Severity of Cervical or upper Thoracic Hemivertebrae score

Purpose To propose a novel and practical classification system for cervical and upper thoracic hemivertebrae (CuTH) and corresponding treatment strategies. Methods This retrospective study included patients with CuTH who underwent orthopedic surgery. Hemivertebra characteristics and associated deformities were assessed, combined with the Self-image domain of the Scoliosis Research Society-22 (SRS-22) questionnaire. A classification system was developed using the minimum clinically important difference (MCID) as a reference. The classification was validated through a case series and a reliability analysis. Results The Severity of Cervical and Upper Thoracic Hemivertebra Score (SoCH score) was developed to assess deformity severity. Total score (TS) thresholds were defined as follows: (1) Type I (TS ≤ 3), conservative treatment recommended; (2) Type II (TS = 4), either conservative or surgical treatment; (3) Type III (TS ≥ 5), surgical treatment recommended. Reliability analysis showed excellent inter-observer (mean κ = 0.899) and intra-observer (mean κ = 0.958) agreement. Conclusions This study is to establish the SoCH scoring system, which stratifies CuTH patients by severity and informs individualized treatment strategies, thereby offering surgeons a practical framework to optimize surgical decision-making and potentially improve patient outcomes.