Objective To assess whole and regional spinal sagittal radiographic parameters before and after a long walk in adult scoliosis patients. Methods A total of 98 adult scoliosis patients, who were admitted to Changzheng Hospital of Naval Medical University (Second Military Medical University) from Jan. 2016 to Jun. 2018, were retrospectively included. According to sagittal radiographic parameters before a long walk, the patients were assigned to two groups:compensated group (sagittal balance before walking, with sagittal vertical axis[SVA]<40 mm and pelvic tilt[PT]>20°) and decompensated group (sagittal imbalance before walking, with SVA ≥ 40 mm and PT>20°). The anteroposterior and lateral radiographs of whole spine were taken before and after a 15-min walk, and the sagittal radiographic parameters were measured, including SVA, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), PT and sacral slope (SS). The sagittal radiographic parameters were compared between the two groups before and after a 15-min walk. The correlations between the differences of SVA and other sagittal parameters before and after a 15-min walk were analyzed in two groups. Results There were 19 patients in the compensated group, including 16 females and 3 males, with an average age of (64.1±5.9) years and a body mass index (BMI) of (24.2±4.6) kg/m². There were 79 patients in the decompensated group, including 67 females and 12 males, with an average age of (66.7±7.2) years and a BMI of (24.9±5.1) kg/m². There were no significant differences in age, gender or BMI between the two groups (all P>0.05). Before walking, the LL was significantly larger in the compensated group than that in the decompensated group (Z=2.784, P=0.003), and the PI-LL and SVA were significantly smaller in the compensated group than those in the decompensated group (Z=1.953, P=0.028; Z=3.815, P<0.01). There were no significant differences in PT, SS or TK between the two groups (all P>0.05). After a 15-min walk, there were no significant differences in PT, SS, LL, TK, PI-LL or SVA between the two groups (all P>0.05). Compared with before walking, the SS, PI-LL and SVA were significantly increased after a 15-min walk in the compensated and decompensated groups (compensated group Z=1.718, P=0.043; Z=2.198, P=0.015; Z=3.875, P<0.01; and decompensated group Z=1.842, P=0.031; Z=1.943, P=0.021; Z=2.917, P=0.002); however, the PT and LL were both significantly decreased after walking (compensated group Z=1.639, P=0.047; Z=3.624, P<0.01; and decompensated group Z=1.812, P=0.039; Z=3.893, P<0.01). In the decompensated group, the TK was also significantly increased after walking versus before walking (Z=2.287, P=0.012). The difference of SVA before and after 15-min walk was negatively correlated with the difference of PT in the compensated and decompensated groups (r_s=-0.519, -0.625; P=0.024, 0.001), and was positively correlated with differences of SS, LL and PI-LL (compensated group r_s0.519, 0.645, and 0.645, all P<0.05; and decompensated group r_s0.625, 0.407, and 0.407, all P<0.01). Conclusion The compensatory mechanisms of sagittal balance in adult scoliosis patients are gradually weakened or disappeared after a long walk, and the fatigue of pelvic and spinal extensor muscles may be the reasons. For the adult scoliosis patients with SVA<40 mm and PT>20°, it is suggested that the anteroposterior and lateral radiographs of whole spine should be taken again after a 15-min walk to re-evaluate the potential sagittal imbalance.