BACKGROUND: Fusion operations using transpedicular screws and cages are commonly employed for spinal stabilization, but they present with drawbacks including increased rigidity and altered biomechanics. Complications such as adjacent segment disease, pseudoarthrosis, and implant failure are often associated with traditional rigid stabilization techniques. To address these challenges, unilateral dynamic stabilization has emerged as a novel approach for patients with unilateral spinal pathologies. This study aims to evaluate the safety, efficacy, and clinical outcomes of unilateral dynamic stabilization and bilateral dynamic stabilization methods. METHODS: This retrospective study encompassed 43 spinal patients who underwent surgery between 2017 and 2020, with at least 2 years of clinical and radiological follow-up. Parameters including demographic data, underlying pathologies, surgical complications, screw malposition rates, perioperative data, and clinical and radiological outcomes were analyzed. Pre- and post-operative Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores were compared to assess surgical efficacy. RESULTS: The mean age of the study population was 39.13 ± 14.11 years, with a mean clinical follow-up period of 29.7 months. Both unilateral and bilateral approaches demonstrated comparable outcomes in symptomatic and radiological criteria, yielding significant improvements in pain levels and functional capacity. Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores exhibited significant reductions in pain. The unilateral approach exhibited shorter hospital stays, reduced surgical durations, and lesser blood loss compared to the bilateral approach. CONCLUSIONS: Unilateral dynamic stabilization presents promising results in terms of stability, improved clinical outcomes, and reduced operation time and cost for patients with unilateral spinal pathologies. This approach offers effective stabilization without compromising mobility and biomechanics. However, caution is warranted when applying unilateral dynamic stabilization for multiple-level operations, as it may entail an increased risk of instrumentation failure.