Sacral vertebroplasty, or sacroplasty, entails the percutaneous insertion of 1 or more bone needles into the sacral ala and, less commonly, the sacral vertebra with fluoroscopic and/or computed tomographic guidance. Acrylic bone cement is then injected under imaging guidance to treat the lesion and stabilize the sacrum. Sacroplasty is indicated for the treatment of painful sacral insufficiency fractures and painful sacral masses, both of which destabilize the sacrum. In properly selected patients, sacroplasty is an extremely efficacious procedure with a low-risk profile when performed with meticulous imaging guidance and a thorough appreciation of the complex sacral anatomy. Complete pain relief is observed in the overwhelming majority of patients that are treated for sacral insufficiency fractures. While the success rate is lower in patients with painful sacral neoplastic lesions, many of these patients experience a reduction in analgesic use and a return to ambulation.