Introduction: Anterior lumbar interbody fusion (ALIF) is a well-established and effective treatment method for patients with chronic back pain due to spondylolisthesis or neural compression. However, the surgery can lead to nerve damage and sexual dysfunction, a complication that has rarely been studied in women. We investigated the incidence and associated factors of sexual dysfunction in women after primary ALIF.
Methods: This observational study included female patients aged between 18-60 years who underwent a primary ALIF surgery at 1-2 levels between L4-S1 between January 2015 and October 2022 in a high-volume centre. Patients were contacted by postal survey in February-March 2023 and asked to complete and return a specially designed questionnaire. The data collected were analysed using descriptive statistics and multivariable logistic regression. The study was approved by the local ethics committee (BASEC-ID 2022-01832).
Results: Of 167 contacted patients, 84 (52.0%) responded and were analysed. The mean age at surgery was 46.3 years (standard deviation [SD] 10.0), the level of fusion was L4/L5 in 6.0%, L5/S1 in 78.6% and L4/L5+L5/S1 in 15.5%. The fusion material was Inductos in 82.1%, pelvic crest in 14.3%, and Redygraft/Crunchychips in 3.6%. The mean follow-up time (from surgery to survey) was 4.1 years (SD 2.2). Approximately two thirds of patients (n = 55, 65.5%) reported no change in sexual function, 23 (27.4%) reported a worsening, 2 (2.4%) reported an improvement and 4 (4.8%) were unsure. Among patients with a worsening of sexual function, the most common sexual problems were dyspareunia (60.9%) and impairment of libido (47.8%). Preliminary regression analysis revealed no association of age, level of surgery, fusion material and time since surgery with occurrence of worsened sexual function. Of patients with a worsened sexual function, 60.9% would have the surgery again, compared to 93.4% of patients with no/unclear change or improvement.
Discussion: The risk of sexual dysfunction after ALIF appears to be considerable and is associated with lower satisfaction with the ALIF-surgery. Adequate and sufficient patient education is essential for an informed decision for ALIF surgery.