1322 - Dislodged at the Dock: A Case Report on Multimodal Treatment of Chronic Coccygeal Dislocation

A 55-year-old male with a history of obesity, bariatric surgery, bilateral knee osteoarthritis, and lumbar spondylosis presented for evaluation of nontraumatic sacrococcygeal pain persisting for the last three years. The patient's previous diagnostic workup for axial back pain included lumbar imaging, which demonstrated lumbar spine degeneration extending to the sacroiliac joints. His treatment history included nonsteroidal anti-inflammatory drugs (NSAIDs), bilateral two-level lumbar radiofrequency ablations, significant weight loss, and physical therapy. Despite these interventions, the patient continued to report coccydynia exacerbated by prolonged sitting and bicycle riding. Dedicated films of the sacrum and coccyx were obtained demonstrating an age indeterminate posterior dislocation of Coccyx 4 on Coccyx 5. The patient’s persistent pain despite conservative measures warranted a combined approach, integrating sacrococcygeal ligament steroid injections under fluoroscopic guidance and pelvic physical therapy. Near 100% pain relief was achieved for 10 months following the initial injection.

Discussions:

This case describes the successful management of chronic coccygeal dislocation, an unusual cause of coccydynia, through a combined approach of sacrococcygeal ligament steroid injection and pelvic physical therapy. A literature review on PUBMED and Google Scholar for management of coccygeal dislocation identified studies that highlighted significant pain relief with conservative treatments, including interventional techniques and physical therapy. Our findings suggest that this combined approach could be effective in alleviating pain and promoting recovery in patients with chronic coccygeal dislocation. This multimodal treatment strategy offers a promising alternative to more invasive interventions; however, further research is necessary to establish long-term outcomes and compare this approach with other treatment modalities.

Conclusions:

The combination of sacrococcygeal ligament steroid injections and pelvic physical therapy appears to be an effective treatment option for managing chronic coccygeal dislocation, offering significant pain relief and functional improvement.