For me, the first treatment is an anti-inflammatory injection (steroid) in the affected joint, as demonstrated by the dynamic films. This can only be done under fluoroscopic control. The result occurs within one week and provides a two to four month relief in 60 to 70% of the patients and full recovery (at one year) in 30%. Despite there is a theoretical risk of local infection, I have performed more than 500 injections in 8 years without any problem. In 10% of the cases, there is a marked post-injection pain for a couple of days.
We have completed a study comparing three manual treatments (manipulation, massage of the pelvic muscles and stretching of these muscles) with a placebo. These treatments work in only 20% of the cases and are actually more efficacious than the placebo.
The last specific treatment is surgery. We have also a study published on this topic. Our success rate is 93% of good and excellent results, provided only patients with luxation or frank hypermobility are operated on. In other cases, the results are not so good. This is a difficult operation for the surgeon. The dissection of the bone has to be very careful and slow to avoid any damage which could compromise the result.
With my colleague, Pr Doursounian, a Parisian orthopaedic surgeon, we have shown that there is a " learning curve " for this surgery, the results being better when the surgeon becomes more skilled and experienced. And this is really the problem with the coccyx, a very rare operation for a basic surgeon.
The patient should not be forgotten, as it is demanding for him/her too : the first post operative month is achieved in a painful condition, and improvement is slow to come. It commonly takes 4 months (and sometimes 6 to 10) for a definitive result.
My full address is : Dr Jean-Yves Maigne, Hotel-Dieu hospital, Department of Physical Medicine, Paris, France. Telephone : ++ 33 1 42 34 82 07, Fax : ++ 33 1 42 34 82 23, Email: jy.maigne@htd.ap-hop-paris.fr
Papers by Dr Maigne about coccydynia:
2004 - Coccygectomy for instability of the coccyx - Doursounian L, Maigne JY, Faure F, Chatellier G
2001 - Management of Common Coccygodynia [FULL PAPER] Maigne, J-Y
2001 - Comparison of Three Manual Coccydynia Treatments: A Pilot Study Maigne, J-Y and Chatellier, G.
2000 - Causes and Mechanisms of Common Coccydynia. Role of Body Mass Index and Coccygeal Trauma - Maigne, J-Y, Doursounian, L, and Chatellier, G.
2000 - Instability of the coccyx in coccydynia - Maigne, J-Y, Lagauche, D, and Chatellier, G.
1998 - Treatment strategies for coccydynia [FULL PAPER] Maigne, J-Y
1996 - Standardized radiologic protocol for the study of common coccygodynia and characteristics of the lesions observed in the sitting position. Clinical elements differentiating luxation, hypermobility, and normal mobility. Maigne JY; Tamalet B
1994 - Idiopathic coccygodynia. Lateral roentgenograms in the sitting position and coccygeal discography. Maigne JY; Guedj S; Straus C
1992 - Coccygodynia: value of dynamic lateral x-ray films in sitting position Maigne JY; Guedj S; Fautrel B
1992 - Anatomie des disques coccygiens. Maigne JY, Molinie V, Fautrel B. Revue de Medecine Orthopedique. 28:34-35
1992 - Coccygodynie: intérêt des clichés dynamiques. Maigne JY. Revue du Rhumatisme et des Maladies Ostéoarticulaires