Adolescent idiopathic scoliosis non-surgical interventions: a systematic review and network meta-analysis of Cobb angle and SRS-22 outcomes

Abstract

Background Adolescent idiopathic scoliosis (AIS) is a common three-dimensional spinal deformity. Non-surgical interventions are important for controlling curve progression and maintaining quality of life, but their comparative effectiveness remains uncertain. Objective To compare the effects of commonly used non-surgical interventions for AIS on Cobb angle and SRS-22 outcomes through a systematic review and network meta-analysis. Methods PubMed/MEDLINE, Embase, Web of Science, Cochrane Library, and major Chinese databases were searched from inception to April 4, 2026. Randomized controlled trials (RCTs) comparing non-surgical interventions and reporting Cobb angle or SRS-22 were included for the primary network meta-analysis. Prospective non-randomized studies served as supplementary evidence. Effect sizes were expressed as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Ranking was assessed using SUCRA, interpreted cautiously with heterogeneity and evidence sparsity. Results Thirteen comparative studies (709 AIS subjects) were included (10 RCTs, 3 non-randomized). Interventions included Schroth training, bracing, scoliosis-specific exercises, core stabilization, and traditional Chinese medicine rehabilitation. Traditional pairwise meta-analysis showed a pooled SMD of −1.39 (95% CI: −2.20 to −0.59) with high heterogeneity (I2 = 95.1%). Network ranking suggested that bracing and Schroth-related therapies had a trend toward better short-term Cobb angle control, but most estimates were imprecise and the evidence network was sparse. Evidence on SRS-22 was limited and exploratory. Conclusion Some non-surgical interventions may improve Cobb angle in AIS; bracing and Schroth-related therapies show a trend toward relative superiority for short-term Cobb angle control. However, due to sparse networks, high heterogeneity, and potential small-study effects, results should be interpreted cautiously and not solely based on SUCRA rankings. SRS-22 evidence remains insufficient. High-quality RCTs with longer follow-up are needed. Systematic Review Registration PROSPERO CRD42024546325.