Current Preclinical and Clinical Evidence of Shock Wave Therapy for Spinal Cord Injury: A Systematic Review.

The diagnosis of spinal cord injury (SCI) remains associated with a poor prognosis due to limited treatment options and the absence of curative therapies. Optimizing treatment strategies is therefore crucial to enhance patients' quality of life, reduce mortality and re-hospitalization rates, and lower overall therapy costs. Shock wave therapy (SWT) is a well-established regenerative treatment option for pathologies of the musculoskeletal system that delivers high-energy acoustic waves. SWT is non-invasive, safe and cost-effective. Preclinical and clinical evidence is emerging, showing the efficacy of SWT in the treatment of both traumatic and ischemic SCI. This systematic review synthesizes evidence on SWT in SCI from 2000 to 2025, excluding case reports and non-regenerative applications. Results were categorized into preclinical and clinical studies, with preclinical findings further divided into functional, histological, cellular, and molecular outcomes. Promising preclinical results led to initial clinical studies, which demonstrated the safety and feasibility of SWT, with a randomized controlled trial currently ongoing (ClinicalTrials.gov: NCT04474106). Overall, the encouraging evidence suggests that SWT is a promising novel regenerative treatment option for SCI, although further research is needed to define optimal treatment protocols and to establish its role in standard clinical care.