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was smaller (P=0.023), the posteriorly inclined segment was longer (P<0.001) and T1 and T3-T11 were more posteriorly inclined (P<0.05) compared to boys. At the peak of the growth spurt, girls still had a relatively lower thoracic kyphosis with more posterior inclination whereas boys already developed a greater thoracic kyphosis with less posterior inclination (P=0.005). Conclusion These results imply that the spine of girls during the growth spurt is more posteriorly inclined, affected by greater posteriorly directed shear loads and rotationally less stable compared to boys and compared to girls after the growth spurt. This may explain why initiation and progression of AIS frequently occurs in girls around puberty.

Natural sagittal spino-pelvic alignment in boys and girls before, at and after adolescent peak height velocity