To investigate the risk factors and prognosis of spinal cord injury (SCI) after surgical procedure in type A aortic dissection (AAD). Between January 2013 and December 2021, a total of 1647 patients with AAD underwent surgical procedure. Postoperative SCI occurred in 58 patients, including 24 patients with paraplegia and 34 patients with paraparesis. Factors associated with SCI was identified through comparison between patients with and without SCI. The mean age was 48.8 ± 10.8 years for patients with SCI and 50.1 ± 12.1 years for those without SCI (P = 0.43), with a comparable gender distribution. Median numbers of intercostal and lumbar arteries with involvement were significantly higher in the SCI group (both P < 0.001). The highest (P = 0.033) and lowest (P = 0.001) level of intraoperative mean arterial pressure (MAP) were significantly lower in the SCI group. Multivariable analysis revealed number of segmental arteries involved (odds ratio [OR]=1.14, 95% CI 1.08-1.20, P = 0.000) and duration of hypothermic circulatory arrest (HCA) (OR = 1.04, 95% CI 1.01-1.08, P = 0.042) were positively associated with the occurrence of SCI. Conversely, the lowest level of MAP was negatively associated with SCI (OR = 0.98, 95% CI 0.96-0.99, P = 0.031). During the long-term follow-up, 14 patients with paraplegia needed the wheel chair, while only one patient with paraparesis needed one (P < 0.001). The risk of postoperative SCI increases when AAD patients experience segmental arteries involved, longer HCA duration, and decreased intraoperative MAP during operation.