arXiv:2509.24165v1 Announce Type: cross Abstract: Adolescent Idiopathic Scoliosis (AIS) is a complex three-dimensional spinal deformity, and accurate morphological assessment requires evaluating both coronal and sagittal alignment. While previous research has made significant progress in developing radiation-free methods for coronal plane assessment, reliable and accurate evaluation of sagittal alignment without ionizing radiation remains largely underexplored. To address this gap, we propose LatXGen, a novel generative framework that synthesizes realistic lateral spinal radiographs from posterior Red-Green-Blue and Depth (RGBD) images of unclothed backs. This enables accurate, radiation-free estimation of sagittal spinal alignment. LatXGen tackles two core challenges: (1) inferring sagittal spinal morphology changes from a lateral perspective based on posteroanterior surface geometry, and (2) performing cross-modality translation from RGBD input to the radiographic domain. The framework adopts a dual-stage architecture that progressively estimates lateral spinal structure and synthesizes corresponding radiographs. To enhance anatomical consistency, we introduce an attention-based Fast Fourier Convolution (FFC) module for integrating anatomical features from RGBD images and 3D landmarks, and a Spatial Deformation Network (SDN) to model morphological variations in the lateral view. Additionally, we construct the first large-scale paired dataset for this task, comprising 3,264 RGBD and lateral radiograph pairs. Experimental results demonstrate that LatXGen produces anatomically accurate radiographs and outperforms existing GAN-based methods in both visual fidelity and quantitative metrics. This study offers a promising, radiation-free solution for sagittal spine assessment and advances comprehensive AIS evaluation.