To investigate the predictive value of preoperative serum transforming growth factor-β1 (TGF-β1), high mobility group protein B1 (HMGB1) and NOD-like receptor thermal protein domain associated protein 3 (NLRP3) on the prognosis of patients with spinal fracture combine with spinal cord injury (SCI). 134 patients with spinal fracture combine with SCI who underwent surgical treatment in Guizhou Orthopaedic Hospital from May 2021 to June 2022 were selected, patients were divided into good prognosis group (83 cases) and poor prognosis group (51 cases) according to the 12 months prognosis after surgery. The preoperative serum levels of TGF-β1, HMGB1 and NLRP3 were detected by enzyme-linked immunosorbent assay. Multifactorial logistic regression was used to analyze the factors of poor prognosis in patients with spinal fracture combine with SCI, and the predictive value of preoperative serum TGF-β1, HMGB1, and NLRP3 levels in patients with spinal fracture combine with SCI was analyzed by receiver operating characteristics (ROC) curves. The incidence of poor prognosis in 134 patients with spinal fracture combine with SCI was 38.06% (51/134) at 12 months after surgery. Compared with good prognosis group, HMGB1 and NLRP3 were higher and TGF-β1 was lower in poor prognosis group (P<0.05). Multivariate logistic regression analysis showed that diabetes, injury to treatment time≥ 8 h, spinal canal encroachment rate ≥ 50%, elevated HMGB1 and elevated NLRP3 were independent risk factors for poor prognosis in patients with spinal fracture combine with SCI, increased ASIA grade and elevated TGF-β1 were independent protective factors (P<0.05). The area under the curve (AUC) of preoperative serum TGF-β1, HMGB1, and NLRP3 combined to predict poor prognosis in patients with spinal fracture combine with SCI was 0.924, which was greater than that predicted by each of the indicators alone (P<0.05). The decrease of preoperative serum TGF-β1 level and the increase of HMGB1 and NLRP3 levels are closely relate to the poor prognosis of patients with spinal fracture combine with SCI, the combination of preoperative serum TGF-β1, HMGB1 and NLRP3 levels has a high predictive value for the poor prognosis of patients with spinal fracture combine with SCI. [ABSTRACT FROM AUTHOR]