The literature search yielded 1118 studies, including 835 in English and 283 in Chinese. After removing duplicates, 797 studies were retrieved. Screening by title and abstract left 341 studies for full-text analysis. After full-text screening, it left 38 studies. According to the inclusion and exclusion criteria, 29 studies [13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41] met the inclusion criteria, 22 in English and 6 in Chinese. Two RCTs [32, 34], six prospective studies [13, 14, 20, 27, 35, 36], and 21 retrospective studies [15,16,17,18,19, 21,22,23,24,25,26, 28,29,30,31, 33, 37, 38, 40, 41] were included. A total of 982 patients with CBT and 1105 patients with PS were compared. One retrospective cohort study [38] did not report the specific follow-up time, but the hardware complication (intraoperative screw malposition) did not require long-term follow-up;thus, it was included. Among the included studies, Lai et al. [26] included patients with lumbar tuberculosis and the rest research only included patients with lumbar degenerative diseases. Summary of study characteristics is presented in Table 1. Although the follow-up population of Lai’s study was osteoporotic patients with lumbar spinal tuberculosis, we only cited the occurrence of Hardware events in that study, so the impact on this study was not significant.

Two RCTs showed that the articles were of good quality, and the specific assessment result is shown in Fig. 2. The NOS assessment results showed the scores of all included studies covered high-quality 6–9 points, defined as high-quality points. The specific assessment results are shown in Table 2.

Cochrane risk bias assessment results

Twenty-four studies [13, 14, 16, 17, 19,20,21,22,23, 25,26,27,28,29,30,31,32,33,34, 37,38,39,40,41] consisting of 862 patients reported the complications of CBT (n = 77). There was a significant heterogeneity (I2 = 84%, P < 0.01). Meta-analysis was performed using a random-effects model. Combined statistics showed a total complication rate of 6% (95% CI [3, 12%]) (Fig. 3).

Meta-analysis of total complication rate of CBT

Twenty-four studies [13, 14, 16, 17, 19,20,21,22,23, 25,26,27,28,29,30,31,32,33,34, 37,38,39,40,41] (consistent with the total complications of CBT) consisting of 998 patients reported the complications of PS (n = 108). There was a significant heterogeneity (I2 = 87%, P < 0.01). Meta-analysis was performed using a random-effects model. Combined statistics showed a total complication rate of 9% (95% CI [4, 15%]) (Fig. 4).

Meta-analysis of total complication rate of PS

Nineteen studies [13, 16, 17, 19,20,21,22,23, 27, 28, 30,31,32,33,34, 37, 38,