Acıbadem Comprehensive Spine Center

Sacrum and Coccyx Bones

The 24 vertebras in the neck, back and waist have disks and facet joints in between, by virtue of which these vertebras can move over one another.

There are no disks or facet joints between the 5 vertebras in the sacrum bone. These 5 vertebras are in the form of a single welded bone. The bone at the end of spinal cord called coccyx has a similar structure. It consists of 4 or 5 vertebras. Sacrum is also joined with pelvis on both sides. These joints are known as sacroiliac joints. Sacrum and coccyx are biomechanically different from the rest of the spine because of these anatomic differences.

Sacrum and Sacroiliac joint pain:

Sacroiliac joints do not move much. They function as transmitters of load between the spine and the hip and legs. The joints are surrounded with very strong bonds so that they can work against the heavy loads effecting them.

The angle of repose of the sacral bone in sagittal plane plays an important role in the sagittal balance of the entire body. Sacrum can be fractured in accidents and traumas. Conservative or surgical treatment may be preferred depending on the location of fracture and its impact on the nerve tissues. Similar traumas may result in opening of sacroiliac joints. This may often be accompanied by other pelvis and abdominal wounds. There may be high levels of internal bleeding. The opened joint may be closed in earlier periods by attaching fixers from outside or inserting screws in the bone.

Some rheumatic diseases, ankylosing spondylitis in particular, effect sacroiliac joints. Gout disease, caused by excessive protein intake, may effect sacroiliac joint as it does to the small joints in feet and legs. The process of arthritis, also called osteoarthritis or spondylosis, may damage the cartilage structure in sacroiliac joints, resulting in pains caused by movement. Pains may also occur with increasing loads in pregnancy period.

This joint is one in which several rheumatic diseases are often involved. It is also effected by the process of arthritis, called osteoarthritis, caused by excessive protein intake. Pains may be felt in these joints during pregnancy period.

Similar to lumbar pains, sacrum and sacroiliac joint pains may spread to hips and knees. Pains may be acute or chronic and can be felt on one side or both sides.

Ankylosing spondylitis:

It is a rheumatic disease involving joints and spine. Its symptom is lumbar pain that appears in early ages (<40). It may gradually increase, after hiding itself at the beginning. The pain typically decreases with movement and increases after rest. This feature is reflected in cases where pain is felt in the second half of the night and towards the morning. It may be accompanied by morning stiffness that lasts for half an hour or longer. Spinal movements may get restricted as the disease progresses.

Rheumatoid arthritis, lupus and other rheumatologic diseases may involve the spine and the sacroiliac joint and cause pain.

Arthritis: Decreasing synovial fluid between the joints leads to cartilage damage and loss of movement. Unlike rheumatologic stiffness, it appears in later ages. Pain decreases after rest and increases when moving.

Coxodynia (Coccyx pain):

It is named with medical terms such as coxodynia, coccygodynia, coxalgia. It develops in conjunction with crushes and fractures caused by sudden falls on the hips. Coxodynia may also be caused by repeated simple traumas. Inflammations, tumors and similar reasons are less frequent causes of coccyx pain.

Treatment is planned after taking dynamic x-rays to see whether there is increasing movement inside the coccyx, whether the fracture shifts to the front or to the back and whether the bone extends out in the sitting zone called spicule.

It generally gives good response to medical treatment or conservative treatment including special sitting apparatus, but healing may take time. It is especially important not to sit for too long on hard surfaces. Surgery may be required less frequently.

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