To investigate the surgical procedure and clinical effectiveness of microsurgical reinforced radiculoplasty for postoperative recurrent sacral Tarlov cysts (TCs). A retrospective analysis was performed on 12 cases of postoperative recurrent symptomatic sacral Tarlov cysts (TCs) between 2019 and 2023, and the clinical features and causes of recurrence were summarized. Microsurgical reinforced radiculoplasty was performed on all patients, and the prognosis was summarized and analyzed. In addition, the experience of reinforced radiculoplasty was introduced. Microsurgical reinforced radiculoplasty was performed on 12 patients (6 females) with recurrent postoperative symptomatic sacral TCs. The ages of the patients ranged from 21 to 75 years. The mean follow-up period was over 1 year. Symptoms included severe pain in the lumbosacral and perineal regions, numbness, urinary dysfunction, and sexual dysfunction. There were 5 cases of solitary sacral cysts and 7 cases of multiple sacral cysts, with multiple cysts being more prevalent. After the second surgery, MRI imaging indicated that the postoperative recurrent sacral TCs had disappeared in all patients, and no adverse events such as new-onset neurological deficits, limb sensory/motor disorders, perineal sensory disorders, bowel/bladder dysfunction, sexual dysfunction, cerebrospinal fluid leakage, or wound infection occurred after the operation. Postoperative JOA scores were evaluated after the second surgery. There was a statistically significant difference between the preoperative and postoperative JOA scores (16.2 ± 1.1 versus 19.8 ± 0.9, p = 0.002). Microsurgical reinforced radiculoplasty demonstrates preliminary clinical efficacy in the treatment of postoperative recurrent sacral TCs and is both safe and effective.