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Objectives Endovascular repair of descending thoracic aortic lesions is associated with a substantial risk of perioperative spinal cord ischaemia (SCI) which may lead to permanent paraplegia. We performed a retrospective analysis of our experience in the endovascular treatment of descending thoracic aortic lesions to define the incidence of SCI and to identify factors that contributed to its development. Methods 67 consecutive patients underwent stent graft repair for descending thoracic aortic lesions including degenerative aneurysm (n = 19), type B dissection (acute n = 2, chronic n = 15), traumatic rupture (acute n = 14, chronic n = 4), penetrating aortic ulcer (n = 5), anastomotic false aneurysm (n = 4), mycotic aneurysm (n = 3) and embolic aortic lesion (n = 1) between June 2000 and June 2005. All procedures were performed with the patient under general anaesthesia and strict blood pressure monitoring. No patient had intra-operative monitoring of spinal evoked potential or cerebrospinal fluid (CSF) drainage to prevent SCI. Neurological evaluation was realized after recovery from general anaesthesia. Fifteen factors, including nature of aortic disease, length of aortic coverage, number of stent-grafts, coverage of the distal third of the thoracic aorta and subclavian artery coverage, were investigated as possible predictors of postoperative SCI. Results Five patients (7.5%) had postoperative neurological deficits (immediate n = 2, delayed n = 3) referable to SCI. Univariate analysis showed that length of aortic coverage (p