The spinal cord is a vital component of the central nervous system and serves as a critical conduit for neural signaling. It is also a primary target for therapeutic interventions in conditions such as Spinal Cord Injury (SCI), chronic pain, neurodegenerative diseases and spinal tumors [1]. However, delivering therapeutic agents to the spinal cord is challenging due to its complex anatomical structure and the presence of the Blood-Spinal Cord Barrier (BSCB), which restricts the passage of many molecules [2]. Various delivery routes have been developed to address these challenges [3], including systemic administration with spinal targeting, epidural injections, intrathecal (subarachnoid) delivery, subarachnoid localized delivery using biomaterials, and intraparenchymal (intramedullary) injections [4]. Each method has its own advantages and disadvantages in terms of invasiveness, precision, and therapeutic efficacy, and specific risks and limitations must be carefully considered in clinical and research settings. This literature review synthesizes current knowledge on these delivery approaches, exploring their underlying principles, technical methodologies, and clinical or experimental applications. By evaluating the suitability of each route for delivering specific therapeutic agents, such as steroids [5], recombinant growth factors [6], gene therapies [7], stem cells [[8], [9], [10], [11]] and biomaterial scaffolds [11], this review aims to elucidate optimal strategies for targeting the spinal cord. Furthermore, the review aims to identify gaps in current research, highlight emerging trends, and provide a foundation for advancing therapeutic development and clinical practice in spinal cord-related disorders.