Post‑operative physiotherapy management of thoracic compression fracture with paraplegia: A case report

Gayathri*

Superintendent Grade – Neuro Physiotherapist, Kauvery Hospital, Electronic City, Bengaluru

*Correspondence

Abstract

Background: Spinal trauma resulting from road traffic accidents is a significant cause of morbidity in young adults. Thoracic compression fractures with associated paraplegia present complex challenges in acute care and rehabilitation. Early physiotherapy intervention is critical to optimize recovery and functional independence.

Objective: To describe the physiotherapy management and outcomes of a 30‑year‑old female patient with thoracic compression fracture and post‑operative paraplegia following surgical fixation.

Methods: A structured physiotherapy program was initiated post‑operatively, including breathing exercises, facilitation techniques, bed mobility training, trunk control exercises, and progressive sit‑to‑stand activities. Functional outcomes were monitored using the ASIA scale, SLIM scores, and trunk control tests.

Results: The patient demonstrated gradual improvements in sensory and motor function, trunk control, and mobility. SCIM scores improved from 16/100 to measurable gains in ADL performance. ASIA scale assessment revealed progressive recovery in lower limb motor function.

Conclusion: This case highlights the importance of early, structured physiotherapy in managing post‑operative paraplegia following thoracic compression fracture. A systematic progression from bed mobility to upright standing contributed to functional recovery, underscoring the role of physiotherapy in acute spinal trauma care.

Keywords: Thoracic compression fracture; Paraplegia; Physiotherapy; Case report; Spinal trauma rehabilitation.

Introduction

Spinal injuries are among the most disabling consequences of road traffic accidents, particularly in young adults who are otherwise healthy and active. Thoracic compression fractures, when complicated by paraplegia, pose significant challenges for both surgical and rehabilitative management. The incidence of spinal trauma in India remains high due to increasing vehicular use and limited road safety compliance, making physiotherapy a vital component of acute care and long‑term recovery. Physiotherapy plays a pivotal role in restoring function, preventing secondary complications, and promoting independence in patients with spinal cord injuries. Early intervention focusing on respiratory care, trunk stability, and progressive mobility is essential to maximize neurological recovery and improve quality of life. Case reports serve as valuable contributions to clinical literature by illustrating individualized management strategies and contextual challenges in resource‑limited settings. This report presents the case of a 30‑year‑old female who sustained a thoracic compression fracture and clavicle fracture following a road traffic accident. Despite surgical fixation, she developed paraplegia and was referred for physiotherapy management. The structured rehabilitation program, outcome measures, and observed improvements are discussed to highlight the role of physiotherapy in acute spinal trauma care and its implications for practice in Indian clinical settings.

Case Presentation

A 30‑year‑old female, employed as a desktop worker, was admitted on 26 January 2026 following a road traffic accident in which she sustained a two‑wheeler skid and fall. She presented with severe pain in the mid‑back and right shoulder region. Initial imaging revealed a horizontal compression fracture of the thoracic vertebrae (D6–D8) and a comminated fracture of the clavicle. Surgical intervention included pedicle screw fixation on 29 January 2026, followed by re‑exploration and minimally invasive thoracic pedicle screw fixation.  Post‑operatively paraplegia was observed. She was subsequently referred to the physiotherapy department for rehabilitation.

On observation

  • The patient was conscious, oriented, and hemodynamically stable.
  • Mesomorphic body build,
  • Presence of edema over the dorsum of both feet,
  • External supports, including a central line, catheter, and shoulder brace.

On examination

  • Muscle tone – Flaccidity in both lower limbs, Normal tone in both upper limbs.
  • Coordination: Both Upper limbs – Normal , Both Lower limbs – Unable to initiate the movement
  • Balance – Unable to dos both sitting and standing
  • Trunk control testing demonstrated good upper trunk stability but poor lower trunk control, with a trunk control test score of 12/100.
  • Bed Mobility – Rolling ( lying onside)- maximum dependent.
  • Neurological examination done using the ASIA scale (30/01/2026)

Functional independence was assessed using the Spinal Cord Independence Measure (SCIM), with an initial score of 16/100. The patient was dependent for feeding, bathing, dressing, grooming, and mobility. Sphincter control was impaired, with bladder management requiring catheterization and bowel control partially preserved.

The physiotherapy diagnosis was impaired motor and sensory integrity associated with non‑progressive spinal cord injury acquired in adulthood.

Impairments (Body functions & structures)• Thoracic compression fracture with spinal cord injury
• Impaired motor and sensory integrity
• Flaccidity of both lower limbs
• Risk of pulmonary complications
• Comminuted clavicle fracture
Activity limitations• Dependent on bed mobility
• Unable to maintain sitting and standing balance
• Dependent in transfer (bed to chair)
• Dependent in dressing
Participation restriction• Increased dependence, psychosocial stress
• Restricted participation in social and community activities

Physiotherapy management

Early phase (Post‑operative Days 1–7)

  • Respiratory care: Breathing exercises were introduced to prevent pulmonary complications and enhance oxygenation.
  • Facilitation techniques: Passive neuro‑facilitation was applied to bilateral lower limbs to stimulate motor responses.
  • Bed mobility training: Rolling practice and assisted repositioning were emphasized to reduce dependence and prevent pressure sores.
  • Trunk control exercises: Focused activities to improve upper trunk stability were initiated, given poor lower trunk control (12/100) on trunk control test).
  • Intermediate Phase (Weeks 2–3)
  • Progressive mobility: Sit‑to‑stand training was introduced with therapist support, despite initial inability to maintain sitting balance.
  • Contract‑relax techniques: Applied to lower limb musculature to reduce flaccidity and encourage active participation.
  • Standing frame practice: Supported standing was gradually incorporated to promote weight‑bearing and proprioceptive input.
  • Functional task training: Grooming and feeding activities were practiced with adaptive support to encourage independence.

Late Phase (Weeks 4–6 )

  • Strengthening and endurance: Progressive resistive exercises were introduced for trunk and upper limbs to enhance stability.
  • Balance retraining: Static and dynamic balance activities were practiced in supported standing.
  • ADL retraining: Transfers from bed to wheelchair and toileting routines were incorporated into therapy sessions.
  • Community mobility preparation: Indoor mobility with assistive devices was initiated, with gradual progression toward outdoor ambulation goals.

Outcome Measure

  • ASIA scale (12/02.2026): Repeated assessments demonstrated gradual sensory recovery at thoracic and lumbar levels, with emerging motor responses in lower limbs.
  • SCIM scores (12.02.2026): Improved from 16/100 to 26/100 at baseline to measurable gains in feeding, grooming, and mobility domains.

Trunk control test: Incremental improvements were noted, with increased ability to roll and partial sitting balance achieved by week 4.

Discussion

This report illustrates the complex rehabilitation challenges following thoracic compression fracture complicated by post‑operative paraplegia. Spinal trauma in young adults often results in significant functional limitations, with paraplegia leading to dependence in activities of daily living and psychosocial distress. Early physiotherapy intervention is therefore critical to optimize recovery and prevent secondary complications such as respiratory compromise, pressure sores, and contractures.

The structured program implemented in this case beginning with respiratory care and bed mobility, progressing to trunk control, sit‑to‑stand training, and supported standing aligns with evidence‑based recommendations for acute spinal cord injury rehabilitation. Studies have emphasized the importance of early mobilization and trunk stabilization in promoting neurological recovery and functional independence. The patient’s gradual improvements in ASIA scale scores, SCIM outcomes, and trunk control test performance reflect the efficacy of a systematic, staged approach.

A key challenge in this patient  was the initial flaccidity of bilateral lower limbs and poor trunk control, which limited early mobility. Facilitatory techniques and contract‑relax methods were employed to stimulate motor responses and reduce dependence. These strategies highlight the role of physiotherapists in applying reasoning‑based interventions tailored to individual deficits, rather than relying solely on protocol‑driven routines.

The Indian context adds further relevance. Road traffic accidents remain a leading cause of spinal trauma, and resource limitations often constrain rehabilitation services. This case underscores the need for structured physiotherapy frameworks that can be adapted to local practice, ensuring continuity of care from acute hospital settings to community reintegration. Moreover, the use of standardized outcome measures such as ASIA and SCIM provides objective benchmarks for monitoring progress and advocating for physiotherapy’s role in multidisciplinary care.

In comparison with published literature, this report reinforces findings that early physiotherapy contributes to improved functional outcomes even in severe spinal cord injuries. However, adherence and patient motivation remain critical determinants of success. Collaborative reasoning engaging patients in goal‑setting and emphasizing functional relevance may enhance compliance and long‑term recovery.

Conclusion

This report highlights the critical role of physiotherapy in the acute management of spinal trauma complicated by paraplegia. A structured, staged rehabilitation program beginning with respiratory care and bed mobility, progressing to trunk control, sit‑to‑stand training, and supported standing facilitated measurable improvements in sensory and motor function, trunk stability, and activities of daily living.

The patient’s gradual recovery underscores the importance of early intervention, individualized reasoning strategies, and consistent outcome monitoring using standardized tools such as the ASIA scale, SCIM, and trunk control tests. Beyond clinical recovery, the case emphasizes the need for physiotherapy frameworks that can be adapted to resource‑limited contexts, ensuring continuity of care from hospital to community.

Ultimately, this report demonstrates that physiotherapy is not merely supportive but central to functional recovery in spinal trauma. Embedding structured rehabilitation into acute care pathways can significantly improve patient outcomes and strengthen the perception of physiotherapy as a frontline discipline in trauma care.

References

  1. Singam A. *Mobilizing Progress: A Comprehensive Review of the Efficacy of Early Mobilization Therapy in the Intensive Care Unit.* Cureus. 2024;16(4):e57595. DOI:10.7759/cureus.57595.
  2. Harris CL, Shahid S. *Physical therapy–driven quality improvement to promote early mobility in the intensive care unit.* Proc (Bayl Univ Med Cent). 2014;27(3):203–207. doi:10.1080/08998280.2014.11929108.
  3. Bhat A, Chakravarthy K, Rao BK. *Mobilization of patients in neurological Intensive Care Units of India: A survey.* Indian J Crit Care Med. 2016;20(6):337–341. doi:10.4103/0972-5229.183911.
  4. Kirshblum SC, Burns SP, Biering‑Sorensen F, et al. *International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI).* J Spinal Cord Med. 2011;34(6):535–546.
  5. Catz A, Itzkovich M, Tesio L, et al. *A multicenter international study on the Spinal Cord Independence Measure, version III: Rasch psychometric validation.* Spinal Cord. 2007;45(4):275–291.
  6. Morris PE, Goad A, Thompson C, et al. *Early intensive care unit mobility therapy in the treatment of acute respiratory failure.* Crit Care Med. 2008;36(8):2238–2243.
  7. Parry SM, Berney S. *Early mobilisation in critical care: a systematic review.* Physiotherapy. 2008;94(1):13–24.

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