BACKGROUND This study compared the clinical efficacy and complication profiles of classical midline versus paramedian incision techniques in coccygectomy for chronic refractory coccygodynia. We hypothesized that the paramedian approach would reduce wound-related complications and improve early postoperative pain and function. MATERIAL AND METHODS A retrospective cohort of 41 patients (32 women, 9 men) who underwent coccygectomy between 2015 and 2023 was analyzed. Patients were divided into a classical midline incision group (n=18) and a paramedian incision group (n=23). Outcomes included wound healing time, wound dehiscence, surgical site infections, intraoperative blood loss, visual analog scale (VAS) pain scores, and Oswestry Disability Index (ODI). Statistical comparisons were performed. RESULTS The paramedian group had significantly lower wound dehiscence rates than the midline group (0% vs 27.8%, P=0.01). There were fewer surgical site infections in the paramedian group than in the midline group (4.3% vs 22.2%), but the difference was not statistically significant (P=0.16). Early postoperative pain at 3 months was significantly lower in the paramedian group than midline group (mean VAS 3.22 vs 4.06, P=0.045). Long-term VAS and ODI scores showed no significant difference. Mean wound healing time was shorter in the paramedian group (4.46 vs 5.12 months), with higher, yet not significant, patient satisfaction. Intraoperative blood loss and operative duration were similar. CONCLUSIONS Both incision techniques offer comparable long-term outcomes. However, the paramedian approach provides better early pain relief and fewer wound complications, representing a safer, more effective alternative for refractory coccygodynia.