Current and emergent therapies targeting spinal cord injury

Spinal cord injury (SCI) is a serious condition characterized by high rates of disability. The complexities of SCI repair arise from intricate pathological mechanisms and the challenges of neural regeneration within the central nervous system. In recent decades, researchers have sought to fully understand these mechanisms and develop effective strategies for promoting axon regeneration and reconstructing neural circuits, though outcomes have often fallen short. Surgical techniques have evolved considerably, with options such as early surgical decompression, effective bony decompression, and expansile duroplasty providing favorable results in enhancing neurological recovery for patients. Accordingly, surgical intervention should be undertaken within 24 h when medically feasible. In addition, there has been a concerted effort to improve non-surgical management, particularly in critical care. In pre-clinical settings, a range of innovative therapies is currently being explored, with some showing enough promise to advance to clinical trials. In this regard, the use of riluzole and anti NOGO antibodies has shown promising results from secondary analyses of high quality RCTs. Moreover, technological innovations in biomechanics and bioengineering are playing an essential role in managing SCI with growing emphasis on creating intermediate neural networks to facilitate regeneration and circuit rebuilding. This review presents an overview of SCI, current treatments, and illustrates future avenues for SCI repair and clinical application.