Introduction

Paralysis affects nearly 5.4 million people in the United States, with spinal cord injury representing one of the leading causes and accounting for approximately 27.3% of cases [1, 2]. Spinal cord injuries (SCIs) result from primary mechanical disruption of axons, neurons, glia, vasculature, and spinal cord parenchyma, followed by secondary injury processes that further contribute to neurologic dysfunction. The presence of residual neural circuitry indicates that the spinal cord can still process complex sensory information despite injury, allowing for flexible treatment [3].

Outcomes following a spinal cord injury depend on numerous factors. The nature of the spinal cord injury plays a profound role in dictating severity, prognosis, and potential for recovery. Injuries closer to the brain, particularly cervical injuries, often yield more extensive and long-lasting impairments. This is due to proximity to critical neural pathways responsible for sensory and motor function, and autonomic control [4].

SCIs can be further categorized as complete or incomplete. In a complete injury, there is a total loss of sensory and motor function below the level of injury [5]. In contrast, an incomplete injury retains some degree of sensory or motor function, offering varying degrees of functional recovery. Incomplete injuries often present opportunities for neural plasticity and recovery that may not be as attainable in complete injuries.

This review focuses on current and emerging strategies for spinal cord injury management, with particular emphasis on recent advances in brain–spine interface (BSI) technologies and their potential role in restoring neurologic function.

Literature search strategy

This narrative review was developed through a targeted search of PubMed/MEDLINE, Google Scholar, and relevant reference lists. Search terms included combinations of “spinal cord injury,” “brain-spine interface,” “brain-computer interface,” “brain-machine interface,” “epidural electrical stimulation,” “transcutaneous spinal cord stimulation,” “neuromodulation,” “functional electrical stimulation,” “neuroplasticity,” and “spinal cord rehabilitation.” The search focused primarily on English-language peer-reviewed articles published from 2000 to 2025, with earlier landmark studies included when relevant. Articles were selected based on relevance to SCI pathophysiology, current and emerging treatments, brain-spine interface mechanisms, clinical translation, and neurorehabilitation. As this was a narrative review, formal risk-of-bias assessment and meta-analysis were not performed.