I sometimes speak with patients to offer support in any way that I can. Occasionally, a patient will have complications from surgery that include nerve damage. And sometimes, that nerve damage results in sexual dysfunction (usually males). Even though people on this forum are anonymous, many choose not to discuss things like retrograde ejaculation and/or loss of sexual sensation after surgery. And that’s too bad, as discussions can inform other patients trying to weigh all the risks of spine surgery.
While arthroplasty is often an excellent option for those qualified patients that require a radical solution, patients should be fully informed of ALL the risks & complications associated with an anterior lumbar procedure. To remedy this sensitive information deficit, I’ve collected a short list of citations from the web, which discusses this issue in detail. Please consider:
- These are dated articles and much has improved in surgical training programs. However, this must be tempered with the large number of surgeons that are new to arthroplasty procedures.
- The different approaches each have their own risks.
- There are even differences between surgical techniques across borders. E.g., some German surgeons do their own “approach,” while their American colleagues have their vascular surgeon perform the surgical approach. We’ve seen some of the pros and cons associated with these differences.
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I hope this information helps patients in some way, and thanks for discussing this topic openly.
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“…The potential disadvantages of disc arthroplasty are significant. The anterior approach to the lumbar spine has intrinsic risks. A surgeon familiar with this approach is necessary to perform the approach since the aorta and common iliac vessels lie anterior to the lower lumbar spine. In men, the superior hypogastric plexus can be injured, resulting in retrograde ejaculation. Furthermore, a repeat retroperitoneal approach is difficult, if not impossible, and dissection and mobilization of the vessels places the patient at significant risk of hemorrhage, particularly if performed by a surgeon unaccustomed to this approach…”
http://www.medscape.com/viewarticle/445057
“…The incidence of retrograde ejaculation in men after anterior lumbosacral spinal surgery has been reported to range from 0.42% to 5.9%…”
http://cat.inist.fr/?aModele=afficheN&cpsidt=14792738
A 1995 European Journal (eleven years old!) about anterior lumbar fusion procedures cites:
Retrograde ejaculation has been underestimated as a complication of anterior interbody fusion in multioperated low back patients. The possibility of this complication should be kept in mind when planning a transabdominal approach for interbody lumbar fusion in male patients. We do not recommend the transabdominal approach in male patients because of the risk of retrograde ejaculation.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retri...983652&dopt=Abstract
Though this report is more than three years old, it appears to be one of the most credible & recent studies on the topic. Here are a few excerpts:
“…The incidence of retrograde ejaculation in men after anterior lumbosacral spinal surgery has been reported to range from 0.42% to 5.9%…
…CONCLUSIONS: A transperitoneal approach to the lumbar spine at L4-L5 and L5-S1 has a 10 times greater chance of causing retrograde ejaculation in men than a retroperitoneal approach…”
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abs...s&list_uids=12768143