Magnesium-based materials demonstrate significant potential for applications in orthopedic, cardiovascular, and other medical device fields due to their excellent biodegradability, favorable mechanical compatibility, and bioactivity. However, challenges such as excessively rapid degradation rates, localized gas formation, and elevated pH in physiological environments have hindered their clinical translation. This review systematically examines the corrosion mechanisms of magnesium-based materials and the specific challenges it faces in various physiological milieus (e.g., bone tissue, blood vessels, and the digestive system). It highlights recent advances in surface modification technologies, including chemical conversion, micro-arc oxidation, polymer coatings, and composite coatings, to enhance the corrosion resistance, biocompatibility, and functional properties (e.g., osteogenic promotion, antibacterial effects, and endothelialization capability) of these materials. Studies indicate that surface modifications can effectively regulate the degradation behavior of magnesium-based materials, achieving synchronized degradation and tissue regeneration. These findings provide both theoretical support and technical strategies for the further development of degradable magnesium-based implantable medical devices.