Spine surgery continues to move into the ambulatory setting in an effort to pair high-quality care delivery with low-cost facilities. The purpose of this review was to assess the current literature for trends in the practice of ambulatory spine surgery. A systematic review of the English language literature from the past five years was performed utilizing PRISMA standards. The results demonstrate that current focus of research emphasizes the safety of ambulatory surgery-with several studies commenting on complication rates, patient selection, and postoperative protocols to prevent readmissions or complications. Research is also focused on quality of care, and ensuring non-inferiority of ambulatory surgery when compared with traditional inpatient hospitalizations. Importantly, no level I or II literature has been published on the topic in the past five years, suggesting a renewed need for high quality prospective studies.