Roper St. Francis
Complex spine surgery - Dr. Porto
Treatments & Conditions

After years of pain, spine surgery restores mobility

September 25, 2026 3 Minute Read Time

In this article

  • Complex spinal deformity in a 70-year-old patient with osteoporosis and severe symptoms.
  • A multidisciplinary approach, the patient underwent a three-stage spinal reconstruction over two days with support from neurosurgery, general surgery, rehabilitation and osteoporosis care.
  • Successful recovery following a three-stage spinal reconstruction and rehabilitation.

A complex spinal condition requires specialized care

A 70-year-old female presented with severe back pain, gait dysfunction, numbness and abnormal posture. She had experienced symptoms since 2021, and in 2023 an out-of-state orthopedist recommended surgery. The patient was in the process of moving to South Carolina at that time and elected to wait. 

By March 2025, the patient’s symptoms had worsened, and a pain management physician referred her to Guilherme Porto, MD, one of the board certified neurosurgeons at Roper St. Francis Healthcare. Within two weeks of referral, she received a full workup and was diagnosed with lumbar degenerative scoliosis, complicated by osteoporosis. Having already exhausted non-operative measures, the patient was eager to proceed with surgery.

“Scoliosis in older patients can be challenging due to the overwhelming number of arthritic changes in the spine, as well as comorbidities and risk factors that become more significant with age,” Dr. Porto says.

Collaborating with colleagues in general surgery, physical rehabilitation and the osteoporosis clinic, Dr. Porto successfully addressed the patient’s spinal deformity in a complex multi-stage procedure in May, just two months after her referral. The patient now experiences less pain, and improved mobility and quality of life.


Neurosurgery

A three-stage surgery and a full recovery

The patient had notable comorbidities including diabetes and osteoporosis, and she had been taking osteoporosis medication for nine months. “The bone quality added an extra challenge to this case, and we took a methodical approach to ensure adequate healing,” Dr. Porto says.

He carefully planned where to attach instrumentation and opted for titanium rods, more flexible than commonly used cobalt rods, to improve healing in soft bone. “One of the nuances of this kind of operation in elderly patients is knowing how to meet soft bone halfway,” he adds.

Dr. Porto, MD

Dr. Porto collaborated with a general surgeon and a second neurosurgeon to perform the complex spinal reconstruction in three stages on two consecutive days:

  • Stage one (anterior): The team performed minimally invasive anterior lumbar interbody fusion to place grafts along the lumbar spine.
  • Stage two (lateral): During the same operation, Dr. Porto performed extreme lateral interbody fusion to place additional grafts to reestablish spinal curvature and restore lost height.
  • Stage three (posterior): On the second day, Dr. Porto used CT-guided navigation to instrument and fuse the patient’s spine from the mid-thoracic region to the sacrum. He also performed a series of osteotomies to further regain natural curvature.

The patient recovered in the hospital for seven days, followed by three weeks of inpatient rehabilitation. At a follow-up approximately one year later, she had returned to normal activities and reported only occasional pain that was adequately controlled. “She is active in her senior community and feels she has regained her quality of life,” Dr. Porto says.

Did you know?

Older adults with scoliosis may face added surgical challenges due to osteoporosis, arthritis and other age-related risk factors.

Why Roper St. Francis Healthcare Neurosurgery?

At Roper St. Francis Healthcare, our Neurosurgery offers the same world-class expertise as major academic medical centers, with the personalized feel of a community hospital. Our multidisciplinary team works closely across specialties to optimize patients for surgery and support them through the postoperative period. “It’s important that we’re communicating well and speaking the same language to support patients through these complex procedures – and that’s something we do exceptionally well here,” Dr. Porto says.

He encourages providers to refer any patient who may be interested in surgical interventions for spinal problems, regardless of comorbidities.

“Patients sometimes get conflicting and discouraging information about whether surgical options are available to them,” he says. “But even if patients don’t want or need a major operation, there may be smaller surgeries we can do to address their symptoms.”

Urgent referrals are reviewed the day they are received and all other referrals within 48 hours. Dedicated intake teams ensure every patient receives necessary imaging and is routed to the appropriate next steps, from surgical evaluation through rehabilitation.

  • It’s important that we’re communicating well and speaking the same language to support patients through these complex procedures – and that’s something we do exceptionally well here.”

    – Dr. Guilherme Porto, MD , Neurosurgery

Ways to refer

Epic: Use referral code RSFPP-Roper St. Francis Spine Intake Clinic or select the specific provider you’d like your patient to see. 

Please indicate the following:

  •  Urgent or non-urgent
  •  Whether you want a specific provider or the next available appointment with any provider

Fax referrals: (843) 606-8059

Call for referrals (843) 723-8823

woman-nurse-stethoscope

Topics

Related Articles

All articles