The purpose of this study was to document the diagnostic findings in a group of adult patients presenting with both scoliosis and pain. Fifty-five adults were evaluated by medical history, physical examination, radiography, myelography followed by computed tomography, discography followed by computed tomography, and single- and dual-photon densitometry. Curves were 49% adult degenerative onset, 44% idiopathic. The older degenerative patients had myelographic defects most commonly within the primary curve and multiple abnormal, not necessarily painful, discs throughout the lumbar spine on discography. The idiopathic group had myelographic defects most commonly in a compensatory lumbar or lumbosacral curve. On discography, all idiopathic patients had at least one abnormal, painful disc, and 88% had their pain reproduced. Pain-producing pathology was frequently identified in areas that would not have been included in the fusion area according to accepted rules for treatment of idiopathic scoliosis.