Analysis of Sacrococcygeal Morphology in Koreans Using Computed Tomography

다국어 초록 (Multilingual Abstract)

Background: The sacrococcygeal morphology of Arabs and Europeans has been studied using computed tomography (CT) or magnetic resonance imaging to determine the cause of coccydynia. Studies have suggested differences in sacrococcygeal morphology among ethnic groups. However, there are no data on the sacrococcygeal anatomy of Koreans.
Methods: We conducted a retrospective analysis of 606 pelvic CT scans that were taken at Cheju Halla General Hospital between 2008 and 2014. Fractures of the sacrum or coccyx were excluded. Differences in the sacrococcygeal morphology among age groups stratified by decade of life and between genders were analyzed using sagittal plane pelvic CT scans. The morphological parameters studied were the sacral and coccygeal curved indexes, sacrococcygeal angle, intercoccygeal angle, coccygeal type, coccygeal segmental number, and sacrococcygeal fusion.
Results: The average sacral and coccygeal curved indexes were 6.15 and 7.41, respectively. The average sacrococcygeal and intercoccygeal angles were 110° and 49°, respectively. Type II coccyx was most common, and the rate of sacrococcygeal fusion was 34%. There was a moderate positive correlation between age and the sacral curved index (r = 0.493, p = 0.000) and a weak negative correlation between age and the coccyx curved index (r = –0.257, p = 0.000). There was a weak negative correlation between age and the intercoccygeal angle (r = –0.187, p = 0.000). The average intercoccygeal angle in males and females was 53.9° and 44.7°, respectively.
Conclusions: The sacrum tended to be more curved and the coccyx straighter with age. The coccyx was straighter in females than males. Knowledge of the sacrococcygeal anatomy of Koreans will promote better understanding of anatomical differences among ethnicities and future studies on coccydynia.

참고문헌 (Reference)

1 Saluja PG, "The incidence of ossification of the sacrococcygeal joint" 156 : 11-15, 1988

2 Karadimas EJ, "Surgical treatment of coccygodynia : an analytic review of the literature" 20 (20): 698-705, 2011

3 Maigne JY, "Standardized radiologic protocol for the study of common coccygodynia and characteristics of the lesions observed in the sitting position : clinical elements differentiating luxation, hypermobility, and normal mobility" 21 (21): 2588-2593, 1996

4 Mouhsine E, "Posttraumatic coccygeal instability" 6 (6): 544-549, 2006

5 Woon JT, "Magnetic resonance imaging morphology and morphometry of the coccyx in coccydynia" 38 (38): E1437-E1445, 2013

6 Maigne JY, "Magnetic resonance imaging findings in the painful adult coccyx" 21 (21): 2097-2104, 2012

7 Kerimoglu U, "Intercoccygeal angle and type of coccyx in asymptomatic patients" 29 (29): 683-687, 2007

8 Maigne JY, "Instability of the coccyx in coccydynia" 82 (82): 1038-1041, 2000

9 Postacchini F, "Idiopathic coccygodynia : analysis of fifty-one operative cases and a radiographic study of the normal coccyx" 65 (65): 1116-1124, 1983

10 Gray H, "Gray’s anatomy" Churchill-Livingstone 1980

11 Tague RG, "Fusion of coccyx to sacrum in humans : prevalence, correlates, and effect on pelvic size, with obstetrical and evolutionary implications" 145 (145): 426-437, 2011

12 Breathnach AS, "Frazer’s anatomy of the human skeleton" J & A Churchill 1965

13 Przybylski P, "Evaluation of coccygeal bone variability, intercoccygeal and lumbosacral angles in asymptomatic patients in multislice computed tomography" 88 (88): 204-211, 2013

14 Marwan YA, "Computed tomography-based morphologic and morphometric features of the coccyx among Arab adults" 39 (39): E1210-E1219, 2014

15 Fogel GR, "Coccygodynia : evaluation and management" 12 (12): 49-54, 2004

16 Patijn J, "Coccygodynia" 10 (10): 554-559, 2010

17 Balain B, "Coccygectomy for coccydynia: case series and review of literature" 31 (31): E414-E420, 2006

18 Lirette LS, "Coccydynia : an overview of the anatomy, etiology, and treatment of coccyx pain" 14 (14): 84-87, 2014

19 Nathan ST, "Coccydynia : a review of pathoanatomy, aetiology, treatment and outcome" 92 (92): 1622-1627, 2010

20 Moore KL, "Clinically oriented anatomy" Williams & Wilkins 1985

21 Kim NH, "Clinical and radiological differences between traumatic and idiopathic coccygodynia" 40 (40): 215-220, 1999

22 Woon JT, "Clinical anatomy of the coccyx : a systematic review" 25 (25): 158-167, 2012

23 Maigne JY, "Causes and mechanisms of common coccydynia : role of body mass index and coccygeal trauma" 25 (25): 3072-3079, 2000

24 Woon JT, "CT morphology and morphometry of the normal adult coccyx" 22 (22): 863-870, 2013