The sacrospinous ligament connects the sacral and coccygeal lateral borders to the ischial spine, converting the sciatic notch into the greater and lesser sciatic foramina alongside the sacrotuberous ligament. It is the preferred fixation point for vaginal vault suspension in apical pelvic organ prolapse repair (sacrospinous fixation). The pudendal neurovascular bundle crosses the ischial spine immediately posterior to the ligament, making this anatomy critical during the procedure.
| Origin | Lateral sacrum and coccyx |
|---|---|
| Insertion | Ischial spine |
| Actions | Converts the greater sciatic notch into the greater sciatic foramen; resists sacral rotation; the fixation landmark for sacrospinous vaginal vault suspension |
|---|
Sacrospinous fixation for vaginal vault prolapse involves placing sutures through the sacrospinous ligament 1 to 2 cm medial to the ischial spine to avoid the pudendal nerve running immediately posterior to the spine. Post-operative buttock pain from nerve irritation occurs in up to 15 percent of cases and usually resolves within 6 weeks as the sutures settle.
Buttock pain from pudendal or inferior gluteal nerve irritation after sacrospinous ligament fixation for vaginal vault prolapse, managed conservatively as it resolves within 6 weeks in most cases.
