Coccygectomy for chronic coccydynia in a 70-year-old patient: a case report illustrating the paramedian approach in coccygectomy

Coccydynia is a painful and debilitating condition affecting the coccygeal region, typically aggregated by activities such as sitting, standing, and defecation. Conservative treatments, including medication and physiotherapy, are the first line of treatment; however, if conservative treatment fails, surgical intervention (e.g., coccygectomy) may be needed. This case report presents a 70-year-old man with chronic coccydynia who underwent a partial coccygectomy after an inadequate response to conservative treatment. Imaging modalities revealed chronic instability at the sacrococcygeal joint due to a fracture on the first coccyx segment. The surgical procedure involved a paramedian approach, which minimized the risk of infection and wound complications by avoiding the intergluteal cleft area. Postoperatively, the patient experienced complete pain relief and showed no signs of complications. This case illustrates the effectiveness of coccygectomy and highlights the potential advantages of the paramedian approach in reducing postoperative complications.