Bioactive Hydrogels for Spinal Cord Injury Repair: Emphasis on Gelatin and Its Derivatives

Spinal cord injuries (SCIs) present a major clinical challenge, often resulting in permanent loss of function and limited treatment options. Traditional approaches, including surgery, drugs, and rehabilitation, have had modest success in restoring neural connectivity due to the complex pathophysiology of SCI. In recent years, bioactive hydrogels have gained attention as a versatile platform for neural repair. Their ability to mimic the extracellular matrix, deliver therapeutic agents, and support cell survival makes them promising tools in regenerative medicine. This narrative review highlights the latest advances in hydrogel-based therapies for SCI, with a focus on innovations such as self-healing, conductive, and anti-inflammatory hydrogels. We also explore hybrid approaches that integrate nanomaterials, stem cells, and bioelectronics to address both primary and secondary injury mechanisms. While various hydrogel systems have been investigated, we place particular emphasis on gelatin-based hydrogels, especially gelatin methacryloyl (GelMA), due to their emerging clinical relevance. GelMA stands out for its bioactivity, tunable mechanics, and compatibility with 3D printing, making it a strong candidate for personalized therapies and scalable production. Unlike previous reviews that broadly summarize hydrogel use, this work specifically contextualizes gelatin-based platforms within the wider landscape of SCI repair, underscoring their translational potential. We also address current challenges, such as immune response, long-term integration, and clinical validation, and suggest future directions for bridging the gap from bench to bedside.