Sexual dysfunction after elective spine surgery: A systematic review identifying knowledge gaps and clinical implications

Introduction: Spine surgery is one of the most frequently performed surgical procedures globally, with increasing numbers particularly among older patients. Sexual function significantly impacts quality of life, yet sexual dysfunction following spine surgery remains underexplored. Research question: This systematic review aims to summarize current research on sexual dysfunction following spine surgery, identify knowledge gaps, and clinical implications. Methods: A systematic literature search was conducted following the PRISMA-DTA guidelines. Relevant articles were identified utilizing MEDLINE and PubMed database focusing on studies reporting sexual function outcomes after elective spine surgery. Fifteen studies meeting the inclusion criteria were analyzed for study type, sample size, surgical approach, and sexual function outcomes. Results: The majority of studies were retrospective and single-center with small sample sizes. About 62% reported no decline or improvement in sexual function after surgery, while 38% documented a decrease. Surgical approaches and patient populations varied widely. Most studies utilized the Oswestry Disability Index (ODI) to address sexual activity, though its limitations in capturing nuanced sexual dysfunction were noted. Research addressing sexual dysfunction on a deeper level, including psychological and gender-specific sexual health remained scarce. Discussion and conclusion: Evidence on sexual dysfunction following spine surgery currently is heterogeneous and limited. There is a critical need for high-quality, prospective, gender-specific research employing comprehensive and validated sexual function assessments. The routine evaluation of sexual function holds the potential to enhance understanding, improve patient counseling, postoperative care, and overall quality of life.