Effect of lumbar spinal stenosis and surgical decompression on erectile function

Retrospective clinical case series.

To evaluate whether and how often patients with lumbar spinal stenosis presenting for surgery have an erectile dysfunction before and after decompressive surgery.

So far, there are no reported data on pre- and postoperative erectile function status for patients with lumbar spinal stenosis.

A total of 197 male patients with lumbar spinal stenosis who underwent spinal decompression between May 2006 and June 2007 were screened. Patients over 75 years, patients who had previous radical prostatectomy, and patients with psychiatric or other severe concomitant diseases were excluded. Patients with further symptoms for cauda equina syndrome were excluded as well. The erectile function of the remaining 38 patients with a mean age of 63 years was retrospectively rated before and after lumbar spinal decompression using a standardized questionnaire (International Index of Erectile Function-5). Additionally, pre- and postoperative pain, quality of life, and walking distance were assessed.

As expected severe preoperative back and leg pain significantly decreased after decompressive surgery. This was associated with a significant increase in the quality of life. The incidence of erectile dysfunction before and after surgery was higher compared to population-based standard data, and surgery was associated with a significant decrease of erectile function at latest follow-up (9.7 months).

Lumbar spinal stenosis is associated with a neglected prevalence of erectile dysfunction. Surprisingly, it does not improve after decompressive spinal surgery; moreover, a decline was observable. Underlying mechanisms of the postoperative decline remain obscure.