Sexual complications of anterior fusion of the lumbar spine.

Recently, there is renewed interest in anterior fusion for spondylolisthesis and congenital and paralytic scoliosis with pelvic obliquity. Some of the candidates are prepubertal boys. Sterility after surgery in urogenitally normal prepubertal boys will not be determined until these patients mature. A worldwide survey of 20 surgeons with 15-20 years of experience (4,500 cases) reports the frequency of sterility (retrograde ejaculation) to be 19 cases (0.42%) and impotence 20 cases (0.44%). One-fourth of the retrograde ejaculation cases resolved and became normal. Impotence is non-organic. The complication of retrograde ejaculation does not appear to be related to approach, though it was related to technique. While the complications of sterility and impotence following anterior fusion have been over-exaggerated, caution and informed consent from adult males and parents of prepubertal male children is advisable.