The “Swimmer's View” as Alternative When Lateral View Is Inadequate During Interlaminar Cervical Epidural Steroid Injections

Abstract

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.

Safe Use of Epidural Corticosteroid Injections: Recommendations of the WIP Benelux Work Group

“…Fluoroscopy is therefore recommended via a lateral (profile) image (patient seated, using hanging‐drop technique), whereas others recommend an approach via a contralateral oblique view (patient in prone position with the head positioned on a pillow). However, the hanging‐drop technique in a patient in a seated position can also incorrectly identify the epidural space, such that fluoroscopy and contrast administration continues to be necessary .…”

On the Geometry of Fluoroscopy Views for Cervical Interlaminar Epidural Injections

“…Several authors previously have extolled the virtues of contralateral oblique views, for various purposes [2–5], but without exploring the geometrical basis for their use. Not known is the extent to which practitioners use oblique views, or simply rely on a routine lateral view to check the depth of their needles.…”

An Alternative Approach to Needle Placement in Cervicothoracic Epidural Injections

“…Numerous techniques have been studied to overcome this situation and to provide sufficient visual anatomy of the lower cervical and upper thoracic bony landmarks. Recently, Abbasi and Malhotra suggested a swimmer's view as an alternative method when the lateral view is inadequate [12], and Zhu et al used an alternative oblique fluoroscopic view by placing a cervical spinal cord stimulator (SCS) at the target space [6]. Both techniques were reported to be effective in managing patients with inadequate lateral fluoroscopic views.…”