The purpose of this report is to examine whether the timely and appropriate
application of long-leg and short-leg braces can contribute to functional
recovery and enable independent walking after surgery.
This case report describes the evaluation methods used over a 600-day follow-up period for a single patient case. Case Presentation:A male in his 40s was diagnosed with a spinal glioma at the T9 vertebral level. He underwent two intramedullary tumor resection surgeries. Following the first surgery (Day X), a histopathological examination revealed a WHO Grade II spinal glioma. The patient regained walking ability within one month of the procedure. However, after tumor recurrence, a second resection surgery was performed at the T8-T10 levels (Day X + 344), and molecular analysis confirmed the H3F3A-K27M mutation, indicative of a WHO Grade IV malignant glioma. Postoperatively, the patient experienced severe motor and sensory deficits in both lower limbs, with slow recovery six months after the second surgery.
Early gait training using orthoses enabled the patient to walk with a T-cane by Day 36 after the first surgery. On Day 36 after the first surgery, the patient’s scores were as follows: McCormick Scale: II, American Spinal Injury Association Impairment Scale, Lower Extremity Motor Score (AIS LEMS): 45 points, Walking Index for Spinal Cord Injury II (WISCI II): 13 points, and Spinal Cord Independence Measure (SCIM): 86 points. On Day 600, the scores were: McCormick Scale: III, AIS LEMS: 23 points, WISCI II: 9 points, and SCIM: 56 points. Following the initial surgery, gait training began on Day X + 2, utilizing a long-leg brace (LLB) and parallel bars. Muscle strength and sensation in the left lower limb progressively improved, enabling the patient to walk independently with a T-cane. After the second surgery, the patient underwent early gait rehabilitation with orthotic therapy alongside radiation therapy and temozolomide (TMZ) chemotherapy. The use of a long-leg brace ensured stability in the knee joint due to lower limb weakness. As the patient’s strength recovered, the brace was transitioned to a plastic ankle-foot orthosis (AFO), enhancing walking function. By discharge, the patient was able to manage daily activities with the aid of a walker and wheelchair.
Early initiation of gait training, in conjunction with multidisciplinary treatment and the use of orthotic devices, is essential in optimizing unctional recovery and ADL with spinal malignancies. This case illustrates the efficacy of early physical therapy and orthotic interventions in restoring walking ability and supporting independence.
The project demonstrates early rehabilitation and orthotic effectiveness post-spinal tumor surgery, potentially enhancing physiotherapy practice, management, education, and policy implementation.
Leg Brace
Gait Recovery
