Sacral and Coccygeal Vertebrae

The Sacral and Coccygeal Vertebras consist, at an early period of life, of nine separate pieces, which are united in the adult so as to form two bones, five entering into the formation of the sacrum, four into that of the coccyx. Occasionally, the coccyx consists of five bones.

The Sacrum is a large, triangular bone , situated at the lower part of the vertebral column, and at the upper and back part of the pelvic cavity, where it is inserted like a wedge between the two innominate bones; its upper part or base articulating with the last lumbar vertebrae, its apex with the coccyx. The sacrum is curved upon itself, and placed very obliquely, its upper extremity projecting forward, and forming, with the last lumbar vertebra, a very prominent angle, called the promontory or sacro-vertebral angle; whilst its central part is directed backward, so as to give increased capacity to the pelvic cavity. It presents for examination an anterior and posterior surface, two lateral surfaces, a base, an apex, and a central canal.

The Anterior Surface is concave from above downward, and slightly so from side to side. In the middle are seen four transverse ridges, indicating the original division of the bone into five separate pieces. The portions of bone intervening between the ridges correspond to the bodies of the vertebrae. The body of the first segment is of large size, and in form resembles that of a lumbar vertebra; the succeeding ones diminish in size from above downward, are flattened from before backward, and curved so as to accommodate themselves to the form of the sacrum, being concave in front, convex behind. At each end of the ridges abovementioned are seen the anterior sacral foramina, analogous to the intervertebral foramina, four in number on each side, somewhat rounded in form, diminishing in size from above downward, and directed outward and forward; they transmit the anterior branches of the sacral nerves and the lateral sacral arteries. External to these foramina is the lateral mass, consisting at an early period of life of separate segments; these become blended, in the adult, with the bodies, with each other, and with the posterior transverse processes. Each lateral mass is traversed by four broad, shallow grooves, which lodge the anterior sacral nerves as they pass outward, the grooves being separated by prominent ridges of bone, which give attachment to the slips of the Pyriformis muscle.

If a vertical section is made through the center of the sacrum, the bodies are seen to be united at their circumference by bone, a wide interval being left centrally, which, in the recent state, is filled by intervertebral substance. In some bones this union is more complete between the lower segments than between the upper ones.

The Posterior Surface  is convex and much narrower than the anterior. In the middle line are three or four tubercles, which represent the rudimentary spinous processes of the sacral vertebra. Of these tubercles, the first is usually prominent, and perfectly distinct from the rest; the second and third are either separate or united into a tubercular ridge, which diminishes in size from above downward; the fourth usually, and the fifth always, remaining undeveloped. External to the spinous processes on each side are the laminae, broad and well marked in the first three pieces; sometimes the fourth, and generally the fifth, are only partially developed and fail to meet in the middle line. These partially developed laminae are prolonged downward as rounded processes, the sacral cornua, and are connected to the cornua of the coccyx. Between them the bony wall of the lower end of the sacral canal is imperfect, and is liable to be opened in the sloughing of bed-sores. External to the laminae is a linear series of indistinct tubercles representing the articular processes; the upper pair are large, well developed, and correspond in shape and direction to the superior articulating processes of a lumbar vertebra; the second and third are small; the fourth and fifth (usually blended together) are situated on each side of the sacral canal and assist in forming the sacral cornua. External to the articular processes are the four posterior sacral foramina; they are smaller in size and less regular in form than the anterior, and transmit the posterior branches of the sacral nerves. On the outer side of the posterior sacral foramina is a series of tubercles, the rudimentary transverse processes of the sacral vertebrae. The first pair of transverse tubercles are large, very distinct, and correspond with each superior angle of the bone; they together with the second pair, which are of small size, give attachment to the horizontal part of the sacro-iliac ligament; the third give attachment to the oblique fasciculi of the posterior sacro-iliac ligaments; and the fourth and fifth to the great sacro-sciatic ligaments. The interspace between the spinous and transverse processes on the back of the sacrum presents a wide, shallow concavity, called the sacral groove; it is continuous above with the vertebral groove, and lodges the origin of the Multifidus spinae.

The Lateral Surface, broad above, becomes narrowed into a thin edge below. Its upper half presents in front a broad, ear-shaped surface for articulation with the ilium. This is called the auricular surface, and in the fresh state is coated with fibro-cartilage. It is bounded posteriorly by deep and uneven impressions, for the attachment of the posterior sacro-iliac ligaments. The lower half is thin and sharp, and terminates in a projection called the inferior lateral angle; below this angle is a notch, which is converted into a foramen by articulation with the transverse process of the upper piece of the coccyx, and transmits the anterior division of the fifth sacral nerve. This lower, sharp border gives attachment to the greater and lesser sacro-sciatic ligaments, and to some fibers of the Gluteus maximus posteriorly, and to the Coccygeus in front.

The Base of the sacrum,  which is broad and expanded, is directed upward and forward. In the middle is seen a large oval articular surface, which is connected with the under surface of the body of the last lumbar vertebra by a fibro-carti-laginous disk. It is bounded behind by the large, triangular orifice of the sacral canal. The orifice is formed behind by the laminae and spinous process of the first sacral vertebra: the superior articular processes project from it on each side; they are oval, concave, directed backward and inward, like the superior articular processes of a lumbar vertebra; and in front of each articular process is an inter-vertebral notch, which forms the lower part of the foramen between the last lumbar and first sacral vertebra. Lastly, on each side of the large oval articular plate is a broad and flat triangular surface of bone, which extends outward, supports the Psoas magnus muscle and lumbo-sacral cord, and is continuous on each side with the iliac fossa. This is called the ala of the sacrum, and gives attachment to a few of the fibers of the Iliacus muscle. The posterior part of the ala represents the transverse process of the first sacral segment.

The Apex, directed downward and slightly forward, presents a small, oval, concave surface for articulation with the coccyx.

The Spinal Canal runs throughout the greater part of the bone; it is large and triangular in form above, small and flattened, from before backward, below. In this situation its posterior wall is incomplete, from the non-development of the laminae and spinous processes. It lodges the sacral nerves, and is perforated by the anterior and posterior sacral foramina, through which these pass out.

Structure. – It consists of much loose, spongy tissue within, invested externally by a thin layer of compact tissue.

Differences in the Sacrum of the Male and Female – The sacrum in the female is shorter and wider than in the male; the lower half forms a greater angle with the upper, the upper half of the bone being nearly straight, the lower half presenting the greatest amount of curvature. The bone is also directed more obliquely backward, which increases the size of the pelvic cavity; but the sacro-vertebral angle projects less. In the male the curvature is more evenly distributed over the whole length of the bone, and is altogether greater than in the female.

Peculiarities of the Sacrum – This bone, in some cases, consists of six pieces; occasionally, the number is reduced to four. Sometimes the bodies of the first and second segments are not joined or the laminae and spinous processes have not coalesced. Occasionally the upper pair of transverse tubercles are not joined to the rest of the bone on one or both sides; and, lastly, the sacral canal may be open for nearly the lower half of the bone, in consequence of the imperfect development of the laminae and spinous processes. The sacrum, also, varies considerably with respect to its degree of curvature. From the examination of a large number of skeletons it would appear that in one set of cases the anterior surface of this bone was nearly straight, the curvature, which was very slight, affecting only its lower end. In another set of cases the bone was curved throughout its whole length, but especially toward its middle. In a third set the degree of curvature was less marked, and affected especially the lower third of the bone.

Articulations – With four bones: the last lumbar vertebra, coccyx, and the two innominate bones.

Attachment of Muscles – To eight pairs: in front, the Pyriformis and Coccygeus, and a portion of the Iliacus to the base of the bone; behind, the Gluteus maximus, Latissimus dorsi, Multifidus spinee, and Erector spinse, and some: the Extensor coccygis.