Postoperative gait training using the Hybrid Assistive Limb for pediatric spinal intramedullary cavernous malformation: illustrative case

BACKGROUND: Pediatric spinal intramedullary cavernous malformations are rare, and their optimal management requires timely surgical intervention and structured postoperative rehabilitation. OBSERVATIONS: An 11-year-old female presented with acute back pain, followed by progressive paraplegia and urinary retention. MRI revealed an intramedullary lesion at T8. The patient's neurological status deteriorated during hospitalization, prompting emergency resection. Histopathological examination confirmed the presence of a cavernous malformation. Postoperatively, conventional physiotherapy was initiated, and robot-assisted rehabilitation using an exoskeletal robot began on postoperative day 14, with 10 sessions completed. Exoskeletal robot-assisted training enabled early standing and gait practice despite significant paresis. The patient showed progressive improvements in muscle strength, gait function, and activities of daily living. The bladder dysfunction resolved, and the patient regained independent ambulation with a T-cane before transfer for further rehabilitation. At 6 months, the patient had regained full strength in all muscle groups and was able to ambulate independently without the need for a cane. LESSONS: Exoskeletal robot-assisted rehabilitation may enhance postoperative recovery in pediatric patients with spinal intramedullary cavernous malformations by promoting early mobilization, improving gait patterns, reducing spasticity, and supporting autonomic function. https://thejns.org/doi/10.3171/CASE26448.