OBJECTIVE: To evaluate the efficacy and safety of low-density versus high-density pedicle screw in patients with Lenke I adolescent idiopathic scoliosis through systematic review and meta-analysis. METHODS: A comprehensive literature search was conducted in PubMed, Web of Science, and Embase databases. Studies comparing low-density and high-density pedicle screw in Lenke I adolescent idiopathic scoliosis were included. Two authors independently selected studies, assessed risk of bias, and extracted data. Meta-analysis was performed using systematic review software. RESULTS: The meta-analysis included 11 studies comprising 697 patients (397 in low-density group and 300 in high-density group). No significant differences were found between low-density and high-density groups in terms of blood loss, operative time, complication rates, or revision rates. Radiographic outcomes, including major Cobb angle, curve correction, thoracic kyphosis, and coronal and sagittal balance, were also similar between the groups. However, low-density pedicle screw was associated with significantly lower costs. CONCLUSIONS: This meta-analysis suggests that low-density pedicle screw can achieve similar clinical and radiographic outcomes compared with high-density constructs in patients with Lenke I adolescent idiopathic scoliosis, while potentially reducing costs, making it a more cost-effective option without compromising patient outcomes.