The posterior sacrococcygeal ligament reinforces the dorsal sacrococcygeal joint and has two layers. The deep layer continues the posterior longitudinal ligament down onto the back of the coccygeal bodies, while the superficial layer runs from the margins of the sacral hiatus to the dorsal coccyx, closing the lower end of the sacral canal in series with the ligamenta flava.
| Origin | Margins of the sacral hiatus and posterior surface of the lower sacrum |
|---|---|
| Insertion | Posterior surface of the coccyx |
Resists excessive coccygeal flexion, maintains the posterior sacrococcygeal junction, and protects the sacral hiatus and caudal epidural space.
The superficial layer covers the sacral hiatus and is pierced (as the sacrococcygeal membrane) in caudal epidural injection, after palpating the sacral cornua. Calcification of the ligament or a narrowed hiatus can make a landmark-guided caudal block fail, and ultrasound or fluoroscopy then helps. Its partial disruption occurs in coccyx fractures and sacrococcygeal sprains.
The posterior sacrococcygeal ligament/membrane is penetrated during caudal epidural injection, providing access to the caudal epidural space for pain management and anaesthesia.
Pain at the sacrococcygeal joint and its ligaments after a fall, childbirth or prolonged sitting, worse when sitting, managed with cushions, injection and rarely coccygectomy.
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