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Introduction: Sacral insufficiency fractures are a growing and frequently underdiagnosed cause of severe lumbopelvic pain in older adults. Prolonged conservative treatment carries high risks of immobilization, dependency, medical complications, and disabling pain. Given this scenario, fluoroscopy-guided percutaneous sacroplasty presents a minimally invasive alternative with clinical benefits in selected cases with refractory and severe symptoms. Objective: To present a detailed and reproducible technical description of a percutaneous sacroplasty integrating its anatomical justification, operative strategy and clinical application in frail patients. Method: The surgical procedure is described step by step, including positioning, radiological planning, access selection, preparation and injection of high-viscosity PMMA cement, and postoperative follow-up. Two representative clinical cases are illustrated: one osteoporotic and the other secondary to a sacral metastatic, both with pain refractory to conservative management and documented clinical progression. Results: Both patients experienced pain relief within 24 hours (VAS reduction > 5 points), allowing for early sitting and walking. No complications or symptomatic leaks were reported. Follow-up showed fracture consolidation and full functional return. In one case, the biopsy identified metastatic disease, which underscores its added diagnostic value. Conclusion: Fluoroscopy -guided percutaneous sacroplasty offers a concrete, effective, and reproducible solution for treating disabling pain in patients with sacral insufficiency fractures. It shortens rehabilitation time, prevents complications from immobilization, and restores patient autonomy quickly and safely. This technique represents a high-impact clinical surgical tool that should be incorporated into the standardized management of modern patients with fragile osteoporotic disease.