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.

Cervical disk arthroplasty anterior cervical discectomy and fusion trauma artificial disk extrusion Prodisc-C a b s t r a c t Background Context: Cervical disk arthroplasty (CDA) has been demonstrated to be a safe and effective method to treat myelopathy with the added benefit of preserving neck mobility compared to anterior cervical discectomy and fusion (ACDF). Few studies describe complications of trauma after CDA, and to our knowledge this is the only study describing a grossly intact artificial cervical disk (ACD) without extrusion after high energy trauma. Based on our case and a review of literature, we hypothesize that, given adequate osseous integration (OI), CDA may be a safe intervention despite their risk for higher energy trauma.Purpose: To present a rare case of high-energy trauma after CDA resulting in a Hangman's fracture and grossly in-tact ACD and to engage a biomechanical discussion of trauma after CDA and ACDF utilizing a literature review.Study Design/Setting: Case-report with literature review and discussion Patient Sample: Electronic medical record data Outcome Measures: Computed Tomography, Magnetic Resonance Imaging, and X-Ray physiologic measures Methods: We report the case of a 44-year-old woman who received a C5-C6 level CDA with a (Synthes Prodisc-C©, Synthes Spine Company, L.P., West Chester, PA) and was subsequently involved in a high-speed motorcycle accident one-and-a-half years later resulting in a Hangman's fracture.