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Retrograde ejaculation as a complication of anterior interbody lumbar fusion was investigated. The diagnosis of retrograde ejaculation was made on the basis of interviews. Patients were informed of the risk of retrograde ejaculation preoperatively. At the follow-up study the patients were asked if they had noticed retrograde ejaculation after their operation. In one case (anejaculation) testis biopsy and vasography was performed. On average, the incidence of retrograde ejaculation as a complication of anterior interbody lumbar fusion has been very low, ranging from only a few cases up to 5.9% of cases involving male patients. We studied 40 male patients with severe low back pain retrospectively after they had undergone anterior interbody lumbar fusion. The mean age at operation was 31.9 years and the mean follow-up time 5.0 years. Retrograde ejaculation occurred after anterior interbody fusion in nine patients. Permanent retrograde ejaculation developed in seven of these patients (17.5%). These patients were all operated on using a transabdominal approach. Major bleeding during the operation (over 2500 ml) was observed in two patients. Seven patients with retrograde ejaculation had undergone a two-level operation (L4-SI), and eight patients had undergone between one and three previous spine operations. 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.

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A randomized, placebo-controlled, double-blind, crossover study in 40 lumbar spinal stenosis patients with a 1-year follow-up showed that calcitonin had beneficial effects on the patients' symptoms without producing any notable side effects. Calcitonin had a clear analgesic effect. The mean of walking distance increased, but the crossover trend was not as good as the analgesic effect. Side effects such as erythema and nausea were usually mild and transient. Calcitonin therapy can be used as a conservative treatment in selected cases of lumbar spinal stenosis. When rest pain was mild or the walking distance was under 200-300 m because of neurogenic claudication, the effect of calcitonin seemed to be poor.

Two different classifications of discograms have been used in a prospective study of 279 injected discs in 100 patients. The five-stage classification of Adams, Dolan and Hutton (1986) showed increased degeneration in the lower lumbar discs and more degenerative changes in men than in women. Exact reproduction of the patient's pain on injection was more common in fissured or ruptured discs than in less degenerate discs, with 81% sensitivity and M% specificity of the discogram for pain. The additional information obtained by