Purpose To determine the risk factors for pulmonary complications after spine surgery and establish a risk assessment table. Methods A total of 627 patients, who underwent spine surgery at Hebei General Hospital from January 2018 to December 2019, were retrospectively collected and studied. Univariate analysis revealed significant variables. Risk factors and the effects of the model were determined by unconditional binary logistic regression analyses and the receiver operating characteristic

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... C) curve, respectively. A risk assessment scale for patients after spine surgery was also established based on the risk factors. Results 49 patients were diagnosed with pulmonary complications (49/627, 7.81 %). Logistic regression analysis showed that age, body mass index (BMI), smoking, diabetes, type of spinal diseases, type of operation, surgical site, American society of anesthesiologists (ASA) scores, type of anesthesia and total length of stay (LOS) were risk factors of pulmonary complications after spine surgery (P < 0.05) and area under the curve was 0.883, 95 % confidence intervals (CI): 0.843–0.923. The risk assessment table included preoperative and postoperative evaluation indicators. There were 8 preoperative evaluation indicators including age, BMI, smoking, hypertension, diabetes, chronic pulmonary diseases, type of spinal diseases, surgical site. Preoperative hospitalization days, ASA scores, type of anesthesia, type of operation and duration of operation were five postoperative evaluation indicators. The highest assessment score of preoperative is 21, postoperative is 18, and the total is 39 points of all these indicators. Conclusions Significant risk factors of pulmonary complications were age, BMI, smoking, diabetes, type of spinal diseases, type of operation, surgical site, ASA scores, type of anesthesia and total LOS after spine surgery. There were 13 evaluation indicators in our established risk assessment table including preoperative and postoperative evaluation indicators. The higher the score, the higher the risk of pulmonary complications after spine surgery.