Sexual and urinary function following anterior lumbar surgery in females

Wuertz‐Kozak, Karin; Bleisch, Dominique; Nadi, Najia; Prömmel, Peter; Hitzl, Wolfgang; Kessler, Thomas M.; Gautschi, Oliver; Hausmann, Oliver

doi:10.1002/nau.23874

Cited by 5 publications

(3 citation statements)

References 18 publications

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“…Additionally, ALIF may require a secondary posterior approach to achieve 360° support, particularly in isthmic spondylolisthesis at L5–S1 [63, 65]. Furthermore, ALIF can result in approach-related complications such as sexual dysfunction, retrograde ejaculation, or urinary incontinence in male patients and vascular injury in all patients [41, 50, 61, 74]. These risks are inherent in an anterior approach to the lumbar spine because of the proximity of the iliac arteries and veins, as well as the sympathetic plexus.…”

Section: Resultsmentioning

confidence: 99%

Interbody Fusions in the Lumbar Spine: A Review

Verma

Virk

Qureshi

2020

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background Lumbar interbody fusion is among the most common types of spinal surgery performed. Over time, the term has evolved to encompass a number of different approaches to the intervertebral space, as well as differing implant materials. Questions remain over which approaches and materials are best for achieving fusion and restoring disc height. Questions/Purposes We reviewed the literature on the advantages and disadvantages of various methods and devices used to achieve and augment fusion between the disc spaces in the lumbar spine. Methods Using search terms specific to lumbar interbody fusion, we searched PubMed and Google Scholar and identified 4993 articles. We excluded those that did not report clinical outcomes, involved cervical interbody devices, were animal studies, or were not in English. After exclusions, 68 articles were included for review. Results Posterior approaches have advantages, such as providing 360° support through a single incision, but can result in retraction injury and do not always restore lordosis or correct deformity. Anterior approaches allow for the largest implants and good correction of deformities but can result in vascular, urinary, psoas muscle, or lumbar plexus injury and may require a second posterior procedure to supplement fixation. Titanium cages produce improved osteointegration and fusion rates but also increase subsidence caused by the stiffness of titanium relative to bone. Polyetheretherketone (PEEK) has an elasticity closer to that of bone and shows less subsidence than titanium cages, but as an inert compound PEEK results in lower fusion rates and greater osteolysis. Combination PEEK–titanium coating has not yet achieved better results. Expandable cages were developed to increase disc height and restore lumbar lordosis, but the data on their effectiveness have been inconclusive. Three-dimensionally (3D)-printed cages have shown promise in biomechanical and animal studies at increasing fusion rates and reducing subsidence, but additive manufacturing options are still in their infancy and require more investigation. Conclusions All of the approaches to spinal fusion have plusses and minuses that must be considered when determining which to use, and newer-technology implants, such as PEEK with titanium coating, expandable, and 3D-printed cages, have tried to improve upon the limitations of existing grafts but require further study.

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Section: Resultsmentioning

confidence: 99%

Interbody Fusions in the Lumbar Spine: A Review

Verma

Virk

Qureshi

2020

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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“…46,47 Additional complications after ALIF include retrograde ejaculation, sexual dysfunction, and urinary incontinence. [48][49][50] In contrast, TLIF through a minimally invasive or open approach avoids the morbidity of the transperitoneal ALIF approach but permits the placement of a substantially smaller graft, thereby decreasing the total surface area available for fusion. Dural tears were also more common during TLIF than ALIF in a recent study.…”

Section: Discussionmentioning

confidence: 99%

Multilevel tandem spondylolisthesis associated with a reduced "safe zone" for a transpsoas lateral lumbar interbody fusion at L4–5

Oyekan

Dalton

Fourman

et al. 2023

Neurosurgical Focus

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OBJECTIVE The aim of this study was to investigate the effect of degenerative spondylolisthesis (DS) on psoas anatomy and the L4–5 safe zone during lateral lumbar interbody fusion (LLIF). METHODS In this retrospective, single-institution analysis, patients managed for low-back pain between 2016 and 2021 were identified. Inclusion criteria were adequate lumbar MR images and radiographs. Exclusion criteria were spine trauma, infection, metastases, transitional anatomy, or prior surgery. There were three age and sex propensity-matched cohorts: 1) controls without DS; 2) patients with single-level DS (SLDS); and 3) patients with multilevel, tandem DS (TDS). Axial T2-weighted MRI was used to measure the apical (ventral) and central positions of the psoas relative to the posterior tangent line at the L4–5 disc. Lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and PI-LL mismatch were measured on lumbar radiographs. The primary outcomes were apical and central psoas positions at L4–5, which were calculated using stepwise multivariate linear regression including demographics, spinopelvic parameters, and degree of DS. Secondary outcomes were associations between single- and multilevel DS and spinopelvic parameters, which were calculated using one-way ANOVA with Bonferroni correction for between-group comparisons. RESULTS A total of 230 patients (92 without DS, 92 with SLDS, and 46 with TDS) were included. The mean age was 68.0 ± 8.9 years, and 185 patients (80.4%) were female. The mean BMI was 31.0 ± 7.1, and the mean age-adjusted Charlson Comorbidity Index (aCCI) was 4.2 ± 1.8. Age, BMI, sex, and aCCI were similar between the groups. Each increased grade of DS (no DS to SLDS to TDS) was associated with significantly increased PI (p < 0.05 for all relationships). PT, PI-LL mismatch, center psoas, and apical position were all significantly greater in the TDS group than in the no-DS and SLDS groups (p < 0.05). DS severity was independently associated with 2.4-mm (95% CI 1.1–3.8 mm) center and 2.6-mm (95% CI 1.2–3.9 mm) apical psoas anterior displacement per increased grade (increasing from no DS to SLDS to TDS). CONCLUSIONS TDS represents more severe sagittal malalignment (PI-LL mismatch), pelvic compensation (PT), and changes in the psoas major muscle compared with no DS, and SLDS and is a risk factor for lumbar plexus injury during L4–5 LLIF due to a smaller safe zone.

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“…In females, however, a 2019 study after ALIF or TDR showed that patients had improved sexual function at six months postoperatively, and persistent improvements in sexual desire, with no increase in urinary incontinence. The authors proposed that the sexual benefits may be secondary to improvements in pain [17].…”

Section: Sexual Dysfunctionmentioning

confidence: 99%

Genitourinary complications in orthopaedic surgery

Testa

Alam

Kahan

et al. 2021

Eur J Orthop Surg Traumatol

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Genitourinary complications following orthopaedic intervention are uncommon but well-described occurrences and exist on a spectrum of severity. These complications vary depending on the anatomic location and surgical approach, with surgery of the spine, hip, and pelvis of particular concern. Injuries to the urinary tract may present acutely with urinary retention or hematuria. However, they often have a delayed presentation with severe complications such as urinary fistula and recurrent infection. Delayed presentations may place the onus of timely and proper diagnosis on the orthopaedic provider, who may serve as the patient's primary source of long-term follow-up. Detailed knowledge of anatomy and at-risk structures is key to both preventing and identifying injury. Although iatrogenic injury is not always avoidable, early identification can help to facilitate timely evaluation and management to prevent long-term complications such as bladder dysfunction, obstructive renal injury, sexual dysfunction, and chronic pain.

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Sexual and urinary function following anterior lumbar surgery in females

Cited by 5 publications

References 18 publications

Interbody Fusions in the Lumbar Spine: A Review

Interbody Fusions in the Lumbar Spine: A Review

Multilevel tandem spondylolisthesis associated with a reduced "safe zone" for a transpsoas lateral lumbar interbody fusion at L4–5

Genitourinary complications in orthopaedic surgery

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