Preoperative serum albumin levels have been an established marker for overall nutrition,and hypoalbuminemia, measured by an albumin level less than 3.5 g/dL can be used as a proxyfor malnourishment.3 A growing corpus of evidence within orthopedics has linked malnutrition to increasedrisk for complications following surgery.4, , –7 These risk factors have also been described in other spinal surgeries such asposterior cervical fusion.2,8. The gene discussed is ALB; the disease is malnutrition.