Osteoblastoma is a benign osteogenic tumor with the same histologic features as osteoid osteoma, a nest of osteoid or mineralized immature bone, often surrounded by a reactive sclerotic zone. However, the clinical presentation and natural course of osteoblastoma differs from that of osteoid osteoma, which mostly presents with localized dull pain or no symptoms. Osteoblastoma has a tendency to develop gradually and is locally aggressive, whereas osteoid osteoma has a tendency to regress spontaneously. Osteoblastoma accounts for 1% of all primary bone tumors, with a male to female ratio of 2:1. 32% to 46% of osteoblastomas involve the spine, and 90% develop between the ages of 10 and 20. Osteoblastoma mostly involves the vertebral arch first and then spreads to the vertebral body. The distribution of osteoblastoma is approximately the same in the cervical, thoracic and lumbar spine. Osteoblastoma shows significant radiological concentrations on bone scans. Reactive sclerosis around the lesion is more common on plain films. Osteoblastoma presents on imaging as (1) >2.0 cm in diameter (<1.5 cm is diagnosed as osteoid osteoma), (2) bone swelling, (3) a soft tissue mass, and (4) multifocal stromal calcification. The change of MRT2 signal depends mainly on the degree of tumor stroma mineralization. After gadolinium contrast injection, all tumor sinuses showed enhancement. Tumor destruction of the bone cortex to form a soft tissue mass and tumor causing a severe inflammatory response in the surrounding soft tissue and adjacent segmental bone (the so-called "scintillation" phenomenon) are different concepts and should be differentiated on imaging. The reactive changes in the bone and soft tissue surrounding the tumor on MRI are not suggestive of tumor grading or prognosis. Enneking's oncologic staging is useful in the development of surgical resection and assessment of prognosis. Although osteoblastoma and osteochondroma present similarly histologically, osteoid osteoma can be ablated radiofrequently or without complete resection, and osteoblastoma is more locally aggressive, larger, has a higher rate of local recurrence, and has a potential for malignancy. Although the two have similar histologic presentations, there is no direct evidence that osteoblastoma develops from osteoid osteoma. A review of 211 osteoblastoma publications was conducted, and 17 were spinal osteoblastomas. Only one case of 8 mm painful osteoblastoma was surgically resected after 7 years of conservative treatment for progressive insensitivity to nonsteroidal anti-inflammatory drugs and was an osteoblastoma at the time of resection. The understanding of the treatment of osteoblastoma of the spine has progressed over time. 20 cases of osteoblastoma were first reported by Drs. Lichtenstein and Sawyer in 1964. They concluded that osteoblastoma of the extremity bones could be treated conservatively, while osteoblastoma of the spine required decompression followed by radiation therapy. Some subsequent physicians described the aggressive nature of osteoblastoma. 83 of the 149 cases (56.6%) of osteoblastoma reported by Raskas et al. invaded the epidural space and required debridement of the tumor from the dura, whereas osteoid osteoma had no such characteristics (0/159). The recurrence rate of osteoblastoma after surgery ranged from 10% to 19%. Because of the high recurrence rate of osteoblastoma after incomplete resection, Drs. Schajowicz and Lemos concluded that it could not be classified as a benign osteoblastoma. They reported eight cases of "malignant osteoblastoma" or aggressive variant, which differed from osteosarcoma because of the absence of metastases. Four of these "aggressive" cases, with Enneking stage S3, grew rapidly and invaded extracapsular or mesenchymal ventricles. 4 cases were biopsied or intracapsularly scraped and 100% (4/4) recurred; 5 cases were "resected in pieces" and 20% (1/5) recurred. recurrence, and 3 cases with whole resection and no recurrence (0/3). The Mayo Clinic Hospital in the United States summarized 306 cases of osteoblastoma over 17.5 years, of which 75 cases had complete follow-up data. The recurrence rate after transmural resection was 19% (10/52); marginal resection, 5.6% (1/18); and complete resection, 20% (1/5). All of them were stage S3 patients. The recurrence rate was 13% (2/13) in the whole resection; 16% (5/32) in the transmural resection; and no recurrence in the transmural + postoperative radiotherapy patients (5/5). 10/10 cases with marginal or extensive borders did not recur in the whole resection. Therefore, he suggested that for non-invasive osteoblastoma in Enneking stage S2, intratumoral resection is done; for aggressive osteoblastoma in Enneking stage S3, whole-block resection is done when possible to reduce recurrence when anatomical structures are possible. The following is one of our cases, a male, 28 years old, with 1.5 years of neck pain, 3 months of numbness in both hands and 2 months of weakness in the extremities, and functional impairment of the spinal cord on examination. pathology on CT-guided puncture biopsy was consistent with osteoblastoma, and the Enneking stage was S3. Surgery was given to C3-4-5 total vertebral "extracapsular" transsphenoidal resection. There was no postoperative recurrence.