Department of Physical Medicine and Rehabilitation, Rothman Institute, Philadelphia, PA.
Pain Physician. 2018 May;21(3):303-308.
Neural 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.
We aim to describe a method for optimal fluoroscopic visualization of the lower CMBTZs using a modified swimmer's view.
A technical report.
A private practice.
Discussion 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.
Visualization of the lower CMBTZs can be successfully obtained with the modified swimmer's view and in select patients is superior to a lateral view.
A limitation to this study is the design as a technical report. A future prospective study is warranted.
Modified 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).
Swimmer's view, cervical medial branch block, facet joint, fluoroscopy.
颈椎内侧支神经阻滞是一种已被证实的用于诊断和治疗颈椎关节突关节疼痛的方法。在侧位透视下，下颈椎内侧支靶区（CMBTZ）的可视化有时具有挑战性，或者由于患者的肩部遮挡了目标而无法实现。宽肩和短颈往往会使问题更加严重。清晰的可视化对于准确性和安全性至关重要。
我们旨在描述一种使用改良的“蛙泳者体位”来优化下颈椎内侧支靶区透视的方法。
技术报告。
私人诊所。
对颈椎进行讨论并伴有透视图像，重点是传统侧位和改良蛙泳者体位下颈椎关节突的侧位。四位作者作为志愿者，分别在两种体位下接受透视检查。尝试并记录下每个下颈椎内侧支靶区的透视图像。比较每个参与者在两种体位下最靠下、最清晰可见的水平。
改良的蛙泳者体位可以成功获得下颈椎内侧支靶区的可视化，并且在某些患者中优于传统的侧位。
本研究的局限性在于其设计为技术报告。未来需要进行前瞻性研究。
改良的蛙泳者体位可以作为可视化下颈椎内侧支靶区的主要方法，或者在侧位无法清晰显示目标标志时作为替代方法。这可以提高进行诊断性颈椎内侧支阻滞（CMBB）的简便性、准确性和安全性。
蛙泳者体位、颈椎内侧支阻滞、关节突关节、透视。
