Shaobo Yang, Feihong Cai, Ruixuan Xie, Jing Li, Jun Zhao, Chen Zhang, Dong Hou, Kai Li, Han Leng, Xiaohui Dou, Jing Zhang, Xiaojuan Cui, Juan Wang, Xiaoyun Yuan, Haitao Zhang, Dezhi Tang, Jiantao Wen, Jin Huang
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.
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.