Sexual Dysfunction: Prevalence and Prognosis in Patients Operated for Degenerative Lumbar Spondylolisthesis.

Abstract

There is a paucity of investigation on the impact of spondylolisthesis surgery on back pain-related sexual inactivity. To investigate predictors of improved sex life postoperatively by utilizing the prospective Quality Outcomes Database (QOD) registry. A total of 218 patients who underwent surgery for grade 1 degenerative lumbar spondylolisthesis were included who were sexually active. Sex life was assessed by Oswestry Disability Index item 8 at baseline and 24-mo follow-up. Mean age was 58.0±11.0 yr, and 108 (49.5%) patients were women. At baseline, 178 patients (81.7%) had sex life impairment. At 24 mo, 130 patients (73.0% of the 178 impaired) had an improved sex life. Those with improved sex lives noted higher satisfaction with surgery (84.5% vs 64.6% would undergo surgery again, P=.002). In multivariate analyses, lower body mass index (BMI) was associated with improved sex life (OR=1.14; 95% CI [1.05-1.20]; P<.001). In the younger patients (age < 57 yr), lower BMI remained the sole significant predictor of improvement (OR=1.12; 95% CI [1.03-1.23]; P=.01). In the older patients (age ≥ 57 yr)-in addition to lower BMI (OR=1.12; 95% CI [1.02-1.27]; P=.02)-lower American Society of Anesthesiologists (ASA) grades (1 or 2) (OR=3.7; 95% CI [1.2-12.0]; P=.02) and ≥4 yr of college education (OR=3.9; 95% CI [1.2-15.1]; P=.03) were predictive of improvement. Over 80% of patients who present for surgery for degenerative lumbar spondylolisthesis report a negative effect of the disease on sex life. However, most patients (73%) report improvement postoperatively. Sex life improvement was associated with greater satisfaction with surgery. Lower BMI was predictive of improved sex life. In older patients-in addition to lower BMI-lower ASA grade and higher education were predictive of improvement.