Objective To analyze the prognostic factors in patients with spinal dural arteriovenous fistulas (SDAVFs).Methods The epidemiological characteristics, imaging features, treatment methods, and follow-up results of 41 patients with SDAVFs admitted to The First Affiliated Hospital of China Medical University from January 2012 to December 2017 were retrospectively analyzed. The patients were divided into surgical group (SDAVFs interruption surgery, SDAVFs embolization not included) (30 cases) and non-surgical group (drug or physical therapy instead of surgical procedure) (11 cases). The Aminoff and Logue Score (ALS) was used to quantify spinal cord function and to analyze the prognostic factors for SDAVFs.Results In the surgical group, the imaging cure rate was 100%(30/30), the clinical symptom improvement rate was 36.7%(11/30), non-response rate was 63.3%(19/30), and the deterioration rate was 0%(0/30); in comparison, the clinical improvement rate, non-response rate, and deterioration rate for non-surgical group were 0%(0/11), 27.3%(3/11), and 72.7%(8/11), respectively. The results indicated that surgery was associated with significant improvement in SDAVFs prognosis (P=0.017). Additionally, patient age (P=0.020), duration of disease (P=0.037), length of the varicose draining vein (P=0.020), and clinical severity on admission (P=0.035) were significantly associated with the prognosis of the patients. A new surgical prognosis scoring system for SDAVFs was therefore proposed. A score of 7-8 denotes a high clinical symptom improvement rate, while a score of 4-6 indicates non-significant clinical improvement after surgery (P=0.000).Conclusions SDAVFs interruption surgery is associated with an extremely high imaging cure rate, and the improvement rate of clinical symptoms of surgical treatment is also higher compared with that of non-surgical treatment.. The SDAVFs surgical prognosis scoring system proposed based on relevant prognostic factors (patient age, duration of disease, length of the varicose draining vein, and clinical severity on admission) can be used to assess the prognosis of SDAVFs surgery.