Dr Victor Wilk performs injections in accordance with the Spine Intervention Society – an internationally recognised organisation that sets standards in the practice of spine related procedures. The procedures are performed under X-ray guidance using the C-arm fluoroscope for maximum accuracy and safety. Proceures are usually performed at the Alfred Centre in Prahran as an outpatient with no cost for the hospital facilities. A fee is charged by Dr Victor Wilk which is claimable through Medicare. There is no need for private hospital Insurance. Brief descriptions of the procedures provided are outlined below;
The coccyx is a common source of pain in people that spend too much time sitting or following a fall onto the buttocks. The small joints between the coccyx bones may become displaced or deformed over time and accessing those joints may require X-ray guidance.
EPIDURAL STEROID INJECTION
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. There are several approaches used to enter the epidural space in the spinal canal – the common ones being caudal (entered via the lower sacrum), interlaminar ( directly from the back near the midline) and transforaminal (entry alongside where the spinal nerves leave the spinal column).
TRANSFORAMINAL EPIDURAL INJECTIONS
The 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. Transforaminal epidurals can be used to treat disc prolapses in the neck (for brachialgia) and lower back (for sciatica) . Non Particulate steroid ( Dexamethasone ) is always used for maximum safety.
FACET JOINT PAIN
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 in young people, but in heavier people and progressively with age the lower facet joints of the lumbar spine do become weight-bearing and are prone to osteoarthiritis, which in some instances can cause pain. Injections of cortisone may provide temporary relief of pain for several weeks or months in conjunction with exercise and manual therapy.
FACET JOINT RADIOFREQUENCY NEUROTOMY
For more persistent pain Radiofrequency denervation (RFD) or neurotomy (RFN) is a procedure used to numb pain from the facet (zygapophyseal joints) of the spine – giving lasting relief of pain for 12 months or longer. 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 along the length of the spine from the upper neck (which can cause headaches) to the lower back and sacrum. Other areas of pain treated successfully with RFN include the knee and shoulder. The procedure is performed as a day case hospital under sedation for comfort.
HIP JOINT INJECTION
The hip joints are located on each side of the pelvis towards the front and groin region. For many patients, Ultrasound guidance is sufficient to local the joints, but for best accuracy and in larger patients, X-ray guidance is commonly used.
SACRO-ILIAC JOINT INJECTION
Diagnostic injections may be performed under x-ray into the joints or over the sacroiliac joint ligaments to confirm the diagnosis of sacro-iliac joint pain. Instability is treated with Dextrose Prolotherapy injections combined with wearing a pelvic belt around the hips and strengthening type exercises engaging the core muscles to encourage strengthening of the dorsal sacroiliac ligaments.