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Retrograde Ejaculation After Anterior Lumbar Spine Surgery

Lindley, Emily M. PhD; McBeth, Zachary L. BS; Henry, Sarah E. MPH; Cooley, Robert PA; Burger, Evalina L. MD; Cain, Christopher M. J. MD; Patel, Vikas V. MA, MD

doi: 10.1097/BRS.0b013e31825752bc
Surgery
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Study Design. A retrospective cohort study.

Objective. To compare the incidence of retrograde ejaculation (RE) after anterior lumbar spine surgery with disc replacement versus fusion with the use of recombinant human bone morphogenetic protein-2 (BMP).

Summary of Background Data. Anterior lumbar interbody fusion (ALIF) has become a popular choice for treating a number of pathologies, largely because it preserves the posterior paravertebral muscles and ligaments. Despite these advantages, the anterior approach is also associated with various complications, one of which is RE. A recent study has questioned whether the risk of RE is increased by the use of BMP in ALIF procedures rather than by the approach alone.

Methods. We conducted a retrospective review of all male patients who received ALIF using BMP or artificial disc replacement (ADR) on at least the L5–S1 level between 2004 and 2011. Medical records were evaluated for the occurrence of RE, and patients were contacted via the phone to obtain current information. The incidence of RE was then compared between the 2 anterior lumbar surgery procedures.

Results. Of the 95 cases of anterior surgery including L5–S1, 54 patients underwent ALIF with BMP (56.8%) and 41 patients were treated with ADR (43.2%). Postoperative RE occurred in 4 of the 54 ALIF patients (7.4%) and in 4 of the 41 ADR patients (9.8%). The incidence of RE was not significantly different between groups (P = 0.7226). At latest follow-up, 1 ALIF and 1 ADR patient reported resolution of the RE.

Conclusion. This study found that RE occurred at a similar rate in patients treated with ADR and ALIF with BMP. The overall rate of RE after retroperitoneal anterior lumbar surgery was higher than expected, which underscores the importance of counseling patients about this risk and specifically questioning patients about the symptoms of RE at postoperative visits.

In this study, we compared the incidence of retrograde ejaculation (RE) in male patients undergoing either ALIF, with rhBMP-2, or artificial disc replacement at L5–S1. We found that the risk for RE was similar in both groups.

From the Department of Orthopaedics, The Spine Center, University of Colorado Denver, Anschutz Medical Campus, Denver, CO.

Address correspondence and reprint requests to Emily M. Lindley, PhD, Department of Orthopaedics, The Spine Center, University of Colorado Denver, Anschutz Medical Campus, Mail Stop B202, 12631 E. 17th Ave., Aurora, CO 80045; E-mail: emily.lindley@ucdenver.edu

Acknowledgment date: November 29, 2011. First revision date: December 16, 2011. Second revision date: February 10, 2012. Acceptance date: March 16, 2012.

The device(s)/drug(s) is/are FDA approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

One or more of the author(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript: e.g., honoraria, gifts, consultancies, royalties, stocks, stock options, decision-making position.

© 2012 Lippincott Williams & Wilkins, Inc.