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Guidelines on How to Perform a Meta-Analysis in Spine Surgery

Strengths and Weaknesses of Design

Gendelberg, David, MD*; Slattery, Casey A., BA; Verma, Kushagra, MD

doi: 10.1097/BSD.0000000000000717

There are many questions in the literature that remain unanswered due to the paucity of available subjects or the large sample size needed to detect a difference. A meta-analysis consists of integrating together data from multiple studies into one larger data set in order to increase the subject size and power of a paper. In essence, it is a systematic review in which one uses statistical methods to summarize the results of these studies. It is important that a meta-analysis be performed in a systematic and orderly manner with the assistance of a statistician. When carried out correctly, these studies serve as powerful tools to help us better address our knowledge. Because of their complexity, they are prone to bias at multiple levels. This article will discuss the steps involved in performing a meta-analysis, select good studies, as well as explain the statistics conducted in these studies. Furthermore, we will discuss examples from the literature that demonstrate a good meta-analysis.

*Harborview Medical Center

University of Washington School of Medicine

University of Washington Medical Center, Seattle, WA

The authors declare no conflict of interest.

Reprints: David Gendelberg, MD, Department of Orthopaedics, Harborview Medical Center, 325 9th Ave, Seattle, WA 98104 (e-mail:

Received November 30, 2017

Accepted July 27, 2018

© 2019 by Lippincott Williams & Wilkins, Inc.