OBJECTIVE: The aim of this study was to compare the effects and complications of microvascular decompression (MVD) and neurectomy of spinal accessory nerve in the treatment of laterocollis and torticollis subtypes spasmodic torticollis (ST). METHODS: Clinical data were retrospectively collected from 121 patients with laterocollis and torticollis subtypes of ST from January 1, 2012 to January 1, 2016. Among all the patients, 80 were treated by MVD and 41 were treated by neurectomy of spinal accessory nerve. The effect of the surgery was evaluated by the reduction in the Toronto Western spasmodic torticollis rating scale total scores before and after the operation. The mean duration of the postoperative follow-up period was 18.7 months (range, 12-27 months). RESULTS: At the final follow-up, the Toronto Western spasmodic torticollis rating scale total score in the MVD group and in the neurectomy group was lowered by 50.43% +/- 20.3% and 30.23% +/- 19.4%, respectively, compared with the preoperative status (P < 0.05). In the MVD group, 25 (31.25%) patients achieved excellent relief, 44 (55%) patients improved moderate spasm, and 11 (13.75%) showed no relief. In the neurectomy group, 6 (14.63%) patients improved with excellent outcome, 7 (17.07%) had moderate relief, and 28 (68.29%) had no relief. There was no mortality or severe complication postoperatively, with the exception of hoarseness, shoulder numbness, and weakness. CONCLUSIONS: MVD for ST of laterocollis and torticollis subtypes can provide satisfactory and lasting improvements without nerve impairment. MVD is to be preferred to neurectomy of accessory nerve in treating ST of laterocollis and torticollis subtypes.