Every year up to a quarter of a million people around the world suffer a spinal-cord injury. These devastating injuries can end lives, rob people of their mobility and burden healthcare systems. As this Outlook shows, advances in medicine and technology are offering new ways to reduce pain and restore mobility.

Researchers are developing a variety of approaches to repairing spinal injuries. Some techniques use stem cells or reprogram existing cells to help the body recreate neurons damaged in an injury (page S4). Regenerative techniques are already helping to mend vertebrae, and replacement discs are being developed that closely mimic their natural components (S7). New drugs can treat pain, improve the level of recovery after an injury, and possibly stimulate biological mechanisms to replace damaged cells (S10). And biomechanical engineer Peter Cripton shows how collecting neck-injury data can trigger ideas for designing better safety devices, such as helmets that protect the head and neck (S13). A growing body of data shows that the consequences of such an injury depend critically on the emergency treatment provided, including medications that limit the damage (S14). If medical action is not enough, the latest technologies could help. Mechanical systems called exoskeletons can help a paraplegic to stand, walk and even climb stairs (S16).

For spine injuries, as with all healthcare, prevention is better than cure. Rehabilitation and prevention specialist Sara Klaas argues that safer behaviour, from avoiding multitasking when driving to eliminating trip hazards, can reduce the chances of an injury and save billions of dollars (S18). Ultimately, a combination of treatments from immediately after an injury to decades beyond can turn a devastated patient into a productive one with a fulfilling life.

We acknowledge the financial support of Mesoblast in producing this Outlook. As always, Nature has full responsibility for all editorial content.