To explore the predictors for the restoration of the sagittal spinal malalignment in the elderly patients with lumbar spinal stenosis (LSS) after short-segment decompression and fusion surgery.We retrospectively reviewed 82 LSS patients with sagittal malalignment (SVA ≥ 50 mm or PT ≥ 20° or PI-LL ≥ 20°) who underwent short-segment decompression and fusion surgery between January 2019 and March 2021. Patients' characteristic, radiographic and paravertebral muscle parameters were assessed. The patients were divided into group A (postoperative malalignment) and B (postoperative alignment) according to whether the postoperative restoration of the sagittal alignment was achieved.There existed more males in group B than in group A (p = 0.002). The age of group A (73.36 ± 8.02) was greater than that of group B (69.08 ± 6.07, p = 0.009). Preoperative PT in group A (27.40 ± 5.82) was greater than that in group B (19.30 ± 7.32, p < 0.001). The functional cross-sectional area (fCSA) in group A (28.73 ± 4.23) was lower than that in group B (36.94 ± 7.81, p < 0.001). And the fatty infiltration rate (FI) of group A (27.16% ± 5.58%) was higher than that of group B (22.61% ± 5.81%, p = 0.001). The fCSA was negatively correlated with the postoperative PT and PTr (p < 0.05).Stronger lumbar paravertebral muscles, smaller preoperative PI, PT or PI-LL, male and younger age are the predictors for the restoration of the sagittal spinal malalignment in the elderly LSS patients after short-segment decompression and fusion surgery.© 2022. The Author(s).