Multidimensional predictive factor analysis of sexual function prognosis in male patients following cord injury without fracture or dislocation

BACKGROUND: Cervical spinal cord injury (CSCI) without fracture or dislocation (CSCIWFD) frequently results in significant male sexual dysfunction, yet comprehensive studies on recovery patterns and predictive factors remain limited. METHODS: This retrospective cohort study evaluated 187 male CSCIWFD patients treated with posterior laminoplasty, with serial assessments at 3-month, 2-year, and final follow-up (median 57 months). Neurological function was assessed using the American Spinal Injury Association (ASIA) Impairment Scale, while sexual function was quantified through validated measures: the International Index of Erectile Function-5 (IIEF-5), the Premature Ejaculation Diagnostic Tool (PEDT), and the International Spinal Cord Injury Male Sexual Function (ISCI-MSF) Basic Data Set. Comprehensive radiographic evaluation included minimal Torg-Pavlov ratio (TPRmin), median Torg-Pavlov ratio (TPRmedian), spinal cord compression rate, and magnetic resonance imaging-based high cord signals (HCS). Demographic and perioperative variables (age, body mass index, preoperative hemoglobin, injury-to-surgery interval, operative duration, and blood loss) were systematically analyzed. RESULTS: Significant sexual dysfunction was prevalent at baseline (97.3% erectile dysfunction; 86.6% ejaculatory disorders). By 2-year follow-up, erectile function improved substantially (mean IIEF-5: 10.24 to 16.20, P < 0.05), with 72.7% achieving normal or mild-affected erectile function (P < 0.05). Ejaculatory control normalized in 87.7% of cases at the 2-year follow up (mean PEDT: 10.73 to 4.54, P < 0.05). Significant global improvements in ISCI-MSF Basic Data Set were observed over the 2-year follow-up (P < 0.001 all comparisons). Strong correlations emerged between recovery and preoperative ASIA grade (ρ = - 0.700 to -0.754), time-to-surgery (ρ = - 0.402 to -0.372), HCS (ρ = - 0.325 to -0.341), TPRmin (ρ = 0.716 to 0.772), TPRmedian (ρ = 0.690 to 0.746), and cord compression rate (ρ = - 0.707 to -0.752) (all P < 0.001). CONCLUSION: CSCI without fracture or dislocation leads to profound sexual dysfunction. Poorer outcomes correlate with delayed surgical decompression, higher ASIA impairment grades, lower TPRmin and TPRmedian, and radiographic evidence of HCS or spinal cord compression. These findings highlight the potential value of integrating neuroimaging biomarkers and psychosexual evaluation into rehabilitation strategies.