• Pain Med · May 2010

    Case Reports

    The "swimmer's view" as alternative when lateral view is inadequate during interlaminar cervical epidural steroid injections.

    • Arjang Abbasi and Gautam Malhotra.
    • Interventional Pain Management and Spine Rehabilitation, Long Island Spine Specialists, New York, NY 11725, USA. abbasiar@yahoo.com
    • Pain Med. 2010 May 1;11(5):709-12.

    ObjectiveTo present a technique that better visualizes the needle during interlaminar cervical epidural steroid injection (ICESI) in patients where the lateral view is inadequate.DesignCase report.SettingPrivate group practice.SubjectA 57-year-old morbidly obese male presenting for ICESI for left neck and upper limb pain after a motor vehicle accident. Magnetic resonance imaging revealed left C6-7 herniated nucleus pulposis and C4-5 osteophytic disc-ridge complex. Electrodiagnostic evaluation revealed activity consistent with a left C7 radiculopathy.InterventionLeft C7-T1 ICESI. Needle was obscured in the lateral view by the patient's shoulders. Needle was made visible by positioning the patient for Swimmer's view.ResultsFull resolution of symptoms without associated complications.ConclusionsGrave complications have been associated with ICESI necessitating impeccable and systematic technique with substantial knowledge of anatomy. Although injection at lower levels is advocated for safety concerns, the needle during lateral view may be obscured by the shoulders in some patients. The "Swimmer's View" position may be attempted when lateral view is insufficient to visualize needle during ICESI.

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