<p>Reinforced radiculoplasty of the sacral nerve roots has been used in the treatment of symptomatic sacral Tarlov cysts (TCs). However, there is still insufficient evidence to support the effectiveness of this procedure in relieving pain, numbness, or bowel and bladder dysfunction in TC patients. In this single-center retrospective study, we reviewed data and conducted telephone follow-ups of 41 patients who underwent surgery between 2021 and 2023. Clinical characteristics—such as age, gender, follow-up duration, cyst length, number of cysts, side of cysts, number of nerves, preoperative selective nerve root block (SNRB), and pre- and postoperative symptoms—were collected and analyzed using binary logistic regression to identify potential predictors. A total of 41 patients were included in the study. Significant improvements were observed in pain and numbness across the entire patient group, the lateral side subgroup, and the no-SNRB subgroup, as well as in pain among female patients (<i>P</i> &lt; 0.05). Among the 33 patients with preoperative pain, binary logistic regression analysis revealed that of age and preoperative visual analogue scale (VAS) scores were significantly associated with pain-free status (<i>P</i> &lt; 0.05). However, no variables were found to be significantly associated with numbness relief (<i>P</i> &gt; 0.05). In conclusion, reinforced radiculoplasty can significantly improve pain and numbness in patients with sacral TC. Older age and lower preoperative VAS scores are associated with a greater likelihood of achieving a pain-free outcome.</p>