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Despite being accounted back in 16th century, Coccydynia still remains a mystery and sometimes controversial.Multiple
treatment modalities have been proposed for conservative treatment of coccydynia. Ganglion Impar (ganglion of Walther)
is an unpaired retroperitoneal structure which provides sympathetic innervation of the perineum. Ganglion block has been
effective in treatment of coccydynia that could not be relieved by classic treatment protocols. We retrospectively analyzed the
collected data of 39 patients with chronic coccydynia (pain > 6 months). Patients were identified by our pain clinic databases
who were treated by RFT of the ganglion between January 2010 and June 2014. The authors succeeded in contacting 35 patients
for follow-up. All patients had been previously treated with conservative methods, but none had pain relief.A retrospective
analysis was done on the basis of questionnaire administered to these patients.Pain level of the patients were assessed by
pre and post treatment visual analogue scale (VAS) score and the modified Oswestry (ODI) disability index. The mean age
of the patients was 39+/-12(range 20-65) with 23 female (67%) and 12males(33%). The average follow up duration was 22
+/- 12months. Statistical significance difference was noted between pre and post procedure VAS score (p<0.01). Patients also
had greater OSW score post procedure but not significantly (p value >0.01). The clinical results among the 35 patients with
follow up were as follows: 14 excellent, 9 good, 6 fair and 6 poor. Marked improvement was noted in 14 of the 35 patients
(40%). There were no major side effects.Various methods of treating coccydynia are found in the literature. The radiofrequency
thermocoagulation of ganglion impar block is a low risk, highly effective and minimally invasive procedure alternative to
surgery for coccydynia patients who are non responsive to conservative treatment. The most important factors determining
success of the procedure is strict patient selection and the technique of the procedure. As the study group was small, further
randomized,prospective study are needed to fully evaluate the effectiveness ofradiofrequency thermocoagulation for ganglion
impar block.
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