Pain from sacral insufficiency fractures or metastatic tumor to the sacrum, refractory to radiation and/or chemotherapy, can be extremely debilitating to affected patients. Conservative medical therapy with rest, limited ambulation, and pain medication has been the mainstay of treatment. Open surgical fixation is reserved for severe fracture that does not heal with rest. A minimally invasive treatment, sacroplasty, is gaining popularity and uses image-guided, percutaneous injection of surgical cement into the fracture. This article reviews the incidence, causes, diagnosis, presentation, and treatment options for sacral fractures, and describes detailed technical steps of the sacroplasty procedure.