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Purpose: Sarcopenia is considered to be an important predictor of adverse outcomes following spinal surgery, but the specific relationship between the two is not clear. The purpose of this meta-analysis is to systematically review all relevant studies to evaluate the impact of sarcopenia on spinal surgery outcomes. Methods: We systematically searched PubMed, Embase and the Cochrane Library for relevant articles published on or before January 9, 2023. The pooled odds ratio (OR) with 95% confidence intervals (CIs) was calculated in a random effects meta-analysis. The main outcome was the risk of adverse outcomes after spinal surgery, including adverse events and mortality. This systematic review and meta-analysis was conducted following the PRISMA guidelines to evaluate the impact of sarcopenia on spinal surgery outcomes. In addition, we also conducted a subgroup analysis and leave-one-out sensitivity analyses to explore the main sources of heterogeneity and the stability of the results. Results: Twenty-four cohort studies, with a total of 243,453 participants, met the inclusion criteria. The meta-analysis showed that sarcopenia was significantly associated with adverse events (OR 1.63, 95% CI 1.17–2.27, P < 0.001) but was no significantly associated with mortality (OR 1.17, 95% CI 0.93–1.46, P = 0.180), infection (OR 2.24, 95% CI 0.95–5.26, P < 0.001), 30-day reoperation (OR 1.47, 95% CI 0.92–2.36, P = 0.413), deep vein thrombosis (OR 1.78, 95% CI 0.69–4.61, P = 0.234), postoperative home discharge (OR 0.60, 95% CI 0.26–1.37, P = 0.002) and blood transfusion (OR 3.28, 95% CI 0.74–14.64, P = 0.015). Conclusion: The current meta-analysis showed that patients with sarcopenia have an increased risk of adverse events and mortality after spinal surgery. However, these results must be carefully interpreted because the number of studies included is small and the studies are significantly different. These findings may help to increase the clinicians' awareness of the risks concerning patients with sarcopenia to improve their prognosis. [ABSTRACT FROM AUTHOR]