Describe the anatomy of the sacrum

Sacral vertebrae and their costal elements fuse and form the
sacrum
Sacral vertebrae become progressively smaller when
descending
Triangular in outline
Wedge shaped superinferiorly and anteroposteriorly
Curved with a concavity towards the pelvis
Base
Upper surface of the first sacral vertebra forms the base
Broad/wider transversely
Lies anterosuperiorly at the marked lumbosacral angle
Anterior margin of the 1st sacral vertebra projects forward,
therefore it is called sacral promontory
Apex
Apex tapers down
Has an oval facet for articulation with the coccyx
Anterior/pelvic surface
Concave
Smooth
Four ridges mark the line of ossification
These ridges separate the bodies of the sacral vertebrae
Remnants of intervertebral discs lie deep to these four ridges
Lateral to these ridges are the four pelvic sacral foramina on
both sides
Anterior/pelvic sacral foramina is larger than the posterior
sacral foramina
Rounded bars of bone between two foramens on one side
represent the head and neck of the ribs

The medial boundaries of anterior sacral foramina is made by

the body of the sacral vertebra, the other of the
circumference is costal in origin
The rounded bar of bone above the first foramen continues the
curved line of the ilium to form the posterior part of the pelvic
brim
Fusion of the costal elements (shafts of the ribs) with each
other form the lateral masses that can be seen lateral to the
foramina
Anterior rami of the upper four sacral nerves pass laterally from
the anterior sacral foramina and therefore lateral masses are
deeply intended by grooves
Piriformis muscles arise:
from the three ridges separating the anterior foramina
from the lateral mass nearby
Dorsal suface
Convex
Irregular
Rough
Marked by five prominent longitudinal ridges
Median sacral ridge is the central ridge; represents fused
rudimentary three or four spinous processes of vertebrae
projecting dorsally from the fused laminae of the vertebrae. (S5
has no spinous process)
Inferior to the superior articular facet of S1 that articulates with
the inferior articular facets of L5, medial to the posterior
foramina is a line of irregular tubercles that represent fusion of
articular processes of the adjacent vertebrae.
The above mentioned low ridge forms the intermediate sacral
crest and it is projected below, alongside the sacral hiatus, to
end in rounded sacral cornu

Lateral to the superior articular facets, the prominence of bone

represent the tips of transverse processes of S1
Below this is the lateral sacral line, in which all the tips of the
transverse processes are fused together making a longitudinal
ridge
The fused costal elements lie lateral to the lateral sacral crest
The gutter between the median and lateral sacral crest is filled
by erector spinae
The posterior layer of the lumbar fascia that covers erector
spinae is attached to both median and lateral crests
The superior part of the lateral surface of the sacrum looks like
an auricle (external ear); because of that this area is called
auricular surface
Its covered with hyaline cartilage during life
It is the site of synovial part of the sacro-iliac joint between the
sacrum and ilium
Deep fossae between the lateral sacral crest and the auricular
surface gives attachment to the posterior sacroiliac ligament
Sacral canal
Sacral canal is the continuation of the vertebral canal in the
sacrum
Triangular in cross section
Curves with the sacrum
The gap above the first sacral laminae/the superior opening of
the sacral canal is closed by the ligament flava attached to the
laminae of L5 vertebrae
Sacral hiatus is the inferior opening in to the sacral canal
Sacral hiatus and the sacral cornua are in the shape of an
inverted U
Sacral hiatus result from absence of the laminae and spinous
process of S5 and sometimes S4

Depth of the sacral hiatus varies depending on howmuch of the

spinous process and laminae of S4 are present
The sacral cornua represents the inferior articular processes of
the S5
Sacral cornua project inferiorly on each side of the sacral hiatus
and are a helpful guide to its location