S1 Dorsal Root Ganglion And Inferior Hypogastric Plexus Pulsed Radiofrequency Neuromodulation May Improve Type III Coccydynia Pain: a Case Report
DOI:
https://doi.org/10.36408/mhjcm.v12i3.1300Keywords:
coccydynia, pain, nociceptive, neuropathic, dorsal root ganglion, inferior hypogastricAbstract
Introduction
Coccygeal pain occurs in 1% to 2.7% of people without a clear coccygeal origin, unless provoked by prolonged sitting or anatomical changes found incidentally during surgery. Pain transmission blocked by pulsed radiofrequency (PRF) neuromodulation of the inferior hypogastric plexus (IHP) and dorsal root ganglion (DRG) can improve both nociceptive and neuropathic pain.
Methods
A 16-year-old female with a one-month history of coccydynia, coccygeal numbness radiating to the heels, and normal motor, micturition and voiding functions. The CSK 15 needle was inserted through both S1 neuroforamens to reach the DRG, then pulsed radiofrequency (PRF) 42°C for 2 minutes using the Cosman G4 device, followed by triamcinolone 20mg 1mL also administered contralaterally. Thus, PRF was also performed on both sides of the IHP anterior to the sacrum through the S2 neuroforamen approach.
Results
Improvement was observed after one month (NRS 0-1), whereas coccygeal numbness improved gradually. The combination analgesic (paracetamol 300mg, diazepam 2mg, diclofenac sodium 12.5mg) or pregabalin 50mg is administered as required, while vitamin B12 50 mcg/ 12h is continued.
Discussion
The pelvic sympathetic trunk (PSN) lies extraperitoneally anterior to the sacral and anteromedial to the anterior sacral neuroforamen with four or five interconnected ganglia. It rise to the lumbar sympathetic trunk (above) and the impar ganglion (below), which involved in transmitting sympathetic nociceptive from the perineum, distal rectum, distal vagina, distal urethra and anus. The parasympathetic afferent cells within the S2-S4 DRGs associated with pelvic splanchnic and somatic nerves.
Conclusion
Neuromodulation treatment for coccydynia has good results in DRG and IHP.
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References
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