STUDY DESIGN A case series of adults with surgical treatment for adult idiopathic thoracolumbar and/or lumbar scoliosis, low back pain, and spinal stenosis was studied. OBJECTIVE To assess pain relief, curve correction, and complications after combined procedures consisting of decompression, spine fusion, and stabilization. SUMMARY OF BACKGROUND DATA Only one publication has focused specifically at this group, and this was before the advent of modern segmental instrumentation. This is the first report of long-term follow-up evaluation in such a patient population. METHODS This study included 16 patients who underwent elective anterior and posterior surgical reconstruction for adult idiopathic thoracolumbar and/or lumbar scoliosis, spinal stenosis, and low back pain with a minimum follow-up period of 2 years. Radiographic findings, clinical results, and long-term outcome data were obtained using the Modified Scoliosis Research Society outcome instrument and the Oswestry Disability Back Pain Questionnaire. RESULTS Restoration of coronal and sagittal balance, or improvement thereof, was achieved in all the patients with balance problems. There was significant improvement in all outcome domains. Overall, 94% of the patients were satisfied with the surgery. Ten major complications occurred in 10 patients, 8 of whom required additional surgery. There were two minor complications. CONCLUSIONS Combined symptoms of back pain and spinal stenosis require complex reconstructive surgery in adults with idiopathic thoracolumbar and/or lumbar scoliosis. Significant pain relief, functional restoration, and satisfaction can be achieved and maintained over the long term in the properly selected patient.