Development of a predictive model for postoperative erectile function recovery in male patients with incomplete traumatic cervical spinal cord injury.

BACKGROUND

Erectile dysfunction (ED) is prevalent after traumatic cervical spinal cord injury (CSCI), yet predictive tools for postoperative recovery remain underdeveloped. This study aimed to develop a clinical prediction model for erectile function recovery in male patients undergoing posterior cervical surgery for incomplete traumatic CSCI (iCSCI).

METHODS

In this retrospective cohort study, 207 male patients (aged 18-60 years) with iCSCI (ASIA grades B-D) who underwent posterior cervical decompression between 2018 and 2023 were included. Erectile function was assessed using the International Index of Erectile Function-5 (IIEF-5) at protocol-defined 3-month and 2-year postoperative follow-up visits. Improvement was defined as an increase of ≥ 1 severity category. Candidate predictors were screened via univariate analysis (P ≤ 0.20) and correlation assessment, followed by forward stepwise logistic regression. Model performance was evaluated using area under the receiver operating characteristic (ROC) curve (AUC) and internally validated via bootstrapping.

RESULTS

Median total follow-up was 41.00 months. Overall, 72.5% of patients showed erectile function improvement. The final prediction model included four independent predictors: preoperative ASIA grade (OR for grade D vs. B: 30.519, P < 0.001), injury level (C0-C3 vs. C4-C7; OR: 5.749, P = 0.012), injury to surgery interval (OR per day: 0.858, P = 0.018), and spinal cord compression ratio (OR per 1%: 0.937, P = 0.002). The model demonstrated robust discrimination (AUC: 0.881) and good calibration (Hosmer-Lemeshow P = 0.194). Bootstrap internal validation yielded an optimism-corrected AUC of 0.850. A nomogram was constructed to facilitate individualized risk estimation.

CONCLUSION

In male iCSCI patients, erectile function demonstrates significant potential for recovery following posterior cervical surgery. The validated four-factor model-presented as a clinical nomogram-enables personalized preoperative risk stratification to guide counseling and rehabilitation planning. External validation is required before widespread clinical implementation.