Spinal cord astrocytoma is a rare malignant tumor of the central nervous system, with unique characteristics in epidemiology, clinical tumor phenotype, molecular genetic markers, and therapeutic research. With the development of surgical techniques and molecular pathology, significant progress has been made in the research and treatment of brain glioma. However, there are only limited advances in the research and treatment of spinal cord astrocytoma. The potential cautions include: (1) it is difficult to carry out research because of the small number of clinical samples; (2) the resistance of the spinal cord to temozolomide, the first-line chemotherapy drug for brain glioma. Therefore, it is urgent to clarify the research status and potential direction of spinal cord astrocytoma to provide clues for improving its clinical efficacy. Here, we comprehensively reviewed the clinical features, pathological classification, molecular characteristics, current treatments, and ongoing studies of spinal cord astrocytoma. In conclusion, the incidence of spinal astrocytoma is less than 1/10 of brain diffuse gliomas. Although spinal cord astrocytoma has younger age than brain hemisphere diffuse glioma, it mainly occurs in adults which is unlike diffuse brain stem gliomas. According to histological phenotype, spinal cord astrocytomas are divided into astrocytoma and glioblastoma. Almost all patients are IDH wild-type, and a high proportion of patients carry the H3 K27M mutation (about 40%). For WHO grade 2/3 patients, maximal surgical resection was associated with a better prognosis, but for WHO grade 4 patients, the prognosis was associated with histological grade, preoperative spinal cord function, and NLR (peripheral blood neutrophil to lymphocyte ratio). Currently, there is no effective treatment for spinal cord astrocytoma other than radiotherapy. Studies on molecular targeted therapy and immunotherapy have brought new hope for spinal cord glioma, but the lack of effective experiment models has limited their progression. Studies in large clinical cohorts, the development of cell and animal experiment models, and the usage of novel study approaches (such as single-cell technology) should be performed as soon as possible on the spinal cord astrocytoma to improve its precision diagnosis and therapy.