Predicting pediatric spinal deformity (PSD) from X-ray images collected on the patient’s initial visit is a challenging task. This work builds on our previous method and provides a novel bio-informed framework based on a mechanistic machine learning technique with dynamic patient-specific parameters to predict PSD. We provide a geometry-based bone growth model that can be utilized in a range of applications to enhance the bio-informed mechanistic machine learning framework. The proposed technique is utilized to examine and predict spine curvature in PSD cases such as adolescent idiopathic scoliosis. The best fit of a segmented 3D volumetric geometry of the human spine acquired from 2D X-ray images is employed. Using an active contour model based on gradient vector flow snakes, the anteroposterior and lateral views of the X-ray images are segmented to derive the 2D contours surrounding each vertebra. Using minimal user input, the snake parameters are calibrated and automatically computed over the dataset, resulting in fast image segmentation and data collection. The 2D segmented outlines of each vertebra are transformed into a 3D image segmentation result. The Iterative Closest Point mesh registration technique is then used to establish a mesh morphing approach and creates a 3D atlas spine model. Using the comprehensive 3D volumetric model, one can automatically extract spinal geometry data as inputs to the mechanistic machine learning network. Moreover, the proposed bio-informed deep learning network with the modified bone growth model achieves competitive or even superior performance against other state-of-the-art learning-based methods.Please check and confirm if the author names and initials are correct for “Yongjie Jessica Zhang” and “Wing Kam Liu”.We confirm they are correct.@en