By Chris Faubel, MD –
The ganglion impar is a group of sympathetic ganglia which are located anterior to the sacrococcygeal junction; it carries nociceptive signals from the perineum area.
Coccydynia is pain in the area of coccyx, and is seen frequently in patients with a history of falling directly on their coccyx (tailbone). If the pain does not resolve on its own, and after a course of antiinflammatories and donut cushion, the ganglion impar is blocked under fluoroscopic guidance.
ICD-9 code: 724.79 (Coccydynia)
ICD-10 code: M53.3 (Sacrococcygeal disorders, not elsewhere classified)
CPT codes: There is no consensus on the correct code to use. Some use:
64530 (Injection, anesthetic agent; celiac plexus, with or without radiologic monitoring).
64999 (Unlisted procedure, nervous system) and submit documentation of medical necessity.
64520 (Injection, anesthetic agent; lumbar or thoracic paravertebral sympathetic)
77003 (Fluoroscopic needle guidance for spine or paraspinous)
Procedure technique:
Position: Prone
Fluoroscopy: A lateral fluoro view is used to visualize the sacrococcygeal junction.
Technique: A 22-25 gauge needle is used to advance through the sacrococcygeal ligament until the needle tip is just barely anterior to the sacrum. Contrast is then injected to visualize correct spread/placement. Finally, a local anesthetic (and sometimes corticosteroid) is injected.
Expectations: Patient should have significant reduction in pain within a minute or two if this is the real source of his/her pain; this injection is then both diagnostic and therapeutic
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- Ganglion Impar Block under fluoroscopy
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- www.hpssandiego.com
How do you diagnose someone with ganglion impar? MRI?
No MRI. Just a history of falling on your coccyx and chronic pain there. Of course, if acute, an xray should be ordered to rule out a fracture.
Since you include local anesthetic in the injectate, the procedure is both diagnostic and therapeutic.
http://www.ncbi.nlm.nih.gov/pubmed/16924191
Successful injection for coccyx pain.
Foye PM, Buttaci CJ, Stitik TP, Yonclas PP.
excellent article.
Hello,
My mother (58) has coccydynia over 2 years, She tried many types of treatment bat nothing help.
I would like to try “Ganglion Impar Block under fluoroscopy” but we live in Israel. Can you tell me how I can faind someone that may help her.
B.R
Daniel
I don’t know how the health care system works in Israel, but I’d just look for a pain medicine physician over there. I’m sure there are excellent specialists treating pain in Israel, I just don’t know of a specific organization there you could check. Best of luck to your mother.
I heard about this Doc from a friend of mine. He might be worth calling up.
http://www.yashar-pain-clinic.co.il/index.html
I am sorry i meant she. Another way to look for a pain specialist is visit http://www.spineuniverse.com/locate/doctors
do you go right through the ligament in the midline, do you curve the needle, or do you go off lateral to coccyx and then curve underneath it?
Right through the ligament…using fluoroscopy-guidance and contrast to make sure you don’t go too far anteriorly and get into the colon.