OBJECTIVES: Transfusions are linked to adverse outcomes such as mortality, post-operative morbidity and increased costs. Patients who have undergone open spine surgery can experience high volume of blood loss and require transfusions due to the extensive muscle dissection associated with the procedure. Recently, there has been a focus on minimally invasive spine surgery techniques (MIS) that can minimize the exposure of tissue during spine surgery, which has resulted in the reduction of blood loss and related transfusions.  METHODS: This retrospective study utilized the Premier Perspective® database to compare costs of transfusion between patients who underwent 1-2 level MIS posterior lumbar interbody fusion (n=727) and open spine fusion (n=727) matched based on age and gender. A regression model was used to assess the impact of factors that affected the likelihood of transfusion.  RESULTS: Patients who underwent MIS surgery had significantly fewer transfusions of perioperative autologous blood (1.8% vs. 6.2%), packed cells (5% vs. 10%) and platelets (0% vs. 0.6%) when compared to open fusion (p<0.05). The per patient transfusion cost for MIS was $252 lower than that of the open surgery.  Per patient costs of antifibrinolytics, ESAs/hematinics and blood drainage were statistically lower for MIS fusion when compared to open fusion (p<0.05). The factors that were identified for the transfusion prediction model were surgery type, Charlson index, implanted screws, type/region of hospital, and type of insurance. The model showed that use of MIS fusion contributed most to the reduction in likelihood of transfusion when compared to the other variables (OR=0.441, p<0.0001).  CONCLUSIONS: MIS fusion patients require fewer transfusions, thus resulting in lower mean transfusion costs when compared to open fusion patients. MIS fusion patients are less likely to receive a transfusion when compared to open fusion patients. A limitation was that pre-op Hct was excluded as a model variable, due to unavailability of data.