Objective To explore the application value of spiral CT scan and multiplanar reconstruction (MPR) technique in the diagnosis of sacrococcygeal diseases. Methods 64 cases of patients with sacrococcygeal pain who were admitted into our hospital between April 2013 and April 2015 were enrolled in the study. The positive side and left-right oblique position DR films of sacrococcyx of all patients were took and all patients underwent spiral CT scanning of sacrococcyx. The CT images were reconstructed by MPR technique. Results The positive side and left-right oblique position DR films showed that there were no bone abnormalities in 54 cases, and 10 cases with suspected fractures; After spiral CT and MPR technique, there were 2 cases with suspected fractures, 14 cases with fractures, 8 cases with tumors and 1 case with abnormal development. Among 16 cases of patients with fractures or suspected fractures, there were 12 cases with soft tissue swelling around sacrum and 6 cases with obvious fracture line. 8 cases had sacrococcygeal tumors (confirmed by clinical pathology). 5 cases had sacral chordoma, sacral osteolytic destruction, lobulated soft tissue masses, localized surrounding organs compression and calcification in tumors. 3 cases had giant cell tumors, and the sacral bone showed soap bubble-like destruction, surrounded by soft tissue masses, with clear boundaries, shift of the surrounding structures, and the surrounding normal bone transition zone narrowing; 1 case had sacral neurofibroma, with enlargement of corresponding sacral foramen, with anterior sacral tumor with clear boundary. 1 cases of abnormal sacral development showed radiolucent zone. Conclusion Spiral CT scan and MPR technique can provide abundant information for clinical diagnosis and treatment of sacrococcygeal lesions.