What is the role of nerve ablation in the treatment of coccyx pain?

Updated: Jan 07, 2021
  • Author: Patrick M Foye, MD; Chief Editor: Consuelo T Lorenzo, MD  more...
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Answer

Ablation injections may provide more long-lasting relief in appropriately selected patients. Ablation is the intentional destruction of human tissue for treatment purposes. For instance, ablation can be used to intentionally destroy nerve fibers at the coccyx, so that those nerves can no longer send pain signals to the brain. Thermocoagulation of the ganglion impar using radiofrequency ablation (RFA) has been reported. [12, 13] Ablation can also be accomplished chemically (eg, by carefully injecting neurotoxic agents such as phenol and/or ethyl alcohol directly onto the targeted nerve tissues). These coccygeal ablation injections have been in clinical use for multiple decades and thus are no longer considered experimental. [2]

Ablation is typically reserved for patients whose pain has failed to be adequately relieved via oral analgesic medications, cushions, coccyx steroid injections, and coccygeal sympathetic nerve blocks (ganglion impar). The ideal specific site for ablation may depend on the individual patient’s specific site of coccygeal pathology. Prior to ablation, a diagnostic injection (test injection, with local anesthetic) is generally performed to ascertain whether a specific target site is likely to provide relief if ablated. Patients who obtain substantial transient (anesthetic) relief via the diagnostic injection would be good candidates for subsequent nerve ablation at the same site where the diagnostic injection was done.

If ablation fails to provide as much relief as the anesthetic/test injection provided, the ablation may soon be repeated, to provide more complete destruction of those nerve fibers.

Even after successful relief via ablation, some patients may have eventual return of the some of their coccyx pain many months or years later, if the remaining coccygeal nerve fibers regrow collateral reinnervation to the sites denervated by the ablation. In those cases, repeat ablation may be performed.

Since ablation injections are intended to cause destructive (albeit therapeutic) changes, they should only be performed by physicians skilled and experienced in these procedures. In addition, they should be performed under image-guidance (eg, fluoroscopy, to add to the specificity of the targeted injection site) and using the smallest amount (eg, milliliters) of ablation necessary to provide the desired therapeutic relief.

Ablation injections may help some coccydynia patients avoid more invasive treatments, eg, helping them avoid surgical removal of the coccyx (coccygectomy).

A retrospective study by Adas et al indicated that radiofrequency therapy of the ganglion impar via a transsacrococcygeal approach can effectively treat chronic coccydynia. The investigators found that compared with pretreatment visual analogue scale scores, there was significant improvement in early, 1-month, and 6-month postprocedure scores, with successful outcomes reported for 90.2% of patients at 6 months. [42]


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