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Case Reports
. 2024 Nov 27;16(11):e74564.
doi: 10.7759/cureus.74564. eCollection 2024 Nov.

Coccydynia Improved by Percutaneous Discectomy

Reon Kobayashi  1 , Ichiro Okano  2 , Asae Taketomi  1 , Eiko Hara  1 , Hitoshi Mera  1
Affiliations
Case Reports

Coccydynia Improved by Percutaneous Discectomy

Reon Kobayashi et al. Cureus. .

Abstract

Usually, coccydynia cases are caused by herniated discs, with lower back pain and sciatica as initial symptoms. However, whether lumbar disc herniation causes coccydynia without back pain remains unclear. We report a case of lumbar disc herniation diagnosed as the underlying cause of coccydynia by discoblock. A woman in her mid-20s was treated for coccydynia experienced during sitting, for several years. There was no coccyx tenderness upon palpation. As the location of the pain could not be identified, it was not possible to perform a block at the site of the pain. Magnetic resonance imaging showed a herniated L5/S1 lumbar disc, without lower back pain and sciatica. Following discoblock, coccydynia was diagnosed as associated pain due to the herniated L5/S1 lumbar disc that was treated with percutaneous discectomy. After surgery, coccydynia was relieved while sitting; no medication was required.Discoblock was used to diagnose lumbar disc herniation as the cause of coccydynia. Percutaneous discectomy was effective for coccydynia without back pain, thus lumbar disc herniation should be considered as a differential diagnosis. Discoblock can be useful for differentiation.

Keywords: coccyx; discectomy; intervertebral disc displacement; lumbar disc; minimally invasive lumbar decompression; nerve block; percutaneous; percutaneous disc decompression.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Showa University Ethics Committee issued approval CR2023027-B; dated September 29, 2023. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Coccy X-ray imaging
The white arrow indicates suspected sacroiliac joint dislocation, although there is no tenderness.
Figure 2
Figure 2. Magnetic resonance imaging T2-weighted images
(a) Sagittal view; a posteriorly protruding disc at high L5/S1 is observed. The white arrows indicate mild HIZs, (b) Axial view of L5/S1; a posterior midline protruding herniated disc is observed. The black arrows indicate mild HIZs. HIZs: high-intensity zones
Figure 3
Figure 3. Magnetic resonance imaging T2-weighted images
(a) Coronal view of the bilateral L5 root nerves; no calcareous deposits compressing nerve roots, including L5/S1, (b) coronal view of the gluteus maximus muscle level; there is no entrapment of the sciatic nerve in the deep gluteal muscles or anatomic variation of the sciatic nerve.
Figure 4
Figure 4. Post-discoblock computed tomography
(a) Axial view at the level of (b), (b) midline sagittal view, (c) axial view at the level of (d), and (d) midline sagittal view. A lumbar disc herniation protruding centrally (white arrows) is observed showing migration both upward and downward and is a contained type that does not penetrate the posterior longitudinal ligament.
Figure 5
Figure 5. Percutaneous discectomy using L’DISQ
(a) Lateral fluoroscopic view illustrating the wand tip (black arrow) touching the posterior longitudinal ligament within the herniation, (b) anteroposterior fluoroscopic view illustrating the wand tip (black arrow positioned in the center of the herniation)
Figure 6
Figure 6. Six-month postoperative magnetic resonance T2-weighted image
(a) Sagittal view; a posteriorly protruding disc at L5/S1 height is observed. The white arrows indicate mild HIZs. (b) Axial view of L5/S1; no obvious disc herniation is observed. HIZs: high-intensity zones
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