Spinal cord injury is a severe traumatic disease that affects motor、sensory and autonomic dysfunction at and below the site of injury. Current treatment options are limited and often ineffective. Mesenchymal stem cell-derived exosomes have shown promise in improving and treating nerve cell dysfunction caused by spinal cord injury through regulating the inflammatory response, improving the blood-spinal barrier, reducing cell death, promoting axon growth, and repairing scar tissue. Due to their potential in clinical application, mesenchymal stem cell-derived exosomes are a hot topic in the treatment of spinal cord injury.