Sexual Function After Corrective Spinal Osteotomy in Female Patients with Ankylosing Spondylitis: A Retrospective Single-Center Case Series

Background/Objectives: Ankylosing spondylitis (AS) may cause progressive spinal rigidity and kyphotic deformity, with consequences for physical function, quality of life, and sexual health. Data regarding sexual function following corrective spinal osteotomy in women with AS are limited. This study aimed to describe radiological and functional changes and to explore within-patient changes in sexual function following corrective spinal osteotomy. Methods: This retrospective single-center case series analyzed prospectively maintained data from female patients with AS who underwent single-level pedicle subtraction osteotomy for thoracolumbar kyphosis between 2015 and 2024. The primary outcome was the change in total Female Sexual Function Index (FSFI) score from baseline to the standardized two-year assessment. Secondary outcomes (analyzed as exploratory, without adjustment for multiplicity) included FSFI domains, Visual Analog Scale, Bath Ankylosing Spondylitis Functional Index, and radiological parameters. Sexual-activity frequency, time to resumption of sexual activity, and preferred coital position were also recorded. Paired outcomes were analyzed using the exact Wilcoxon signed-rank test, and exploratory radiological–FSFI associations using Spearman’s correlation with false-discovery-rate adjustment. Results: Eleven patients with complete two-year data were included. Significant postoperative changes were observed in several sagittal alignment parameters, as well as in Visual Analog Scale (VAS) and Bath Ankylosing Spondylitis Functional Index (BASFI) scores. Total FSFI and the desire, arousal, orgasm, and satisfaction domains increased, whereas lubrication and pain did not change significantly. A descriptive shift toward higher-frequency sexual activity and different preferred coital positions was also observed. Radiological–FSFI correlations were interpreted cautiously because of the small sample and multiple comparisons. Conclusions: In this small exploratory cohort, postoperative assessment was associated with improved radiological alignment, pain, physical function, and several domains of self-reported sexual function. These findings represent within-patient changes and exploratory associations and do not establish a causal effect of spinal osteotomy on sexual function or a specific safe interval for resumption of sexual activity. Larger prospective studies are needed to confirm these observations.