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Their composition is similar to that of human tissues, which reduces the risk of immune rejection. As critical mediators of intercellular communication, exosomes transmit signals and information that regulate the physiological states of surrounding tissues. Depending on their cellular origin and molecular content, exosomes can either promote nerve regeneration and functional recovery at the site of spinal cord injury (SCI) or exacerbate the local injury microenvironment. However, as a cellular product, the composition and function of exosomes are affected by the type and state of the cells from which they originate, and thus, there may be specificity problems in treatment, such as the possible instability of the therapeutic effect, et cetera. Moreover, exosomes need to be further optimized in terms of their delivery and release strategies in order to improve the duration and stability of the therapeutic effect. 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