Introduction <p>Acute spinal cord injury (ASCI) often leads to severe disability and post-traumatic stress disorder (PTSD), yet evidence on early psychological prevention during the emergency stage is limited.</p> Aim <p>This study aimed to evaluate whether emergency psychological intervention can effectively prevent PTSD in ASCI patients and improve rehabilitation outcomes, addressing a key gap in current trauma management research.</p> Methods <p>A retrospective cohort study was conducted among 191 ASCI patients admitted to the emergency department of the Affiliated Hospital of Xuzhou Medical University from June 2023 to December 2024. Patients were divided by injury severity (ISS ≥ 16 or ISS &lt; 16) and exposure to emergency psychological intervention. Primary outcome was PTSD incidence; secondary outcomes included exercise compliance, muscle strength recovery, emergency stay time, readmission rate, and medical costs.</p> Results <p>The incidence of PTSD was significantly lower in the severe intervention group than in controls (26.7% vs. 51.8%, <i>P</i> = 0.024). Exercise compliance and muscle strength recovery were higher in intervention groups, and average medical expenses per patient decreased by ¥3,953 in the severe group.</p> Conclusion <p>Early emergency psychological intervention can effectively prevent PTSD and enhance rehabilitation outcomes in ASCI patients, while reducing healthcare costs and improving efficiency in emergency care. These findings support integrating a “physiological–psychological” management model into routine trauma practice.</p> Clinical trial number <p>Not applicable.</p>