Robotic Exoskeleton–Assisted Gait Training in Spinal Fracture Rehabilitation: Clinical Rationale and Functional Outcomes

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Abstract
Spinal fractures are frequently associated with prolonged functional impairment, delayed ambulation, and reduced independence, particularly when neurological involvement or prolonged immobilization is present. Conventional rehabilitation remains the cornerstone of recovery; however, its capacity to deliver early, intensive, and repetitive gait training may be limited in patients with pain, biomechanical instability, or reduced motor control. In this context, robotic lower-limb exoskeletons have emerged as a promising rehabilitative technology capable of supporting upright mobility and structured gait practice. This review analyzes current evidence on robotic exoskeleton-assisted rehabilitation with specific emphasis on its potential role in post-fracture spinal recovery and the acceleration of functional reintegration. A structured narrative review methodology was employed, integrating findings from neurological rehabilitation, spinal cord injury studies, orthopedic rehabilitation research, and biomechanical analyses. The results indicate that exoskeleton-assisted gait training is associated with improved walking initiation, increased training intensity, reduced assistance requirements, and acceptable safety profiles when applied under appropriate clinical protocols. Although direct evidence in spinal fracture populations remains limited, the biomechanical rationale and indirect clinical findings support the conceptual applicability of exoskeleton-assisted rehabilitation in this group.