Spinal Cord Injury 2.0: Bridging the Gap Between Neurobiology, Technology, and Hope in the Era of Precision Medicine.

Spinal cord injury (SCI) is a devastating neurological condition with profound motor, sensory, and autonomic consequences, affecting 10-83 individuals per million annually worldwide. This review explores the evolving SCI landscape, from acute ionic imbalance, excitotoxicity, and vascular disruption to chronic neuroinflammation and glial fibrosis, which collectively impede neural regeneration. Breakthroughs in regenerative bioengineering-such as stem cell-driven neurogenesis and CRISPR-Cas9-mediated axonal growth modulation-are converging with neurotechnological advances, including spinal neuromodulation, brain-computer interface integration, and AI-enhanced robotic locomotor systems, to redefine therapeutic frontiers. Precision medicine, guided by multi-omic biomarker stratification and patient-specific computational modeling, enables individualized intervention strategies. Despite unprecedented progress, translation to the clinic demands optimized preclinical models, harmonized trial methodologies, and ethical frameworks ensuring equitable access. Together, these innovations herald a shift from compensatory care toward structural repair and functional restoration in SCI.