uu.seUppsala University Publications
Change search
ReferencesLink to record
Permanent link

Direct link
Sex life and sexual function in men and women before and after total disc replacement compared with posterior lumbar fusion
Department of Orthopedic Surgery, Falu Hospital.
2009 (English)In: The spine journal, ISSN 1529-9430, E-ISSN 1878-1632, Vol. 9, no 12, 987-994 p.Article in journal (Refereed) Published
Abstract [en]

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.


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.


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.


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.


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.

Place, publisher, year, edition, pages
2009. Vol. 9, no 12, 987-994 p.
Keyword [en]
Sex life, Sexual dysfunction, Retrograde ejaculation, Total disc replacement, Lumbar fusion, Low back pain
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-123607DOI: 10.1016/j.spinee.2009.08.454OAI: oai:DiVA.org:uu-123607DiVA: diva2:315033
Available from: 2010-04-28 Created: 2010-04-28 Last updated: 2012-08-24Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full text
In the same journal
The spine journal
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 177 hits
ReferencesLink to record
Permanent link

Direct link