Abstract Introduction: Pedicle screw fixation (PSF) is traditionally considered the gold standard in posterior lumbar spine fusion. However, cortical bone trajectory (CBT) has emerged as an alternative technique, offering potential advantages in screw anchorage and reduced tissue trauma. Aim: To conduct a systematic review and meta-analysis to compare complication rates between CBT and PSF in lumbar spine fusion. Material and Methods: A systematic literature search was performed in major scientific databases. Fourteen studies were included: 3 meta-analyses and 11 clinical studies (2 randomized controlled trials and 9 cohort studies), involving 1,122 patients (542 with CBT, 580 with PSF). Complication rates were analysed using hazard ratios. Heterogeneity was assessed using χ² and I² statistics. Results: No significant differences were found between CBT and PSF in terms of total complication rate, wound infection, dural sac injury, segment non-union, or revision surgeries. Adjacent segment disease was more frequently observed in PSF, with a 7% higher risk, though not statistically significant (p=0.28). Most results showed high homogeneity (I² = 0%). Conclusions: CBT and PSF show comparable safety profiles in lumbar spine fusion. CBT may offer a potential advantage in reducing adjacent segment disease. However, further high-quality clinical trials are needed to confirm these findings and determine the optimal fixation technique. Keywords: complication, screw trajectory, reoperation, non-union, cortical bone trajectory, pedicular screw fixation