Medical Student University of Utah School of Medicine Salt Lake City, Utah, United States
Introduction: The medical literature on prisoner healthcare is quite limited, despite data showing that prisoners experience high rates of physical and mental health challenges. Our objective was to compare clinical outcomes for prisoners undergoing spine fusion with comparable patients from the general population and determine what factors might be implicated in differences in outcomes.
Methods: Prisoners who underwent spinal fusion at our hospital in 2011–2021 were retrospectively reviewed. An age-, sex-, and procedure-matched 3:1 control group of nonincarcerated patients that underwent spinal fusion during a similar time period was used for comparison. The primary outcome was fusion failure based on 1) lack of bridging bone between vertebrae on computed tomography or radiographic images >1 year postoperatively; or 2) evidence of instrumentation failure (such as screw breakage or rod fracture) with resultant >2 mm of translation during spinal flexion/extension on radiographs.
Results: Twenty-seven prisoners met the inclusion criteria and 81 non-incarcerated controls were used for comparison. Ten prisoners and 6 control patients experienced nonunion (37% vs.7%, p< 0.01). Rates of traditional risk factors for fusion failure such as any smoking history, elevated body mass index, chronic steroid use, diabetes mellitus, previous spine surgery, and levels fused were not significantly different between prisoners and controls. Among prisoners, those with nonunion were younger (45 vs. 53 years, p=0.03), had greater body mass index (34 vs. 29, p=0.02), and were more likely to undergo reoperation (30 vs. 0%, p=0.02). Multivariate analysis revealed that prisoners carry a 9.62 increased odds of fusion failure compared with controls.
Conclusion : Prisoners experienced a significantly higher rate of fusion failure than age-, sex-, and procedure-matched control patients from the general population treated at the same hospital, suggesting additional measures may be necessary postoperatively to support fusion in prisoners.
