European Spine Journal

, Volume 27, Issue 10, pp 2395–2426 | Cite as

Sexual activity after spine surgery: a systematic review

  • Azeem Tariq Malik
  • Nikhil Jain
  • Jeffery Kim
  • Safdar N. Khan
  • Elizabeth Yu



Sexual function is an important determinant of quality of life, and factors such as surgical approach, performance of fusion, neurological function and residual pain can affect it after spine surgery. Our aim was to perform a systematic review to collate evidence regarding the impact of spine surgery on sexual function.


A systematic review of studies reporting measures of sexual function, and incidence of adverse sexual outcomes (retrograde ejaculation) after major spine surgery was done, regardless of spinal location. Pubmed (MEDLINE) and Google Scholar databases were queried using the following search words “Sex”, “Sex life”, “Sexual function”, “Sexual activity”, “retrograde ejaculation”, “Spine”, “Spine surgery”, “Lumbar surgery”, “Lumbar fusion”, “cervical spine”, “cervical fusion”, “Spinal deformity”, “scoliosis” and “Decompression”. All articles published between 1997 and 2017 were retrieved from the database. A total of 81 studies were included in the final review.


Majority of the studies were retrospective case series and were low quality (Level IV) in evidence. Anterior lumbar approaches were associated with a higher incidence of retrograde ejaculation, especially with the utilization of transperitoneal laparoscopic approach. There is inconclusive evidence on the preferred sexual position following fusion, and also on the impact of BMP-2 usage on retrograde ejaculation/sexual dysfunction.


Despite limited evidence from high-quality articles, there is a general trend towards improvement of sexual activity and function after spine surgery. Future studies incorporating specific assessments of sexual activity will be required to address this important determinant of quality of life so that appropriate pre-operative counselling can be done by providers.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Sexual dysfunction Sexual activity Spine surgery Retrograde ejaculation 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

586_2018_5636_MOESM1_ESM.pptx (432 kb)
Supplementary material 1 (PPTX 432 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Azeem Tariq Malik
    • 1
  • Nikhil Jain
    • 1
  • Jeffery Kim
    • 1
  • Safdar N. Khan
    • 1
  • Elizabeth Yu
    • 1
  1. 1.Department of OrthopaedicsThe Ohio State University Wexner Medical CenterColumbusUSA

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