OBJECTIVES: The use of navigation and intraoperative imaging permits to perform a large number of procedures more accurately and safely. The aim of this study was to estimate the cost savings achieved by an integrated operating room with full rotation 3-D intraoperative imaging and navigation (NT) compared with a standard operating room in three types of surgery: balloon kyphoplasty, lumbar fusion, and fusion cervical. METHODS: We developed a cost analysis through a published literature review of full rotation 3-D intraoperative imaging and navigation studies, taking into account a hospital perspective. We identified the studies with data related to hospital resource savings when compared with a standard operating room (imaging test outside the operating room). Subsequently, potential savings per patient were estimated for each surgery and were updated to euros 2013. Cost data were taken from e-Salud database and Spanish regional tariffs. RESULTS: The use of full rotation 3-D intraoperative imaging and NT versus a standard operating room increases surgical process efficiency due to: avoid post surgery computer tomographies to confirm the success of the procedure, increase the accuracy of surgical interventions, avoid complications and reduce the need for re-interventions, reduce the operating room time, faster patient recovery and reduce hospital length of stay. Potential savings by type of surgery were € 615, € 3,242, and € 4,458 for balloon kyphoplasty, posterior cervical fusion, lumbar fusion, respectively. CONCLUSIONS: The use of full rotation 3-D intraoperative imaging and NT leads to improved clinical outcomes and increased hospital efficiency in surgeries carried out with it. A 3-D intraoperative imaging system is a cost-saving strategy for balloon kyphoplasty, lumbar fusion, and cervical fusion surgeries from a hospital perspective.