Coccyx pain

[MD87]

I have a patient with several months of coccyx pain. Worse with sitting, TTP over coccyx. Otherwise normal exam. No trauma, but she has an anteriorly displaced coccyx. Failed NSAIDs and no one around me does good pelvic floor PT. I scheduled her for ganglion impar injection, but her insurance won't pay for it. They wouldn't even let me to a peer-to-peer... they just straight up said they won't cover it. Any other treatment options? I don't want to send her to a surgeon. Thanks.

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[callmeanesthesia]

Sacrococcygeal joint injection - bill as small joint/fluoro. If your needle happens to pass just a little anterior...

 

[Ligament]

sacrococygeal joint injection
ganglion impar block
coccygeal-coccygeal joint injection
coccygeal nerve block
coccygeal nerve pulsed or thermal RF or cryoablation
thermal ablation of the coccygeal ligaments
rectal branch of the pudendal nerve?
PRP or prolotherapy to the coccygeal ligaments
just some thoughts.

These three are PRP to the cocygeal ligaments and platlelet lysate to the coccygeal nerves in the top pic.

 

[Ligament]

This is scorched earth warfare on the coccygeal nerves

 

[Ligament]

 

[MD87]

Thanks for the responses. If I bill for the joint injection, I assume I also bill for fluoro guidance into joint, NOT spine, correct?

 

[Orin]

I have a patient with several months of coccyx pain. Worse with sitting, TTP over coccyx. Otherwise normal exam. No trauma, but she has an anteriorly displaced coccyx.

Self-manipulation of the coccyx for coccydynia

I injured my tailbone somehow 4 months ago. The pain gradually increased in intensity pain until I had to completely forgo my workout program.

www.coccyx.org

The Coccyx Revisited: External and Internal Exam Correction Procedures | Dynamic Chiropractic

www.dynamicchiropractic.com

But if you don't want to go that way, I would just start with a caudal

 

[ghost800]

Hi ligament! Long time lurker, first time poster here so please forgive any unpleasantries and go easy on me!

Did any of these interventions work, and if so, for how long? I’ve been doing ganglion of impar block combined with saccrococcygeal nerve block and caudal epidural for these and have been getting decent results with most patients getting between 4-6 months of about 80% relief. However, I’m always looking for better outcomes and was wondering what these might yield. Thanks!

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[clubdeac]

Ligament, damn! Show that coccyx who's boss...Did the patient have a huge ass chancre when you were done?

 

[Ligament]

Ligament, damn! Show that coccyx who's boss...Did the patient have a huge ass chancre when you were done?

Patient expired halfway through procedure but I kept going.

 

[deleted993114]

sacrococygeal joint injection
ganglion impar block
coccygeal-coccygeal joint injection
coccygeal nerve block
coccygeal nerve pulsed or thermal RF or cryoablation
thermal ablation of the coccygeal ligaments
rectal branch of the pudendal nerve?
PRP or prolotherapy to the coccygeal ligaments
just some thoughts.

These three are PRP to the cocygeal ligaments and platlelet lysate to the coccygeal nerves in the top pic.

View attachment 279876
View attachment 279874
View attachment 279904

Lots o needles.

I thought the pain generator in coccydynia was the residual disc (ligament) between the sacrum and coccyx? I usually place 1-2 needles and get decent results. In many instances, there will be an angular displacement at the point of the presumed pain generator.

It certainly would not hurt to place the additional needles and I am not being critical at all (whatever works- sounds like you get very good results), but I'll bet you could get by with fewer.

I've done ganglion of impar neurolytic injections, but only on patients with recto-sigmoid cancer, and never for benign pain. You can access it by two different methods, the easiest is just going a little deeper in the above images (like one of the segmental needles pictured).

 

[Ligament]

Lots o needles.

I thought the pain generator in coccydynia was the residual disc (ligament) between the sacrum and coccyx? I usually place 1-2 needles and get decent results. In many instances, there will be an angular displacement at the point of the presumed pain generator.

It certainly would not hurt to place the additional needles and I am not being critical at all (whatever works- sounds like you get very good results), but I'll bet you could get by with fewer.

I've done ganglion of impar neurolytic injections, but only on patients with recto-sigmoid cancer, and never for benign pain. You can access it by two different methods, the easiest is just going a little deeper in the above images (like one of the segmental needles pictured).

Oh yes, if I suspect coccydynia I'll typically try a sacrococcygeal joint injection combined with and impar block at the same time since the needle is there. Unfortunately on the above patients, that did not help.

 

[dhcofc]

Aren’t the target nerves on the ventral side of the coccyx? I’ve done ganglion of impar blocks but haven’t figured out how to do an RFA successfully.

 

[painfree23]

This is scorched earth warfare on the coccygeal nerves

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excuse my ignorance, but what is being done here?

 

[TIVAndy]

Patient expired halfway through procedure but I kept going.

i just did this but what cpt do u use? 64640 + 77003?

 

[TIVAndy]

this is also a nice paper about treatment algorithm. basically etiology is unclear at this point. in my experience some respond to ganglion impar nicely and some dont..

 

[deleted993114]

this is also a nice paper about treatment algorithm. basically etiology is unclear at this point. in my experience some respond to ganglion impar nicely and some dont..

Interesting article- thanks for posting.

It's kind of hard to determine efficacy with a retrospective study and one in which there is no statistical analysis, but the qualitative description of the procedure is interesting. The schematic was very helpful in identifying the target sites and the treatment algorithm/options was helpful.

What is your personal experience? We used to do cryo on the very same sites several years ago with marginal success. It might be interesting to try the rf on those who fail the injections. Note, however, that surgical outcomes are usually quite good, albeit more invasive.

 

[lonelobo]

excuse my ignorance, but what is being done here?

Lots of billing

 

[Ferrismonk]

I think someone doesn't pay for their own needles...

To get ganglion impar approved, it needs to be CRPS. Chronic pelvic pain can count, but not tailbone pain.

I often will just take a single quinke and walk it down the coccyx from sacrococcygeal joint to the bottom depositing local and steroid along the way. Works well, bill as medium joint with flouro.

 

[Ligament]

excuse my ignorance, but what is being done here?

RF of the coccygeal nerves.

Mr. Mtxipicksixzxkds has a much more elegant technique to do this that I recommend trying first. This patient already had that particular technique and it did not work, so I wanted to repeat with a scorched earth technique to see if it would do the trick.

 

[TIVAndy]

Interesting article- thanks for posting.

It's kind of hard to determine efficacy with a retrospective study and one in which there is no statistical analysis, but the qualitative description of the procedure is interesting. The schematic was very helpful in identifying the target sites and the treatment algorithm/options was helpful.

What is your personal experience? We used to do cryo on the very same sites several years ago with marginal success. It might be interesting to try the rf on those who fail the injections. Note, however, that surgical outcomes are usually quite good, albeit more invasive.

in fellowship with RF there was mixed results.. i'm about to find out soon about my recent patient. i used two probes and burned in four locations along the coccyx

 

[Green Grass]

Anyone using stim?

 

[Baron Samedi]

Anyone using stim?

I have an n=1 experience using BurstDR with about 80% relief in a woman with coccydynia after a fall from horseback a decade prior. Unfortunately I can't recall the effective level but she was very satisfied post implant.