BACKGROUND: Spinal cord injury is a serious disease of the central nervous system, characterized by weak regeneration of neurons and complex pathological processes. Mitochondrial autophagy is a highly selective autophagy that can degrade damaged mitochondria and plays an important role in energy supply, cell metabolism and neuronal survival. OBJECTIVE: To explore the mechanism of mitochondrial autophagy and the effects of drugs on mitochondrial autophagy, and provide a new target for the treatment of spinal cord injury. METHODS: In CNKI, Wanfang and PubMed databases, “spinal cord injury, mitophagy, autophagy, mitochondria” were used as search terms. We searched for articles on the role and mechanism of mitophagy and spinal cord injury. RESULTS AND CONCLUSION: (1) The regulation of mitochondrial autophagy level plays a key role in the treatment of spinal cord injury, and its regulatory mechanism is complex, mainly including PINK1/Parkin, Nix/BNIP3L, FUNDC1, and Atg proteins. In addition, GIT1 regulatory pathway and down-regulated miRNA-124 induction pathway were also found. (2) In terms of treatment, rapamycin, acetyl-L-carnitine, salidroside, betulinic acid, and maltol can inhibit apoptosis and improve spinal cord injury by appropriately activating mitochondrial autophagy. In contrast, rosiglitazone ameliorates spinal cord injury by inhibiting mitochondrial autophagy. This suggests that activation or inhibition of mitochondrial autophagy may improve spinal cord injury, which is related to the different mechanisms of drug action. The specific mechanism of action of the drugs remains to be further studied. [ABSTRACT FROM AUTHOR]