The results of upper cervical anterior rhizotomy and accessory nerve section in the treatment of twenty patients with spasmodic torticollis are reviewed. The majority of these patients presented with pain in addition to postural deformity. There was no evidence in any of them to suggest that the condition was psychogenic. Good results can be expected, particularly in those patients without evidence of cervical spondylosis. We suggest that in symptomatic torticollis surgery is more effective than medical, psychiatric, or other described forms of treatment. Electromyography may be helpful to delineate the affected musculature and to assess postoperative improvement. The operating microscope is a valuable adjunct to surgery to preserve radicular vessels and ensure total division of the relevant motor roots.