This document replaces previous guidance on endoscopic division of epidural adhesions (interventional procedure guidance 88).
1.1 Current evidence on therapeutic endoscopic division of epidural adhesions is limited to some evidence of short-term efficacy, and there are significant safety concerns. Therefore this procedure should only be used with special arrangements for clinical governance, consent and audit or research.
1.2 Clinicians wishing to undertake therapeutic endoscopic division of epidural adhesions should take the following actions.
Inform the clinical governance leads in their Trusts.
Ensure that patients and their carers understand the uncertainty about the procedure's safety and efficacy, in particular the risk of neural damage, dural puncture and visual disturbance, and provide them with clear written information. In addition, the use of NICE's information for patients ('Understanding NICE guidance') is recommended.
Audit and review clinical outcomes of all patients having therapeutic endoscopic division of epidural adhesions (see section 3.1).
1.3 Further research on this procedure should clearly describe case selection. Outcomes should include pain relief, duration of effectiveness and whether other treatments are subsequently required.