10 randomized controlled trials with a total of 614 patients with lumbar degenerative disease undergoing a transforaminal lumbar interbody fusion procedure were included in this meta-analysis comparing unilateral (n=294) and bilateral pedicle screw fixation (n=320). Pooled outcomes of interest included fusion rate, back and leg pain on a Visual Analog Scale (VAS), the Oswestry Disability Index (ODI), total blood loss, operative time, hospital stay, complications, and cage migration. The pooled results demonstrated significantly quicker operative time and less blood loss with unilateral pedicle screw fixation, but a higher risk of cage migration. Pooled fusion rates, pain, ODI scores, hospital stay, and rate of complications were similar between the two groups.