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What's New — Spine — August 2026

20 new articles published this month.

Themes: Pediatric Deformity Risk Stratification · Cervical Deformity and Myelopathy · Lumbar Degeneration and Imaging · Hip-Spine Syndrome Interactions · Predictive Analytics and Risk Models · Miscellaneous and Corrections

Digest generated 2026-09-14 08:30:47+00:00.

Highlights

Pediatric Deformity Risk Stratification

Risk prediction in paediatric spinal deformity surgery is a focus this month. The SCARE Score offers a simplified, statistically robust tool for predicting intraoperative neuromonitoring signal loss, with an accompanying commentary highlighting its clinical utility [9, 5]. Complementing this, a large NSQIP-Pediatric analysis demonstrates that frailty (Pediatric Spine Frailty Index) and surgical invasiveness (Surgical Invasiveness Index) independently predict 30-day complications, reoperation, and readmission, with a commentary advocating combined use of both tools [12, 7]. Separately, a systematic review clarifies the prevalence and incidence of isthmic spondylolisthesis in children and adolescents, addressing inconsistent definitions and the role of sports participation and low back pain [15].

Cervical Deformity and Myelopathy

Cervical spine topics span deformity planning, historical perspectives, and trauma care. Principles for upper and lower instrumented vertebra selection in adult cervical deformity surgery are outlined, accounting for bone health, sagittal alignment, and combined cervicothoracolumbar deformities [1]. A centennial review traces Japan's pioneering contributions to degenerative cervical myelopathy, from the Hattori classification and ten-second test to posterior decompressive techniques developed in response to high OPLL prevalence [10]. The French school's broader innovations in sagittal balance, deformity correction, and instrumentation, including EOS imaging, provide complementary historical context [18]. Additionally, factors associated with emergency airway intervention after extubation in traumatic cervical spinal cord injury are analyzed to guide postoperative airway management [19].

Lumbar Degeneration and Imaging

Lumbar degenerative disease and advanced imaging dominate several articles. Multi-parametric quantitative MRI (T1, T2, proton density mapping) objectively characterizes disc high-intensity zones associated with discogenic low back pain, moving beyond subjective conventional MRI assessment [13]. A systematic review examines the therapeutic effect of saline injections in lumbar injection trials, revealing that presumed inert placebo may itself improve patient-reported outcomes in radiculopathy and discogenic pain, confounding trial interpretation [14]. Sagittal alignment patterns in forward head posture are analyzed with standing EOS radiographs, correlating cranio-cervical through lumbopelvic parameters and highlighting upper cervical contributions to global sagittal balance [11].

Hip-Spine Syndrome Interactions

The interplay between spinal pathology and hip surgery emerges as a distinct theme. At 10-year follow-up after hip arthroscopy for femoroacetabular impingement, patients with concomitant lumbar spinal disease (hip-spine syndrome) show less improvement in patient-reported outcomes than matched controls [16]. In total hip arthroplasty planning, spinal morphology classified by the modified Roussouly system influences standing-to-supine pelvic mobility, with implications for acetabular anteversion and component positioning [17]. These studies underscore the importance of assessing spinal alignment and mobility when planning hip surgery, particularly regarding acetabular cup placement.

Predictive Analytics and Risk Models

Prediction modeling and risk quantification across orthopaedics receive critical appraisal. A perspectives piece cautions that machine-learning models predicting surgical complications, despite frequently exceeding AUC 0.80 in development cohorts, rarely undergo external validation, limiting clinical readiness [2]. The paediatric frailty and invasiveness scoring literature [12, 7] and the SCARE Score [9, 5] exemplify rigorously developed risk tools, while a retrospective study defines an operational reduced-BMD subgroup among adults with type 2 diabetes using routine DXA and clinical variables, testing whether complex classifiers improve discrimination beyond age and sex [8].

Miscellaneous and Corrections

Remaining articles include a correction to a spinal cord injury study on circ_0044235 and miR-338-5p neuroinflammation signaling, correcting only the corresponding author's name [4]. A humanities perspective reflects on the personal cost of spinal degeneration in laborers and the restorative mission of orthopaedic surgery [6]. Paediatric vertebral fractures managed conservatively show minimal kyphotic progression, suggesting reduced radiographic surveillance may be appropriate in this radiosensitive population [3].

Articles by Theme

Pediatric Deformity Risk Stratification (5)

5. Jiang L, Soh RC. Simplicity Meets Utility: The SCARE Score in Pediatric Spinal Deformity Surgery. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.26.00420

This commentary discusses the SCARE Score, a simplified risk score for predicting intraoperative neuromonitoring loss during paediatric spinal deformity surgery. The author highlights the score's clinical utility as a straightforward tool for identifying patients at risk of neuromonitoring alerts, which serve as surrogate markers of impending spinal cord compromise. Such risk stratification can guide intraoperative vigilance and prompt intervention to prevent permanent neurological injury.

7. Truong WH. Using Frailty and Surgical Invasiveness Scores in Patients with Pediatric Spinal Deformity. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.26.00528

This commentary reviews a study using the ACS NSQIP Pediatric database of over 46,000 patients demonstrating that both frailty (Pediatric Spine Frailty Index) and surgical invasiveness (Pediatric Spine Surgical Invasiveness Index) independently predict perioperative complications in paediatric spinal deformity surgery. The commentary supports incorporating both patient comorbidity and anticipated surgical magnitude into multidisciplinary preoperative assessments. This dual assessment approach improves risk prediction compared to either tool alone.

9. Moore D, Keohane D, Haffey S, et al. The SCARE Score: A Simplified Risk Score for Predicting Intraoperative Neuromonitoring Signal Loss in Pediatric Spinal Deformity Surgery. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.25.01192

Using prospectively collected data from 413 paediatric spinal deformity surgeries at a tertiary center, the authors performed univariate and multivariable regression on preoperative variables to build a weighted risk score (SCARE) for predicting intraoperative neuromonitoring signal loss, with internal validation via a 70/30 split. The score identifies patients at elevated odds of neuromonitoring events preoperatively. Clinically, it offers surgeons a simple bedside tool for risk stratification and perioperative planning in paediatric deformity correction.

12. Chan V, Simmonds A, Maclean L, et al. Frailty and Surgical Invasiveness Are Independently Associated with Complications in Pediatric Spinal Deformity Surgery. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.25.01477

This retrospective cohort study of 46,399 paediatric spinal fusion patients from the NSQIP-Pediatric database (2016-2023) used multivariable logistic regression to test whether frailty (Pediatric Spine Frailty Index) and surgical invasiveness (Pediatric Spine Surgical Invasiveness Index) independently predict 30-day outcomes. Both domains were independently associated with adverse events, reoperation, and readmission, with risk rising when combined. Clinically, preoperative frailty assessment should be integrated with planned surgical invasiveness when counseling families and optimising paediatric deformity patients.

15. Rostamian N, Lopez Gomez MF, Stoffers P, et al. Prevalence and Incidence of Isthmic Spondylolisthesis in Children and Adolescents: A Systematic Review. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/23259671261466477

This PRISMA-compliant systematic review synthesized cross-sectional and longitudinal studies reporting radiologically confirmed isthmic spondylolisthesis prevalence and incidence in children and adolescents ≤20 years, stratified by organized sports participation, low back pain, and diagnostic method. It documented widely varying estimates attributable to inconsistent definitions and populations, with higher rates among athletes. The results underscore the need for standardised diagnostic criteria to inform screening and prevention strategies, particularly for young athletes with LBP.

Cervical Deformity and Myelopathy (4)

1. Sardar ZM, Coury JR, Bautista AG, et al. Principles of Level Selection for Instrumentation in Adult Cervical Spinal Deformity Surgery. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.25.01540

This review outlines evidence-based principles for selecting upper and lower instrumented vertebrae in adult cervical spinal deformity surgery. Key recommendations include C3-C4 as the upper instrumented vertebra for isolated deformities with good bone health versus C2 for global deformity or poor bone quality, and extension into the proximal thoracic spine (T1-T3) when sagittal alignment is poor. These guidelines help surgeons balance construct stability against the morbidity of extended fusions when planning cervical deformity correction.

10. Chikuda H. Clinical evolution in the treatment of degenerative cervical myelopathy in Japan: excellence born from necessity. International Orthopaedics 2026. doi:10.1007/s00264-026-06972-3

This centennial narrative review traces Japan's contributions to degenerative cervical myelopathy care, from pre-MRI diagnostic landmarks (Hattori classification, ten-second test) to the invention and refinement of laminoplasty techniques (open-door, double-door), driven by the high local prevalence of developmental canal stenosis and OPLL. It documents how demographic necessity produced globally adopted diagnostic and surgical standards. The clinical implication is that posterior decompressive approaches and neurological assessment methods pioneered in Japan remain foundational to contemporary DCM practice.

18. Marie-Hardy L, Chatelain L, Bouthors C, et al. Essential innovations in spinal surgery: Contributions from the French school. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104842

This narrative review traces French contributions to spinal surgery over the past fifty years, covering sagittal balance concepts (Stagnara, Duval-Beaupère, Legaye, Roussouly), 3D deformity correction and segmental instrumentation for scoliosis (Cotrel-Dubousset), and trauma/instrumentation advances (Roy-Camille, Louis, Argenson, Onimus, Marnay). It also catalogs technological innovations including EOS imaging, vertebroplasty, disc prostheses, pedicle guidance, and planning platforms. The review highlights how these foundational biomechanical and surgical concepts continue to shape modern spine care and points to future directions for the specialty.

19. Ijuin S, Inoue A, Nishimura T, et al. Analysis of factors associated with emergency airway intervention after extubation in patients surgically treated for traumatic cervical spinal cord injury without planned prophylactic airway management. Injury 2026. doi:10.1016/j.injury.2026.113622

This retrospective cohort of 221 patients surgically treated for traumatic cervical spinal cord injury without planned prophylactic airway management examined factors associated with emergency airway intervention after extubation. Twenty-three percent required emergency airway intervention, with multivariable analysis identifying neurogenic shock, complete motor impairment, and vertebral artery injury as independent risk factors. These findings can help clinicians identify tCSCI patients who may benefit from closer postoperative airway surveillance or planned prophylactic airway management.

Lumbar Degeneration and Imaging (3)

11. Rios-Peralta KN, Firouzabadi A, Curran KM, et al. Sagittal alignment patterns in forward head posture: an EOS-based head-to-pelvis correlation analysis. BMC Musculoskeletal Disorders 2026. doi:10.1186/s12891-026-10267-4

In this retrospective EOS radiographic study of 201 adults evaluated for low back pain, head-to-pelvis sagittal alignment was compared between individuals with and without forward head posture using 16 sagittal balance parameters and age-adjusted regression. FHP was associated with greater upper cervical extension and increased cervical sagittal vertical axis, T1 slope, thoracic kyphosis, and global sagittal vertical axis. The findings suggest FHP reflects a whole-spine compensatory alignment pattern rather than an isolated craniovertebral finding, supporting global sagittal assessment beyond CVA alone.

13. Meng L, Liu X, Jiang K, et al. Multi-parametric quantitative MRI for characterizing of lumbar intervertebral disc high-intensity zones in patients with chronic low back pain. Journal of Orthopaedic Surgery and Research 2026. doi:10.1186/s13018-026-07129-z

In this cross-sectional study, patients with chronic low back pain underwent conventional and multi-parametric quantitative MRI (T1, T2, proton density mapping of nucleus and annular subregions), and generalized estimating equation models identified independent factors associated with posterior annulus high-intensity zones. The integrated model combining quantitative and morphological parameters showed discriminative ability for HIZ detection. This supports quantitative MRI as an objective complement to subjective visual assessment when evaluating suspected discogenic pain and annular tears.

14. Sadh P, Dassow M, Suleman Y, et al. The Therapeutic Effect of Saline in Lumbar Injection Trials. JBJS Reviews 2026. doi:10.2106/jbjs.rvw.26.00057

This systematic review of RCTs (2000-2025) pooled within-arm pre-post changes in VAS and ODI following saline injection in lumbar radiculopathy and discogenic pain trials, with subgroup analyses by injection route and follow-up up to 1 year. Saline injection produced measurable, at times durable, improvements in pain and disability outcomes. The clinical implication is that saline is not an inert placebo in lumbar injection studies, and its intrinsic therapeutic effect can bias comparative effectiveness estimates.

Hip-Spine Syndrome Interactions (2)

16. Chen L, Shelbaya S, Ruff G, et al. Poster 136. Patients With Concomitant Lumbar Spinal Disease Have Less Significant Improvement Than Those Without Lumbar Spinal Disease at 10-Year Follow-up Following Hip Arthroscopy for Femoroacetabular Impingement. Orthopaedic Journal of Sports Medicine 2026. doi:10.1177/2325967126s00438

In this propensity-matched retrospective analysis (28 hip-spine syndrome patients vs 56 controls) of hip arthroscopy for femoroacetabular impingement with minimum 10-year follow-up, patient-reported outcomes (mHHS, NAHS) and MCID achievement were compared. Patients with concomitant lumbar spinal disease demonstrated less significant improvement than matched controls at 10 years. Clinically, preoperative lumbar pathology should be considered when counseling FAIS patients about expected long-term benefit from hip arthroscopy.

17. Casasola D, Pierson A, Boukhelifa S, et al. The influence of spinal morphology on the standing-to-supine pelvis mobility in preoperative planning for total hip arthroplasty. Consequences in THA planning. Orthopaedics & Traumatology: Surgery & Research 2026. doi:10.1016/j.otsr.2026.104818

This retrospective study of 93 THA patients used standing EOS and supine scout imaging to measure spinopelvic parameters (SS, PI, PT, LL) and classify spinal morphology by the modified Roussouly classification. Sacral slope was significantly higher supine than standing (46° vs 41°, p<0.001), with the magnitude of pelvic mobility varying by spinal morphology type. The findings suggest that preoperative assessment of spinal morphology and standing-to-supine pelvic mobility should inform acetabular anteversion planning in THA via direct anterior approach.

Predictive Analytics and Risk Models (6)

2. Kamal H. Machine Learning Models for Predicting Orthopaedic Surgical Complications. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.26.00770

This perspective article cautions that machine-learning prediction models for orthopaedic surgical complications, despite frequently reporting AUC values above 0.80 in development cohorts, are generally not ready for clinical use. A cited systematic review of 59 models found only 10 had undergone any external validation, and reporting quality was limited. The author argues that performance in one dataset does not translate to reliability in another, emphasizing the need for external validation before clinical deployment.

5. Jiang L, Soh RC. Simplicity Meets Utility: The SCARE Score in Pediatric Spinal Deformity Surgery. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.26.00420

This commentary discusses the SCARE Score, a simplified risk score for predicting intraoperative neuromonitoring loss during paediatric spinal deformity surgery. The author highlights the score's clinical utility as a straightforward tool for identifying patients at risk of neuromonitoring alerts, which serve as surrogate markers of impending spinal cord compromise. Such risk stratification can guide intraoperative vigilance and prompt intervention to prevent permanent neurological injury.

7. Truong WH. Using Frailty and Surgical Invasiveness Scores in Patients with Pediatric Spinal Deformity. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.26.00528

This commentary reviews a study using the ACS NSQIP Pediatric database of over 46,000 patients demonstrating that both frailty (Pediatric Spine Frailty Index) and surgical invasiveness (Pediatric Spine Surgical Invasiveness Index) independently predict perioperative complications in paediatric spinal deformity surgery. The commentary supports incorporating both patient comorbidity and anticipated surgical magnitude into multidisciplinary preoperative assessments. This dual assessment approach improves risk prediction compared to either tool alone.

8. Lu S, Wan B, Qian C, et al. Clinical characteristics of the reduced bone mineral density subgroup among adults with type 2 diabetes mellitus: a retrospective cross-sectional study. BMC Musculoskeletal Disorders 2026. doi:10.1186/s12891-026-10346-6

This retrospective cross-sectional study of 329 adults with type 2 diabetes mellitus who underwent dual-energy X-ray absorptiometry defined an operational reduced-BMD subgroup (any site T-score ≤ -1.0 at lumbar spine, femoral neck, or total hip) using routine hospital data. The analysis examined whether routinely available clinical variables showed incremental associations with reduced BMD and whether complex classifiers improved discrimination beyond age and sex. The findings inform identification of skeletal fragility risk in T2DM patients, a population in which areal BMD incompletely represents fracture susceptibility.

9. Moore D, Keohane D, Haffey S, et al. The SCARE Score: A Simplified Risk Score for Predicting Intraoperative Neuromonitoring Signal Loss in Pediatric Spinal Deformity Surgery. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.25.01192

Using prospectively collected data from 413 paediatric spinal deformity surgeries at a tertiary center, the authors performed univariate and multivariable regression on preoperative variables to build a weighted risk score (SCARE) for predicting intraoperative neuromonitoring signal loss, with internal validation via a 70/30 split. The score identifies patients at elevated odds of neuromonitoring events preoperatively. Clinically, it offers surgeons a simple bedside tool for risk stratification and perioperative planning in paediatric deformity correction.

12. Chan V, Simmonds A, Maclean L, et al. Frailty and Surgical Invasiveness Are Independently Associated with Complications in Pediatric Spinal Deformity Surgery. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.25.01477

This retrospective cohort study of 46,399 paediatric spinal fusion patients from the NSQIP-Pediatric database (2016-2023) used multivariable logistic regression to test whether frailty (Pediatric Spine Frailty Index) and surgical invasiveness (Pediatric Spine Surgical Invasiveness Index) independently predict 30-day outcomes. Both domains were independently associated with adverse events, reoperation, and readmission, with risk rising when combined. Clinically, preoperative frailty assessment should be integrated with planned surgical invasiveness when counseling families and optimising paediatric deformity patients.

Miscellaneous and Corrections (3)

3. Wegmann S, Lenz M, Babasiz T, et al. Minimal kyphotic progression following pediatric vertebral fractures: implications for reduced radiographic surveillance. Archives of Orthopaedic and Trauma Surgery 2026. doi:10.1007/s00402-026-06482-2

This retrospective cohort study of 54 paediatric patients (mean age 12.3 years) with traumatic vertebral body fractures examined kyphotic progression during conservative management. Cobb angle measurements at 1, 3, and 6 weeks showed essentially unchanged kyphosis angles across all intervals, with minimal progression. The findings suggest routine radiographic surveillance may be reduced in this radiosensitive population, decreasing cumulative radiation exposure in children with stable compression fractures.

4. Lin M, Huang L, Zhang B, et al. Correction: circ_0044235 exacerbates neuroinflammation and apoptosis following spinal cord injury by targeting miR-338-5p. Journal of Orthopaedic Surgery and Research 2026. doi:10.1186/s13018-026-07193-5

This is a publisher's correction notice for a previously published study on circ_0044235 and spinal cord injury. The correction addresses an error in the corresponding author's name, which was incorrectly listed as 'Wencong Zen' rather than 'Wencong Zeng.' No scientific content or findings were altered.

6. Singh P. They Built Their Lives with Their Bodies. Journal of Bone and Joint Surgery 2026. doi:10.2106/jbjs.26.00856

This humanities perspective piece offers a reflective narrative on orthopaedic surgery as restoration of human function rather than mere mechanical repair. Through personal recollections of a father's spinal degeneration endured silently during labor and caregiving, the author emphasizes that joints represent the means by which people live and love, lifting children, working, and moving through life. The piece underscores the humanistic dimension of orthopaedic practice beyond technical precision.

20. Lee S, Jayne C, Kim MT, et al. Patients with Cervical Degenerative Disease Have Greater Postoperative Opioid Use and Reoperation Following Shoulder Instability Procedures. JSES Reviews, Reports, and Techniques 2026. doi:10.1016/j.xrrt.2026.100859

This retrospective comparative study evaluated postoperative opioid use and reoperation rates after shoulder instability procedures in patients with versus without cervical degenerative disease. Patients with cervical degenerative disease demonstrated significantly greater postoperative opioid consumption and higher reoperation rates following shoulder instability surgery. The results suggest cervical degenerative disease is a relevant comorbidity to consider when counseling patients and managing expectations after shoulder instability procedures.

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b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.