Combined PLGA scaffolds and therapeutic stem cells for locomotion recovery in spinal cord-injured rats: a systematic review and meta-analysis

This study aimed to assess, based on preclinical evidence, the therapeutic potential of combining PLGA scaffolds with therapeutic stem cells (TSCs) for promoting locomotor recovery following traumatic spinal cord injury (TSCI). Two researchers independently screened relevant records retrieved from systematic searches of PubMed, Embase, and the Cochrane databases. Inclusion was limited to studies involving rodent models that evaluated the combined transplantation of PLGA scaffolds and TSCs for spinal cord injury (SCI). Outcomes were reported as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Pooled analysis showed that, despite substantial heterogeneity, the transplantation of PLGA scaffolds combined with TSCs significantly improved locomotor recovery compared to non-treated groups (SMD = 4.63, 95% CI: 2.79–6.47; I2 = 90.5%, P < 0.001), scaffold-only groups (SMD = 3.74, 95% CI: 2.54–4.94; I2 = 87.2%, P < 0.001), and TSCs-only groups (SMD = 1.80, 95% CI: 0.32–3.29; I2 = 87.9%, P < 0.001). Subgroup analyses revealed that PLGA scaffolds combined with bone marrow mesenchymal stem cells (BMSCs) yielded more pronounced functional improvements compared with non-treated groups, whereas combinations with neural stem cells (NSCs) did not achieve statistical significance. PLGA scaffolds seeded with induced pluripotent stem cells (iPSCs) failed to enhance motor function recovery compared to scaffold-only treatment. Additionally, high-dose stem cell transplantation and the use of immunosuppressants conferred no additional benefits. Notably, the electrospun PLGA scaffold subgroup demonstrated greater stability and reproducibility of outcomes compared to phase separation or porogen leaching fabrication methods. Collectively, these findings confirm that electrospun PLGA scaffolds combined with BMSCs represent a promising therapeutic strategy for TSCI repair. Future translational efforts must now address the clinical readiness of this approach, focusing on its safety and efficacy profiles.