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

OBJECTIVE

To present a technique that better visualizes the needle during interlaminar cervical epidural steroid injection (ICESI) in patients where the lateral view is inadequate.

DESIGN

Case report.

SETTING

Private group practice.

SUBJECT: A 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.

INTERVENTION: Left 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.

RESULTS

Full resolution of symptoms without associated complications.

CONCLUSIONS

Grave 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.