Association between the LDL-C/TG ratio and scoliosis: a retrospective cross‑sectional study

To investigate the association between the low‑density lipoprotein cholesterol to triglyceride (LDL‑C/TG) ratio and the severity of spinal deformity in a surgical population.

This retrospective cross‑sectional study analyzed 166 patients undergoing spinal surgery. Scoliosis severity was defined by the Cobb angle. Multivariable logistic regression models were constructed to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Restricted cubic splines (RCS) were used to characterize dose‑response relationships. Receiver operating characteristic (ROC) curves and decision curve analysis (DCA) were performed to assess discriminative ability and clinical utility. Sensitivity analyses were conducted using a 20° threshold and by excluding participants younger than 18 years.

A total of 166 participants were enrolled, with 71 (42.77%) in the higher Cobb angle group (≥ 19.71°). The LDL‑C/TG ratio was significantly associated with scoliosis severity. In the model 2, each 1‑unit increase in the ratio correlated with an 148% higher risk (OR = 2.48, 95% CI: 1.09-5.62). The third quartile (Q3) showed a 307% higher risk compared to the lowest (Q1) (OR = 4.07, 95% CI: 1.44-11.51). RCS confirmed a dose‑response relationship (P = 0.027). The ratio demonstrated modest discriminatory performance (AUC = 0.67) and provided a higher net benefit than default strategies.

The LDL‑C/TG ratio is significantly associated with spinal deformity severity and may serve as a potential indicator for risk stratification. Further prospective studies are needed to validate these findings.