Department of Orthopaedics, The Ohio State University Wexner Medical Center, 725 Prior Hall, Columbus, OH, 43210, USA.
Eur Spine J. 2018 Oct;27(10):2395-2426. doi: 10.1007/s00586-018-5636-7. Epub 2018 May 23.
Sexual function is an important determinant of quality of life, and factors such as surgical approach, performance of fusion, neurological function and residual pain can affect it after spine surgery. Our aim was to perform a systematic review to collate evidence regarding the impact of spine surgery on sexual function.
A systematic review of studies reporting measures of sexual function, and incidence of adverse sexual outcomes (retrograde ejaculation) after major spine surgery was done, regardless of spinal location. Pubmed (MEDLINE) and Google Scholar databases were queried using the following search words "Sex", "Sex life", "Sexual function", "Sexual activity", "retrograde ejaculation", "Spine", "Spine surgery", "Lumbar surgery", "Lumbar fusion", "cervical spine", "cervical fusion", "Spinal deformity", "scoliosis" and "Decompression". All articles published between 1997 and 2017 were retrieved from the database. A total of 81 studies were included in the final review.
Majority of the studies were retrospective case series and were low quality (Level IV) in evidence. Anterior lumbar approaches were associated with a higher incidence of retrograde ejaculation, especially with the utilization of transperitoneal laparoscopic approach. There is inconclusive evidence on the preferred sexual position following fusion, and also on the impact of BMP-2 usage on retrograde ejaculation/sexual dysfunction.
Despite limited evidence from high-quality articles, there is a general trend towards improvement of sexual activity and function after spine surgery. Future studies incorporating specific assessments of sexual activity will be required to address this important determinant of quality of life so that appropriate pre-operative counselling can be done by providers. These slides can be retrieved under Electronic Supplementary Material.
性功能是生活质量的一个重要决定因素，手术入路、融合的完成情况、神经功能和残留疼痛等因素都会影响脊柱手术后的性功能。我们的目的是进行系统评价，以综合整理有关脊柱手术后性功能影响的证据。
系统评价了报告主要脊柱手术后性功能测量和不良性功能结果（逆行射精）发生率的研究，无论脊柱位置如何。使用以下搜索词在 Pubmed（MEDLINE）和 Google Scholar 数据库中查询：“Sex”、“Sex life”、“Sexual function”、“Sexual activity”、“retrograde ejaculation”、“Spine”、“Spine surgery”、“Lumbar surgery”、“Lumbar fusion”、“cervical spine”、“cervical fusion”、“Spinal deformity”、“scoliosis”和“Decompression”。从数据库中检索到 1997 年至 2017 年期间发表的所有文章。共有 81 项研究纳入最终综述。
大多数研究为回顾性病例系列研究，证据质量较低（IV 级）。前路腰椎入路与逆行射精的发生率较高相关，尤其是使用经腹腔腹腔镜入路。关于融合后首选的性交体位，以及 BMP-2 使用对逆行射精/性功能障碍的影响，尚无定论。
尽管高质量文章的证据有限，但脊柱手术后性功能活动和功能普遍有改善的趋势。需要未来的研究纳入对性功能活动的具体评估，以解决这一生活质量的重要决定因素，以便提供者能够进行适当的术前咨询。这些幻灯片可在电子补充材料中检索。
