TITLE:
Various Aetiologies of Non-Traumatic Coccydynia Cause Pain in the Posterior Sacrococcygeal Leg of the Pelvic Tripod: A Burden on the Healthcare Sector
AUTHORS:
Kumar Satya Nandivada Venkata Kiran, Nadavinamani Shivanand Raghavendra, Oommen Elsy Biju, Bharadwaja Nikhil Nandivada, Nandivada Vaishnavi, Rizvi Usama Ahmed
KEYWORDS:
Coccydynia, Coccygodynia, Pelvic Floor, Chordoma, Pilonidal Sinus, Fused Sacrococcygeal Segment, Non-Traumatic Coccydynia, Entrapment of Coccygeal Nerves, Dural Syndrome
JOURNAL NAME:
Open Journal of Orthopedics,
Vol.14 No.7,
July
31,
2024
ABSTRACT: Introduction: Coccydynia, television disease, and coccygodynia are the different names given to this disabling disease, which can become chronic. It was described by Simson in 1859. Coccydynia means pain at the end of the vertebral column. Non-traumatic coccydynia is a diagnosis, which is never straightforward like traumatic coccydynia because the onset is unclear, and both the patient and the unaware clinician face many challenges in treating it on time and with accuracy. Coccyx was likened to a cuckoo bird’s beak as a curved bone of fused 3 to 5 vertebrae with remnant disc material in some rare cases, unfused segments, linear scoliosis or subluxations and deformities. Stress X-rays of the coccyx in the antero-posterior and lateral views in standing and sitting reveal the “Dynamic Instability” due to congenital coccygeal morphological, pathological and mechanical variations. Material and Methods: This is a complex study having retrograde data collected from online publications from various databases, like PubMed, Embase, and Cochrane Library and also antegrade data collected from 100 patients with their consent from patients in Adam and Eve Specialised Medical Centre-based at Abu Dhabi, UAE and data was processed in the research centre of Krushi Orthopaedic Welfare Society based in India between 2014-2024 following all guidelines of Helsinki and approved by the ethics board of Krushi Orthopaedic Welfare Society. Clinical Presentation: The coccyx is painful, with aches, spasms, and an inability to sit. This affects daily activities without any particular date of onset. The onset remains insidious for the non-traumatic variety of coccydynia. Aetiology and Patho Anatomy: Non-traumatic coccydynia can be caused by a myriad of reasons, like congenital morphological variations, acquired dynamic instabilities, and hidden trauma remaining quiescent to re-surface as a strain-induced pain. Radiological Presentations: Unless clarity is focused on these coccygeal views, the errors of the unevacuated rectum, non-dynamic standing views, improper X-ray exposure and refuge by insurance companies to approve the much needed but multiple views in radiological investigation (Stress X-ray), MRI scan, lack of awareness by the clinician, all lead to missed diagnosis with its repercussions as congenital variations in morphology, acquired changes in structure/mobility, pathologies like tumours like congenital teratoma & adult onset chordoma, Tarlov cysts, pilonidal sinus or infections—even tuberculosis, dural syndrome, stiff coccyx due to ankylosing spondylitis and many others like relation to neurosis have all been documented. Treatment options are outside the scope of this research topic, as only the differential diagnosis is being stressed here, so that the clinician and the patient do not overlook the varying aetiology, which is the first step to timely and appropriate treatment. Conclusion: Level 3 evidence is available pointing towards many aetiologies causing non-traumatic coccydynia, and in this study of 100 patients by Krushi O W S, a non-profit organisation, the results were as follows: 1) Coccydynia is more common in Type II coccyx and bony spicules. 2) Coccydynia is more prevalent when the sacrococcygeal joints are not fused. 3) Coccydynia is more prevalent when there is subluxation at the intercoccygeal joints. 4) Coccydynia is more when the sacral angle is lower. 5) Coccydynia is associated with higher sacrococcygeal curved length. 6) Coccydynia is associated with a lower sacrococcygeal curvature index. 7) Gender variations: The coccygeal curvature index was lower in females with coccydynia; the intercoccygeal angle was lower in males. 8) Both obese and thin individuals can get affected due to different weight-bearing mechanics in play.