[Artificial Disc Replacement] Sex life and sexual function in men and women before and after total disc replacement compared with posterior lumbar fusion

[Justin]

The Spine Journal
Volume 9, Issue 12, December 2009, Pages 987-994

Sex life and sexual function in men and women before and after total disc replacement compared with posterior lumbar fusion

Svante Berg MDa, Peter Fritzell MD, PhDb and Hans Tropp MD, PhDc. aStockholm Spine Center, Löwenströmska Hospital, SE-19489, Upplands Väsby, Stockholm, Sweden. bDepartment of Orthopedic Surgery, Falu Hospital, S-791 82 Falun, Sweden. cDepartment of Orthopedic Surgery, Linköping University Hospital, S-581 85 Linköping, Sweden. Copyright © 2009 Elsevier Inc.


Background context

Sex life and sexual function may be affected by low back pain (LBP). Sexual dysfunction after anterior lumbar fusion is reported in both men and women, but focus is mainly on impaired male biological function (retrograde ejaculation) as this may cause infertility. This has led to concern as to whether anterior surgery should be employed in men, at least in younger age groups.

Purpose

To investigate how chronic low back pain (CLBP) of assumed discogenic origin affects sex life and sexual function in patients considered for surgical treatment, whether this is affected by surgical treatment (total disc replacement [TDR] or posterolateral fusion [PLF]/posterior lumbar interbody fusion [PLIF]), and if so, are there differences between the surgical procedures undertaken.

Study design

A randomized controlled trial comparing TDR and instrumented lumbar spine fusion, performed either as a PLF or PLIF.

Patient sample

One hundred fifty-two patients were included in this randomized controlled trial to compare the effect on CLBP of either TDR via an anterior retroperitoneal approach or instrumented posterior lumbar fusion, PLF or PLIF.

Outcome measures

Global assessment of back pain, back pain (visual analog scale [VAS] 0-100), function (Oswestry Disability Index [ODI] 0–100), quality of life (EQ5D [EuroQol] 0–1), and answers on specific sexual function.

Methods

Outcome was assessed using data from the Swedish Spine Register (SweSpine). In ODI, one question, ODI 8, reflects the impact of back pain on sex life. This question was analyzed separately. Patients also answered a gender-specific questionnaire preoperatively and at the 2-year follow-up to determine any sexual dysfunction regarding erection, orgasm, and ejaculation. Follow-up was at 1 and 2 years.

Results

Before surgery, 34% reported that their sex life caused some extra LBP, and an additional 30% that their sex life was severely restricted by LBP. After surgery, sex life improved in both groups, with a strong correlation to a reduction of LBP. The gender-specific questionnaire used to measure sexual function after 2 years revealed no negative effect of TDR or Fusion in men regarding erection or retrograde ejaculation. However, 26% of all men in the Fusion group, compared with 3% in the TDR group, reported postoperative deterioration in the ability to achieve orgasm, despite a reduction of LBP.

Conclusions

Impairment of sex life appears to be related to CLBP. An improvement in sex life after TDR or lumbar fusion was positively correlated to a reduction in LBP. Total disc replacement in this study, performed through an anterior retroperitoneal approach, was not associated with greater sexual dysfunction compared with instrumented lumbar fusion performed either as a PLF or as a PLIF. Sexual function, expressed as orgasm, deteriorated in men in the Fusion group postoperatively, in spite of this group reporting less LBP after 2 years.

Sex life; Sexual dysfunction; Retrograde ejaculation; Total disc replacement; Lumbar fusion; Low back pain

[Jack-of-all-trades]

One suggestion is to check the testosterone level in men. Even if testerone is just low normal the med could be considered. Chronic narcotic use, age, fear of damage to their prosthesis, and of course pain or fear of pain during sex can make a negative impact on especially males sex life.
There is a topical androgenic steroid (Androgel) that can be administered in small doses that works well for this. That is baring any contra-indicating factors for its use.