Spinal cord injury (SCI) leads to loss of motor and sensory function below the injury level and imposes a considerable burden on patients, families, and society. Repair of the injured spinal cord has been recognized as a global medical challenge for many years. Significant progress has been made in research on the pathological mechanism of spinal cord injury. In particular, with the development of gene regulation, cell sequencing, and cell tracing technologies, in-depth explorations of the SCI microenvironment have become more feasible. However, translational studies related to repair of the injured spinal cord have not yielded significant results. This review summarizes the latest research progress on two aspects of SCI pathology: intraneuronal microenvironment imbalance and regenerative microenvironment imbalance. We also review repair strategies for the injured spinal cord based on microenvironment imbalance, including medications, cell transplantation, exosomes, tissue engineering, cell reprogramming, and rehabilitation. The current state of translational research on SCI and future directions are also discussed. The development of a combined, precise, and multitemporal strategy for repairing the injured spinal cord is a potential future direction.

脊髓损伤 (SCI) 导致损伤水平以下的运动和感觉功能丧失，给患者、家庭和社会带来相当大的负担。多年来，受损脊髓的修复一直被认为是一项全球性的医学挑战。脊髓损伤病理机制研究取得重大进展。特别是随着基因调控、细胞测序、细胞示踪等技术的发展，深入探索SCI微环境变得更加可行。然而，与损伤脊髓修复相关的转化研究尚未取得显着成果。本文综述了SCI病理学两个方面的最新研究进展：神经元内微环境失衡和再生微环境失衡。我们还回顾了基于微环境失衡的脊髓损伤修复策略，包括药物、细胞移植、外泌体、组织工程、细胞重编程和康复。还讨论了 SCI 转化研究的现状和未来的发展方向。开发用于修复受损脊髓的联合、精确和多时间策略是一个潜在的未来方向。