Osteoid osteoma and the related osteoblastoma are benign, osteoid-forming lesions characterized by a small osteolytic nidus surrounded by reactive, sclerotic bone. With lesion progression, peritumoral inflammation can cause muscle spasms and the formation of a nonrigid scoliosis. With further progression, the curve may become structural and require surgical intervention. In this chapter, we discuss the management of osteoid osteoma and the deformity of comorbid spinal deformity that can develop. Given the early age of onset, the priorities of care are similar to deformity management in other pediatric populations, emphasizing early diagnosis and growth-preserving technologies, where surgical intervention is required.