Background: The objective was to evaluate the efficacy of virtual reality-based therapy (VRBT) compared to therapeutic exercise in increasing balance and functional status in patients with acquired spinal cord injury (SCI). Methods: Following PRISMA recommendations, we searched randomized controlled trials that meets the inclusion criteria in PubMed Medline, Scopus, Web of Science and PEDro without language and publication date limitations. Methodological quality and risk of bias were evaluated using the PEDro scale. Results: Six RCTs providing data on 131 patients with SCI were included in this systematic review. Based on the information gathered from the included studies, both therapies can increase balance and functional status between pre- and post-assessment. However, it seems that there is a higher rate of improvement in balance and function in SCI patients in favor of the group that uses VRBT in their treatment (p < 0.05). Conclusions: Although there is evidence in favor of the effectiveness of VRBT in increasing balance and functional status in patients with SCI, this is limited, and further research is necessary. Even so, taking into account the results found, our systematic review suggests that VRBT provides an effective therapeutic use to implement alongside conventional therapies for patients with SCI.