BackgroundIn order to improve post-operative patient’s quality-of-life, attention must be paid to the identification of factors that play a role in patient’s satisfaction with surgical treatment. Patient satisfaction with the outcomes of scoliosis surgery has not been addressed so comprehensively in Saudi literature, as well as the effect of patient satisfaction on the different domains of the SRS-22 questionnaire and radiographic parameters is yet to be reported locally. The aim of this study is to explore such findings especially in our population.MethodsA retrospective cohort study was conducted at two of the largest centers of spine surgery in the Kingdom of Saudi Arabia. A total of 316 eligible patients were selected via consecutive sampling technique. Data were collected from eligible patients who fit our inclusion criteria, which includes patients with adolescent idiopathic scoliosis aged from 10 to 21 years. Student t test, Pearson’s and Spearman’s correlation coefficients statistical tests were used.ResultsThere were 283 (89.6%) females and 33 (10.4%) male patients with a mean age of 15.09 (± 2.27 SD) years. All the domains of SRS-22 showed significantly higher scores 2-year postoperatively, when compared with preoperative values (P< 0.001). The change in all SRS-22 domains correlated positively and significantly with the 2-year postoperative satisfaction using Pearson’s correlation coefficient (P< 0.05); the total score showed the highest correlation followed by the self-image domain. The major Cobb angle correction percentage correlated significantly (P< 0.05) solely with the change in pain domain.ConclusionSelf-image correlated highly and significantly with patient satisfaction postoperatively. It also had the biggest influence SRS-22 scores postoperatively in conjunction with satisfaction scores. That is an indication of the role it plays in patient satisfaction and quality-of-life postoperatively, which may influence the surgical decision making.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13018-023-03925-z.