Angiolipoma sacro. Reporte de un caso / Sacral angiolipoma. A case report

Fundamento: Los angiolipomas son tumores benignos que se presentan en adultos con una localización, preferentemente, en el espacio epidural posterior torácico. Objetivo: Presentar un caso que debutó con un traumatismo axial lumbosacro donde se evidenció una localización poco común de la lesión y sin relación con las estructuras del canal raquídeo. Presentación del caso: Hombre de 25 años que se cayó y debido a ello se le hizo un traumatismo directo en la región sacrococcígea con dolor y aumento de volumen regional, asociado a parestesias glúteas. Los estudios radiológicos evidenciaron una fractura del cóccix y la presencia de una lesión ubicada en las partes blandas, de aspecto redondeado, homogéneo, sólido, de poco más de 50 mm de diámetro. Se le realizó tratamiento quirúrgico que consistió en coccigectomía subperióstica y exéresis macroscópica de la masa. El estudio histológico concluyó el diagnóstico de un angiolipoma. Conclusiones: Los angiolipomas son tumores raros que tienen características radiológicas peculiares, requieren de alta sospecha clínico-imagenológica para indicar los estudios y el tratamiento. La exéresis total es recomendada para evitar la recurrencia y mejorar el pronóstico.

Background: Angiolipomas are benign tumors that appear in adults with special location in the posterior thoracic epidural position. Objective: To present a case that appeared with a lumbosacral axial trauma where a non-common lesion location was evidenced with no relation among the structures of the spinal canal. Case presentation: 25-year-old man who fell down, consequently suffered a painful direct trauma to the sacrococcygeal region and increased regional volume, associated with gluteal paresthesias. Radiological studies showed a fracture of the coccyx and presence of a lesion located in the soft tissues, with a rounded, homogeneous, solid aspect, a little more than 50 mm in diameter. Surgical treatment consisted of subperiosteal coccygectomy and macroscopic excision of the mass. Histological study concluded the diagnosis of an angiolipoma. Conclusions: Angiolipomas are rare tumors with peculiar radiological features, they require high clinical-imaging suspicion for studies and treatment. Total excision is recommended to avoid recurrence and improve prognosis.

Clinical Outcomes of Coccygectomy for Chronic Coccygodynia

STUDY DESIGN: Retrospective study. OBJECTIVES: To confirm the clinical outcomes of coccygectomy for intractable chronic coccygodynia. SUMMARY OF LITERATURE REVIEW: Coccygectomy has been reported to be one of the good options for the failure of conservative treatment. MATERIALS AND METHODS: A retrospective review was conducted, including nine patients who underwent coccygectomy for intractable chronic coccygodynia. RESULTS: Improvements in the mean visual analogue scale (VAS) scores, from 5.6 to 2.1, were observed. As for patient satisfaction, there were four cases with excellent outcomes, three with good outcomes, one with a fair outcome, and only one with a poor outcome. Surgical complications, such as wound infection, did not occur in any of the cases. CONCLUSIONS: Irrespective of the causes, coccygectomy for chronic coccygodynia, for which nonsurgical management, including cushions, nonsteroidal anti-inflammatory drugs, and corticosteroid injections, has no effect, is considered a useful method because it brings definite pain relief and leads to high patient satisfaction.

Coccygectomy for Treatment of Coccygodynia / 대한정형외과학회잡지

PURPOSE: Coccygodynia is a painful condition localized in the region of the coccyx. Most cases of coccygodynia are treated conservatively. However, we conducted an analysis of patients who underwent coccygectomy, with chronic intractable coccygodynia and assessed the results of their treatment. MATERIALS AND METHODS: From March 2003 to August 2013, this study was conducted in order to investigate the benefit of coccygectomy in cases where conservative treatment has failed. We compared preoperative and postoperative visual analog scales (VAS) scores and confirmed duration of symptom free, complications. RESULTS: The average duration of symptom free was 3.4 months, and VAS score improved from 7.3 to 1.6. There was one wound infection. CONCLUSION: We can obtain satisfactory results through coccygectomy for chronic intractable coccygodynia.

Coccygectomy as a Surgical Option in the Treatment of Chronic Traumatic Coccygodynia: A Single-Center Experience and Literature Review

STUDY DESIGN: Retrospective cohort study. PURPOSE: Trauma is the most common cause for chronic coccygodynia. The present study aims at presenting our results after complete removal of the coccyx for refractory traumatic coccygodynia in terms of pain level, complication rates, and patients' overall satisfaction. OVERVIEW OF LITERATURE: There is limited extant literature describing the success rate and complications in refractory isolated traumatic coccygodynia. METHODS: From January 2011 to January 2012, 10 consecutive patients with posttraumatic coccygodynia (six males and four females; mean age, 42 years) were enrolled in our study. Conservative treatment of the condition had failed in all patients. The same surgeon performed a complete coccygectomy on all patients. Postoperative outcomes included measurements of pain relief and degree of patient satisfaction with the procedure's results. RESULTS: In our selected cohort, all patients indicated complete pain relief or significant pain improvement in follow up-care and would recommend this procedure. One patient developed a subcutaneous hematoma that required surgical intervention. CONCLUSIONS: Our results suggest that complete removal of the coccyx relieves pain in patients with refractory chronic traumatic coccygodyniaand is therefore a reasonable treatment option after conservative treatment failure.

Coccygodynia and Coccygectomy

OBJECTIVE: A review of the literature on coccygectomy and our patients was performed to assess the effectiveness of coccygectomy for chronic refractory coccygodynia. METHODS: An English language PubMed search was conducted with the terms "coccygodynia" and "coccygectomy" from January 1980 to January 2012. We retrospectively reviewed the medical records and performed telephone questionnaire on 61 patients who underwent coccygectomy at UCDMC between 1997 and 2009. RESULTS: There were 28 case series from 1980 to 2012 for a total of 742 patients who underwent coccygectomy following failed conservative management. The mean age ranged from 26.4 to 52.8 years. The most common cause was direct trauma (58.5%) with a male:female ratio of 1:5.2. Most patients (84%) had a good to excellent outcome after coccygectomy. The most common complication is wound infection (10.0%). The overall complication rate was 13.3%. Similarly, 84.6% of patients from our own surgical case series reported good to excellent outcomes with 11.5% wound infection. CONCLUSION: Coccygectomy is an effective treatment for chronic refractory coccygodynia. The surgery isrelatively simple to perform but precaution must be taken to avoid wound infection.