Cervical hemivertebra resection and torticollis correction: report on two cases and literature review

Purpose Hemivertebra of the cervical spine is a rare but complex spinal malformation. To our knowledge, only one publication describes excision of an upper–middle cervical (between C2 and C4) hemivertebra. We present our experience with two cases of C3 hemivertebra resection and torticollis correction via a combined anterior–posterior–anterior surgical approach and short segment fixation. Methods Two 12-year-old patients with torticollis due to congenital C3 hemivertebra underwent surgery consisting of combined anterior vertebral body osteotomy, posterior element resection with segment instrumentation and deformity correction, and iliac bone graft reconstruction and fixation via an anterior approach. During the osteotomies, the transverse process accompanied with the vertebral artery was disconnected and freed away from the spinal column. Then the deformity was corrected without touching the vertebral artery, which made the procedure safe and comfortable. The details of this technique are presented. Pre- and postoperative radiographic features, as well as clinical outcomes were evaluated. Results The treatment process was uneventful. The patients had satisfactory clinical outcomes at a mean of 1.5 years follow-up. Head tilt and chin rotation were corrected completely. Radiographs showed favorable deformity correction, well-balanced coronal and sagittal alignment, and solid bony fusion. Conclusion Combined anterior–posterior–anterior hemivertebra resection with short segment instrumentation is a reasonable option for the treatment of congenital cervical hemivertebra, which provided satisfactory deformity correction and good clinical outcomes. Level of evidence 4.