Objective: To evaluate the effect of surgical treatment on health related quality of life (HRQOL) and radiographic variables in patients with adult scoliosis. Methods: Sixty-eight patients with adult spinal deformities underwent radiographic analysis. The enrollment criteria were as follows: age older than 18 years, adult degenerative or progressive idiopathic scoliosis (Cobb angle >10 degrees), and surgical treatment within one year before this study was undertaken. The following variables were measured: curve type, apical level, curve magnitude, coronal and sagittal balance using a C-7 plumb line (C7PL) and gravity line, lateral intervertebral olisthesis, lumbar lordosis, sacral slope and pelvic tilt. HRQOL was assessed by the Oswestry Disability Index (ODI). Both preoperative and postoperative data were collected and changes in radiographically assessed variables and ODI scores attributable to surgery calculated; correlations between these changes were then assessed. The radiographically assessed variables and ODI scores were analyzed with SigmaStat (SPSS, Chicago, IL, USA). The level of statistical significance was set at P < 0.05. Results: Surgical treatment resulted in improvements in ODI scores and several radiographically assessed variables, including sagittal balance, lumbar lordosis, lateral olisthesis and coronal Cobb angle. Only sagittal balance expressed as C7PL was correlated to both preoperative and postoperative ODI. Gravity line, an alternative measurement of spinal balance, did not provide better correlations with HRQOL than C7PL. Conclusions: Spinal balance assessed by gravity line did not provide a better correlation with HRQOL than C7PL. Loss of sacral slope and retroverted pelvis are commonly seen in adult scoliosis and are not significantly changed by surgical treatment, including restoration of lumbar lordosis and sagittal balance.