Effectiveness of Manipulation under Anesthesia in Patients with Chronic Coccydynia: A Case Series with Three-Month Follow-up and Rehabilitation Protocol

Abstract

Objective:  To evaluate the effectiveness of MUA with steroid injection in patients with chronic coccydynia and outline a standardized rehabilitation protocol.

Methods:  A descriptive case series was conducted at the Department of Neurosurgery, Punjab Institute of Neurological Sciences, Lahore. Seventy-five patients aged 25–60 years with chronic coccydynia unresponsive to conservative management underwent MUA under general anesthesia. The coccyx was manipulated with a per rectal technique, and 40 mg of methylprednisolone with 10 ml of 0.25% bupivacaine was infiltrated locally. Outcomes were assessed at 3 months using VAS and need for analgesia. Data were analyzed using SPSS v17.

Results:  The mean age was 42.5 ± 11 years; 53.3% were male. The mean disease duration was 9.8 ± 3.7 months. Success was achieved in 88% of patients, with only 2.7% requiring analgesia after the procedure. No significant difference was found in outcomes based on age, gender, or disease duration.

Conclusion:  MUA with local steroid infiltration is a highly effective treatment for chronic coccydynia, offering substantial relief with minimal morbidity. Incorporation of a post-MUA rehabilitation protocol enhances outcomes and reduces the need for surgical intervention.