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STUDY DESIGN Retrospective, cross-sectional. OBJECTIVE To evaluate the impact of unoperated adolescent idiopathic scoliosis (AIS) in adulthood on pain, quality of life, and need for operative management. BACKGROUND Long-term studies of AIS in adulthood demonstrate most patients function well, though some have increased disability. The Oswestry Disability Index (ODI) and SRS-22r are validated questionnaires for assessing back disability and quality of life. Correlation of these questionnaires to patient outcomes and necessity for surgery have not been fully defined. METHODS Unoperated adults with AIS seen in a tertiary deformity clinic from 2008-2018 were identified. Variables included demographics, comorbidities, family history, curve size/location, pain score, ODI, SRS-22r, and previous treatment. ODI and SRS-22r scores were analyzed across three age groups: 20-39, 40-59, and ≥ 60. RESULTS 275 eligible patients were identified and 255 (93%) patients had an ODI and/or SRS-22r score. ODI scores (220 patients) had a positive correlation with age, BMI, and curve size (p < .001). SRS-22r (204 patients) pain score was worse in all age-gender-matched domains (p < .05). Of the 255 patients in the study, 10% underwent surgery after presentation. In 118 patients with surgical-size curves (thoracic ≥ 50°; thoracolumbar ≥ 40°), no difference was seen in age or curve size between surgical and non-surgical patients; however, ODI and SRS-22r scores (excluding mental health) were significantly worse in surgical patients (p ≤ .01). CONCLUSIONS Patients with AIS have SRS-22r scores that are lower than age-gender-matched controls in most domains. ODI had a positive linear correlation with age, body mass index, and curve size. Only 10% of adults with surgical-size curves evaluated for scoliosis elected to undergo surgery. Patients treated surgically reported worse preoperative quality-of-life scores than their non-surgical counterparts. These results can help healthcare providers when counseling patients and families concerning management options. LEVEL OF EVIDENCE III.