PURPOSE: To evaluate patient outcomes after sacroplasty (percutaneous sacral augmentation) with guidance using CT compared to fluoroscopy with augmented reality overlay using fluoroscopic cone-beam CT and FDA-approved software (CBCT-AF). MATERIALS AND METHODS: Retrospective IRB-approved study of all patients undergoing sacroplasty between 3/2019-9/2020 was performed. Procedural details were collected including whether the procedure was performed with CT-fluoroscopic guidance versus cone beam CT with vector navigation and real-time neuroforaminal contour overlay. Clinical details collected included Visual Analogue Scale (VAS) pain scores within 6-months post intervention. Images were analyzed on PACS to measure exact volumes of implanted cement. RESULTS: Twelve patients underwent sacroplasty using either CT (n = 13 hemisacra) or CBCT-AF (n = 10 hemisacra). No clinically significant complications occurred. Comparing CT versus CBCT-AF guidance there was no significant difference in radiation dose (CBCT-AF trended toward lower dose, p = 0.20), total anesthesia time (p = 0.71), or infused cement volume (p = 0.21). VAS pain scores decreased an average of 6.14 and 5.25 points for the CT and CBCT-AF groups respectively (p = 0.46, no significant difference between groups). CONCLUSION: Sacroplasty improved back pain in all patients, while CBCT-AF safely provided similar outcomes with trends toward lower radiation dose and cement volume compared to CT-fluoroscopy.