12 studies comparing percutaneous and open pedicle screw fixations, including 2 randomized controlled trials and 10 observational studies (619 patients total), were included in this meta-analysis. Analyses were performed to compare surgical outcomes (operative time, blood loss, length of hospital stay), radiological outcomes, and clinical outcomes between exposure methods. Pooled analyses indicated that percutaneous fixation was associated with significantly shorter operative time, lower blood loss, and lower back pain postoperatively compared to open fixation. Parameters of radiological outcome demonstrated no significant differences between cohorts.