After a single-level ACDF, an athlete may return to contact sports if there are normal findings on a neurological examination, full range of neck movement, and solid arthrodesis. There may be an increased risk of the development of adjacent segment disease above or below the level of fusion. Cord hyperintensity may not necessarily preclude RTP.

Background: Multiple factors increase the risk for spinal surgical site infection (SSI): prior SSI, obesity, diabetes mellitus, advanced age, American Society of Anesthesiologists class, alcohol abuse, low prealbumin levels, smoking, history of cancer, chronic steroids, immunosuppressive drugs, rheumatoid arthritis, and hypothyroidism. Methods: Here, we performed a retrospective medical record review at one facility involving 5065 patients from 2010 to 2015. In 2011, there was an increase in the infection rate (1.07%) which prompted this analysis, resulting in the subsequent introduction of a protocol to reduce the infection risk. Results: The overall infection rate in this series was 0.59%. The lowest infection rate was 0.00% for anterior cervical discectomy and fusion. The highest rate of infections occurred among patients undergoing posterior cervical fusions, lumbar fusions, and tumor resections. Higher infection rates were also correlated with diabetes mellitus, obesity, and increased surgical time. Conclusions: Since 2011, we instituted a protocol to limit the risks of spinal SSIs, particularly for patients exhibiting increased medical comorbidities.

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Obesity and body mass index (BMI) have received increasing attention by both health care professionals and media. Obesity is defi ned by the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) as a BMI of 30 or above. A January 2012 press release from the CDC noted that in 2009-2010, the prevalence of obesity among adults in the United States was 35.7%. That translates to more than 78 million Americans being obese. In June 2013, the American Medical Association offi cially labeled obesity a disease, which may affect how insurers and the government pay for not only weight-loss drugs but also reimbursement for inpatient and outpatient services. This increasing attention to obesity places some increased focus on how obesity may impact other clinical conditions. This article addresses the factors that affect postoperative complications in high-risk overweight and obese patients and describes how to decrease the length of hospital stay in this population. Category: SpineLearning Objectives: After participating in this CME activity, the neurosurgeon should be better able to: 1. Identify the factors that can help minimize postoperative complications in high-risk patients. 2. Decrease the length of hospital stay for obese patients, which has become a critical element in today's health care environment.