Sacral fractures in elderly patients with associated lumbosacral lesions can be overlooked easily because of vague symptoms and delayed neurological insufficiency. A 70-year-old female and a 73-year-old female presented with delayed neurological insufficiency caused by transverse sacral fracture after minor trauma. Both patients had suffered from lower extremity symptoms with dysuresia and dyschezia for more than a month. Coexisting lumbosacral pathological lesions may confuse the correct diagnosis for sacral fractures. Decompressive sacral laminectomy was performed, and the patients showed relatively favorable outcomes.