Background <p>Osteoblastomas are rare, benign but aggressive bone tumors that can cause significant spinal instability and neurological symptoms, particularly when located near critical structures. While smaller lesions may be treated with radiofrequency ablation (RFA), larger tumors often require surgical resection to prevent recurrence and preserve spinal function. However, ensuring complete removal can be challenging, especially in atypical locations. Advanced intraoperative navigation, such as the O-arm 3D system, can aid in precise tumor localization and safe excision.</p> Case description <p>We present a 9-year-old boy with persistent upper back pain, progressive kyphoscoliosis, and worsening symptoms over eight months. Imaging revealed a growing osteoblastoma at the D2 vertebra, involving the pedicle and compressing the spinal cord. Given the tumor’s location and risk of neural injury, en bloc resection was performed using O-arm navigation to guide precise removal. The procedure was successful, ensuring complete excision while maintaining spinal stability. The patient recovered well, with complete resolution of symptoms and restored spinal alignment.</p> Conclusion <p>This case highlights the importance of individualized surgical planning in complex spinal tumors. O-arm navigation proved invaluable in ensuring accurate localization and safe en bloc excision, reinforcing the role of surgery over RFA for larger, high-risk osteoblastomas.</p>