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Mind the gap: paramedian approach for coccygectomy
David Frolov1, Kai Zhu1, Maksim Rusev1
1Washington State University, Elson S. Floyd College of Medicine 412 E Spokane Falls Blvd, Spokane, WA, USA.
Summary
The paramedian approach to coccygectomy significantly reduces infection rates and improves outcomes for patients with refractory coccydynia (tailbone pain). This surgical technique offers a better alternative to the traditional midline incision, enhancing patient recovery and satisfaction.
Area of Science:
- Orthopedic Surgery
- Pain Management
- Surgical Innovation
Background:
- Coccydynia (tailbone pain) can be debilitating, often requiring surgical intervention when conservative treatments fail.
- The standard midline coccygectomy approach is associated with high infection rates due to incision proximity to the anus and the gluteal cleft's crevice effect.
- Improving surgical outcomes for coccydynia necessitates exploring alternative approaches to minimize complications.
Purpose of the Study:
- To introduce and evaluate the paramedian approach for coccygectomy as a method to decrease surgical site infection and enhance wound healing.
- To leverage the paramedian approach's benefits, including increased distance from the anus and improved closure thickness, for better patient results.
Main Methods:
- A case series of 41 patients with refractory coccydynia undergoing paramedian coccygectomy between 2011 and 2022.
- Surgical technique involved a 4-6 cm paramedian incision, 0.5-1.5 cm lateral to the midline, for coccyx removal.
- Outcomes assessed via Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) pain, patient satisfaction, infection rates, and return to activities.
Main Results:
- The study included 41 patients (68% female, average age 45.8, 71% overweight/obese), with trauma as the most common cause (75.6%).
- Postoperative complications occurred in 12.1% of patients (one requiring drainage, four treated with antibiotics).
- Significant improvements were observed: VAS pain decreased from 7.5 to 2.3 (p<.001), ODI improved from 30.1 to 9.6 (p<.001), with 86.7% reporting good/excellent results.
Conclusions:
- The paramedian approach effectively overcomes the limitations of the midline coccygectomy, particularly regarding infection risk.
- This technique provides a safe and effective surgical option for patients with persistent coccydynia unresponsive to non-operative management.
- The paramedian approach demonstrates superior wound healing and patient-reported outcomes compared to historical midline approaches.
