Degenerative spinal deformity (DSD) refers to a disease in which the spine undergoes degenerative changes due to aging, gradually developing into coronal/sagittal spinal deformities. If the patient has persistent pain, progressive kyphosis, or impaired neurological function, orthopedic surgery should be considered to relieve nerve compression and restore the balance of the coronal and sagittal spine. However, the development of previous surgical plans mainly relied on spinal imaging parameters, while neglecting the importance of bone and skeletal muscle degeneration, resulting in mechanical complications even with good correction of sagittal morphology. Therefore, it is necessary to pay attention to the comprehensive evaluation of osteoporosis and paraspinal muscle degeneration in clinical practice, accurately assess the sagittal balance of the patient's spine and predict the risk of postoperative complications, and adopt corresponding surgical strategies and preventive measures to reduce the incidence of internal fixation failure.