Improving Fluoroscopic Visualization for Lower Cervical Medial Branch Blocks with a Modified Swimmer’s View: A Technical Report

摘要

Background: Neural blockade of the cervical medial branches is a validated procedure in thediagnosis and treatment of cervical zygapophyseal joint pain. Fluoroscopic visualization of thelower cervical medial branch target zones (CMBTZs) in lateral view is sometimes challenging or notpossible due to the patient’s shoulders obscuring the target. Large shoulders and short necks oftenexacerbate the problem. Clear visualization is critical to accuracy and safety.Objective: We aim to describe a method for optimal fluoroscopic visualization of the lowerCMBTZs 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 onthe lateral aspects of the lower cervical articular pillars in both the traditional lateral view andmodified swimmer’s view. Four authors served as volunteers for undergoing fluoroscopic x-rays inboth views. Visualization of each lower CMBTZ was attempted and stored. The most caudal, clearlyvisualized levels were compared in both views for each participant.Results: Visualization of the lower CMBTZs can be successfully obtained with the modifiedswimmer’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 prospectivestudy is warranted.Conclusions: Modified swimmer’s view can serve as a primary method of visualizing the lowerCMBTZs 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 branchblocks (CMBBs).