This article aimed to predict the occurrence of postoperative mechanical complications in adult spinal deformity (ASD) patients through the total sequence and proportional score of the spinal sagittal plane, to improve the quality of life of patients after surgery. The study adopted a comprehensive evaluation and data analysis method, including data collection and preprocessing, feature selection, model construction and training, and constructed a prediction model based on the Random Forest (RF) algorithm. The experimental results showed that the model significantly reduced the risk of complications in randomized controlled trials. The incidence of mechanical complications in the experimental group was 10 %, while that in the control group was 25 %, with statistical significance (P < 0.05). In addition, in retrospective data analysis, the accuracy of the article's model on five datasets ranged from 89 % to 93 %, outperforming logistic regression and support vector machine models, and performing well on other performance data. In prospective studies, the model's predictions showed good consistency with the actual occurrence of complications. Sensitivity analysis shows that the model has low sensitivity to changes in key parameters and exhibits stability, indicating that the model proposed in this article is suitable for uncertain medical environments. The expert rating further confirmed the effectiveness and practicality of the model in predicting postoperative mechanical complications in ASD patients, with the highest score reaching 4.9. These data demonstrate the high accuracy and clinical potential of the model in predicting postoperative complications of ASD.