A spinal midline indicator (10) has a body (14) of radiolucent material for insertion between adjacent vertebrae (18, 20) and a radiographic marker (12) located centrally with the body to indicate the position of the spinal midline (22) in anterior-posterior images when the body is centrally located between the vertebrae. The radiographic marker is typically an elongate metal handle. The body may carry secondary radiographic markers (16) on opposite sides of and equidistant from the handle so that the handle indicates the position of the spinal midline when the body is placed centrally between the vertebrae.