Tumor Disarmed: A Strategic Approach to Cervical Osteoblastoma Near Vital Vessels in a Young Patient.

Osteoblastoma is a rare benign bone tumor that may exhibit locally aggressive behavior. The cervical spine is the most frequently involved region, and delayed diagnosis can lead to progressive symptoms and neurological deficits. Surgical excision remains the definitive treatment to prevent morbidity. A 15-year-old male presented with a 14-month history of persistent neck pain and right upper limb radiculopathy. Radiological evaluation identified an expansile lesion arising from the right transverse process of the sixth cervical vertebra (C6), involving adjacent neurovascular structures. The lesion was surgically excised with meticulous preservation of the surrounding neurovascular anatomy. Intraoperative three-dimensional computed tomography (3D CT) was utilized to verify complete tumor excision, while continuous intraoperative neurophysiological monitoring (IONM) ensured neural function preservation and enhanced surgical safety. Histopathological examination confirmed osteoblastoma. Preoperatively, the patient exhibited severe disability (Oswestry Disability Index (ODI) score of 70) and intense pain (Numeric Rating Scale (NRS) score of 8). Postoperatively, remarkable clinical improvement was noted, with ODI reduced to 10 and NRS to 1, indicating minimal disability and significant pain relief. No recurrence was observed at five-year follow-up. This case highlights the crucial role of timely imaging and accurate diagnosis in cervical spinal osteoblastoma management. The combination of enabling technologies, namely intraoperative 3D CT and IONM, facilitates safe, complete tumor excision in vascularly complex locations and results in excellent functional recovery.