Painful scoliosis is a well-recognized presentation of spinal osteoid osteoma, especially in adolescents, and is thought to be caused by pain-provoked muscle spasm on the side of the lesion. The diagnosis, however, is often initially missed, and prolonged duration of symptoms and rigid spinal curve may result. In this report, we present two cases of adolescent patients with painful scoliosis, subsequently diagnosed with spinal osteoid osteomas. Complete surgical excision resulted in dramatic symptomatic resolution after surgery and improved spinal curve at 1-year follow-up in both cases.