American Journal of Physical Medicine & Rehabilitation
2006 Sep; 85(9): 783-4.
Patrick M. Foye, MD, Charles J. Buttaci, DO, Todd P. Stitik, MD, and Peter P. Yonclas, MD
Physical Medicine and Rehabilitation, UMDNJ-New Jersey Medical School, 90 Bergen Street, DOC-3100, Newark, NJ 07103-2499. tailbonedoctor.com/
Summary by Jon Miles
Coccydynia may be treated by injecting a local anesthetic, lidocaine, into the ganglion impar (ganglion of Walther). A thin, 25 guage, spinal needle is passed through the joint between the sacrum and the coccyx or through the first joint in the coccyx. Contrast is injected and flouroscopy is used to ensure that the needle reaches just past the joint, before lidocaine is injected. The technique often produces 50-75% relief of pain.
This 'Visual vignette' paper shows the flouroscopic images taken during treatment of an obese 70-year old woman suffering from severe coccydynia after using a stationary bike with a narrow saddle. The patient obtained 100% pain relief, without any subsequent recurrence.