OBJECTIVES: Open spine surgery (OS) is associated with significant muscle trauma leading to delayed recovery, prolonged pain, and significant medical resource utilization. Minimal Access Spinal Technologies (MAST™) aim  at minimizing muscle trauma, reduce blood loss, decrease postoperative pain, reduce length of stay in hospital (LoS), and expedite return to normal activities for the patient. The objective of this study is to determine and compare the resource consumption associated with open vs. minimal invasive surgery in patients with degenerative spinal disorder. METHODS: This activity-based cost-analysis was conducted in two Italian hospitals where patient flow and resource utilization were mapped and segmented through interviews with medical staff.  Unit costs were retrieved from public sources and hospital data for the following categories 1) staff time; 2) tests; 3) drugs/consumables; 4) operating room (OR); 5) spinal implants/instrumentation; and 6) general costs. Costs were compared between pathways (open vs. MAST™) and for each phase (pre-hospitalization, hospitalization, surgery, post-surgery and follow-up. RESULTS: Both surgery and post-surgery were the most resource intense episodes: on average post-surgery accounted for 14% of the total costs in MAST™,  and 24% in OS. MAST™ was associated with less overall resource use in both hospitals, mainly driven by shorter LoS post surgery (2 vs. 4 days), less blood loss and less demanding wound care. Total hospitalization costs were €6970-8310 for MAST™ and €8021- 8760 for OS. CONCLUSIONS: The study confirms published evidence on the shorter LoS with MAST™ and the economic benefits of a less invasive procedure. Despite initial higher investments (instrumentation, learning curve) MAST™ may be an effective and cost-saving alternative to OS. Further cost savings may be incurred due to faster return to work, not investigated in this study.