Neuroprotection of the Compressed Spine: A Systematized Narrative Review of Riluzole for Humans with Spinal Cord Injury.

Traumatic spinal cord injury (tSCI) is associated with significant disability and limited neurologic recovery, largely due to a complex secondary injury cascade that lacks established pharmacologic therapy. This narrative review summarizes relevant randomized controlled trials, secondary analyses, and meta-analyses evaluating Riluzole in tSCI and degenerative cervical myelopathy. It examines pharmacologic mechanisms, pharmacokinetic-pharmacodynamic relationships, biomarker findings, clinical and functional outcomes, safety considerations, and implications for future clinical research. Although primary efficacy endpoints were not uniformly met, multiple studies reported improved neurologic, functional, and patient-reported outcomes. Other agents with potential use or future promise are also highlighted.