Spinal cord injuries are often devastating and result in severe functional limitations. Our review breaks down the pathophysiology, molecular mechanisms, and omics approaches regarding spinal cord injuries. The pathophysiology can be divided into two main phases, with the secondary phase being of greater interest. Understanding the underlying mechanisms behind these phases allows for targeted approaches to be developed. Advancements in omics technologies (genomics, epigenomics, transcriptomics, proteomics, and metabolomics) are excellent tools in creating tailored spinal cord injury treatment plans. Emerging therapeutic solutions involving ion imbalance, oxidative stress, and mitochondrial dysfunction also show promising results. Mitochondrial transplantation has shown promising initial results in maintaining cellular homeostasis and reducing inflammation. However, significant challenges remain in translating the omics and therapeutic approaches from animal models to clinical trials.