Back surgery preserves male fertility

March 7, 2011 9:46:33 AM PST
A cutting-edge approach to back surgery may preserve male fertility.

Spinal fusion is a common procedure for patients with back pain-but it also carries the risk of damage to sets of tiny nerves in the abdomen. Some of those nerves, especially in men, control sexual function and fertility. Surgeons are testing a high-tech approach that may eliminate the undesirable side effects.

Reading is the best way for Anthony Williams to bond with his niece and nephew while he recovers from back surgery. Williams has been living in pain from a violent car crash.

"The guy swerved over into the left, and pushed me into the island and I was bouncing back and forth like a ping-pong ball," said Williams.

The accident left Williams with a herniated and bulging disc, which got worse and worse. Surgery became his best option.

Doctors at the University of Pennsylvania are using a three dimensional robotic operating system for back surgeries. The goal is to avoid damaging tiny nerves in the abdomen that control sexual function.

"We could actually see these individual nerves branching off and spreading out. If you can see them, you can spare them," said Daniel Eun, MD, Assistant Professor of Urology, University of Pennsylvania School of Medicine, Director of Minimally Invasive Robotic Urologic Oncology and Reconstruction, The Pennsylvania Hospital.

With some approaches to back surgery, as many as forty percent of male patients may experience fertility problems. With the robotic approach, urologists advance the surgical instruments. Then neurosurgeons take over and fuse the spine endoscopically.

"I'm of the age where I remember the cartoons where the people were shrunk and put inside the body, and the first time I did this I felt like I was the person literally standing on the patient's spine," said William C. Welch, MD FACS, FICS, Clinical Vice Chairman of Neurological Surgery, Chief of Neurological Surgery, The Pennsylvania Hospital.

Williams' spinal fusion alleviated his pain-without side effects. He says other young men may be relieved to have this option.

"At 20, 21...Looking ahead as far as a family," said Williams.

The robot-assisted approach to spinal surgery is FDA approved. However, neurologists do not use the robot during the spinal fusion itself.


Olivia Fermano
Department of Communications
Penn Medicine