Spinal cord injury (SCI) is a severe central nervous system trauma (CNS) that has two primary and secondary phases. The initial phase, which is irreversible, causes nerve tissue destruction and bleeding. Various factors in the second phase together aggravate the primary damage. One of the important factors of the second phase is the cascading of inflammatory factors, which, contribute to the further destruction of nerve tissue. In addition to surgical treatments, drug and cell-based or extracellular vesicles therapy, by modulating the immune system and reducing inflammatory factors at the lesion site, prevent further destruction of nerve tissue and help improve the patient\\\'s neurological and motor function. Researchers have provided many chemical and herbal medicines to reduce complications caused by spinal cord injury, many of which are currently being used and are also known as drugs of choice. However, sometimes the long-term use of these drugs causes side effects. Today, the new approach of cell therapy and the use of extracellular vesicles (EVs) is being investigated, which has minimized the side effects of drug treatments and helped to improve the function of nerve cells. Mesenchymal stem cells (MSCs), have a high ability to differentiate into different cells and to modulate the immune system by secreting paracrine factors. But since they cannot cross the blood-brain barrier (BBB), researchers solved this problem by extracting extracellular vesicles (EVs) derived from mesenchymal stem cells (MSCs), which also contain all paracrine factors. In this study, a brief overview of drug treatments, stem cells, and extracellular vesicular therapy in the treatment of spinal cord injury has been discussed

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