title: Chronic coccydynia in adolescents. A series of 53 patients.
abstract: BACKGROUND
  Little is known about coccydynia in adolescents.
  
  
  OBJECTIVE
  The aim of this study was to explore causes, clinical and imaging features and response to treatment of chronic coccydynia in adolescents.
  
  
  METHODS
  This was a cohort study.
  
  
  METHODS
  The study included patients followed up at a specialized consultation in a university hospital.
  
  
  METHODS
  A series of 53 adolescent patients with chronic coccydynia were followed for 1-4 years. Investigations included dynamic X-ray films, with a magnetic resonance imaging scan of the coccyx in 26/53. Treatment was by coccygeal steroid injection or non-steroidal anti-inflammatory drugs (NSAIDs). Amitriptyline or coccygectomy were used as second-line treatment. Outcomes were assessed at a consultation two months after the treatment, then between one to four years later, by telephone interview, questionnaires and by a visual analogue scale (VAS). Fifty-one adult patients with coccydynia formed the control group.
  
  
  RESULTS
  In 20 cases (37.7%) the coccydynia was subsequent to trauma. Obesity was not a risk factor. Abnormal mobility was rarer and spicules more frequent compared to adult patients (P<0.001); 11/27 MRI scans showed a hypersignal within the disc or adjacent bone and 6/27 a hypersignal surrounding the tip of the coccyx (bursitis). Initial treatment was a coccygeal steroid injection for 41 patients and NSAIDs for 12. Ten were given amitriptyline and 3 a coccygectomy. At final assessment, there was no pain or almost no pain in 32/53 (60.4%), moderate pain and functional impairment in 12/53 (22.6%) and severe pain and functional impairment in 9/53 (17%).
  
  
  CONCLUSIONS
  Coccydynia in adolescents differs from coccydynia in adults. A MRI scan is helpful and should be obligatory for diagnosis. Prognosis is relatively good.
  
  
  CONCLUSIONS
  Our results should help clinicians manage this rare and debilitating condition.
authors: Physical Medicine, Paris University Hospital, Paris, France. jy.maigne@htd.aphp.fr
authors: J-Y
authors: JY
authors: Maigne
authors: I
authors: I
authors: Pigeau
authors: N
authors: N
authors: Aguer
authors: L
authors: L
authors: Doursounian
authors: G
authors: G
authors: Chatellier