Paramedian Approach to Coccygectomy in the Treatment of Chronic Coccydynia: A Technical Note

Abstract

Objective: There is a growing body of clinical evidence to support coccygectomy as an effective treatment for chronic coccygodynia. To date, the authors identified no other studies that describe and evaluate the paramedian surgical approach to coccygectomy and post-operative outcomes. Methods: A case report of 36 patients who underwent coccygectomy with a paramedian or midline approach. All patients had chronic coccydynia that was refractory to conservative treatment. Three patients were excluded from the study due to additional lumbar surgery (2) or missing data (1). Outcomes assessed were Visual Analog Scale (VAS), operative and post-operative complications, use of post-operative pain medication, and surgery time. Results: Included in the study were 24 females and 9 males with a mean age of 46 years (range 18-74 years). The most common etiologies were trauma (26) and idiopathic (7). Twenty seven patients underwent coccygectomy with a paramedian approach and 6 had the same procedure with the midline incision. There was a significantly lower infection rate in the paramedian group (p-value=0.00871). Conclusion: The paramedian and midline approach to coccygectomy are both viable treatments for coccygodynia. The two methods offer low complication rates and high patient satisfaction. Surgeon and patient preference should be taken into account when choosing a surgical approach for coccygectomy. Further examination comparing traditional midline vs. paramedian approach are needed to assess superiority.

Minimally Invasive Coccygectomy: 2-Dimensional Operative Video

“…1,2 Current operative techniques are associated with a high rate of wound complications reaching 12%. 1,3 These techniques place the incision midline, 4,5 in a location prone to pressure injury in a bacteria-rich environment. A newer paramedian approach was reported with considerably less infections than in their traditional approach group, yet the rate still approached 11%.…”