Background <p>Spinal cord injury (SCI) is a disabling condition. While conventional rehabilitation provides benefits, its effects are often limited. This study aimed to evaluate the efficacy and safety of blood flow restriction (BFR) training combined with routine rehabilitation in SCI patients after decompression surgery.</p> Methods <p>A retrospective analysis was conducted on 80 patients with SCI who underwent decompression surgery and received rehabilitation treatment at our hospital between January 2023 and January 2024. Based on treatment records, patients were categorized into a control group (routine rehabilitation only) and a combination group (BFR plus routine rehabilitation). Treatment lasted for 12 weeks. Outcomes assessed included muscle strength, Lower Extremity Motor scores (LEMS), Activity of daily living (ADL), lower limb muscle circumference, hemodynamic parameters, and adverse events.</p> Results <p>At 3-month follow-up, patients in the combination group exhibited greater improvements in hip, knee, and ankle muscle strength, LEMS scores, ADL scores, and lower limb muscle circumference compared to both baseline and the control group (<i>P</i> &lt; 0.05). No significant intergroup differences were observed at baseline or at 1-month follow-up. Heart rate, blood pressure, and adverse event incidence remained similar between the two groups throughout the observation period (<i>P</i> &gt; 0.05).</p> Conclusion <p>BFR training combined with routine rehabilitation may enhance motor function, gait performance, and daily living abilities in SCI patients after decompression surgery without increasing adverse events. These findings support its clinical feasibility, but further prospective studies are warranted to confirm the results.</p>