Epidural injections have been used in the treatment of back pain and sciatica for about 90 years. The use of epidural injections has seen some controversy in the 1980s because of the use of cortisone. Since that time, the National Health and Medical Research Council has determined that there are no definite adverse effects with the use of cortisone in epidural injections.
Epidurals are also used to treat disc prolapses in the neck with associated shooting pains into the shoulders and arms (known as radicular pain or brachialgia). Treatment of disc prolapse where there is irritation of the nearby nerve causing severe pains shooting into the arm and when conservative treatment hasn’t helped within a week or two of onset.
A new more precise technique of transforaminal epidural injection has been developed with the assistance of C-arm fluoroscopy (a high tech X-ray machine that looks at the spine from all directions). In this instance the needle is aimed under X-ray guidance directly between the nerve root and the corner of the disc.
The facet joints are the small joints at the back of the spine. They control the movement of the spine. They are generally non-weight-bearing joints, but in heavier people the lower facet joints of the lumbar spine do become weight-bearing and this can add to pain.
Radiofrequency denervation (RFD) or neurotomy is a procedure used to numb pain from the facet (zygapophyseal joints) of the spine. The procedure involves using an electrically generated current that is passed down a thin needle to heat up and deactivate the small nerves deep in the spine that receive pain signals from the facet joints. These nerves are located at the back of the spine.
Complex Regional Pain Syndrome Type 1 is a pain disorder often developing unpredictably following a variety of injuries. Commonly the condition may follow a fracture or crush injury of a hand or a foot. It can also come on after local spinal strain or injury.
Dr Victor WilkMusculoskeletal Medicine
MBBS Grad. Dip. Musculoskeletal Med.
Available M, W, F am & Th, F pm
Victor Wilk is a Musculoskeletal Physician and Medical Director of the Brighton Spinal Group. He is a past president of the Australasian Faculty of Musculoskeletal Medicine. From a background originally in sports medicine in the early 1980s, Victor has over 20 years of experience in dealing with acute and chronic back pain problems. He has completed a post graduate diploma in Musculoskeletal Medicine and a masters degree in Pain Medicine. In addition to his work at Brighton, he has developed guidelines for managing low back pain for the Royal Australian College of General Practitioners, and regularly gives lectures and seminars to doctors and allied health professionals in Australia and overseas. He maintains an open minded holistic approach in diagnosing and managing difficult spinal problems. At Brighton he oversees pain management programs utilising the onsite gymnasium. Specific treatments used also include prolotherapy, platelet rich plasma and cortisone injections for muscle and tendon problems. Dr Wilk also perfoms x-ray guided injections and denervation techniques for chronic spinal pain, headaches and sciatica at the Alfred Centre, Melbourne.