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The Manubrium as an External Guide for Centralizing Anterior Cervical Plates: Technique Tips and Initial Experience

Scientific Paper

Chin KR1, Stieber JRMehta SCohen JDAuerbach JD.

Interested medical professionals can read the full paper, as published in Spine, here.


Technique tips and retrospective review of prospectively collected data.


To describe a technique for centralizing cervical plates using the center of the manubrium as a primary external guide and its alignment with the mandible as a secondary guide.


Proper alignment of cervical plates is desirable to avoid improper placement of screws and possibly altered biomechanical performance. Large body habitus may portend suboptimal exposure, a limited utility of skin surface landmarks for level determination, and may make it difficult to reliably centralize plates in the coronal plane during anterior cervical surgery.


We describe a technique that uses the center of the manubrium to determine the midline of the cervical spine and align a line drawn through the manubrium with the center of the mandible to provide a central axis for placing cervical plates along the entire cervical spine. We used anteroposterior fluoroscopy to validate that a line from the middle of the manubrium to the mandible bisected the spinous processes and midline of the vertebral bodies. We prospectively collected data on 39 consecutive patients undergoing anterior cervical discectomy and fusion with cervical plates using this technique.


The mean amount of angulation and translation about a midline axis were 2.24 degrees +/- 1.49 degrees and 1.04 +/- 0.86 mm, respectively. There were no statistical differences among 1-level, 2-level, and 3-level fusions (P > 0.05). The intraobserver correlation coefficient for the measurement technique was R = 0.90 (P = 0.0016).


We validated that the midline of the cervical spine is in line with a straight bovie cord connecting the midline of the manubrium to the midline of the mandible using anteroposterior fluoroscopy. Using this line, we prospectively centered cervical plates with no significant difference between levels. These data may also serve as a benchmark for assessing cervical plate alignment.



Dr. Kingsley R. Chin, Founder of philosophy and practice of The LES Society and The LESS Institute

Dr. Kingsley R. Chin is a board-certified Harvard-trained Orthopedic Spine Surgeon and Professor with copious business and information technology exposure. He sees a niche opportunity where medicine, business and info. tech meet – and is uniquely educated at the intersection of these three professions. He has experience as Professor of Clinical Biomedical Sciences & Admissions Committee Member at the Charles E. Schmidt College of Medicine at Florida Atlantic University, Professor of Clinical Orthopedic Surgery at the Herbert Wertheim College of Medicine at Florida International University, Assistant Professor of Orthopaedics at the University of Pennsylvania Medical School, Visiting Spine Surgeon & Professor at the University of the West Indies, Mona, and Adjunct Professor of Clinical Biomedical Sciences at the University of Technology, Jamaica.

Learn more about Dr. Chin here and connect via LinkedIn.


Less Exposure Surgery (LES) is based on a new philosophy of performing surgery, leading the charge to prove through bench and clinical outcomes research that LES treatment options are the best solutions – to lowering the cost of healthcare, improving outcomes and increasing patient satisfaction. Learn more at LESSociety.org.

The LES Society philosophy: “Tailor treatment to the individual aiding in the quickest recovery and return to a pain-free lifestyle, using LES® techniques that lessen exposure, preserve unoffending anatomy and utilize new technologies which are safe, easy to adopt and reproducible. These LES®techniques lessen blood loss, surgical time and exposure to radiation and can be safely performed in an outpatient center. Less is more.” – Kingsley R. Chin, MD


The LESS Institute is the world leader center of excellence in Less Exposure Surgery. Our safe, effective outpatient treatments help patients recover quickly, avoid expensive hospital stays and return home to their family the same day. Watch our patient stories, follow us on Facebook and visit TheLESSInstitute.com to learn more.


The above study utilized LES Technology from SpineFrontier – leading provider of LES Technologies and instruments – offering surgeons and patients superior technology and services.



Chin KR1, Stieber JRMehta SCohen JDAuerbach JD.

Author information

  1. The Institute for Minimally Invasive Spine Surgery (iMIS), Palm Beach, FL, USA. [email protected]

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