This prospective study analyzes clinical characteristics and outcomes of sacral extradural spinal meningeal cysts (SESMC) without spinal nerve root fibers (SNRF) undergoing neck transfixion. Using the relationship between the cysts and SNRF, SESMCs were divided into two types: cysts with SNRF known as Tarlov cysts and cysts without. If the SESMCs were identified as those without SNRFs, the neck of the cyst was transfixed, ligated and the remaining cyst wall removed distal to the clip. The improved Japanese Orthopedic Association (IJOA) scoring system was used to evaluate preoperative and postoperative neurological functions of the patients. Twenty-seven patients were included in this study. The average age was 42.7 ± 11.93 years. The mean preoperative IJOA score was 17.5 ± 2.47, and postoperative IJOA score was 19.1 ± 1.41. The difference between preoperative and postoperative IJOA scores was statistically significant (t = -3.75, P = 0.001), with a significant improvement in neurological function after surgery. Among the improvements in neurological function, the most significant was bowel/bladder function (z = -2.33, P = 0.02). Most patients experienced significant improvement in their neurological function after surgery. The most significant area of neurological improvement was bowel/bladder dysfunction, however, preoperative stool or urine incontinence did not recover completely.