Coccydynia

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ive had great success with RF of the "coccygeal nerves" with bipolar RF alongside the distal coccyx segment and across the segment. (was a crap shoot) but he's done great afterwards when impar provided only temporary benefit.

re RF of these structures, I have never found a good description of a good validated technique. I have asked 5-6 world pain experts/PDs on how they do this and everyone does it slightly differently. i should have asked plancarte when i saw him last year.
 
Generally I do coccygeal nerve block first, then impar block.

Recently did conventional RFA on the ganglion impar for a guy who would only get a week or so relief from blocks. I saw him for a followup recently 6 weeks out and he was very satisfied. Not sure what the longterm result will be.

20201001_085110.jpg
 
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Baron Samedi said:
Generally I do coccygeal nerve block first, then impar block.

Recently did conventional RFA on the ganglion impar for a guy who would only get a week or so relief from blocks. I saw him for a followup recently 6 weeks out and he was very satisfied. Not sure what the longterm result will be.

View attachment 319485
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So standard impar approach. Contrast.

what is your conventional RFA settings and testing procedure?

No concerns for rectal injury?
 
They were counseled on the risk of rectal injury and I tried to be as superficial as possible and still get contrast pattern. I tested motor, figured if they had rectal spasm I was in trouble(and it'd make a mess). I did 80 degrees for 90 seconds, same protocol outlined in this article:

Transsacrococcygeal approach to ganglion impar: radiofrequency application for the treatment of chronic intractable coccydynia - PMC

Coccydynia is defined as pain in the coccygeal region. Among the many causes of coccydynia, the most common cause is trauma as a result of falling on the buttocks, repetitive microtrauma, or childbirth. Several methods are currently used for the ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov
 
I will either try coccyx injection, just dropping bupi and depo along each joint of the coccyx posteriorly or impar. For just coccyx pain I seem to have better luck with the coccyx injection. Impar works better for pelvic pain imo.

I've done the coccyx RFA with good results as well. Two needles, along the distal lateral walls of the sacral hiatus.
 
Baron Samedi said:
Generally I do coccygeal nerve block first, then impar block.

Recently did conventional RFA on the ganglion impar for a guy who would only get a week or so relief from blocks. I saw him for a followup recently 6 weeks out and he was very satisfied. Not sure what the longterm result will be.

View attachment 319485
Click to expand...

Impending flatus....

Drop the meds and get out of there.
 
Anyone do a caudal?

also, wats a “coccyx block” entail? Just injected steroid around the coccyx or do you mean the impar block?
 
Ferrismonk said:
I will either try coccyx injection, just dropping bupi and depo along each joint of the coccyx posteriorly or impar. For just coccyx pain I seem to have better luck with the coccyx injection. Impar works better for pelvic pain imo.

I've done the coccyx RFA with good results as well. Two needles, along the distal lateral walls of the sacral hiatus.
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What are you coding for thing, ICD 10, CPT? Any issues getting paid both with medicare and commercial insurance?
 
Anything other than caudals and ganglion impar for coccyx dislocations? Seeing one tomorrow. Looked at his films tonight and it’s actually a decent dislocation (from a fall). I’m guessing if no neuro deficits or b/b dysfunction then no need for a surgical correction
 
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So attempted an impar block today using transsacrococcygeal approach and just could not advance past the anterior disc space both at the sacroccygeal joint and intracoccygeal joint. Patient had a bit of sclerosis which made even accessing the joint spaces challenging. Never had this challenge before.

I've only ever done transsacrococcygeal approach. Anyone have recommendations for alternative approach, such as paracoccygeal?
 
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Baron Samedi said:
So attempted an impar block today using transsacrococcygeal approach and just could not advance past the anterior disc space both at the sacroccygeal joint and intracoccygeal joint. Patient had a bit of sclerosis which made even accessing the joint spaces challenging. Never had this challenge before.

I've only ever done transsacrococcygeal approach. Anyone have recommendations for alternative approach, such as paracoccygeal?
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I’ve never attempted paracoccygeal. Did you use 22 gauge or 25 gauge?
 
Baron Samedi said:
It was a 25G, considering trying again with a 22G for some more oomf.
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I usually use 22g. Very rarely the space is so tight that I can't get a 22g in and I have to switch to a 25g (this happened maybe once?). But I agree that trying again with a 22g may do the trick.
 
jwalker12 said:
Anyone have pictures of the "coccygeal" block (not the impar)? is everyone advancing in lateral view? thanks
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Not too exciting, its just a field block. AP to make sure you're midline, advance in lateral to os and inject. I normally do 20mg triamcinolone and 1mL of 0.25% bupivicaine. Can use point of maximal tenderness to help guide how far cephalad/caudad you inject. I generally inject a little bit at 2-3 sites up and down the field.
 

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Baron Samedi said:
Not too exciting, its just a field block. AP to make sure you're midline, advance in lateral to os and inject. I normally do 20mg triamcinolone and 1mL of 0.25% bupivicaine. Can use point of maximal tenderness to help guide how far cephalad/caudad you inject. I generally inject a little bit at 2-3 sites up and down the field.
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Thank you so much for sharing. Appreciate it
 
I had good response from this. really good response. no neuritis. have done this in 5 patients with similar presentation and outcomes.
 

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