Rodrigo Martínez Rivera

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.

Three-dimensional (3D) printing has emerged as an increasingly relevant tool in complex abdominal reconstruction, offering surgeons a tangible means of understanding distorted anatomy and improving surgical planning. This review synthesizes evidence from 23 multidisciplinary studies conducted across diverse healthcare systems, including contributions from Mexico, Colombia, and Ecuador, to evaluate the clinical utility, technical workflows, and operational barriers of patient-specific 3D-printed models. Findings reveal that 3D printing consistently enhances spatial understanding of complex anatomical relationships, supports the selection of resection and reconstruction strategies, and strengthens multidisciplinary communication in high-risk procedures. Pediatric abdominal oncology and abdominal wall reconstruction represent the most robust areas of application, reflecting the need for greater precision in tumor mapping and defect quantification. The technology likewise demonstrates substantial educational value, helping trainees interpret imaging more effectively and develop operative reasoning in a controlled environment. However, the review also identifies persistent challenges that restrict large-scale adoption, including time-intensive segmentation, high operational costs, limited multimaterial printing access, and lack of standardized outcome metrics. Latin American studies highlight that feasibility increases significantly when institutions integrate in-house segmentation and printing units, emphasizing the importance of workflow adaptation in resource-variable settings. Overall, the evidence positions 3D printing as a transformative adjunct that enhances surgical accuracy, safety, and training quality. Its continued growth will depend on improved segmentation automation, cost-efficient production models, interdisciplinary training, and standardized reporting frameworks. As abdominal reconstruction becomes increasingly complex, 3D printing is poised to evolve from an emerging innovation into a routine component of modern surgical practice.