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Scientific Paper

Kingsley R. Chin, MD, Fabio J.R. Pencle, MB BS, Jason A. Seale, MB BS

Interested medical professionals can read through the full paper, as published in the Journal of Spine Surgery, here.


Level III


Adjacent segment disease and dysphagia remain concerns of anterior cervical discectomy and fusion (ACDF) with fixation using anterior cervical plates (ACPs). The authors aim to demonstrate the feasibility, outcomes and fusion rate of a standalone PEEK cage in the outpatient setting.


The medical records of 48 consecutive patients undergoing single level standalone ACDF (S-ACDF) (Group 1) were compared to our control group of 49 patients who had single-level ACDF with ACP (Group 2). Outcomes assessed included VAS neck and arm, NDI scores, and radiation dose.


Forty eight patients in Group 1 (S-ACDF) and 49 patients in Group 2 (ACDF-ACP). No statistical differences in gender, age or BMI were found between groups, p=0.286, 0.691 and 0.947 respectively. There was no intergroup statistically significant difference in preoperative and postoperative outcomes. Mean radiation dose in group 1 of 24.1+/-8.2mAS and 2.0+/-0.7mSv was significantly less compared to group 2 which was 29.8+/-5.4 and 2.5+/-0.5mSv, p<0.001. The average radiation dose for single level fusion in Group 1 was 15.6+/-1.5 mAs and 1.3+/-0.1mSv this is compared to average radiation dose in Group 2 of 27.8+/-3.9mAs and 2.3+/-0.3mSv, p=0.001. The average radiation dose for two level fusion in Group 1 was 30.9+/-3.5 mAs and 2.6+/-0.3mSv this is compared to average radiation dose in Group 2 of 33.9+/-6.0 and 2.9+/-0.5mSV, p=0.012.


In the outpatient setting, S-ACDF has shown statistically significant intergroup difference in overall radiation dose, as well as single and two-level fusions, (p<0.001). We conclude that S-ACDF can decrease overall radiation exposure to patients. This is comparable to single level ACDF-ACP in the outpatient setting.


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



Kingsley R. Chin, MD1,2,3,Fabio J.R. Pencle, MB BS3, Jason A. Seale, MB BS3

Author information

1. Herbert Wertheim College of Medicine at Florida International University

2. Charles E. Schmidt College of Medicine at Florida Atlantic University

3. Less Exposure Surgery (LES) Society

4. Less Exposure Surgery Specialists Institute (LESS Institute).

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