For a study, researchers aimed to review the current spine surgery literature for the establishment of a definition for adequate spine decompression using intraoperative ultrasound (IOUS) imaging. The search strategy yielded 985 potentially relevant publications, 776 underwent title and abstract screening, and 31 full-text articles were reviewed. The study found IOUS to be useful in spine surgery for decompression of degenerative cases in all regions of the spine. The thoracic spine was found to be unique for IOUS-guided decompression of fractures and the lumbar spine for decompressing nerve roots. Although researchers did not identify a universal definition for adequate decompression, there was a common description of decompression that qualitatively described the ventral aspect of the spinal cord as “free-floating” within the cerebrospinal fluid. Other measurable definitions, such as spinal cord diameter or spinal cord pulsatility, were not found to be good definitions given there was insufficient evidence and/or poor reliability. The systematic review examined the current literature on IOUS and spinal decompression surgery. The study identified a common qualitative definition for adequate decompression involving a “free-floating” spinal cord within the cerebrospinal fluid, which indicated the spinal cord was free from contact with the anterior elements.