The sacrospinous ligament converts the greater and lesser sciatic notches into the greater and lesser sciatic foramina. The pudendal nerve and internal pudendal vessels wind around the ischial spine at its lateral border, making the ischial spine the landmark for pudendal nerve block. In pelvic floor reconstruction, the sacrospinous ligament is used for vaginal vault suspension in sacrospinous colpopexy.
| Origin | Lateral sacrum and coccyx |
|---|---|
| Insertion | Ischial spine |
| Actions | Resists sacral nutation; divides the greater from the lesser sciatic foramen; the pudendal nerve winds around the ischial spine immediately medial to the sacrospinous ligament |
|---|
Sacrospinous colpopexy for vaginal vault prolapse attaches the vaginal cuff to the sacrospinous ligament using a retroperitoneal approach — the ligament is accessed through the right pararectal space. The pudendal neurovascular bundle must be identified and protected medial to the ligament. Buttock pain after sacrospinous colpopexy indicates inferior gluteal nerve entrapment at the stitch.
Inferior gluteal or pudendal nerve entrapment from sacrospinous colpopexy sutures producing buttock pain managed with suture removal if severe.
