Here is an Infographic showing all the chapters in the coccyx book “Tailbone Pain Relief Now!”
#CoccyxPain #TailbonePain #Tailbone #Coccydynia
Infographic showing all the chapters in the coccyx book “Tailbone Pain Relief Now!” #CoccyxPain #TailbonePain #Tailbone #Coccydynia
COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Coccyx Pain Center in the United States, go to: www.TailboneDoctor.com
– Patrick Foye, M.D., Director of the Tailbone Pain Center, New Jersey, United States.
A few of my patients with tailbone pain are professional drummers.
One of them recently told me that he finds the Carmichael Throne Chairs (more specifically their stools for drummers) to be significantly helpful when he needs to sit for a prolonged duration when drumming during a set for a live gig.
I don’t sponsor or promote any particular products, but I provide this info. for educational benefit as these chairs and stools may be helpful for some other patients with coccyx pain, whether you are a drummer or not.
Carmichael Throne, Chairs and Drummer Stools, for Tailbone Pain
COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Coccyx Pain Center in the United States, go to: www.TailboneDoctor.com
– Patrick Foye, M.D., Director of the Tailbone Pain Center, New Jersey, United States.
Dr. Foye has published extensively in the medical literature, including writing medical textbook chapters, original research articles published in peer-reviewed journals, various review articles, and an entire 272-page book specifically about tailbone pain.
Below is a partial list of these publications.
Selected references (re: coccyx pain) from the medical literature:
Foye PM, et al. Successful injection for coccyx pain. Am J Phys Med Rehabil. 2006 Sep;85(9):783-4.
Foye PM. Finding the cause of coccydynia (coccyx pain). J Bone Joint Surg [Br]. Published 1-18-07 online: http://www.jbjs.org.uk/cgi/eletters/88-B/10/1388.
Foye PM. Ganglion impar injection techniques for coccydynia (coccyx pain) and pelvic pain. Anesthesiology. 2007 May;106(5):1062-3.
Foye PM. Coccydynia (Coccyx Pain) Caused by Chordoma. Int Orthop. 2007 Jun;31(3):427.
Foye PM. New approaches to Ganglion Impar Blocks, via Coccygeal Joints. Regional Anesthesia and Pain Medicine. 2007 May-Jun;32(3):269.
Foye PM, Buttaci CJ. Coccyx Pain. In: Plantz SH, eMedicine: Physical Medicine and Rehabilitation. San Francisco: eMedicine; 2007. www.emedicine.com/pmr/topic242.htm
Foye PM. Reasons to Delay or Avoid Coccygectomy for Coccyx Pain. Injury. 2007 Nov;38(11):1328-1329. Epub 2007 Sep 19.
Foye PM. Ganglion Impar Blocks for Chronic Pelvic and Coccyx Pain. Pain Physician. 2007 Nov;10(6):780-1.
Buttaci CJ, Foye PM, Stitik TP. Coccydynia Successfully Treated with Ganglion Impar Blocks: A Case Series. American Journal of Physical Medicine and Rehabilitation. 2005; 84(3):218.
Liang CW, Foye PM, Sorenson MK. Low Incidence of Vascular Uptake in Ganglion Impar Injections for Coccydynia (Coccyx Pain). American Journal of Physical Medicine and Rehabilitation. 2007 Apr;86(4):S104.
Rhee M, Foye PM, Tung D. Coccydynia (Coccyx Pain) due to Dynamic Instability of the Tailbone: A Case Report. Archives of Physical Medicine and Rehabilitation. 2007 Sep;88(9): E36.
Foye PM, et al. Coccydynia (Coccyx Pain) after Colonoscopy. American Journal of Physical Medicine and Rehabilitation. 2008 Mar;87(3): S36.
Foye PM. A New Diagnostic Test for Coccyx Pain (Tailbone Pain): Seated MRI. American Journal of Physical Medicine and Rehabilitation. 2008 Mar;87(3): S36.
Foye PM. Safe ganglion Impar blocks for visceral and coccyx pain. Techniques in Regional Anesthesia and Pain Management. 2008 Apr;12(2):122-123.
Foye PM. Ganglion Impar Blocks via Coccygeal versus Sacrococcygeal Joints. Regional Anesthesia and Pain Medicine. 2008 May-Jun;33(3):279-80.
Foye PM. Dextrose prolotherapy for recalcitrant coccygodynia fractures. Journal of Orthopaedic Surgery (Hong Kong). 2008 Aug;16(2):270.
Foye PM, et al. Cookie-Bite Coccyx- Retained Coccygeal Fragment after Coccygectomy. American Journal of Physical Medicine and Rehabilitation. 2009 Mar;88(3): S56.
Foye PM, et al. Coccyx Cushions for Tailbone Pain: Donut Cushions Versus Wedge Cushions. American Journal of Physical Medicine and Rehabilitation. 2009 Mar;88(3): S56.
Foye PM. Tailbone Pain (Coccydynia) Treated with Phenol Chemical Ablation of Somatic Nerves at the Posterior Coccyx. American Journal of Physical Medicine and Rehabilitation. 2009 Mar;88(3): S56-57.
Foye PM, Patel SL. Paracoccygeal Corkscrew Approach to Ganglion Impar Injections for Tailbone Pain. Pain Practice (the official journal of the World Institute of Pain). 2009 July-Aug;9(4):317-321
Foye PM, Kamrava E, Enriquez R. Tailbone Pain Associated with a Keel-Shaped Coccyx: a Case Series. PM R, 2009 Sept;1(9):S176-S177.
Foye PM, Kamrava E, Enriquez R. Tailbone Pain from Coccyx Injuries on Water Slides: a Case Series. PM R, 2009 Sept;1(9):S177.
Foye PM, Enriquez R, Kamrava E. Seated MRI for Patients with Tailbone Pain: a Case Series. PM R, 2009 Sept;1(9):S223-S224.
Foye PM, et al. Psychological versus Physical Pain Descriptors in Patients with Tailbone Pain. AJPMR, 2010 April;89(4):S32-3.
Foye PM. Coccyx Pain Diagnostic Workup: Necessity of MRI in Detecting Malignancy Presenting with Tailbone Pain. AJPMR, 2010 April;89(4):S33.
Foye PM, Stitik TP. Diagnostic Ultrasound in a Patient with Tailbone Pain: Detecting Coccygeal Dislocation/Listhesis but Failing to Detect an Avulsion Fracture of the Coccyx. AJPMR, 2010 April;89(4):S33.
Foye PM. Coccyx Pain and MRI: Precoccygeal epidermal inclusion cyst. Singapore Med J. 2010 May;51(5):450.
Foye PM. Stigma Against Patients with Coccyx Pain. Pain Med. 2010 Dec;11(12):1872.
Foye PM. Causality of concomitant coccyx pain and lumbar pain. J Bone Joint Surg [Br]. 2010 Dec. http://www.bjj.boneandjoint.org.uk/content/92-B/12/1622/reply#jbjsbr_el_5412
Foye PM. Ganglion Impar Pulsed Radiofrequency for Coccyx Pain. Journal of Pain and Symptom Management. April 2011. 41(4):e11-12.
Foye PM, et al. Sit-To-Stand Exacerbation of Coccyx Pain As a Predictor of Coccygeal Dynamic Instability Versus Bone Spurs. Am J Phys Med Rehabil, 2011 April; 90(4):
Lercher K, Foye PM. Heterotopic Ossification of the Coccyx as a Post-Operative Complication of Coccygectomy. Am J Phys Med Rehabil, 2011 April; 90(4): 87-88.
Foye PM, et al. Local anesthetic injection L. Banana boat Tailbone Trauma: 100% Complete Listhesis, a Dynamic Dislocation. Am J Phys Med Rehabil, 2011 April; 90(4):a25.
Foye PM, Kumar S. CT Morphology and Morphometry of the normal adult coccyx. Eur Spine J. March 2014; 23(3):701. PMID: 24292276.
Foye PM, Desai RD. MRI, CT scan, and dynamic radiographs for coccydynia. Joint Bone Spine. 2014 May;81(3):280. PMID: 24462128. (Also expected to be published in La Revue du Rhumatisme as well after translation into French.)
Foye PM, et al. Coccyx fractures treated with intranasal calcitonin. Pain Physician. 2014 Mar-Apr;17(2):E229-33.
Mehnert MJ, Shamim F, Foye PM. Coccygodynia. Chapter In: Simon J, Freedman M, Mehnert MJ. Interventional Spine Procedures – A Case Based Approach. (Jaypee Brothers Medical Publishers Ltd. Published 2014) ISBN-13: 978-9351521693 ISBN-10: 9351521699
Foye PM. Tailbone Pain Relief Now! United States: Top Quality Publishing, 2015. Print (soft cover book, 272 pages). ISBN-13: 978-0996453509.
Hsieh S, Hwang GE, Foye PM, Kumbar SV, Koon CT. Iatrogenic Coccydynia (Coccyx Pain) After Chiropractic Actuator Treatments: Case Report. WebmedCentral PAIN 2015;6(10):WMC004998.
Foye, PM, Shenouda M. In: Maigne J-Y, Doursounian L. (ed.) Coccyx Disorders. (Best Practice Publishing, 2018). Papers from The First International Symposium on Coccyx Disorders. Chapter: Ganglion Impar (Walther) Sympathetic Nerve Procedures for Coccydynia. Pages 106-116. Online at: https://www.bestpractice-publishing.com/index.php/product/coccyx-disorders/
Foye PM, Sajid N, D’Onofrio GJ. Ganglion impar injection approaches and outcomes for coccydynia. Indian J Radiol Imaging 2018;28:482-3. Available online: http://www.ijri.org/text.asp?2018/28/4/482/247777
Foye PM, Abdelshahed DM, Kamrava E, Enriquez R, D’Onofrio GJ. Tailbone Pain from Coccyx Injuries on Water Slides: A Case Series. J Emerg Med. 2018 Aug;55(2):e33-e35. Available online here: https://www.jem-journal.com/article/S0736-4679(18)30373-1/fulltext (Accessed: 6-13-18)
Foye PM, Sanapati JS, John A, Jow SL. Avascular Necrosis (AVN) of the Coccyx as a Cause of Coccydynia (Tailbone Pain). WebmedCentral PAIN 2018;9(8):WMC005505. Available online here: http://www.webmedcentral.com/article_view/5505
Foye PM, Singh R, Tangri V. Cerebrospinal fluid leak after fracture of the sacrum or coccyx. Spine J. 2019 Dec;19(12):2044. doi: 10.1016/j.spinee.2019.07.018. PMID: 31759438.
Foye PM, Nweke N, Singh R. Variability in Coccygeal Dynamic Mobility in Different Populations. Interv Neuroradiol. 2020;26(2):239. Published online 2019: https://doi.org/10.1177/1591019919870422
Foye PM, Varghese CA, Singh R. Looking Below the Sacrococcygeal Joint in Patients with Coccydynia (Coccyx Pain). Indian Journal of Orthopaedics, 54(1), 104. Published in print 2/2020. IJOO. https://link.springer.com/article/10.1007/s43465-019-00036-y
Foye PM, Woon J, Zheng K, Leong K. Low incidence of vascular uptake during ganglion impar sympathetic nerve blocks for coccydynia. Indian Journal of Radiology and Imaging. April-June 2020;30(2): 181-183. DOI: 10.4103/ijri.IJRI_302_19
COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Coccyx Pain Center in the United States, go to: www.TailboneDoctor.com
– Patrick Foye, M.D., Director of the Tailbone Pain Center, New Jersey, United States.
Cerebrospinal fluid (CSF) leak after Fracture of the Sacrum or Coccyx.
Dr. Foye’s Summary:
Leakage of Cerebrospinal fluid (CSF) is much more commonly expected after fracture of the sacrum, rather than after fracture of the coccyx (tailbone).
The reason is that the anatomy of the sacrum contains the spinal canal, which contains CSF.
Meanwhile, the anatomy of the coccyx bones do NOT include any spinal canal, and thus the coccyx does not have any CSF.
Leakage of CSF after a fracture limited to only the coccyx would mainly only happen if the trauma caused substantial pulling onto the filum terminale (fibrous tissue that extends from the lower tip of the spinal cord to its attachment on the upper coccyx).
Citation: Foye PM, Singh R, Tangri V. Cerebrospinal fluid leak after fracture of the sacrum or coccyx. Spine J. 2019;19(12):2044. doi:10.1016/j.spinee.2019.07.018
Cerebrospinal Fluid Leak after Coccyx Fracture, Published
Cerebrospinal Fluid Leak after Coccyx Fracture, Published in The Spine Journal
COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Coccyx Pain Center in the United States, go to: www.TailboneDoctor.com
– Patrick Foye, M.D., Director of the Tailbone Pain Center, New Jersey, United States.
As a medical school Professor and international medical educator, Dr. Foye provides free educational content through many different social media sites.
Here are some places where you can find Dr. Foye and his educational materials online:
Note and Disclaimer: Public education via social media is NOT a substitute for in-person medical attention from a physician with experience in treating your condition. Posts by Dr. Foye in public website should NOT be considered as a recommendation for any specific person to take or not take any particular action regarding their medical care. Instead, those with medical conditions should discuss their conditions with their in-person treating physicians. Also, Dr. Foye’s comments online do not necessarily reflect the views of any university, school, hospital or employer. Also, medical knowledge and opinions change over time, so the materials you may read may become outdated over time and, once again, you should discuss all options and concerns with an in-person physician with experience in treating the condition that you are suffering from.
COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Coccyx Pain Center in the United States, go to: www.TailboneDoctor.com
– Patrick Foye, M.D., Director of the Tailbone Pain Center, New Jersey, United States.
Many patients come to see me for coccydynia (coccyx pain, tailbone pain).
Occasionally we discover that their pain seems to be coming from a mass, tumor, abscess, or similar problem. (We see these types of things in ~ less than 5% of our patients with coccyx pain.)
One such mass is called a Tailgut Cyst (Retrorectal Hamartoma).
Tailgut Cysts are Located Near the Coccyx
This mass is typically located just in front of the coccyx or just below the coccyx, or sometimes in front of the lower sacrum.
Note: a ‘Tailgut’ Cyst is very different from a ‘Tarlov’ Cyst.
Note that Tailgut Cysts fail to show up on plain x-rays, which is why advanced imaging studies such as MRI are often helpful and necessary in cases where coccyx pain is persisting or failing to improve with standard non-surgical treatments. (But the MRI needs to be done correctly! See: Link)
Excellent recent article on Tailgut Cysts
There was a recent (2019) research study and review article on this topic which was excellent. I recommend that you use the link below to read the full article, for free, at the Journal’s website. The journal is called: the Annals of Coloproctology.
Below are my summary points from the article (highlighting important points or quotes from the article, as part of Fair Use commentary):
Surgery is recommended for Tailgut Cysts, for a few reasons:
1) to confirm the diagnosis,
2) to make sure the mass is not a cancer,
3) to avoid complications that can occur if left in place, such as infection or the mass turning into a cancer.
Important quote from the article:
“Surgical treatment is always required because of complications including malignant transformation, infection, and perianal fistula formation.”
Should Coccygectomy be done for a Tailgut Cyst (Retrorectal Hamartoma)?
On the topic of whether the surgery for a tailgut cyst should also include coccygectomy (surgical removal/amputation of the coccyx), this seems to be up for debate:
“Debate persists about whether the coccyx should be removed with the cyst.Several studies advocate coccygectomy since it improves surgical exposure and decreases risk of recurrence assuming that the coccyx may harbor a nidus of totipotential cellular remnants that may cause recurrence [4, 26]. However, the concern that the coccyx will increase risk of recurrence has not been demonstrated in other studies, especially for cysts not adherent to the coccyx and that can be removed entirely without coccygectomy; hence, coccyx removal is not required [27]. Removal of coccyx was based on the cyst itself and not the coccyx harboring aberrant remnants of the postanal gut leading to cyst formation. Recent trials report preserving the coccyx unless en bloc resection is required for malignancy or cysts densely adhere to the coccyx. Based on our findings, we removed the coccyx for 4 patients: 3 due to the cyst adhering to the coccyx and 1 for a large cyst requiring a combined coccygectomy and lower sacrectomy; the latter cyst was malignant.”
Ann Coloproctol. 2019 Oct;35(5):268-274. doi: 10.3393/ac.2018.12.18. Epub 2019 Oct 31.
Single-center Experience of 24 Cases of Tailgut Cyst.
Sakr A1,2, Kim HS1, Han YD1, Cho MS1, Hur H1, Min BS1, Lee KY1, Kim NK1.
Author information: 1: Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Author information: 2: Colorectal Surgery Unit, Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University Hospitals, Mansoura, Egypt.
Journal article on 24 Cases of Tailgut Cysts, 2019, Annals of Coloproctology
Also, below is a different link to a review article by different researchers who looked at 196 cases of Tailgut Cysts, and reported that as high as 26% of them became malignant (cancer). https://onlinelibrary.wiley.com/share/G6DK393WUEMJNUQFUFUW?target=10.1111/codi.14628 or https://doi.org/10.1111/codi.14628
Reference: Nicoll K, Bartrop C, Walsh S, Foster R, Duncan G, Payne C, Carden C. Malignant transformation of tailgut cysts is significantly higher than previously reported: systematic review of cases in the literature. Colorectal Dis. 2019 Aug;21(8):869-878. doi: 10.1111/codi.14628. Epub 2019 Apr 30. PMID: 30932326.
COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Tailbone Pain Center in the United States, go to: www.TailboneDoctor.com
– Patrick Foye, M.D., Director of the Coccyx Pain Center, New Jersey, United States.
Below is the abstract: (Presented here as part of “Fair Use” for discussion, commentary, etc.)
World Neurosurg. 2020 Jan 10. pii: S1878-8750(19)33195-X. doi: 10.1016/j.wneu.2019.12.163. [Epub ahead of print]
Myelographic CT, a check-valve mechanism, and microsurgical treatment of sacral perineural Tarlov cysts.
Kikuchi M, Takai K, Isoo A, Taniguchi M.
Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, 2-6-1, Musashidai, Fuchu, Tokyo, Japan.
Abstract
“OBJECTIVE:
There is currently no consensus regarding surgical indications for symptomatic sacral perineural cysts.
METHODS:
Nine patients with symptomatic sacral perineural cysts underwent microsurgery. All patients fulfilled the following criteria: (1) cyst sizes are larger than 15 mm; (2) cysts show the “delayed inflow” and/or “delayed outflow” of contrast on myelographic CT, and (3) neurological symptoms correlate with the primary cyst.
RESULTS:
On myelographic CT, all primary cysts showed the “delayed inflow” of contrast; the average cyst/thecal sac Hounsfield units (HU) ratio was 0.17. In 7 patients, the primary cyst showed “delayed outflow”; the average cyst/thecal sac HU ratio increased to 3.12 on images obtained 24 hours after contrast injection. Regarding modified Rankin Scale, 67% of patients reported that their overall symptoms improved to normal activities after surgery. The most improved symptom was coccydynia (75% improvement, p=0.017), followed by leg radiation pain (67% improvement, p=0.027) and buttock pain (50% improvement, p=0.068). Bowel/bladder dysfunction improved in 100% of patients, but newly developed in 1 patient (p=0.32). Perineal pain only decreased in 33% (p=0.41).
CONCLUSIONS:
To the best of our knowledge, this is the first study to have performed a quantitative analysis of the dynamics of CSF in sacral perineural cysts using myelographic CT. Sixty-seven percent of patients benefited from surgery; however, our criteria may not be a necessary and sufficient condition for patient selection because 33% did not respond to surgery despite the successful elimination of the check-valve.”
Dr. Foye’s comments:
This was a small study, where there were only 9 patients.
Still, it is important for reporting that in patients who had a Tarlov Cyst and coccydynia (coccyx pain, tailbone pain), surgery for the Tarlov Cyst apparently helped relieve the the tailbone pain in a significant percentage of those patients.
So, for patients who have a Tarlov cyst and tailbone pain, if typical treatment for tailbone pain is not helping, the patient may want to consider Tarlov cyst surgery.
COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Tailbone Pain Center in the United States, go to: www.TailboneDoctor.com
– Patrick Foye, M.D., Director of the Coccyx Pain Center, New Jersey, United States.
Today I was informed that my latest publication on coccyx pain has just been published by the Indian Journal of Orthopaedics.
The title is:
Looking Below the Sacrococcygeal Joint in Patients with Coccydynia (Coccyx Pain)
Our 3 main points:
When treating patients with tailbone pain (coccyx pain, coccydynia), unfortunately doctors often limit themselves to the sacrococcygeal joint (SCJ) and they fail to look lower than that.
Doctors often fail to consider the lower coccyx on imaging studies, or during physical exam, or when providing treatments.
This oversight is a problem since the sacrococcygeal joint is usually NOT the site that is causing the tailbone pain. Instead, more often the source of tailbone pain is one of the other joints within the coccyx, or a distal coccyx bone spur .
Due to copyright, I don’t know if I can post the full publication here on my website, so here is the Journal’s Link to the article online: https://rdcu.be/b0jak
Below are the screenshots from the congratulations/announcement of the publication, as well as the publication header and citation.
Looking Below the Sacrococcygeal Joint, by Foye, Header of Publication
Looking Below the Sacrococcygeal Joint (SCJ), email to Foye, announcing publication
Indian Journal of Orthopaedics, Journal Cover
Looking Below the Sacrococcygeal Joint, by Foye, Citation for Publication
COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Tailbone Pain Center in the United States, go to: www.TailboneDoctor.com
– Patrick Foye, M.D., Director of the Coccyx Pain Center, New Jersey, United States.
Podcast pic, Some of Your Parts, Interviewing Dr Foye about Coccyx Pain, Tailbone Pain, Coccydynia
Podcast, Some of Your Parts, Interviewing Dr Foye about Coccyx Pain, Tailbone Pain, Coccydynia
COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person at Dr. Foye’s Tailbone Pain Center in the United States, go to: www.TailboneDoctor.com
– Patrick Foye, M.D., Director of the Coccyx Pain Center, New Jersey, United States.
