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Purpose: To evaluate technical success and long-term outcome of CT-guided radiofrequency ablation (RFA) of spinal osteoid osteomas (OO) and osteoblastomas (OB) in six different European centres., Methods: Eighty-seven patients with spinal OO (77) or OB (10) were treated with CT-guided RFA, after three-dimensional CT-guided access planning. Patient's long-term outcome was assessed by clinical examination and questionnaire-based evaluation including 10-point visual analogue scales (VAS) regarding the effect of RFA on severity of pain and limitations of daily activities. Clinical success was defined as a reduction of > 30% in the VAS score and patient's satisfaction., Results: Overall, RFA was technically successful in 82/87 cases (94.3%) with no major complications; clinical success was achieved in 78/87 cases (89.7%). The OO/OB were localized in the cervical (n = 9/3), the thoracic (n = 27/1), the lumbar (n = 29/4), and the sacral spine (n = 12/2). A decrease in severity of pain after RFA was observed in 86/87 patients (98.9%) with a persistent mean reduction of overall pain score from 8.04 ± 0.96 to 1.46 ± 1.95 (p < 0.001) after a median follow-up time of 29.35 ± 35.59 months. VAS scores significantly decreased for limitations of both daily (5.70 ± 2.73 to 0.67 ± 1.61, p < 0.001) and sports activities (6.40 ± 2.58 to 0.67 ± 1.61, p < 0.001)., Conclusion: In a multicentric setting, this trial proves RFA to be a safe and efficient method to treat spinal OO/OB and should be regarded as first-line therapy after interdisciplinary case discussion.