Background: Coccydynia is pain in the coccyx
region. The most common cause of coccydynia
is trauma, either from a direct axial force such
as during a fall onto the coccyx or from cumulative
trauma as a result of poor sitting mechanics.
Risk factors include obesity, female gender and
rapid weight loss. The anatomy of the region is
not well vascularized, and consists of the coccyx
bones, and supporting ligaments and tendons.
For a majority of patients, conservative management
may be successful but for the remainder
of patients, pain relief may only be transient and
pain can become debilitating. What has yet to be
fully explored is the possible beneficial effect of
local injection of platelet-rich plasma (PRP) for
the treatment of refractory coccydynia. PRP injections
have been successful in treating a variety
of chronic tendon, ligament and bone injuries by
inducing an inflammatory response to promote or
re-initiate healing. In addition, local injections of
PRP to the coccyx would be a less invasive option
than surgery for patients who have exhausted all
other treatment options and continue to struggle
with the debilitating effects of coccydynia.
Objectives: To demonstrate the important role
of PRP therapy in treating coccydynia refractory
to traditional conservative management.
Study Design: Retrospective case series.
Methods: Three patients with coccygeal pain
for greater than 6 months who presented to an
outpatient pain management office in New York
from 2014 until 2016, and failed conventional
treatments. When the pain was deemed refractory
for the patient, offering for PRP was done.
This was presented with the option to repeat once
again at the 6-8 week mark if needed. All patients
underwent PRP with fluoroscopic injection, and
the use of the same PRP commercially available
system; Magellan-Arteriocyte. The patients were
evaluated with a numerical rating scale, and percentage
of pain relief at 6-8 week post-injection, 6
months post-injection, 12 months post-injection,
and 24 months post-injection was recorded.
Percentage of pain relief was then calculated.
Results: Overall the patient series demonstrated
significant improvement in numeric pain scale, as
well as percentage of pain reduction. At the 6-8
week follow-up for all the post-PRP injections,
there was an average of 75% improvement in
overall pain. At 6 months, 1 patient had no change,
while 2 patients maintained the same reduction
in pain at the 12- and 24-month follow-ups.
Limitations: This retrospective case
series is only a small sample size of pat
i e n t s w i t h r e f r a c t o r y c o c c y d y n i a .
Conclusions: Here we discuss the first case
series of PRP for coccydynia. The results of the
3 patients in this case series are encouraging.
PLATELET-RICH PLASMA INJECTION THERAPY FOR REFRACTORY COCCYDYNIA: A CASE SERIES
