Adolescent idiopathic scoliosis (AIS) can lead to back pain, functional limitations, and decreased quality of life. Long-term outcomes, especially residual pain and postoperative satisfaction, are essential for optimizing perioperative management and patient counselling. This study evaluated patient-reported outcomes using the SRS-22 questionnaire, focusing on pain and satisfaction domains. Pain-related Questions 1, 2, and 8 were dichotomized into mild (1) and significant pain (2). Question 11 (analgesic use) and Question 17 (sick leave requirement) were categorized as no (1) and yes (2). The minimal clinically important difference (MCID) for the pain domain was 0.2. Satisfaction Questions 21 and 22 were dichotomized into high (1) and low satisfaction (2). 87.8% of total 303 patients were female, with mean age 15.8±3.8 years. Mean hospital stay was 3.4±0.6 days and operative duration 138.8±45.3 minutes. The mean preoperative major Cobb angle was 65.4±16.0°, improved to 23.0±12.1° postoperatively, with correction rate of 65.8±12.1%. Mean follow-up duration was 74.0±12.9 months. Preoperatively, significant pain was reported by 20.1%, 20.1%, and 38.9% of patients for Questions 1, 2, and 8, respectively. At 5 years, these proportions decreased to 13.2%, 8.9%, and 23.1%. Analgesic use increased from 9.6% preoperatively to 31.4% at follow-up. Despite this increase, sick leave requirement decreased significantly from 10.9% to 4.6%. Only 38.3% achieved MCID for pain. Satisfaction improved significantly, with 90.7% and 85.5% reporting high satisfaction compared with 64.2%–64.4% preoperatively (p<0.001). Weak but significant positive correlations were found between postoperative pain and preoperative pain (ρ=0.141), and satisfaction (ρ=0.137). Postoperative pain and hospital stay demonstrated very weak, non-significant negative correlation (ρ=−0.101). Regression analysis identified hospital stay (B=−0.161) and preoperative pain score (B=0.141) as significant predictors of postoperative pain. Posterior spinal fusion for AIS provides significant long-term improvement in patient-reported pain and satisfaction at 5-year follow-up. Although postoperative analgesic use increased, overall prevalence of significant pain and sick leave decreased. Preoperative pain levels and hospital stay were predictors of postoperative pain, highlighting importance of preoperative pain optimization and perioperative management strategies.