, with mean changes of 3.5 and 4.9, respectively. There was no pain recurrence at 12 months and just one patient had no improvement of the pain. Follow-up CT images confirmed fixation of the sacrococcygeal bone segments in nine patients; however, no correlation was found between final imaging results and clinical outcome (p=0.1).

Conclusions Patients with refractory painful coccyx subluxation and hypermobility undergoing CP have a favorable clinical response at 3- and 12-months' follow-up. Further studies are required to validate this technique and to identify predictors of treatment response. Coccygeoplasty may be considered a reasonable alternative to coccygectomy.

  • Spine
  • Lumbosacral
  • Intervention
  • Technique

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  • Twitter @gennadanna, @JoshuaAHirsch

  • Contributors LM and AEdV performed the procedures. LM developed the technical approach and participated in the study design. RVC and SM conception and study design. GD’A is involved in planning and supervising the work. TB and PCP processed the analysis and designed the figures. IG drafted the manuscript and aided in interpreting the results. JAH was responsible for revising the intellectual content of the paper. All authors discussed the results and commented on the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.