Image Guidance for Tailbone Injections: Fluoroscopy for Coccyx Injections

Image guidance for tailbone injections:
  1. The most important first step is for the treating physician to thoroughly assess for the CAUSE of the tailbone pain. In many ways, this can be more important then which type of injection is done and whether or not image-guidance is used for the injection. It is extremely important for the treating physician to assess for whether the tailbone pain  is being caused by a bone spur at the lowest tip of the coccyx versus an unstable joint up at the highest end of the coccyx. Without such an evaluation, how would the physician know where to inject?
  2. Depending on what country you are in, image-guidance may or may not be available for your injection. In the United States, such injections are typically done using image-guidance. For example, I am located in New Jersey and I use image-guidance for almost all of the coccyx injections that I perform.
  3. There are different types of radiology methods for image guidance. 
  • Fluoroscopy:  The most common method is fluoroscopy. Fluoroscopy is like immediate x-ray images that are displayed up on a computer screen. This allows the physician to see the target (the specific joint or bone spur or other abnormality where they want to place the injection). Fluoroscopy also allows the physician to see the tip of the needle, so that they can guide it to the best specific location.
  • CT scans: CT (computerized  tomography) is another method of image guidance for injections. Historically, CT scans are known as a source of substantial radiation to patients. Newer methods may allow the CT scan and to be done using less radiation, but it is still an area of concern.
  • MRI (magnetic resonance imaging): there are a couple of research papers that talk about using MRI-guidance for coccyx injections. But MRI is extremely expensive compared to other methods.
  • Ultrasound: in the future, ultrasound-guidance may have a significant role in performing tailbone injections. One limitation is that ultrasound can really only see the back wall of the coccyx, not being able to see past that bony surface. So it is limited at this time.
  • Overall: Fluoroscopy is the most common method of image guidance for coccyx injections.
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