A step-by-step guide for designing systematic reviews in spine surgery: a narrative review.

Background and Objective: Systematic reviews and meta-analyses are essential tools in spine surgery, providing a rigorous method for synthesizing evidence from multiple studies to guide clinical decision-making. These reviews help address conflicting outcomes across studies and enhance statistical power, making them invaluable for evaluating the effectiveness and safety of surgical interventions. The purpose of this review is to outline how to design and conduct a systematic review and meta-analysis specifically in the field of spine surgery. Methods: A preliminary search was performed across several key databases, including PubMed/MEDLINE, Embase, Cochrane Library, Scopus, and Web of Science, to identify relevant literature on spine surgery. The search strategy, search terms, inclusion and exclusion criteria, and screening process were detailed to ensure a comprehensive and standardized approach. This was followed by a narrative integration to synthesize and highlight significant trends, innovations, and gaps within the field. Key Content and Findings: Systematic reviews in spine surgery are conducted through a standardized and repeatable approach to search for, evaluate, and synthesize information. At the top of the evidence-based hierarchy, systematic reviews can represent the most compelling evidence when they include high-quality research, combining outcomes from multiple primary studies into comprehensive findings. When augmented with a meta-analysis that employs statistical techniques to join the results of three or more studies, systematic reviews become invaluable tools for addressing research questions. Conclusions: This first installment focuses on the development of a research question and methods for sourcing and screening relevant databases. A forthcoming companion manuscript will detail the execution phase, including quality assessment, risk of bias, and meta-analysis techniques tailored to spine surgery. The databases most frequently utilized for identifying studies are PubMed/MEDLINE, Embase, Cochrane Library, Scopus, and Web of Science. While not exhaustive, this document aims to serve as an introductory resource for those interested in undertaking or critically evaluating systematic reviews and meta-analyses within the domain of spine surgery.