Background: Lumbar disc replacement is a good alternative to fusion in young patients with degenerative disc disease or discogenic back pain. Despite the increase in the use of anterior lumbar disc replacement, there has been little published data of the specific types and frequencies of the complications associated with its use.

Aims & Methods: Purpose of the study is to retrospectively study the perioperative complications associated with CHARITÉ® Artificial Disc replacement. The lumbar spine is retroperitoneally approached, viscera and major vessels retracted and the disc replaced. We reviewed the operative and hospital records of 54 charite disc replacements done by the senior author from 2004 till September 2006.

Results: The study group had 23 men and 31 women with a mean age of 38 years (range 31–47). Preoperative diagnosis was degenerative disc disease in 42 patients (78%); discogenic back pain in 12 patients (22%). The most common level replaced was L4/5 (48%) followed by L5/S1 (35%). The most common complication during the procedure was venous injury involving one of the left iliac vein tributary (9 patients, 16%). There was no arterial injury. The median blood loss was 450ml (100–1500ml). There was peritoneum breach in six patients, but no case of bowel, ureter, and bladder or kidney injury. There were two incidences of significant post operative ileus and one developed S1 radiculopathy from lateral disc placement. One developed incisional hernia and two patients had to be revised to fusion. Retrograde ejaculation was reported in 3 patients. No incidence of epidural vein bleed, CSF leak, infection, paraplegia or death.

Conclusions: Anterior spinal surgery is a relatively safe procedure with a lower complication rate than was previously reported. Vascular injury was the most frequent complication. The incidence of autonomous dysfunction affecting pelvic floor function appears to be under-estimated and needs further study.

Background: Retrograde ejaculation has been reported to range from 2% to 16% following anterior surgical approaches to lower lumbar spine, but the exact incidence is not known. It has been felt for sometime that transecting or extensive dissection of the hypogastric plexus about the lumbo sacral junction could interrupt the sympathetic control of urogenital system and interfere with sexual function.

Invasive tests such as urodynamic tests, anorectal manometry and post ejaculatory urine sample would precisely determine its incidence. As a first step we, along with Urogynaecologist devised and validated a questionnaire to determine the urogenital function post operatively.

Aims & Methods: To retrospectively determine the incidence of sympathetic dysfunction in anterior lumbar spine surgery. 46 of 60 patients (76% response) who had anterior lumbar spinal surgery answered a validated questionnaire with urinary and bowel function, International Index of Erectile Function (IIEF) for men and Female Sexual Function Index (FSFI).

Results: All the females post operatively had retained bowel function and there were no reported cases of sense of urgency, incontinence of stools or flatus. But only one patient reported urinary stress incontinence. There was no change of sexual function as concluded from FSFI score.

In males we had 3 cases of retrograde ejaculation which affected the sexual function (based on IIEF score), and were reported to be resolving slowly. There was no incidence of any urinary or bowel dysfunction postoperatively.

Conclusions: This retrospective study only showed the overall picture of the incidence of pelvic floor dysfunction following anterior spinal surgery. A prospective trial is underway to determine its incidence.