Lower Cervical Nerve Root Block Using CT Fluoroscopy in Patients with Large Body Habitus: Another Benefit of the Swimmer's Position

Patient is a 59-year-old man with a large chest and shoulders (suit coat size, 46 regular) having left-sided neck pain, C7 and C8 radiculopathy.

A–C, CTF images in neutral position at C7–T1 with exposure parameters: 120 kVp/50 mA (A), 140 kVp/50 mA (B), and 140 kVp/100 mA (C).

D–F, CTF images in the swimmer's position at C7–T1 with exposure parameters: 120 kVp/50 mA (D), 140 kVp/50 mA (E), and 140 kVp/100 mA (F).

Progressive reduction in beam-hardening artifact and improved bone/tissue definition are noted in that the CTF exposure parameters in both neutral position (A–C) and swimmer's position (D–F) are increased. Reduced beam-hardening artifact and improved bone/tissue definition are present in the swimmer's position (D–F) compared with the neutral position (A–C) at the same kilovolt-pascal/milliampere exposure settings. The swimmer's position offers a greater range of approach options to the left C7–T1 foramen (F, arrow) compared with limitations presented in the neutral position (C, arrow) because of the proximity of the clavicle, lateral chest wall, and shoulder.

G, swimmer's position induces vertebral body and foramen tilt, altering visible appearance of the needle approach. The needle is seen approaching the inferior margin of the C7 transverse process tubercle and roof of the C7–T1 foramen (short arrow). C8 nerve root is seen exiting medially and inferiorly to the foramen roof (long arrow).

H, Successful C8 CNRB performed at C7–T1 (arrow) with contrast seen adjacent to the C8 root. Patient's symptoms completely resolved with the C7 and C8 injections.