Four cases of cervical osteoid osteoma occurred predominantly in the adolescent age group with either pain, pain with scoliosis, or radicular pain usually without neurological signs. The initial X-rays did not demonstrate the lesions but a high index of suspicion led to additional roentgenographic as well as tomography examinations and eventually an accurate diagnosis. The lesions were located in the posterior elements in all 4 cases. Treatment consisted of excision in 3 cases and excision and fusion in one case and resulted in cure with no recurrence.