Study design <p>Systematic review and meta-analysis.</p> Objective <p>To propose a clear classification and definition of currently used ST indices, and to provide a comprehensive evidence assessment of the reliability of ST. Additionally, the study also aims to explore factors that may influence the reliability of these indices.</p> Method <p>A systematic literature search was conducted in PubMed and Web of Science. Studies evaluating the reliability of ST indices were screened and selected. Data extraction and assessment of the quality of evidence were also performed following the COSMIN guideline framework. Extracted data included study characteristics and measurement properties. Measurement properties were evaluated according to the COSMIN quality criteria, and methodological quality of the included studies was assessed using the COSMIN Risk of Bias checklist. Quality of evidence was graded using the GRADE approach. Meta-analysis was performed to synthesize the measurement properties.</p> Results <p>Nineteen studies involving a total of 778 participants were included in this review. The findings indicated that most ST indices demonstrated sufficient reliability for clinical application, although the overall level of evidence was rated as low to moderate.</p> <p>Furthermore, the review suggested that factors such as the use of marker points, participant age, and the presence or absence of scoliosis did not significantly influence the reliability of ST. However, the scanning posture may affect the reliability of ST.</p> Conclusions <p>This review highlights ST as a potential radiation-free, informative tool for scoliosis assessment, providing comprehensive data on global musculoskeletal alignment changes with important clinical significance. However, high-quality studies and algorithm improvement are still needed to further explore ST application in screening, progress monitoring, and comprehensive scoliosis assessment.</p>