Musculoskeletal models have the potential to improve diagnosis and optimize clinical treatment by predicting accurate outcomes on an individual basis. However, the subject-specific modeling of spinal alignment is often strongly simplified or is based on radiographic assessments, exposing subjects to unnecessary radiation. We therefore developed a novel skin marker-based approach for modeling subject-specific spinal alignment and evaluated its feasibility by comparing the predicted with the actual intervertebral joint (IVJ) locations/orientations (ground truth) using lateral-view radiographic images. Moreover, the predictive performance of the subject-specific models was evaluated by comparing the predicted L1/L2 spinal loads during various functional activities with in vivo measured data obtained from the OrthoLoad database. IVJ locations/orientations were predicted closer to ground truth as opposed to standard model scaling, with average location prediction errors of 0.99+/-0.68 cm on the frontal and 1.21+/-0.97 cm on the transverse axis as well as an average orientation prediction error of 4.74{deg}+/-2.80{deg}. Simulated spinal loads showed similar curve patterns but considerably larger values as compared to in vivo measured data. Differences in spinal loads between generic and subject-specific models become only apparent on an individual subject level. These results underline the feasibility of the proposed method and associated workflow for inter- and intra-subject investigations using musculoskeletal simulations. When implemented into standard model scaling workflows, it is expected to improve the accuracy of muscle activity and joint loading simulations, which is crucial for investigations of treatment effects or pathology-dependent deviations.
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