Objective To analyze the application of hierarchical monitoring management combined with gel surface inflatable body position pad in the prevention of pressure sores in patients undergoing prone spinal surgery. Methods This study was a prospective randomized trial. A random number table method was used to select 80 patients with prone spinal surgery admitted to Zhengzhou Orthopedic Hospital from September 2021 to September 2022. The patients were divided into routine group (routine intervention, 40 cases) and combined group (routine intervention＋graded monitoring management combined with gel surface inflatable position pad intervention, 40 cases). The incidence of pressure sores, intraoperative compression and comfort changes were compared between the two groups. Results The incidence of pressure ulcers in the combined group (5.00%) was significantly lower than that in the routine group (20.00%) (P＜0.05), the pressure values of head and face, left ilium, right ilium and anterior chest were significantly lower than those in the routine group (all P＜0.05). After 5 days of intervention, the scores of general comfort questionnaire (GCQ) in the combined group were significantly higher than those in the routine group (all P＜0.05). Conclusion Grading monitoring management combined with gel surface inflatable body position pad has a significant effect on preventing pressure sores in patients undergoing prone spinal surgery, which can reduce the intraoperative pressure value of patients and improve their comfort.