11 randomized controlled trials (RCTs) with a total of 756 patients were included in this meta-analysis. The purpose of this analysis was to compare the efficacy and safety of unilateral and bilateral pedicle screw fixation in short-segment lumbar spinal fusion. The findings of this meta-analysis indicated that there is moderate-quality evidence that fusion rates were comparable between unilateral and bilateral pedicle screw fixation and that unilateral pedicle screw fixation reduced operation time and blood loss. There was low-quality evidence that device-related complications were similar between unilateral and bilateral pedicle screw fixation. Additional research is needed to evaluate pain, disability, and hospital stay before definitive conclusions can be made with regard to these outcomes