Clinical management of complications after chronic spinal cord injury: a review of recent advances

INTRODUCTION: Chronic spinal cord injury (SCI) is a severe neurological disorder resulting from trauma or disease, characterized by persistent motor, sensory, and autonomic deficits below the level of the lesion. As the condition becomes long-standing, the management of multisystem complications - particularly those affecting motor, respiratory, cardiovascular, gastrointestinal, and urinary functions - emerges as a major clinical challenge. These complications not only impair quality of life but also contribute to increased rates of rehospitalization and impose significant economic burdens on healthcare systems. DISCUSSION: Although no curative therapy is currently available, treatment strategies have evolved into a comprehensive, multilayered framework incorporating rehabilitation, pharmacological interventions, neuromodulation techniques, and surgical procedures. Nevertheless, existing management approaches remain predominantly reactive and symptom-oriented, with notable limitations in long-term effectiveness, accessibility, and sustained patient engagement. This review synthesizes recent advances in understanding the pathophysiology of chronic SCI complications and critically evaluates current therapeutic limitations. A fundamental paradigm shift is urgently required - one that moves beyond traditional reactive models toward proactive, patient-centered care grounded in multidisciplinary collaboration and individualized treatment plans. CONCLUSION: Given the numerous challenges and the limitations of the current management strategies, further research is urgently needed for the management of chronic spinal cord injury complications. Future progress is expected to be driven by innovations in neural regeneration and precision medicine, aiming to transform clinical management from passive symptom mitigation to active functional restoration, thereby improving long-term outcomes for individuals living with chronic SCI.