• David S Stolzenberg, Ryan Pheifer, Joshua Armstrong, George Young, Jeffrey Gehret, Jeremy Simon, and George C Chang-Chien.
• Department of Physical Medicine and Rehabilitation, Rothman Institute, Philadelphia, PA.
• Pain Physician. 2018 May 1; 21 (3): 303-308.

BackgroundNeural 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.ObjectiveWe aim to describe a method for optimal fluoroscopic visualization of the lower CMBTZs using a modified swimmer's view.Study DesignA technical report.SettingA private practice.MethodsDiscussion 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.ResultsVisualization of the lower CMBTZs can be successfully obtained with the modified swimmer's view and in select patients is superior to a lateral view.LimitationsA limitation to this study is the design as a technical report. A future prospective study is warranted.ConclusionsModified 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 WordsSwimmer's view, cervical medial branch block, facet joint, fluoroscopy.

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