Objective To explore the clinical effect of nursing guided by Neuman’s systems model on adolescent idiopathic scoliosis surgery patients. Methods This study is a randomized controlled trial. A total of 120 patients with adolescent idiopathic scoliosis who underwent surgery in our hospital from Jan. to Dec. 2023 were enrolled. According to the order of enrollment, they were randomly assigned to experimental group or control group, with 60 patients in each group. The control group received routine nursing, while the experimental group received nursing guided by Neuman’s systems model. Independent-sample t test and χ² test were used to compare the surgical efficacy, postoperative recovery, quality of life, and self-management ability of the 2 groups. Results Six months post-surgery, the main curve Cobb angle in the experimental group was significantly smaller than that in the control group (［14.33±0.78］° vs ［16.65±1.02］°, P＜0.001). The postoperative bedtime (［4.78±1.32］) d vs ［6.13±1.26］ d), incision healing time (［13.43±3.29］ d vs ［15.32±5.23］ d), and hospital stay (［13.17±5.36］ d vs ［16.93±3.14］ d) were all significantly shorter in the experimental group than those in the control group (all P＜ 0.05). The overall complication rate in the experimental group was significantly lower than that in the control group (5.00% ［3/60］ vs 21.67% ［13/60］, P＝0.016). Six months post-surgery, the experimental group scored better in terms of physical functioning, bodily pain, general health, vitality, social functioning, role-emotional, and mental health compared to the control group (all P＜0.05). In terms of patient self-management, the experimental group also had significantly higher scores in common management (17.53±5.98 vs 13.34±7.32) and symptom management (30.95±8.12 vs 27.32±7.87) compared to the control group (both P＜0.05). Conclusion The nursing guided by Neuman’s systems model for adolescent idiopathic scoliosis surgery patients can promote their postoperative recovery and improve their quality of life and self-management capabilities.