Exosomes have emerged as promising therapeutic agents for spinal cord injury (SCI). The present study was conducted to provide a systematic bibliometric analysis of research trends related to SCI and exosomes.Publications on exosomes in SCI were identified from the Web of Science Core Collection using specific search criteria. VOSviewer, CiteSpace, and R-based Bibliometrix were employed to visualize collaboration networks and research hotspots.The analysis included 281 publications across 66 countries. The publication numbers were consistently trending upwards, with the United States and China being two of the top producing countries. The top three articles were cited 539, 300, and 254 times, respectively. The analyzed publications were from 153 journals, and the Journal of Neurotrauma, Journal of Nanobiotechnology, and Stem Cell Research & Therapy had the highest total link strength in co-occurrence networks. Stem Cell Research & Therapy, Journal of Nanobiotechnology, and Molecular Neurobiology were the top journals in coupling networks. Fan Jin, Cai Weihua and Cao Yong were the most prolific and highly cited authors. Keywords analysis revealed emerging research hotspots including microglia modulation, engineered exosomes, extracellular vesicles, and targeted delivery systems.The findings underscore the accelerated exploitation and promise of exosomes as a novel treatment for SCI with significant translational potential through emerging hotspots such as microglia modulation and engineered exosome platforms. The insights gained from this study are important and may be essential for the advancement of exosome-based treatments by researchers and clinicians in the field of spinal cord injury.© 2025 Wang et al.