On the lateral aspect of the sacral groove is a linear series of tubercles produced by the fusion of the articular processes which together form the indistinct medial sacral crest. The articular processes of the first sacral vertebra are large and oval-shaped. Their facets are concave from side to side, face to the back and middle, and articulate with the facets on the inferior processes of the fifth lumbar vertebra.
The tubercles of the inferior articular processes of the fifth sacral vertebra, known as the sacral cornua, are projected downward and are connected to the cornua of the coccyx. At the side of the articular processes are the four posterior sacral foramina; they are smaller in size and less regular in form than those at the front, and transmit the posterior divisions of the sacral nerves. On the side of the posterior sacral foramina is a series of tubercles, the transverse processes of the sacral vertebrae, and these form the lateral sacral crest. The transverse tubercles of the first sacral vertebra are large and very distinct; they, together with the transverse tubercles of the second vertebra, give attachment to the horizontal parts of the posterior sacroiliac ligaments; those of the third vertebra give attachment to the oblique fasciculi of the posterior sacroiliac ligaments; and those of the fourth and fifth to the sacrotuberous ligaments.
The lateral surface of the sacrum is broad above, but narrows into a thin edge below. The upper half presents in front an ear-shaped surface, the auricular surface, covered with cartilage in the immature state, for articulation with the ilium. Behind it is a rough surface, the sacral tuberosity, on which are three deep and uneven impressions, for the attachment of the posterior sacroiliac ligament. The lower half is thin, and ends in a projection called the inferior lateral angle. Medial to this angle is a notch, which is converted into a foramen by the transverse process of the first piece of the coccyx, and this transmits the anterior division of the fifth sacral nerve. The thin lower half of the lateral surface gives attachment to the sacrotuberous and sacrospinous ligaments, to some fibers of the gluteus maximus at the back and to the coccygeus in the front.