Abstract: OBJECTIVE: There is an increasing number of intervention modalities for the conservative treatment of adolescent idiopathic scoliosis, and a comprehensive assessment of the comparative efficacy between different non-surgical intervention modalities is lacking. The authors compared the effectiveness of different nonsurgical therapies to intervene in adolescent idiopathic scoliosis by network meta-analysis, with the aim of providing clinicians with an evidence-based medical reference for the nonsurgical treatment of adolescent idiopathic scoliosis. 
METHODS: Two researchers independently searched for randomized controlled trials on non-surgical interventions for adolescent idiopathic scoliosis published from January 2014 to August 2024 in Web of Science, PubMed, Embase, and Cochrane Library. The Cochrane Risk of Bias tool in Review Manager 5.4 was applied to evaluate the quality of the literature. GRADEPro software was used for evidence assessment, and R Studio was used for pairwise analysis as well as network meta-analysis. The outcome indicators were ranked by surface under the cumulative ranking curve to compare the clinical efficacy of different non-surgical therapeutic interventions. 
RESULTS: (1) A total of 26 randomized controlled trials were included, with 1 212 patients who were randomly assigned to receive one of 19 different treatment options. (2) Risk of bias assessment showed that most of the included studies had a low risk of bias. (3) The order of probability of surface under the cumulative ranking curve in terms of cobb angle intervention (the smaller the probability, the better the intervention effect) showed that Schroth exercise and Hippotherapy training (5.5%) > Pelvic rotation correction and Schroth exercise (9.1%) > Schroth exercise and Sling exercise (19.3%). The surface under the cumulative ranking curve probability ranking in terms of angle of trunk rotation intervention (the smaller the probability, the better the intervention effect) showed Schroth exercise and Hippotherapy training (8.1%) > Schroth exercise and Sling exercise (12.7%) > Schroth exercise and Balance training (17.1%). The ranking of the probability of improvement in quality of life after treatment for surface under the cumulative ranking curve (the larger the probability, the better the effect) showed Lyon exercise (99.2%) > Schroth exercise and Sling exercise (84.8%) > Pelvic rotation correction and Schroth exercise (82.4%). 
CONCLUSION: Based on the surface under the cumulative ranking curve and network meta-analysis results, Schroth exercise combined with Hippotherapy training showed the best efficacy in reducing cobb angle and angle of trunk rotation in patients with adolescent idiopathic scoliosis, and Lyon exercise was more effective in improving quality of life. Due to the limited number of included studies, more high-quality literature should be introduced in the future to assess the durability of efficacy and provide more accurate clinical guidance.

Key words: adolescent idiopathic scoliosis, nonsurgical treatment, network meta-analysis, Schroth exercise, Lyon exercise, Hippotherapy, clinical efficacy, systematic review