<p>Spinal cord injury (SCI) is characterized by irreversible loss of motor and sensory function, imposing a substantial burden on patients and their families. Tetramethylpyrazine (TMP), a bioactive compound derived from traditional Chinese medicine, possesses a wide range of pharmacological activities and has demonstrated potential therapeutic effects in the treatment of SCI. Therefore, this article provides a comprehensive review of the mechanisms by which TMP promotes spinal cord repair. This review compiles a large body of in vitro, in vivo, and clinical studies, including a total of 86 publications documenting the effects of TMP on SCI. The results indicate that the mechanisms by which TMP exerts its effects in SCI treatment include promoting nerve regeneration, improving vascular dysfunction, exerting anti-inflammatory effects, inhibiting neuronal apoptosis, reducing oxidative stress, regulating iron metabolism, maintaining ion homeostasis, alleviating pyroptosis, and modulating autophagy. Through these mechanisms, TMP contributes to the restoration of spinal cord morphology, motor function, and electrophysiological parameters in experimental animal models. Clinical reports on the use of TMP injection for SCI are relatively limited, and its clinical efficacy requires further investigation. The combined application of nanotechnology or hydrogels provides an efficient targeted delivery and sustained-release system for TMP in the spinal cord, thereby significantly enhancing its bioavailability. Overall, TMP shows promising potential in SCI treatment and may serve as a valuable adjunctive therapeutic strategy.</p>