Spinal cord injury (SCI) distinguishes itself from peripheral nerve injury by causing devastating and irreversible damage to the spine, resulting in profound motor, sensory, and autonomic dysfunction. The ensuing complex microenvironment of SCI, characterized by hemorrhage, inflammation, and scar formation, poses substantial challenges to regeneration and complicates numerous transplantation strategies. Recent research has shifted its focus towards manipulating the intricate SCI microenvironment to enhance regeneration, with some approaches demonstrating significant therapeutic efficacy. Consequently, the reconstruction of an appropriate microenvironment post-transplantation emerges as a potential therapeutic solution for SCI. This review aims to provide a comprehensive overview, firstly summarizing the influential compositions of the microenvironment and their diverse effects on regeneration. Secondly, we highlight recent research employing various transplantation strategies to modulate distinct microenvironments induced by SCI, aiming to facilitate regeneration. Lastly, we discuss prospective transplantation strategies for SCI, emphasizing the importance of addressing the complex microenvironment for successful therapeutic outcomes.
