||It has been suggested that Sacral promontory be merged into this article. (Discuss) Proposed since January 2014.|
|Sacrum, pelvic surface|
|Image of a male pelvis (sacrum is in center)|
In humans, the sacrum (// or //; plural: sacrums or sacra) is a large, triangular bone at the base of the spine and at the upper and back part of the pelvic cavity, where it is inserted like a wedge between the two hip bones. Its upper part connects with the last lumbar vertebra, and bottom part with the coccyx (tailbone). It consists of usually five initially unfused vertebrae which begin to fuse between ages 16–18 and are usually completely fused into a single bone by age 34.
It is curved upon itself and placed obliquely (that is, tilted forward). It is kyphotic—that is, concave facing forward. The base projects forward as the sacral promontory internally, and articulates with the last lumbar vertebra to form the prominent sacrovertebral angle. The central part is curved outward toward the posterior, allowing greater room for the pelvic cavity. The two lateral projections of the sacrum are called ala (wings), and articulate with the ilium at the L-shaped sacroiliac joints.
The sacrum consists of several parts:
- The pelvic surface of the sacrum is concave from above downward, and slightly so from side to side.
- The dorsal surface of the sacrum is convex and narrower than the pelvic.
- The lateral surface of the sacrum is broad above, but narrowed into a thin edge below.
- The base of the sacrum, which is broad and expanded, is directed upward and forward.
- The apex (apex oss. sacri) is directed downward, and presents an oval facet for articulation with the coccyx.
- The vertebral canal (canalis sacralis; sacral canal) runs throughout the greater part of the bone; above, it is triangular in form; below, its posterior wall is incomplete, from the non-development of the laminae and spinous processes. It lodges the sacral nerves, and its walls are perforated by the anterior and posterior sacral foramina through which these nerves pass out.
The sacrum articulates with four bones:
- the last lumbar vertebra above
- the coccyx (tailbone) below
- the illium portion of the hip bone on either side
Rotation of the sacrum superiorly and anteriorly whilst the coccyx moves posteriorly relative to the ilium is sometimes called "nutation" (from the Latin term nutatio which means "nodding") and the reverse, postero-inferior motion of the sacrum relative to the ilium whilst the coccyx moves anteriorly, "counter-nutation." In upright vertebrates, the sacrum is capable of slight independent movement along the sagittal plane. When you bend backward the top (base) of the sacrum moves forward relative to the ilium; when you bend forward the top moves back.
The sacrum is called so when referred to all of the parts combined. Its parts are called sacral vertebrae when referred individually.
Sometimes the uppermost transverse tubercles are not joined to the rest of the ala on one or both sides, or the sacral canal may be open throughout a considerable part of its length, in consequence of the imperfect development of the laminae and spinous processes.
The sacrum also varies considerably with respect to its degree of curvature.
The sacrum is noticeably sexually dimorphic (differently shaped in males and females).
In the female the sacrum is shorter and wider than in the male; the lower half forms a greater angle with the upper; the upper half is nearly straight, the lower half presenting the greatest amount of curvature. The bone is also directed more obliquely backward; this increases the size of the pelvic cavity and renders the sacrovertebral angle more prominent.
In the male the curvature is more evenly distributed over the whole length of the bone, and is altogether larger than in the female.
|This section requires expansion. (November 2013)|
|This section requires expansion. (November 2013)|
The sacrum is one of the main sites for the development of the sarcomas known as chordomas (chordosarcomas) that are derived from the remnants of the embryonic notochord. Much of the information on these cancers can be found at the Chordoma Foundation's website.
In osteopathic medicine
Sacral Diagnosis is a common issue in Osteopathic Manipulative Medicine. There are many types of sacral diagnoses, such as torsion and shear. To diagnose a sacral torsion, the axis of rotation is found with the axis named after its superior pole. If the opposite side of the pole is rotated anteriorly, it is rotated towards the pole, in which case it is called either a right-on-right (R on R) or left-on-left (L on L) torsion. The first letter in the diagnosis pertains to the direction of rotation of the superior portion of the sacrum opposite the side of the superior axis pole, and the last letter pertains to the pole. 
The name is derived from the Latin (os) sacrum, (sacer, sacra, sacrum, "sacred"), a translation of the Greek hieron (osteon), meaning sacred or strong bone. It is called so either because supposedly sacrum was the part of an animal offered in sacrifice (since the sacrum is the seat of the organs of procreation) or because of the belief that the soul of the man resides there. In Slavic languages and in German this bone is called the 'cross bone' (Kreuzbein), in Dutch 'holy bone' (Heiligbeen).
|Wikimedia Commons has media related to Sacrum.|
- Joseph D. Kurnik, DC. "The AS Ilium Fixation, Nutation, and Respect".
- Maitland, J (2001). Spinal Manipulation Made Simple. Berkeley: North Atlantic Books, p. 72.
- Wedel, F.P. "D.O.". A.T. Still University School of Osteopathic Medicine. Retrieved 18 February 2014.
- Online Etymology Dictionary
- LEO E-G Results for "sacrum"
- Anatomy photo:43:os-0401 at the SUNY Downstate Medical Center - "The Female Pelvis: Articulated bones of pelvis"
- Anatomy photo:43:st-0401 at the SUNY Downstate Medical Center - "The Female Pelvis: Bones"
- sacrum at eMedicine Dictionary