DOS 2020

DOS Kongressen 2020 · 179 Coccydynia – the efficacy of available treatment options: a systematic review Gustav Østerheden Andersen, Stefan Milosevic, Mads Moss Jensen, Mikkel Østerheden Andersen, Ane Simony, Mikkel Mylius Rasmussen, Leah Carreon Student, Aarhus University ; Center for Spine Surgery & Research, Middelfart Hospital; Cense-Spine, Department of Neurosurgery, Aarhus University Hospital Background: Coccydynia is pain originating from the os coccygis, a condition for which several treatments, of a more or less invasive character, are being practised today. Purpose / Aim of Study: Through a systematic review and meta-analysis this study aims to evaluate the efficacy of available treatment options for patients with persistent coccydynia. Materials and Methods: Methods: Original peer-reviewed publications on coccydynia and its treatment were identified according to PRISMA guidelines by performing a wide literature search of relevant bibliographic databases, from their inception to January 17th, 2020, combined with other sources. Data on extracted treatment outcome was pooled in suitable categories to allow for meta-analysis of efficacy. Outcome measures: All outcomes relevant to the treatment efficacy of coccydynia were extracted. No single measure of out- come was consistently present among the included studies. For the main analy- sis Visual Analogue Scale (VAS) of pain was evaluated. Eligible studies: Studies with treatment outcome on adult patients with persistent, primary coccydynia. Findings / Results: In this review a total of 1980 patients across 64 studies were identified: 5 RCTs, 1 experimental study, 1 quasi-experimental study, 11 prospective studies, 45 retrospective studies and a pool of unpublished data from the DaneSpine registry. The greatest improvement in pain was achieved by those patients who underwent RFT (VAS decreased by 5.11 cm on average). A similar mean improvement was achieved from ESWT (5.06), Ganglion Block (4.92), Coccygectomy (4.86) and Injection (4.22). Although improved, the mean change was less for those who received Stretching/Manipulation (2.19) and Conservative/Usual Care (1.69). Conclusions: Conservative therapy and stretching/manipulation showed lim- ited improvement. Interventional treatments (ganglion impar block, injections, RFT and ESWT) showed promising results and should be considered before coc- cygectomy, which however remains the most investigated treatment, and de- spite varying complication rates consistently demonstrates high efficacy when treating otherwise refractory patients. 158.