The evolving landscape of pharmacotherapy for spinal cord injury: Three decades of progress and future prospects

Background: Pharmacological interventions for spinal cord injury have shifted from symptom management to complex regenerative strategies over the past three decades. This study aimed to systematically synthesize this trajectory and identify emerging research paradigms. Methods: A bibliometric analysis was conducted using the Web of Science Core Collection. A total of 3,470 original research articles published between 1992 and 2025 were retrieved. Network analysis (via CiteSpace) was performed to decode publication trends, collaborative patterns, and the evolution of research foci. Results: Research foci transitioned from generalized antiinflammatory strategies toward targeted molecular pathways and regenerative mechanisms. The United States maintained historical leadership in citation impact, while China demonstrated explosive growth in research output since 2022. Key research hotspots evolved from traditional small-molecule drugs to advanced frontiers, including nanomedicine, biomaterial scaffolds, exosomes, hydrogels, and cell-free therapies. Conclusions: Pharmacotherapy for spinal cord injury is transitioning toward precision medicine. Combinatorial strategies integrating advanced drug delivery systems with targeted drugs represent a promising trajectory toward functional neural repair.