Sex and gender determinants following spinal fusion surgery: A systematic review of clinical data

Abstract

In the last decade, numerous studies analyzed and described the surgical outcomes in male and female patients submitted to orthopedic surgery. Although this, the impact of sex/gender on spinal fusion surgery clinical outcomes is still poorly defined. This review systematically maps and synthesizes the scientific literature on sex/gender differences in postoperative outcomes for patients undergoing spinal fusion surgery. The search was performed in PubMed, Scopus, and Web of Science in the last 22 years. Clinical studies evaluating potential sex/gender differences in postoperative outcomes and/or complications, as primary or secondary aim, were included and analyzed. Out of the 1,885 records screened, 47 studies were included. These studies comprised a total of 1,158,555 patients (51.31% female; 48.69% male). About 77% of the analyzed studies reported sex/gender-related differences in postoperative outcomes. Most studies treated patients for lumbar degenerative diseases and more than 55% of them reported a worse postoperative outcome in female patients in terms of pain, disability, health-related quality of life questionnaires, and complications. Differently, a significant heterogeneity across studies on patients treated for cervical and sacral degenerative diseases as well as for spinal deformity and traumatic spinal fracture prevented the understanding of specific sex/gender differences after spinal fusion surgery. Despite this, the present review highlighted those female patients treated for lumbar degenerative spine diseases could require more clinical awareness during postoperative care. The understanding of how sex/gender differences can really affect clinical outcomes after spinal fusion surgeries is mandatory for all spinal pathological conditions to drive clinical research toward oriented and personalized protocols.

Intraoperative Spinal Cord Stimulation Mitigates Central Sensitization After Spine Surgery in Mice

“…It is also noteworthy that postoperative outcomes, including pain, are reportedly worse in women than in men after spine surgery. 31 This aligns with our results suggesting that spine surgery induces greater central sensitization in females than in males. Future studies are warranted to determine whether females and males develop central sensitization after spine surgery in a mechanistically different manner, and if so, whether it is the basis of the sex differences in the pain-related outcomes of spine surgery and the efficacy of SCS.…”

“…Our results support the clinical report, showing that SCS-treated female mice were still more hypersensitive to von Frey filament stimulation of their hind paws than their male counterpart. It is also noteworthy that postoperative outcomes, including pain, are reportedly worse in women than in men after spine surgery 31. This aligns with our results suggesting that spine surgery induces greater central sensitization in females than in males.…”

Gender-Related Issues in the Management of Low-Back Pain: A Current Concepts Review

“…Salamanna et al analyzed in a review the studies considering sex-and gender-related differences in patients treated for lumbar degenerative diseases (disc degeneration, disc herniation, and spondylolisthesis) [56]. More than half of the studies reported a worse postoperative outcome in terms of pain, disability, health-related quality of life (HRQoL), and complications in women, while the remaining reported worse clinical outcomes in terms of satisfaction and HRQoL in male patients [56].…”

“…Salamanna et al analyzed in a review the studies considering sex-and gender-related differences in patients treated for lumbar degenerative diseases (disc degeneration, disc herniation, and spondylolisthesis) [56]. More than half of the studies reported a worse postoperative outcome in terms of pain, disability, health-related quality of life (HRQoL), and complications in women, while the remaining reported worse clinical outcomes in terms of satisfaction and HRQoL in male patients [56]. In studies examining pain, disability, and HRQoL differences between females and males, the complexity of evaluating these parameters, which include many clinical signs and subjective outcomes, must be considered [56].…”

Decellularized biological matrices for the repair of rotator cuff lesions: a systematic review of preclinical in vivo studies

“…None of the included studies analyzed sex differences because they did not test the efficacy of the patches in both sexes simultaneously; the research groups either used only male animals ( Ide and Tokunaga, 2018 ; Chen et al, 2020 ; Chen et al, 2022 ; de Lima Santos et al, 2020 ; He et al, 2021 ; Santos et al, 2022 ) or, to a lesser extent, female animals ( Thangarajah et al, 2018 ; Credille et al, 2023 ). It is now well established that sex differences, mainly due to hormonal variations and levels, affect musculoskeletal pathologies, including tendons ( Contartese et al, 2020 ; Tschon et al, 2021 ; Mondini Trissino Da Lodi et al, 2022 ; Salamanna et al, 2022 ; Salamanna et al, 2023 ). Clinical studies involving both men and women have shown a difference in prevalence ( Razmjou et al, 2016 ; Sabo et al, 2021 ) on the extent of shoulder pathology, repair, and healing, with a higher rate of re-tear in women than in men ( Collin et al, 2015 ; Razmjou et al, 2016 ).…”