This meta-analysis identified 18 cohort studies and 2 randomized controlled trials, comparing computer-navigated and non-navigated pedicle screw placements. 8359 screws in total were identified in the 20 studies, in which 4814 were navigated and 3725 were non-navigated. Results from the analysis indicated that insertions with neuronavigation were associated with a significantly lower risk of pedicle screw perforation than non-navigated insertions. No significant difference was seen between the two techniques for mean operation time, estimated blood loss, and complication rate.