Advances in understanding the mechanism and treatment strategies of radiation myelopathy

Radiation myelopathy (RM) is a severe, late-onset complication of radiotherapy, involving complex pathological processes, such as vascular endothelial cell damage, disruption of the blood-spinal cord barrier, inflammation, demyelination, hypoxia, and tissue necrosis. Traditional treatments, including corticosteroids and immunoglobulins, can effectively alleviate acute symptoms, but their long-term use may cause side effects and offer limited efficacy, especially in advanced stages of the disease where significant neurological recovery remains challenging. In recent years, emerging therapeutic strategies for RM – such as neuromodulation technologies, stem cell transplantation, tissue engineering, and gene therapy – have gained increasing attention. These approaches promote spinal cord repair and functional recovery through mechanisms, such as neuroprotection, myelin regeneration, axonal regeneration, and immune modulation. In addition, the use of biomaterials, such as hydrogels and nanodelivery systems has enhanced the delivery efficiency and therapeutic efficacy of both drugs and cells. Future research should focus on optimizing intervention timing and developing combination treatment strategies – such as incorporating antifibrotic drugs, anti-inflammatory therapies, and hyperbaric oxygen therapy – to improve the microenvironment of injury and enhance therapeutic outcomes. This review evaluates the pathological mechanisms of RM, explores emerging therapeutic strategies, and highlights future research directions to improve clinical efficacy.