Thoracic paddle lead spinal cord stimulation for a chronic pain syndrome associated with posttraumatic coccydynia: A case report

Background: Chronic coccydynia can significantly impair quality of life and may persist despite conservative therapies. Literature evaluating spinal cord stimulation (SCS) for refractory coccydynia remains limited, particularly for thoracic paddle lead systems. Case Description: A 48-year-old woman with longstanding posttraumatic coccydynia that evolved to include low-back and bilateral lower-extremity pain remained symptomatic despite conservative and interventional treatments. A percutaneous SCS trial produced approximately 70–80% overall pain relief, with good coverage of buttock and lower-extremity pain but incomplete coverage of chronic coccygeal pain. She subsequently underwent T9 laminotomy with permanent thoracic paddle lead implantation. Intraoperative somatosensory evoked potential testing and fluoroscopy confirmed physiologic engagement and appropriate lead positioning. At approximately 6.5 years after implantation, the patient reported approximately 90% overall pain relief with continuous SCS use, significant improvement in quality of life, and cessation of pain medication, although the 90% improvement reflected overall pain relief rather than a separate assessment of coccygeal pain. Conclusion: This case describes a favorable and durable patient-reported outcome following thoracic paddle lead SCS in a patient with longstanding posttraumatic coccydynia as part of a broader chronic pain syndrome. Given the single-patient design and retrospective long-term assessment, further study is needed to determine appropriate patient selection and the role of thoracic paddle lead SCS in patients with refractory coccygeal pain.