decent [Neurosurgery Wiki]

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 meaning acceptable and useful, but not outstanding.

If you want it to go from "decent" to "strong" or even "excellent," here are three simple upgrades you could make:

Clarify Bias Handling:
Explicitly state how you minimized bias — for example, "two independent reviewers performed the selection and data extraction." Right now, it's not clear.

Discuss Heterogeneity:
Mention that different studies measured deviation differently (2D vs 3D, tip vs entry point, etc.) and that no meta-analysis was performed because of this heterogeneity.

Tone Down the Conclusion Slightly:
Instead of affirming strongly that deviations don't affect spinal fusion, you could say:

"Minor deviations appear not to significantly compromise screw placement accuracy, although direct evidence linking deviation to fusion outcomes remains limited."

That way, your conclusion sounds solid and cautious — like in a top-tier systematic review.