The aim of the study was to reveal independent risk factors for postoperative infections after spine surgery and to develop a nursing pathway based on ERAS principles focused on these risks. They retrospectively analyzed 220 patients operated between January 2022 and December 2024 and identified risk factors using multivariate logistic regression. Advanced age, longer duration of surgery, and greater intraoperative blood loss were independent risk factors for infectious complications, while prophylactic antibiotic administration was protective (all statistically significant, p < 0.05). The combined predictive model had high accuracy with an area under the ROC curve of AUC = 0.940. Based on the principles of ERAS and these risks, a matrix-structured nursing pathway was created by multidisciplinary consensus. In a prospective cohort of 50 patients (January–June 2025) using this pathway, the postoperative complication rate was 8% versus 24% in a matched control group of 50 patients with conventional care (p = 0.029). At the same time, the intervention group had a shorter operation time, shorter postoperative hospitalization and less intraoperative blood loss (all p < 0.05). The authors conclude that an ERAS-guided matrix nursing pathway is feasible and associated with improved perioperative outcomes in spine surgery.