E1920. A Pain in the Bottom…of the Spine: A Review of Anatomy and Pathology of the Sacrum and Coccyx
  1. Ashley Howell; Baylor Scott and White Medical Center
  2. Robert Smith; Baylor Scott and White Medical Center
  3. Connie So; Baylor Scott and White Medical Center
  4. Ricardo Garza-Gongora; Baylor Scott and White Medical Center
  5. Harold Sonnier; Baylor Scott and White Medical Center
The sacrum and coccyx are potentially overlooked but commonly imaged regions across intersecting radiology subspecialties. Unrecognized pathology of the sacrum and coccyx may result in debilitating pain and can disrupt regular daily activity even while sitting. Therefore, this exhibit has been created to provide a helpful review of the important landmarks and pathology in this region.

Educational Goals / Teaching Points
This educational exhibit will begin by highlighting the anatomy of the sacrum and coccyx to aid in understanding of the pathologic entities to follow. Then, imaging characteristics of various sacrococcygeal pathology will be discussed using multiple modalities. Sacral, coccygeal, and sacroiliac joint pathology will be delineated.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Anatomy of the sacrum and coccyx will be reviewed to include 1) sacrococcygeal segmentation, 2) bone landmarks, and 3) associated soft tissue structures. Knowledge of anatomy can aid in initial detection of pathology on radiographs, which can prompt further evaluation with cross-sectional imaging. Various sacral pathology discussed will include anomalous articulation, insufficiency fractures, and benign and malignant lesions. Various coccygeal pathology discussed will include mechanical considerations of the four coccygeal types, bone spicule, and sacrococcygeal and intercoccygeal joint disease and hypermobility. Sacroiliac joint pathology discussed will include sacroiliitis, metabolic bone disease, and septic arthritis. Pathology will be illustrated through multiple modalities on this image-rich exhibit.

The need for familiarity with sacrococcygeal anatomy and pathology is relevant across intersecting radiology subspecialties given the frequency with which this region is imaged. Unrecognized pathology may cause significant patient morbidity. This educational exhibit will provide the learner with an applicable review of sacrococcygeal anatomy and pathology in order to increase understanding and confidence in accurately evaluating and diagnosing pathology within this region.