As society ages, spinal surgery demand increases due to advancements in surgical techniques and safer anesthesia. Approximately 10 to 20% of patients undergoing spinal surgery may experience complications. Rare complications include cerebrovascular accidents (CVA). In this review, we aim to investigate remote cerebrovascular accidents after spinal surgery. The study was conducted according to PRISMA guidelines and registered with PROSPERO (CRD42023425418). PubMed/Medline, Embase, Scopus, GoogleScholar were searched until 4 March 2024. Twenty cohort studies comprising 612,135 patients were included, among whom 3990 cerebrovascular events were reported. The pooled incidence of CVA with a pooled event rate of 0.002 (95% CI: 0.001–0.003). with substantial heterogeneity (I²=66.97%). This overall estimate combines studies with different follow-up periods and does not represent the risk of CVA over any specific time interval. The meta-regression analysis showed the insignificant role of gender (p-value: 0.966), age (p-value: 0. 1256), diabetes (p-value: 0.8701) and previous cardiovascular disease (p-value: 0.5064) in the incidence of spinal surgery-induced CVA. This systematic review shows that cerebrovascular events after spine surgery are uncommon but not negligible and that their reported frequency depends strongly on the duration of outcome ascertain. Besides, none of the factors used for meta-regression predict the incidence of remote vascular complications.