The congenital disorder, spina bifida, occurs as a result

The congenital disorder, spina bifida, occurs as a result of a defective embryonic neural tube, characterised by the incomplete closure of vertebral arch or of the incomplete closure of the surface of the vertebral canal.[10] The most common sites for spina bifida malformations are the lumbar and sacral areas.
Another congenital disorder is that of caudal regression syndrome also known as sacral agenesis. This is characterised by an abnormal underdevelopment in the embryo (occurring by the seventh week) of the lower spine.[11] Sometimes part of the coccyx is absent, or the lower vertebrae can be absent, or on occasion a small part of the spine is missing with no outward sign.
Fracture Sacral fractures are relatively uncommon however they are often associated with neurological deficits. In the presence of neurological signs most of the times they are treated with surgical fixation.[12] Cancer The sacrum is one of the main sites for the development of the sarcomas known as chordomas that are derived from the remnants of the embryonic notochord.[13] In osteopathic medicine Sacral diagnosis is a common issue in osteopathic manipulative medicine. There are many types of sacral diagnoses, such as torsion and shear. To diagnose a sacral torsion, the axis of rotation is found with the axis named after its superior pole. If the opposite side of the pole is rotated anteriorly, it is rotated towards the pole, in which case it is called either a right-on-right (R on R) or left-on-left (L on L) torsion. The first letter in the diagnosis pertains to the direction of rotation of the superior portion of the sacrum opposite the side of the superior axis pole, and the last letter pertains to the pole.[14]