Mesut YILMAZ, Ahmet ÖĞRENCİ, Orkun KOBAN, Sedat DALBAYRAK, Ezgi AKAR

Polymethylmetacrylate Cement Augmentation of the Coccyx (Coccygeoplasty) for Fracture: A Case Report

Background: Coccydynia is a painful condition of the sacrococcygeal region, with symptoms associated with sitting and rising from a seated position. It is frequently related to trauma and idiopathic causes, and the pain is mostly chronic. Percutaneous vertebroplasty and sacroplasty are the methods that are widely used for treating compression fractures and sacral insufficiency fractures, respectively. However, the success of polymethylmethacrylate injection in the treatment of osteoporotic coccyx fractures and coccydynia is still unknown. Case Report: A 68-year-old man was admitted to our clinic with complaints of pain in the sacrococcygeal and perianal regions. In the imaging studies, a fracture line in the fifth sacral and first coccygeal segments was observed as evidenced by a bony edema. Since the patient’s pain did not improve with conservative methods, we treated him with coccygeoplasty. No complication was encountered. The day after the operation, he was discharged from the hospital with complete pain relief. The patient confirmed having no pain on the third postoperative month and so did not need any analgesics.Conclusion: Coccyceoplasty may be a good treatment option for retractable pain in patients with acute or subacute osteoporotic coccygeal fractures and coccydinia with edema.

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1. Maigne JY, Pigeau I, Roger B. Magnetic resonance imaging findings in the painful adult coccyx. Eur Spine J 2012;21:2097-104.
2. Karadimas EJ, Trypsiannis G, Giannoudis PV. Surgical treatment of coccygodynia: an analytic review of the literature. Eur Spine J 2011;20:698-705.
3. Maigne JY, Doursounian L, Chatellier G. Causes and mechanisms of common coccydynia: role of body mass index and coccygeal trauma. Spine (Phila Pa 1976) 2000;25:3072-9.
4. Pommersheim W, Hellinger-Huang F, Baker M, Morris P. Sacroplasty: a treatment for sacral insufficiency fractures. Am J Neuroradiol 2003;24:1003-7.
5. Dean LM, Syed MI, Jan SA, Patel NA, Shaikh A, Morar K, et al. Coccygeoplasty: treatment for fractures of the coccyx. J Vasc Interv Radiol 2006;17:909-12.
6. Lirette LS, Chaiban G, Tolba R, Eissa H. Coccydynia: an overview of the anatomy, etiology, and treatment of coccyx pain. Ochsner J 2014;14:84-7.
7. Marinko LN, Pecci M. Clinical decision making for the evaluation and management of coccydynia: 2 case reports. J Orthop Sports Phys Ther 2014;44:615-21.
8. Foye PM. Coccydynia: Tailbone Pain. Phys Med Rehabil Clin N Am 2017;28:539-49.
9. Wray C, Easom S, Hoskinson J. Coccydynia. J Bone Joint Surg Br 1991;73:335-8.
10. Mahmood B, Pasternack J, Razi A, Saleh A. Safety and efficacy of percutaneous sacroplasty for treatment of sacral insufficiency fractures: a systematic review. J Spine Surg 2019;5:365-71.