Spinal cord injury (SCI) is a catastrophic event that can lead to significant sensory and motor dysfunction, affecting patients' quality of life and imposing substantial economic burdens on society. The pathological process of SCI is divided into primary and secondary injuries, with the latter being a cascade of amplified responses triggered by the primary injury. Due to the complexity of SCI, there is currently no clear and effective treatment strategy in clinical practice. Exosomes, extracellular vesicles with a diameter of 30–150 nm, play a critical role in intercellular communication and have emerged as an ideal vehicle for drug delivery. This review introduces the preparation, functions, and administration routes of exosomes, and summarizes their effects and mechanisms in repairing SCI. Various exosomes, including neural stem cell-derived exosomes (NSCs-Exos), Schwann cell-derived exosomes (SCs-Exos), mesenchymal stromal cell-derived exosomes (MSCs-Exos), astrocyte-derived exosomes (AS-Exos), platelet-rich plasma-derived exosomes (PRP-Exos), macrophage-derived exosomes (M-Exos), induced pluripotent stem cell-derived exosomes (iPSCs-Exos), microglia-derived exosomes (MG-Exos), and regulatory T cell-derived exosomes (Treg-Exos), have shown promising results in promoting nerve regeneration, angiogenesis, anti-inflammatory effects, antiapoptotic effects, and antioxidative stress effects. Additionally, exosomes combined with hydrogels and drug delivery systems have been explored to enhance their therapeutic efficacy. However, challenges such as low amounts, low targeting, and the need for further research on safe storage, transport, and preservation of exosomes remain. Despite these challenges, exosomes represent a promising therapeutic strategy for SCI repair.Spinal cord injury (SCI) is a catastrophic event that can lead to significant sensory and motor dysfunction, affecting patients' quality of life and imposing substantial economic burdens on society. The pathological process of SCI is divided into primary and secondary injuries, with the latter being a cascade of amplified responses triggered by the primary injury. Due to the complexity of SCI, there is currently no clear and effective treatment strategy in clinical practice. Exosomes, extracellular vesicles with a diameter of 30–150 nm, play a critical role in intercellular communication and have emerged as an ideal vehicle for drug delivery. This review introduces the preparation, functions, and administration routes of exosomes, and summarizes their effects and mechanisms in repairing SCI. Various exosomes, including neural stem cell-derived exosomes (NSCs-Exos), Schwann cell-derived exosomes (SCs-Exos), mesenchymal stromal cell-derived exosomes (MSCs-Exos), astrocyte-derived exosomes (AS-Exos), platelet-rich plasma-derived exosomes (PRP-Exos), macrophage-derived exosomes (M-Exos), induced pluripotent stem cell-derived exosomes (iPSCs-Exos), microglia-derived exosomes (MG-Exos), and regulatory T cell-derived exosomes (Treg-Exos), have shown promising results in promoting nerve regeneration, angiogenesis, anti-inflammatory effects, antiapoptotic effects, and antioxidative stress effects. Additionally, exosomes combined with hydrogels and drug delivery systems have been explored to enhance their therapeutic efficacy. However, challenges such as low amounts, low targeting, and the need for further research on safe storage, transport, and preservation of exosomes remain. Despite these challenges, exosomes represent a promising therapeutic strategy for SCI repair.