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.