Spinal cord injury (SCI) is a debilitating condition characterized by primary mechanical damage followed by secondary injury processes, including inflammation and gliosis. These complex pathophysiological responses significantly hinder neuronal recovery and functional restoration. Emerging therapies, such as low-level laser therapy (LLLT), offer promising avenues for mitigating these secondary effects and promoting repair. This review aims to explore the pathophysiology of SCI, with a focus on inflammation and gliosis, and to evaluate the therapeutic potential of LLLT in improving outcomes after SCI. A comprehensive literature search was conducted across PubMed, Scopus, Cochrane Database, Google Scholar, and Web of Science databases to identify studies published from 2000 to 2024. Keywords included "spinal cord injury," "inflammation," "gliosis," and "low-level laser therapy." Articles were screened based on relevance, and data were extracted and synthesized to provide insights into the mechanisms and therapeutic applications. Inflammation following SCI involves a cascade of cellular and molecular events that contribute to secondary damage. Gliosis, predominantly driven by astrocytes and microglia, forms a glial scar that impedes axonal regeneration. While these processes are initially protective, their prolonged activation exacerbates neural damage. LLLT has shown the potential to modulate these responses by reducing oxidative stress, promoting anti-inflammatory pathways, and enhancing neuroprotection. Preclinical studies demonstrate that LLLT improves functional recovery, reduces gliosis, and supports axonal regeneration, although standardized protocols and clinical validation remain challenges. The interplay between inflammation and gliosis significantly influences the outcomes of SCI. LLLT emerges as a promising therapeutic strategy by targeting these processes and promoting regeneration. Further research is needed to standardize LLLT protocols and validate its efficacy in clinical settings, paving the way for improved management of SCI.