With the increase of traffic accidents, traumatic injuries and sports injuries, spinal cord injury (SCI) has been on the rise, and most SCI patients are young adults, which has caused a heavy blow to the patients and their families, and greatly jeopardized human health. Due to the special neurological dysfunction after SCI, the treatment of spinal cord injury has been pessimistic. In recent years, with the development of molecular biology and the study of pathophysiological mechanisms of spinal cord injury, the treatment and rehabilitation of spinal cord injury have made great progress. Currently, it has been found that the influencing factor for the inability of effective regeneration after SCI is mainly the presence of CNS growth inhibitory factors [1], including oligodendrocyte-expressed nogo protain (nogo protain), myelin-associated glycoprotain (MAG), and chondroitin sulfate proteoglycans in the scar, ( chondroitin sulfate proteoglycan (CSPG) in the scar, etc. Recognizing that the main purpose of SCI treatment is to provide a favorable regenerative microenvironment for SCI through various therapeutic measures to promote the regeneration of damaged nerve axons to achieve functional recovery, we have been actively treating spinal cord injuries accordingly, including surgical treatments, drug treatments, cell-tissue transplants gene therapy, physical therapy, rehabilitation therapy and so on. Especially, nerve transplantation and gene therapy have good prospects. We believe that the cure of SCI can be realized in the near future. Surgical treatment of SCI Experimental studies have shown that there is a greater chance of recovery within 6-8 hours after the injury, and the compression of spinal nerves by spinal stenosis is an important factor that hinders the recovery of nerve function. Early surgery to relieve the compression, and at the same time, the fracture is repositioned and fixed to rebuild the stability of the spinal column, creating the most powerful conditions for the repair and recovery of spinal cord injury. Surgical methods mainly include anterior and posterior surgery. Anterior surgery is a new development in recent years, and its advantage lies in the ability to directly remove the compression under direct vision, fully decompression of the spinal canal, and at the same time for the restoration and fixation and fusion. Autogenous bone, allograft bone or artificial interbody fusion instruments are used to support the implant fusion between the vertebrae to restore the height of the vertebral body and stabilize the fusion area, providing a good environment for the recovery of SCI. Nowadays, there are many anterior internal fixation devices, such as Z-plate, TSRH, ORION, APOFIX, etc. However, there are many complications in anterior approach. However, the anterior approach has more complications and should be operated by experienced orthopedic surgeons with strict control of the indications. The posterior approach is easier to operate. For thoracolumbar fractures with less than 50% compression in the anterior aspect of the spinal canal, the fracture can be satisfactorily indirectly repositioned by propping up the intervertebral space through the posterior approach. Posterolateral decompression of the spinal canal can be achieved by occluding the pedicle posteriorly, or semi-circumferential or circumferential decompression can be achieved by subtotal resection of the vertebral body. Traditionally, decompression of the spinal canal is accomplished by laminectomy. However, after laminectomy, the stability of the spine is damaged, because the anterior and middle columns of the spine have been damaged, and then the posterior column is damaged, so that the postoperative kyphosis is aggravated. Currently, the posterior surgical instrumentation is very perfect, and the short-segmented nail-rod system, with short fixation segments, can achieve three-dimensional reset and fixation, and the impact on the spinal column is small, and the combination of intervertebral implant fusion is used, if necessary, to restore the stability of the spinal column, but the trauma of the posterior surgery is larger, However, posterior surgery is more traumatic, has more bleeding, and does not relieve the direct compression from the anterior part of the spinal canal. Therefore, if the anterior compression of the spinal canal exceeds 50% or if there is free bone, anterior surgery should be considered. After spinal cord injury, the spinal cord is hemorrhaged, edematous and compressed. Surgical decompression can improve the blood circulation of the spinal cord, prevent the spinal cord from degeneration, and preserve the residual spinal cord function. The application of microsurgical techniques to anastomose the residual nerve roots after cauda equina injury can partially change the motor sensation of the lower limbs and urinary and fecal functions, and improve the quality of life, which is now accepted by clinicians. Tissue and cell transplantation for SCI Tissue and cell transplantation is used to achieve bridging of the damaged spinal cord and to improve the microenvironment of central nerve regeneration, prompting axons to cross the glial scar and achieve reconstruction. I. Nerve tissue transplantation, including embryonic nerve tissue transplantation, neural stem cell transplantation, and peripheral nerve tissue transplantation. Embryonic nerve tissue transplantation is a hot spot in current research, and experiments have proved that embryonic nerve tissue has strong growth and survival ability. It can not only survive and differentiate and mature, but also protect the remaining neurons and axons of the host, establish new nerve fiber connections with the host spinal cord, inhibit the formation of glial scar, induce regenerative axons to cross the scar, and restore part of the function of the host spinal cord. Embryonic spinal cord transplantation is currently the most commonly used tissue, the technology is currently in the laboratory stage, the application of clinical application still has many problems: rejection, results are difficult to control, there are ethical difficulties. Neural stem cells (NSCs) transplantation for the treatment of spinal cord injury is a new field of SCI repair, which is characterized not only by its ability to self-replicate and regenerate, to produce progeny identical to itself and to maintain a stable cellular reserve, but also by its multidirectional differentiation potential, i.e., its ability to evolve into different mature cell types under different internal environments. Currently, neural stem cell transplantation has been used in various animal models. For example, in an animal model of Parkinson’s disease, transplantation of stem cells into the striatum was able to replace degenerated dopaminergic neurons and promote limited functional recovery. In the spinal cord injury model, neural stem cells can differentiate according to the internal environment of the transplantation site and combine with host tissues to replace some necrotic cells, rebuild the neural circuits, provide bypass relay stations for the normal tissues below the injury site, and achieve functional recovery.Han reported that transplanted neural stem cells can replace some necrotic cells, rebuild the neural circuits and provide bypass relay stations for the normal tissues below the injury site. Okano found that neural stem cell transplantation could restore the flexibility of forelimb in spinal cord injured rats. Second, Schwann cells (SCs) transplantation, SCs are myelinating cells of neuronal axons in the peripheral nervous system, which can secrete neurotrophic factors such as NGF, BDNF, GDNF, etc., and produce extracellular matrix and cell adhesion molecules, which can nourish and support the neuronal cells, and induce axonal regeneration effectively when nerve is injured; demyelination of altered axons is remyelinated; some people have found that transplantation of SCs into neuronal cells can restore the flexibility of the forelimb of rats with spinal cord injury. Myelination; it has been found that the ability to promote regeneration is stronger when SCs are applied together with neurotrophic factors or when SCs are transplanted after being modified with BDNF and NGF genes. However, how to maintain the biological activity of SCs after transplantation and increase its migration distance will be the focus of future research. Third, olfactory ensheathing cells transplantation, olfactory ensheathing cells (OECs) is the glial cells of the olfactory system, is the only glial cells found to be able to cross the border between central and peripheral nerves, which can secrete many kinds of neurotrophic factors, such as neuropeptide Y, platelet-derived growth factor, cellular matrix components, etc., and can be integrated with the spinal cord, to enclose the regenerating axons and prevent the regeneration of the axons, and to prevent the regeneration of the axons. Surrounding the regenerated axon, preventing the contact of central inhibitory factors, providing a good microenvironment for axon regeneration, and inducing the axon to the corresponding target cells, realizing functional recovery. Autologous olfactory sheath cell transplantation has no rejection reaction, and may become the most promising clinical application of SCI treatment methods. Fourth, gene therapy, the use of transgenic technology for the treatment of SCI, is an adenovirus as a carrier, exogenous genes (neurotrophic factors and neurotransmitter synthase genes) recombination into the virus, and then transfected with receptor cells, such as Shewan’s cells, fibroblasts, neural stem cells, and so on, and then implanted in the site of spinal cord injury, so that it continues to provide the target genes, to play a role in the treatment. There have been many experimental reports of gene therapy for SCI, which can reduce the secondary damage of the spinal cord, inhibit the apoptosis of nerve cells, and have a certain repair effect on the morphology and function of SCI tissues. However, there are still some problems: immune rejection, the survival time of transplanted cells and the intensity of expression diminishes with time, and the therapeutic effect may be lost. Therefore further in-depth research is needed to improve the efficacy of gene therapy for SCI. In recent years, many scholars have combined transgenic technology with embryonic spinal cord transplantation, nerve growth factor and inhibitory factor therapy. By stimulating and guiding the host fiber and graft integration contact; or spinal cord regeneration in the spinal cord regeneration inhibitory protein cloning, import its antisense nucleotide, inhibit the expression of the protein, so as to achieve the purpose of promoting regenerative repair. Fifth, nerve growth factor treatment, which is a soluble chemical substance with the function of stimulating the survival and differentiation of many kinds of neurons. It plays an important role in spinal cord growth, development, regeneration and repair. At present, the most researched ones are Neuotrophic factors (NTFs). Experiments have proved that NTFs can promote and maintain the growth, survival and differentiation of neurons, and are some proteins necessary for neuron development, survival and function. It is divided into two groups, one is Neu2rotrophins (NT), which mainly includes brain-derived neurotrophic factor (BDNF), glial-derived neurotrophic factor (GDNF), nerve growth factor (NGF), neurotrophic factor 23 (NT23), NT24/5, and NT26, etc., and the other is ciliary neurotrophic factor (ciliary neu2 rotrophic factor), which is a protein that is essential for neuronal development, survival, and function. NTFs enhance the resistance of spinal motor neurons to early death, reduce the release of excitotoxins after SCI, and have obvious biological effects on regeneration after nerve injury, neuronal plasticity, and the treatment of delayed neuropathy, and are important trophic factors for motor and sensory neurons. Hyperbaric oxygen therapy after SCI SCI nerve cell edema and lipid peroxidation triggered by oxygen free radicals, resulting in microcirculation obstacles to the spinal cord tissue due to ischemia and hypoxia occurring degeneration, to prevent neurons and glial cells degeneration and death is the main purpose of early treatment of spinal cord injury. Studies have shown that hyperbaric oxygen can prevent or reverse the secondary pathological changes after SCI. Hyperbaric oxygen can inhibit the free radical-mediated lipid peroxidation process, improve the antioxidant tension of the lipid structure of the cell membrane, reduce the extracellular calcium ion inward flow, protect the spinal cord cells and tissue structure, and promote the regeneration of nerve fibers and the recovery of the conduction function; it makes the blood rheology change. On the one hand, the blood is diluted, the blood flow speed is accelerated, and the tissue blood flow is increased; on the other hand, the fibrin solubility is increased, the risk of thrombosis is reduced, and the blood circulation of the spinal cord tissue is improved. Research has confirmed that hyperbaric oxygen has the effect of promoting the motor and sensory conduction function of the spinal cord. The recovery of motor disorder in early treatment is more obvious, and there is a significant difference comparing with the middle and late stage. after SCI, there is not only cell necrosis in the acute stage, but also apoptosis in the subacute stage, and its apoptosis lasts for three or four weeks, and experiments have proved that the earlier the treatment is, the better the effect is, and the effect of the treatment on the middle and late stage still needs further in-depth research. Drug treatment of SCI Spinal cord injury is mainly caused by violence to the spinal cord caused by the primary injury; and due to the spinal cord blood transport disorders and metabolites, such as the spinal cord caused by secondary injury caused by the spinal cord. Primary damage is irreversible, while secondary damage can be stopped or prevented. A number of drugs have been developed in the hope of preventing or minimizing damage to the spinal cord from secondary changes, or promoting the growth of nerve axons. Currently, various antioxidants, free radical scavengers, gangliosides (GM-1) and high-dose methylprednisolone (MP) are used in clinical practice. Ganglioside (GM-1) Ganglioside plays an important role in the development and differentiation of normal neurons. In experimental studies, exogenous ganglioside can promote the growth of neural axons and increase the number of axon survival at the site of injury. It has been clinically reported that the administration of ganglioside 100mgqd within 72 hours of acute spinal cord injury for a period of 18d~32d can help the recovery of neurological function]. High-dose methylprednisolone (MP) corticosteroid hormone is the classic drug for the treatment of spinal cord injury, the United States organized the National Acute Spinal Cord Injury Study (the National Acute Spinal Cord Injury Study ,NASCIS) proved that all the patients received the treatment within 3-8 hours after the injury, and the method of application was as follows: the first shock dose of 30mg/kg from the periphery of the spinal cord injury. The first shock dose of 30mg/kg was infused from peripheral vein within 15min, and after 45min interval, it was maintained at 5.4mg/kg/h for 23h. At present, it is believed that high-dose MP has various functions in the treatment of acute spinal cord injury, including improving microcirculation, stabilizing lysosomal membranes, inhibiting the reaction of lipid peroxidation of oxygen free radicals, decreasing intracellular calcium accumulation and increasing secretion of atrial natriuretic peptide, and maintaining the excitation of neurons, etc. The duration of treatment is limited to 3-8hours, and the treatment time is limited to 3 hours. Methylprednisolone has been used in the treatment of spinal cord injury, but its treatment time is limited to within 8h after the injury, if it is applied after 8h of spinal cord injury, not only the effect is not good, but also the complication is increased. High-dose methylprednisolone is considered to be an effective drug in the clinical treatment of acute spinal cord injury. Opioid receptor antagonist: opioid receptor antagonist naloxone applied in large doses can increase spinal cord blood flow, reduce post-injury ischemic damage, and help the recovery of spinal cord neurological function; Calcium channel antagonist: many scholars use calcium channel antagonist for the treatment of spinal cord injury, which is easy to pass through the blood-brain barrier, and it can reduce the secondary damage after spinal cord injury; Mannitol: Mannitol is not only in the early stage of spinal cord injury, it has the effect of dehydration, Reduce edema, but also in the anti-free radicals have unique efficacy. Dilatation of blood vessels, improve microcirculation drugs: early application of drugs to improve microcirculation, such as Panax ginseng glycosides or scopolamine, etc., to improve spinal cord blood circulation, increase blood flow, dilate vasospasm due to ischemia, inhibit cytotoxic damage. The therapeutic effect of such drugs needs further study. Rehabilitation engineering intervention in SCI How to maximize the restoration of residual limb function, improve the quality of life of patients, establish standing or walking function and reduce complications after spinal cord injury is an important part of rehabilitation therapy, which is also an important link in the treatment of spinal cord injury patients. Spinal cord injury patients are prone to many complications which are difficult to deal with and are problems that should be emphasized in the rehabilitation clinic, such as rehabilitation of spasticity, rehabilitation of neurogenic bladder, rehabilitation of osteoporosis and heterotopic ossification, and rehabilitation of pathological fracture. Spinal cord injury complicating osteoporosis: secondary osteoporosis is a common complication, often leading to heterotopic ossification and pathological fracture. Patients lose the ability to take care of themselves. The pathogenesis of osteoporosis after spinal cord injury is still unclear, and it may be related to post-injury braking, disuse, vegetative nerve dysfunction after nerve injury and endocrine factor changes. In the evaluation index of osteoporosis, we can refer to: the change of biochemical indexes can observe the abnormal bone metabolism; imaging examination can find the osteoporosis image changes; bone mineral measurement can assist the diagnosis, and can predict the risk of fracture and observe the effect of treatment. For the treatment of osteoporosis after spinal cord injury, there are the following aspects: early walking training away from the bed; early functional electrical stimulation therapy and the use of diphosphonate drug therapy to prevent the continued loss of bone mass. Further exploration of the mechanism of spinal cord injury complicating osteoporosis and the search for ways to prevent and control osteoporosis are still the focus of future research. Spasticity complicating spinal cord injury: at present, spasticity is still a difficult problem to deal with, and there are many treatment methods for spasticity in SCI, such as spasticity-relieving exercise therapy, spasticity-relieving medication (e.g. baclofen), nerve block (phenol, botulinum toxin A), surgery (motor nerve branch severance, selective posterior spinal nerve rhizotomy), etc. However, each method has its own limited indications, and it is important to find ways to prevent and control osteoporosis. However, each method has its own limited indications and unsatisfactory points. Drugs to botulinum toxin and baclofen are most commonly used, it can better improve the spasticity of SCI, but it may affect the rehabilitation of other functions, can inhibit the patient’s cough reflex sensitivity, and may affect the sexual function of some patients, in recent years some people have proposed to implant a subcutaneous micro-pump input baclofen, which can significantly reduce the side effects. Rehabilitation of the urinary system: In patients with spinal cord injury, bladder dysfunction causes severe urinary retention and urinary tract infection, and chronic renal failure occurs in the late stage. Therefore, preventing urinary retention and urinary tract infection and reconstructing the bladder function of spinal cord injury patients are of great significance in reducing renal failure, improving the quality of life of paraplegic patients and reducing mortality. (1) Vesicourethral interposition, for those who have no or low reflex of bladder urethral muscle after spinal cord injury and normal urethral pressure, the anterior and posterior sheaths of rectus abdominis muscle can be surgically separated and bladder can be placed between the anterior and posterior sheaths of rectus abdominis muscle, which can avoid the over distension of the bladder after the operation, and the rectus abdominis muscle can be contracted to increase the force of urethral muscle during urination, and the hand can be used to assist in the external pressure of bladder for urination. Most patients urinate on their own after surgery, and the residual urine can be reduced to less than 100 ml. (2) The bladder controller, i.e. Sacral Anterior Root Stimulator SARS, consists of three parts, including the in vivo implantation part, the ex vivo control part and the test block part. The in vivo implantation part is made by surgically placing two electrodes on the lead wire in front of the right and left sacral nerve roots, and fixing them with sutures between the silicone sheets next to the electrodes. The ex vivo control section consisted of a control box, a continuous wire and a transmitter block. The test block is used to check whether the transmitter block works properly before each stimulation. As early as 1976, Brindley developed the bladder controller and used it in the clinic. Now has developed a domestic bladder controller, the animal experiments show that the controller to rebuild the bladder function has a good therapeutic effect. After continuous improvement, if used in the future, it is expected to greatly improve the quality of life of patients. Rehabilitation of walking ability: In the past, most of the patients with complete paraplegia of thoracic and above thoracic segments had to rely on wheelchair for their whole life, and only the patients with complete paraplegia of below waist level had the possibility of standing and practical walking after training. In recent years, due to the development and advancement of rehabilitation engineering, rehabilitation biomechanics, rehabilitation training, and rehabilitation devices, especially walking devices, paraplegics below the thoracic 4 level have been able to stand up and have the ability to walk, making it possible for them to return to the society and participate in social activities. The first step is to surgically reconstruct spinal stability and then use a walker (consisting of a knee-ankle-foot orthosis and an interactive hinge device) to achieve standing and walking with fewer complications. The ARGO (Advanced Reciprocating Gait Orthosis) is a mobility-assisted walker that has achieved good clinical results. The walker uses the metal half-ring at the hip and sacral area as the lever pivot point, and the chest and back strap as the force point. When the patient’s center of gravity is placed on one side of the lower limb, the opposite side of the upper limb down support, so that the opposite side of the lower limb off the ground, the patient to stretch out the crotch, applying force on the back harness, the opposite side of the lower limb forward; step forward through the power of the steel cable to the opposite side of the lower limb, at this time to move the crutches, so that the center of gravity of the body to move forward and turn to the opposite side of the lower limb, repeat the above action and take another step. In this way, the patient’s center of gravity reciprocates to both sides, guiding the patient’s body forward so that the patient can actually use his or her own lower limbs to stand and walk. Thus, ARGO has made it possible for the majority of paraplegics below the 4th thoracic level to move out of their wheelchairs. Neuroprosthesis: A neuroprosthesis is an artificial electronic device that stimulates a target organ controlled by an injured nerve instead of the injured nerve, in order to realize its function. In paraplegic patients, because of the spinal cord injury, the muscles lose the pathway connection with the brain, and the artificial implanted myoelectric control system replaces the connection between the brain and the muscles in order to rebuild the function of the muscles. (1) Control Walking System: It is a computerized system developed by applying microelectronic technology and signal processing technology for the rehabilitation of paraplegic patients, which enables paraplegic patients to generate muscle power in paralyzed limbs under the control of microcomputer through functional electrical stimulation, and realize basic functional movements such as standing up, sitting down, and stepping forward, and it is a method to promote the rehabilitation training of paraplegic patients. (2) Small electronic walker: The application of functional electrical stimulation (FES) provides an effective means for the functional reconstruction and training of muscle paralysis caused by damage to the central nervous system, and it can be used to assist walking as well as for therapeutic purposes. However, it is mainly applied to patients with incomplete limb paralysis. The intervention of rehabilitation engineering technology greatly improves the rehabilitation effect of spinal cord injury patients and improves the quality of life, such as: paraplegic walking orthosis, which can help paraplegic patients to walk independently; weight-loss walking training device can enhance the ability of incomplete paraplegic patients to walk and improve the effect of training; environmental control system and nursing robots can greatly help quadriplegic paraplegic patients to live a self-care life. Comprehensive application of various rehabilitation measures Comprehensive application of various rehabilitation measures for spinal cord injury patients, strengthen the clinical application of research, improve the rehabilitation effect of patients, improve the quality of life of patients, and promote the patients to return to their families and society to a greater extent. Prospect Spinal cord injury is one of the difficult problems in the world medicine, which has been emphasized by scholars at home and abroad. At present, the research on spinal cord injury mainly focuses on the following aspects: prevention and reversal of secondary pathological injury after spinal cord injury; recovery of structurally intact neurological function in the damaged area after spinal cord injury; regeneration of spinal cord or spinal cord transplantation. In summary, the treatment of spinal cord injury has a wide range of applications, especially in the regeneration of the spinal cord, transplantation, gene therapy, etc.,. However, in general, it is not satisfactory, and further in-depth basic and clinical research is needed.