1. 2018;21;303-308Improving Fluoroscopic Visualization for Lower Cervical Medial Branch Blocks with a Modified Swimmer’s View: A Technical Report
   Technical Report
   George C. Chang Chien, DO, George Young, DO, Jeremy Simon, MD, Jeffrey Gehret, DO, Joshua Armstrong, DO, David S. Stolzenberg, DO, and Ryan Pheifer, DO.

BACKGROUND: Neural blockade of the cervical medial branches is a validated procedure in the diagnosis and treatment of cervical zygapophyseal joint pain. Fluoroscopic visualization of the lower cervical medial branch target zones (CMBTZs) in lateral view is sometimes challenging or not possible due to the patient’s shoulders obscuring the target. Large shoulders and short necks often exacerbate the problem. Clear visualization is critical to accuracy and safety.

OBJECTIVE: We aim to describe a method for optimal fluoroscopic visualization of the lower CMBTZs using a modified swimmer’s view.

STUDY DESIGN: A technical report.

SETTING: A private practice.

METHODS: Discussion with accompanying fluoroscopic images of the cervical spine, focusing on the lateral aspects of the lower cervical articular pillars in both the traditional lateral view and modified swimmer’s view. Four authors served as volunteers for undergoing fluoroscopic x-rays in both views. Visualization of each lower CMBTZ was attempted and stored. The most caudal, clearly visualized levels were compared in both views for each participant.

RESULTS: Visualization of the lower CMBTZs can be successfully obtained with the modified swimmer’s view and in select patients is superior to a lateral view.

LIMITATIONS: A limitation to this study is the design as a technical report. A future prospective study is warranted.

CONCLUSIONS: Modified swimmer’s view can serve as a primary method of visualizing the lower CMBTZs or an alternate view when a lateral view is unable to clearly demonstrate target landmarks. This can improve the ease, accuracy, and safety of performing diagnostic cervical medial branch blocks (CMBBs).

KEY WORDS: Swimmer’s view, cervical medial branch block, facet joint, fluoroscopy