Objective <p>To examine the risk factors and intervention strategies for post-traumatic stress disorder (PTSD) in patients with spinal cord injuries (SCI).</p> Methods <p>A retrospective study involving 195 SCI patients (from January 2023 to December 2024) divided them into two groups: those with PTSD (<i>n</i> = 61) and those without PTSD (<i>n</i> = 134). Various demographic, clinical, and complication factors were analyzed, with significant differences further explored using multivariate logistic regression.</p> Results <p>Among 195 SCI patients, 61 (31.28%) developed PTSD. Significant differences were observed between the PTSD and non-PTSD groups in terms of age, sex, education level, severity of SCI, predicted rehabilitation outcome, and number of complications (<i>P</i> &lt; 0.05). No significant differences were found in marital status, personal income level, cause of injury, pulmonary and urinary tract infections, pressure ulcers, deep vein thrombosis, autonomic nervous system dysfunction, or psychological disorders (<i>P</i> &gt; 0.05). Multivariate logistic regression analysis identified age ≥ 45 years (95% CI: 2.884–19.513, OR = 7.502, <i>P</i> &lt; 0.001), female sex (95% CI: 1.225–6.736, OR = 2.873, <i>P</i> = 0.015), education level &lt; 12 years (95% CI: 1.160–6.409, OR = 2.726, <i>P</i> = 0.021), SCI severity grade C or higher (95% CI: 1.051–5.965, OR = 2.503, <i>P</i> = 0.038), non-self-sufficient predicted rehabilitation outcome (95% CI: 1.148–10.799, OR = 3.522, <i>P</i> = 0.028), and more than two complications (95% CI: 4.818–31.544, OR = 12.328, <i>P</i> &lt; 0.001) as independent risk factors for PTSD.</p> Conclusion <p>Prompt recognition and specific interventions for high-risk spinal cord injury patients are crucial for minimizing PTSD and enhancing results.</p>