Coccyx osteochondrosis (coccygodynia)

Coccygodynia is a syndrome, the main symptom of which is paroxysmal or constant Pain in the coccyx. First described in 1859 by J. Simpson.

Due to the anatomical features of the structure of the pelvic organs of coccygodynia 2-3 times more common in women, pain in the tailbone during pregnancy. The age of patients is the most diverse, but more often - from 40 to 60 years. The pathogenetic relationship of coccygodynia with pathology of not only the musculoskeletal system of the pelvic region, but also with diseases of its organs was revealed. So, paracoccygeal pain is 0.8% in women, in proctologic patients - 1.5; 0.6% - in urological patients. Coccygodynia combined with disorders such as pollakiuria, urinary incontinence, chronic and often recurrent diseases of the bladder, genital organs, rectum, visceroptosis, cystic formations of the pelvis. A special place for pain in the coccyx is occupied by reflex-spastic and muscular-tonic reactions. Pain in the caudal part of the spine is caused by damage to both the bone and cartilage part, and its muscular-fibrous environment with neurovascular elements.

[1], [2]

Causes of coccygodynia

On the etiology of coccygodynia indicate the majority of researchers:

1. He is in no doubt a violation of mobility in the coccygeal diarthrosis. As a result of injuries, subluxations and dislocations occur in the sacrococcygeal joint, hypermobility or its immobility, which alter the biomechanics of the pelvic floor and small pelvis, causing myalgia.
2. Ischemia of the nervous apparatus, primarily of the coccygeal, presacral and hypogastric nerve plexuses, forms “intrapelvic sympathetic plexitis”, “reactive neuritis”, and tunneling neuropathy.
3. Complications after childbirth or childbirth by large fruit if women have a narrow pelvis. At the same time, the sacrococcygeal joint is easily injured with the development of degenerative-dystrophic processes in the cartilaginous disc.
4. The presence of orthopedic defects of the pelvis and lumbar region, including anomalies of the sacral and pelvic areas. Post-traumatic deformities, lumbarization and sacralization, hypoplasia of the coccyx and pelvic bones, joints, anomalies of the axial skeleton or connective tissue, accompanied by various changes in regional homeostasis.
5. Pathological processes in the organs and tissue of the pelvis (urethritis, prostatitis, colliculitis, salpingoophoritis, spastic proctitis, neural cysts, etc.) lead to reflex muscular-tonic reactions or neural irritations.
6. Surgical interventions on the perineum, the anorectal region, the pelvic organs, as well as tactical errors often lead to the development of a massive adhesions in the pelvis or ligamentous-fascial apparatus and pain transformation.
7. The formation of local muscle hypertonia, trigger points in the muscular system; pathobiomechanical changes in the muscle that raises the anus, including the anal sphincter, and the gluteus maximus, which attach directly to the coccyx; in the muscles of the pelvis (coccygeal, locking, pear-shaped); in muscles attached to the branches of the pubic and sciatic bones; posterior thigh and adductor muscles.

Thiele (1963) drew attention to the spasm of the pelvic muscles in coccygodynia - levator anus, coccygeal, pear-shaped. After research R.Maigne musculo-tonic syndrome was considered crucial among pathogenetic links coccygodynia. Repeatedly emphasized the reflex nature of muscle responses.

According to a number of researchers, in the genesis of coccygodynia, a significant role is played by functional and anatomical changes of the pelvis, sacrum, and coccyx, leading to a violation of their kinetics and progressive muscular-ligamentous dystonia. Under the influence of various factors (traumatic, neurodystrophic, vascular-dystrophic, metabolic), the formation of pathological changes in the binding apparatus occurs - the formation of fasciitis, ligamentitis or ligamentosis. The most significant for the occurrence of the disease should be considered:

• Sacrococcygeal ligaments - four dorsal, two lateral, two ventral.
• The coccyx-solid cerebral-ligament ligament, which is a continuation of the end thread of the dura mater of the spinal cord.
• Sacro-knoll and sacral-spinous paired ligaments, also attached to the front walls of the coccyx with part of their fibers.
• Sacroiliac, especially ventral, ligaments.
• The tendon arch, which is a line of initial fixation of the muscle in the region of the descending branches of the pubic bones.
• The kopchiko-rectal, unpaired, representing in the upper sections a thin, soft-elastic fibrous cord, in the lower sections - a dense anoccygeal tendon intertwining with the muscle lifting the anus.
• In women, the ligaments of the uterus, first of all, are the sacro-uterine, reaching the coccyx in the lower sections, the wide ligaments of the uterus, the pelvic-uterine ligaments, the round ligaments of the uterus, which form a hanging dynamic framework of this organ and other pelvic structures. Of particular importance is the fibrous-elastic apparatus of the rectovascular uterine and uterine cystic spaces.
• In men, the fibro-ligamentous apparatus of the rectovascular-vesicular and, below, the rectal-prostatic spaces, formed by a plate of the pelvic function.
• Pelvic ligaments, which together with the muscles form the arch of the urogenital diaphragm.

It is possible that the iliac-femoral, pubic-femoral and sciatic-femoral ligaments may have indirect significance in the genesis of coccygodynia.

[3], [4]

Tailbone anatomy

tailbone is an unpaired bone, the lower part of the spinal column (spine) of the spinal column. The tailbone has the appearance of a flat, arcuate, curved posterior and uneven wedge on the sides. The tailbone is twice as long as wide. The tailbone consists of the tailbone vertebrae, which are the remains of the bodies of the caudal vertebrae. In 61% of cases, the tailbone contains 4 vertebrae, in 30% - 3 vertebrae and in 9% - 5 vertebrae. Synoctosis of coccygeal vertebrae begins at the age of 12-14 years and goes from the bottom up. Distal vertebrae are usually adhered to each other after 40 years. The connection between the bodies of the V of the spinal cord and the I coccygeal occurs through the intervertebral disc, which allows the coccyx to bend backwards (for example, during labor). However, assimilation in the vertebrae of the sacrococcygeal process is not uncommon, and the last sacral vertebra can bone-seal with the coccygeal on one or both sides. At the same time, the coccygeal vertebrae interconnect with each other through synchondrosis.

In old age, especially in men, all coccygeal vertebrae, except for the first one, grow together. In women, the tailbone is located more superficially than in men, due to the anatomical features of the pelvis (an increase in its inclination in front). A stable connection between the coccyx and the sacrum, in addition, is carried out through the continuation of the anterior and posterior longitudinal and lateral ligaments (lig. Sacrococcygeal).

Symptoms of coccygodynia

A complex of disorders is characteristic of coccygodynia, which includes: pain in the coccyx, mental disorders, joint and pelvic ring syndromes, ligament-fascial syndrome, internal organs syndrome, pelvic and abdominal cavity, disimmunoses, vegetative disturbances. The first four signs are detected constantly with the disease (obligate signs of coccygodynia), the last three are periodically (optional signs of coccygodynia).

Coccygodynia disease is characterized by persistent pain. Patients can not accurately localize their pain, indicate their mosaic. Most often, the pain in the coccyx has the character of dull, arching, pulling, sometimes burning. In some cases, the pain decreases or disappears in the position of the patient standing, lying down and aggravated in the sitting position, especially on hard, with coughing and physical exertion. Because of the pain, patients are forced to sit on one half of the pelvis, their movements become cautious.

Violations of the mental sphere: the cycle of sleep and wakefulness is disturbed, vegetative disturbances appear (headaches, sensations of heat in the abdomen, lower back, vasomotronic disorders, etc.). There are vague fears, anxiety, inner anxiety.

Disturbances in the locomotor system develop: pathological changes in the sacrococcygeal, sacroiliac, and hip joints is found in most patients. At the same time, the kinetics suffers, the joints of the lower extremities are overloaded, a non-optimal motor stereotype arises (asymmetry of the supporting function arises when sitting, biomechanical disorders of the pelvic ring, spinal deformities occur, gait changes). Regional ligamentous-fascial pathology, displacement and dyskinesia of the pelvic organs occurs.

When coccygodynia occur functional disorders of the internal organs, primarily of the small pelvis, then the abdominal cavity. Among pelvic organ disorders, rectal dyskinesias predominate, urological disorders occur in 25% of patients with coccygodynia. Often, these disorders include vegetative disorders: Dyspnea, palpitations, dizziness, sensation of heat or cold, peripheral angiospasm, arterial dystonia.

Coccygodynia is characterized by seasonal exacerbations.