Authors: Andrew K. Chan, MD; Praveen Mummaneni, MD; Leslie Robinson; Kai-Ming Fu, MD, PhD; Paul Park, MD; Mohamad Bydon, MD; Mark Shaffrey, MD; Michael Wang, MD; Mohammed Alvi; Jian Guan, MD; Erica Bisson, MD, MPH (San Francisco, CA)

Introduction: There is a paucity of investigation on the impact of spondylolisthesis surgery on sexual function. We investigated factors predictive of improved sexual function following surgery. Methods: This was an analysis of the prospective Quality Outcomes Database registry of surgery for grade 1 degenerative lumbar spondylolisthesis. 221 patients were included who were sexually active and had both baseline and two-year sexual function follow up. Data was collected at baseline and two-year follow up. Sexual function was assessed by Oswestry Disability Index question, “With regards to pain, how would you say your sex life is?” The six, ordinal responses ranged from “Normal and causes no extra pain” (no dysfunction) to “Not sexually active because of pain” (most dysfunction). Univariate and multivariate analyses were conducted. Results: At baseline, 179 (81.0%) patients had sexual dysfunction. Of those with baseline dysfunction, 126 (70.4%) improved in sexual function at two years. Of the 42 patients with no baseline dysfunction, 12 (28.6%) experienced some dysfunction post-operatively. Those receiving fusions (n=200) had greater baseline sexual dysfunction (83.5%vs.57.1% with dysfunction, p =0.008) and two-year dysfunction (51.0%vs.23.8% with dysfunction, p =0.02) compared to those receiving decompressions only (n=21). Overall, patients improved significantly in sexual function following surgery (baseline 19%vs.post-op 51.6% with no dysfunction, p <0.001). Both those receiving fusions (baseline 16.5%vs.post-op 49% with no dysfunction, p =0.008) and decompressions only (baseline 42.9%vs.post-op 76.2% with no dysfunction, p =0.03) improved significantly at 24 months. In multivariate analyses, leg pain predominant presentation (OR=7.6,95%CI[1.6-59.7], p =0.02;reference=back pain), baseline NRS back pain (OR=1.3,95%CI[1.04-1.6], p =0.02), and surgeries utilizing MIS techniques (OR=3.9,95%CI[1.6-10.1], p =0.003) were associated with improved sexual function at two-year follow up. Conclusion: A majority of patients presenting with sexual dysfunction improved following surgery. Both fusion and decompression patients significantly improved their sexual function with spondylolisthesis surgery. Leg pain predominant presentation, magnitude of baseline back pain, and MIS were significant predictors of improved sexual function following spondylolisthesis surgery.