Achieving shoulder balance is a critical factor in evaluating the outcomes of cervicothoracic hemivertebra surgery in adolescents. Current classification systems for hemivertebrae fail to adequately consider shoulder balance. This study introduces a novel classification system for adolescent cervicothoracic hemivertebrae, incorporating both the positional characteristics of the hemivertebrae and an assessment of shoulder balance.

The relationship between hemivertebrae and shoulder balance was analyzed, resulting in the definition of three distinct curve types. The interobserver reproducibility and intraobserver reliability of this classification system were systematically evaluated. A retrospective analysis of X-ray films was performed for 209 consecutive adolescent patients with cervicothoracic hemivertebrae who underwent surgical treatment from September 2006 to August 2022.

The curves were classified into three primary types: type I accounted for 53%, type II for 14%, and type III for 33%. The retrospective analysis identified one case of decompensation, requiring an extension of the fusion segments. The average kappa coefficient for interobserver reproducibility ranged from 0.832 to 0.958, and the intraobserver reliability coefficient averaged 0.944, demonstrating good to excellent reliability.

This classification system provides spinal surgeons with a structured framework to achieve optimal curve correction and postoperative shoulder balance during hemivertebra resection. Its high interobserver reproducibility and intraobserver reliability establish it as an invaluable tool for guiding the surgical treatment of adolescent cervicothoracic hemivertebrae in clinical practice.

Adolescent cervicothoracic hemivertebrae

Classification

Scoliosis

Shoulder balance

Radiographic shoulder height

© 2025 The Authors. Published by Elsevier Inc.