Inhibition of epidural fibrosis after microendoscopic discectomy with topical application of mitomycin C: a randomized, controlled, double-blind trial

Object The authors conducted a study to evaluate the effects and the safety of locally applied mitomycin C (MMC) on epidural fibrosis after microendoscopic discectomy (MED). Methods Seventy-five patients undergoing single-level unilateral MED for lumbar disc herniation were randomly assigned to receive cotton wool impregnated with either 0.5 mg/ml MMC or saline applied at the site of discectomy for 5 minutes. Outcome measures included degrees of pain severity, functional disability, physical symptoms, and quantitative evaluation of postoperative epidural fibrosis shown on follow-up lumbar contrast-enhanced MRI. Results Sixty-two patients completed the follow-up. Neither serious drug adverse effects nor clinically significant laboratory adverse effects were observed. Patients in both groups showed similar clinical recoveries postoperatively. A statistically significant difference (p < 0.05) between the 2 treatments was shown in a quantitative evaluation of postoperative MRI-documented epidural fibrosis in the MMC group and the saline group using a modified grading system. The mean cross-sectional areas of epidural fibrosis were 7.32–70.06 mm2 in the MMC group and 22.94–90.48 mm2 in the saline group. The epidural fibrosis index ranged from 0.0296 to 0.3267 in the MMC group and from 0.1191 to 0.3483 in the saline group. A significant difference was also observed using the Ross grading system to evaluate postoperative MR images. Conclusions Although no benefit was observed clinically, the authors observed a notable reduction of epidural fibrosis after MED radiologically, with 0.5 mg/ml MMC locally applied and no clinical side effects. Clinical trial registration no.: ChiCTR-TRC-10001079 (http://www.chictr.org/cn/proj/show.aspx?proj=326).

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Intracameral Bevacizumab Versus Sub-Tenon’s Mitomycin C as Adjuncts to Trabeculectomy: 3-Year Results of a Prospective Randomized Study

Journal of Clinical Medicine ◽

10.3390/jcm10102054 ◽

2021 ◽

Vol 10 (10) ◽

pp. 2054

Author(s):

Gerasimos Kopsinis ◽

Dimitrios Tsoukanas ◽

Dimitra Kopsini ◽

Theodoros Filippopoulos

Keyword(s):

Mitomycin C ◽

Primary Outcome ◽

Randomized Study ◽

Primary Outcome Measure ◽

Complication Rates ◽

Filtration Surgery ◽

Significant Difference ◽

Exfoliative Glaucoma

Conjunctival wound healing determines success after filtration surgery and the quest for better antifibrotic agents remains active. This study compares intracameral bevacizumab to sub-Tenon’s mitomycin C (MMC) in trabeculectomy. Primary open-angle or exfoliative glaucoma patients were randomized to either bevacizumab (n = 50 eyes) or MMC (n = 50 eyes). The primary outcome measure was complete success, defined as Intraocular Pressure (IOP) > 5 mmHg and ≤ 21 mmHg with a minimum 20% reduction from baseline without medications. Average IOP and glaucoma medications decreased significantly in both groups at all follow-up points compared to baseline (p < 0.001), without significant difference between groups at 3 years (IOP: bevacizumab group from 29 ± 9.4 to 15 ± 3.4 mmHg, MMC group from 28.3 ± 8.7 to 15.4 ± 3.8 mmHg, p = 0.60; Medications: bevacizumab group from 3.5 ± 0.9 to 0.5 ± 1, MMC group from 3.6 ± 0.7 to 0.6 ± 1.1, p = 0.70). Complete success, although similar between groups at 3 years (66% vs. 64%), was significantly higher for bevacizumab at months 6 and 12 (96% vs. 82%, p = 0.03; 88% vs. 72%, p = 0.04, respectively) with fewer patients requiring medications at months 6, 9 and 12 (4% vs. 18%, p = 0.03; 6% vs. 20%, p = 0.04; 8% vs. 24%, p = 0.03, respectively). Complication rates were similar between groups. In conclusion, intracameral bevacizumab appears to provide similar long-term efficacy and safety results as sub-Tenon’s MMC after trabeculectomy.

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Mitomycin C–Enhanced Revision Endoscopic Dacryocystorhinostomy

Otolaryngology ◽

10.1177/0194599812450280 ◽

2012 ◽

Vol 147 (5) ◽

pp. 937-942 ◽

Cited By ~ 25

Author(s):

Sameh M. Ragab ◽

Hossam S. Elsherif ◽

Emad M. Shehata ◽

Ahmed Younes ◽

Ahmed M. Gamea

Keyword(s):

Mitomycin C ◽

Controlled Study ◽

Safe Procedure ◽

Endoscopic Dacryocystorhinostomy ◽

Randomized Controlled ◽

Group I ◽

Significant Difference ◽

Endoscopic Dcr ◽

Causes Of Failure

Objectives (1) To conduct an adequately powered randomized controlled trial investigating the safety and efficacy of mitomycin C–enhanced revision endoscopic dacryocystorhinostomy (DCR) and (2) to analyze causes of failure after primary endoscopic DCR. Study Design A randomized controlled study. Setting General hospital. Subjects and Methods Seventy-six revision endoscopic DCRs were randomized into 2 groups: endoscopic DCR with mitomycin (group I), where 0.5 mg/mL mitomycin C was applied for 10 minutes, and endoscopic DCR without mitomycin (group II). Follow-up settings were done to document the patient’s subjective improvement, to judge ostium patency on irrigation, and to record any complications. Results Causes of failure in the original 92 patients included canalicular obstruction (14%), small misplaced bony window (43%), very small nasolacrimal stoma due to development of synechia (23%), and complete closure of nasolacrimal stoma with tough fibrous tissue (63%). There was no significant difference between the 2 groups in subjective and objective success rates and adverse events. Group I demonstrated a significantly longer operative time and a significantly lower number of debridement sessions (mean of 1.2 vs 1.9). Conclusions Recurrent nasolacrimal duct obstruction after primary endoscopic DCR is mainly due to reclosure of the nasolacrimal stoma with synechia and fashioning of the small misplaced bony window. Mitomycin C does not increase the success rate of revision endoscopic DCR. It is a safe procedure and may be of value only in patients inaccessible to strict follow-up because it induces a better healing profile in terms of mucosal recovery, wound healing, and less need for debridement sessions.

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Does the Beta-Lactam Matter? Nafcillin versus Cefazolin for Methicillin-Susceptible Staphylococcus aureus Bloodstream Infections

Chemotherapy ◽

10.1159/000499033 ◽

2018 ◽

Vol 63 (6) ◽

pp. 345-351 ◽

Cited By ~ 6

Author(s):

Corey C. Burrelli ◽

Eleanor K. Broadbent ◽

Alice Margulis ◽

Graham M. Snyder ◽

Howard S. Gold ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Adverse Effects ◽

Treatment Failure ◽

Kidney Injury ◽

Bloodstream Infections ◽

Composite Endpoint ◽

Acute Interstitial Nephritis ◽

Beta Lactam ◽

Significant Difference

Background: Antistaphylococcal penicillins have historically been regarded as the drugs of choice for methicillin-susceptible Staphylococcus aureus (MSSA) bloodstream infections (BSI). However, recent outcomes data compared to cefazolin treatment are conflicting. Objective: This study compared treatment failure and adverse effects associated with nafcillin and cefazolin for MSSA BSI. Methods: Adult inpatients with MSSA BSI between January 1, 2009 and August 31, 2015 were included in this retrospective cohort study if they received ≥72 h of nafcillin or cefazolin as directed therapy after no more than 72 h of any empiric therapy. The primary composite endpoint was treatment failure defined by clinician documentation, 30-day recurrence of infection, all-cause 30-day in-hospital mortality, or loss to follow-up. Secondary outcomes included antibiotic-related acute kidney injury (AKI), acute interstitial nephritis (AIN), hepatotoxicity, and rash. Results: Among 157 patients, 116 (73.9%) received nafcillin and 41 (26.1%) received cefazolin. The baseline characteristics were similar except cefazolin-treated patients had higher APACHE II scores and more frequent renal dysfunction. No difference in the composite treatment failure outcome (28.4 vs. 31.7%; p = 0.69) was detected between the nafcillin and cefazolin groups, respectively. In a sensitivity analysis excluding patients without known follow-up, there was no significant difference of treatment failure. AKI, AIN, hepatotoxicity, and rash were all numerically more frequent among nafcillin-treated patients. Conclusions: Among nafcillin- or cefazolin-treated patients with MSSA BSI, there was no significant difference in treatment failure. Observing more frequent presumptive adverse effects associated with nafcillin receipt, future prospective studies evaluating cefazolin appear warranted.

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Ankle Arthrodesis: A Long-term Study

Foot & Ankle ◽

10.1177/107110079201300602 ◽

1992 ◽

Vol 13 (6) ◽

pp. 307-312 ◽

Cited By ~ 79

Author(s):

Richard V. Abdo ◽

Stephen A. Wasilewski

Keyword(s):

Ankle Arthrodesis ◽

Radiographic Examination ◽

Radiographic Evaluation ◽

Grading System ◽

Term Study ◽

Evaluation Score ◽

Long Term Study ◽

Significant Difference

Few studies of ankle arthrodesis have assessed tarsal mobility. This study was performed to evaluate radiographically the effect of ankle arthrodesis on tarsal motion. Thirty patients (31 ankles) returned for clinical and radiographic examination, review of charts, and completion of questionnarie forms. Radiographs were evaluated for success of fusion, position of fusion, tarsal motion, hindfoot position, and subtalar and midtarsal arthritis. The median follow-up time was 7.0 years (range 2–20 years). Results showed that fusion was achieved in 22 patients (71%). The evaluation score based on the grading system of Mazur et al. 16 correlated with success of fusion and patient satisfaction. However, no correlation existed between evaluation score and tarsal motion or position of fusion in the sagittal or coronal planes. Radiographic evaluation showed no significant difference between tarsal motion of the fused side and the unfused side. Tarsal mobility was not affected by ankle arthrodesis or by the techniques performed to achieve fusion.

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Results of tadalafil treatment in patients following an open nerve-sparing radical prostatectomy

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2016.1.4 ◽

2016 ◽

Vol 88 (1) ◽

pp. 4

Author(s):

Erkan Hirik ◽

Aliseydi Bozkurt ◽

Mehmet Karabakan ◽

Özkan Onuk ◽

Mustafa Bahadır Can Balcı ◽

...

Keyword(s):

Radical Prostatectomy ◽

Adverse Effects ◽

Erectile Function ◽

Nerve Sparing ◽

Ultrasound Evaluation ◽

Significant Difference ◽

Daily Dose ◽

The Mean ◽

Positive Effect

Purpose: To evaluate the effect of postoperatively administering a low daily dose of tadalafil on the erectile function of patients who underwent a nerve-sparing radical prostatectomy(NSRP) due to localized prostate cancer (PCa). Materials and Methods: Of 138 patients, who underwent NSRP due to PCa between 2012 and 2014, 55 patients who had not had pre-operative erectile dysfunction (ED) were included in the study. The mean age of the patients was 64 (54-72). On the 15th day after surgery, after ultrasound evaluation, all 55 patients started on a daily dose of 5 mg tadalafil that was continued for 2.5 months. The erectile function of patients was evaluated pre-operatively, post-operatively, and at the 3rd and 6th month after surgery using the International Index of Erectile Function (IIEF-5) test. None of the patients was treated with hormonal therapy or radiotherapy before or after surgery. Results: Three patients were excluded from the study due to the adverse effects of tadalafil and two patients elected to discontinue the treatment. Of the remaining 50 patients whose pre-operative erectile function had been found normal, at 3 months after surgery, 36 (72%) had normal erectile function; of the remaining patients in the study six (12%) presented with mild, two (4%) with moderate, and six (12%) with severe ED. Six months after surgery, 35 patients (70%) had normal erectile function while seven (14%) had mild, three (6%) moderate and five (10%) severe ED. There was no statistically significant difference between the results obtained at the 3rd and 6thmonth follow-up (p > 0.05). Three patients reported adverse effects with tadalafil including flushes in 2 (3.6%) and a headache in 1 (1.8%). Conclusions: The administration of a 5 mg post-operative dose of tadalafil to patients that had undergone a bilateral NSRP was found to have a positive effect on the recovery and maintenance of erectile function. However, there is still a need to investigate a larger series of cases.

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Efficacy of Low Dose Topiramate and Propranolol in Migraine Prophylaxis

Journal of Shaheed Suhrawardy Medical College ◽

10.3329/jssmc.v9i2.37262 ◽

2018 ◽

Vol 9 (2) ◽

pp. 49-54

Author(s):

Muhammad Abdul Momen Khan ◽

Jannatul Ferdous ◽

AKM Golam Kabir ◽

Md Mamnur Rashid ◽

Md Enayet Ul Islam ◽

...

Keyword(s):

Adverse Effects ◽

Low Dose ◽

Migraine Prophylaxis ◽

Drop Out ◽

Group I ◽

Significant Difference ◽

Propranolol Group ◽

Baseline Information ◽

Group Ii

Background: Migraine, the second most common cause of headache that can significantly impair the lives of people. Various drugs are available for migraine prophylaxis but all of which have varying degrees of adverse effects that may significantly limit their use.Objectives: To observe whether low dose topiramate is more effective compared to propranolol in migraine prophylaxis.Methods: Total 120 patients the age range of 18 to 50 years were recruited as study population of migraine in the Out Patient Department (OPD) & Headache Clinic,BSMMU.60 patients were administered by Tab.Topiramate 50 mg/ day named as group-I and rest of 60 patients were administered by Tab. Propranolol 80 mg /day named as group-II. Out of them in total 96 patients had completed the study. 47 patients had completed study in group-I and 49 patients in group-II. During trial, three follow up visits were taken for both groups, 1st follow up after 4 weeks of baseline information, 2nd follow up after 4 weeks of treatment, 3rd follow up after 8 weeks of treatment. Efficacy of treatment was measured by frequency, duration and severity of headache as measured by the visual analogue scale (VAS).Results: The mean (SD) age of group-I (topiramate) and group-II (propranolol) group were found 29.72±9.58 years and 30.96±10.11 years respectively. Female sex was found predominant in both groups. At final follow up, there was statistically significant difference in mean (SD) value of frequency of migraine between topiramate and propranolol group (4.72±2.80 vs. 3.48±2.20; p=0.024]. Propranolol appeared statistically significant than topiramate [TPM 5.53±2.98 vs. PRO 4.36±1.55; p=0.047].Regarding severity of headache, better results also were observed in the propranolol group than topiramate (p< 0.05). Both drugs appeared significant in efficacy measurement (p<0.001). Patient drop out was more in the topiramate group than the propranolol group (21.68 % vs. 18.34%). Furthermore, in the topiramate group, patients complained of more adverse effects than propranolol group (23.4% vs. 14.3%), which was statistically significant.Conclusion: The present study suggests that low dose topiramate and propranolol are effective for migraine prophylaxis in reduction of frequency, severity and duration of migraine individually and propranolol appears more effective compared to that of topiramate.J Shaheed Suhrawardy Med Coll, December 2017, Vol.9(2); 49-54

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Nimodipine reduces delayed cerebral vasospasm after intracranial tumor surgery: a retrospective study

10.21203/rs.3.rs-32931/v2 ◽

2020 ◽

Author(s):

Ying Yu ◽

Yunqian Li ◽

Zheng Jin ◽

Fan Chen

Keyword(s):

Retrospective Study ◽

Normal Saline ◽

Saline Group ◽

Intracranial Tumor ◽

Tumor Surgery ◽

Normal Saline Group ◽

Mortality And Morbidity ◽

Delayed Cerebral Vasospasm ◽

Significant Difference

Abstract Background：Cerebral vasospasm (CVS) is a serious neurosurgical complication. This retrospective study was performed to analyze if nimodipine can improve prognosis and reduces ischemia secondary to delayed CVS after intracranial tumor surgery.Methods：Retrospective analysis of 94 patients with an anterior cranial fossa tumor and underwent intracranial tumor surgery was performed, with 42 cases treated with normal saline and 52 cases treated with nimodipine solution. Transcranial Doppler ultrasonography was used to measure velocity in the middle cerebral artery (MCA) and the distal extracranial internal carotid artery (eICA). An examination was conducted 1 day before surgery and 1, 3, 5, 7, and 14 days after surgery. Follow-up was performed using the Glasgow Outcome Scale (GOS) 3 months after discharge.Results：We showed that in the nimodipine group, CVS occurred in 13 (25%) patients who did not have CVS in the first three days after operation; nine patients had CVS between 4 and 7 days, and 4 had CVS between 8 and 14 days. In the normal saline group, nineteen (45%) patients had CVS, 3 presented with CVS within 3 days, 11 between 4-7 days and 5 between 8-14 days. A significant difference in the occurrence of CVS was observed between the two groups. Preoperative and postoperative the MCA velocities were compared, revealing a significant change in the normal saline group (P < 0.05) but not in the nimodipine group. Furthermore, significant differences in the outcome were observed between the two groups at the 3-month follow-up (P < 0.05).Conclusions：Nimodipine markedly improves prognosis and significantly reduces ischemia secondary to delayed CVS after intracranial tumor surgery, as well as the risks of mortality and morbidity.

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Evaluation of Conjunctival Autografting Augmented with Mitomycin C Application versus Ologen Implantation in the Surgical Treatment of Recurrent Pterygium

Journal of Ophthalmology ◽

10.1155/2021/8820926 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Faried M. Wagdy ◽

Hassan G. Farahat ◽

Amin F. Ellakwa ◽

Sameh S. Mandour

Keyword(s):

Postoperative Complications ◽

Mitomycin C ◽

University Hospital ◽

Time Interval ◽

Randomised Study ◽

Significant Difference ◽

Recurrent Pterygium ◽

Group B ◽

Conjunctival Autografting

Objectives. To evaluate the safety and efficacy of augmenting conjunctival autografting with intraoperative mitomycin C (MMC) application versus Ologen implantation in the management of recurrent pterygium. Materials and Methods. This prospective randomised study included 63 eyes of 63 patients, with recurrent nasal pterygium, who presented to the outpatient clinic of Menoufia University Hospital in Shebin El Kom and Manshiet Soltan from January 2016 to December 2019. Patients were randomly enrolled into two groups. Group A included 32 eyes of 32 patients who underwent conjunctival autografting augmented with the topical application of MMC (0.2 mg/mL), and group B included 31 eyes of 31 patients who underwent conjunctival autografting augmented with Ologen implantation. All the patients underwent follow-up examinations for a period of 24 months. During each visit, a complete ophthalmic examination was performed. Pterygium regrowth of 1 mm or more, over the cornea, was considered a recurrence. Results. In the MMC group, no recurrence was reported during the 24-month follow-up period. In the Ologen implantation group, recurrence was reported in 2 (8%) eyes. The time interval from surgery to recurrence was 5 months in one case and 8 months in the other. No other serious postoperative complications were reported, and there was no statistically significant difference between the groups in this regard. Conclusion. Ologen implantation with conjunctival autografting shows promising results in the surgical management of recurrent pterygium with mild non-vision-threatening postoperative complications comparable to that of MMC application with conjunctival autografting. Registration number: ClinicalTrials.govNCT04419038.

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Comparison of final values in the prophylaxis of superficial transitional cell papillary carcinoma of the bladder, T1G2, treated with mitomycin C, doxorubicin and Bacillus Calmette-Guerin Pasteur intravesical instillations, after therapeutic transurethral resection

Urologia Journal ◽

10.1177/039156039205901s56 ◽

1992 ◽

Vol 59 (1_suppl) ◽

pp. 170-175

Author(s):

M. Baruffi ◽

F. Cappellano ◽

F. Torelli ◽

E. Della Morte ◽

F. Catanzaro

Keyword(s):

Papillary Carcinoma ◽

Mitomycin C ◽

Transurethral Resection ◽

Transitional Cell ◽

Significant Difference ◽

The Difference ◽

Carcinoma Of The Bladder ◽

Doxorubicin Group ◽

Reported Data

In our Department of Urology, from June ‘88 to February ‘92, 135 patients, with superficial transitional cell papillary carcinoma of the bladder, T1G2, were treated with intravesical antiblastic instillations, after therapeutic transurethral resection. 45 patients (33%) were treated with Mitomycin C; 40 patients (30%) were treated with Doxorubicin; 50 patients (37%) were treated with B.C.G. Pasteur. In the Mitomycin Ck group (follow-up 6.’88 ÷ 2.’92), only 20 patients out of 45 (i.e. 44%) were free of tumor at 30.5 months. Of the 16 patients with unifocal carcinoma, 12 patients (i.e. 75%) had no recurrences at 31.2 months, while of the 29 patients with multifocal carcinoma only 8 patients (i.e. 25%) were free of tumor at 29.1 months. In the Doxorubicin group, (follow-up 10.’89 ÷ 2.’92) 33 patients out of 40 (i.e. 82%) were free of tumor at 16.5 months. Of the 15 patients with unifocal carcinoma, 13 (i.e. 86%) had no recurrences at 17 months, while of the 25 patients with multifocal carcinoma 20 (i.e. 80%) were free of tumor at 18.4 months. As to the B.C.G. group (follow-up 11.’89 ÷ 2.’92), 35 patients out of 50 (i.e. 70%) were free of tumor at 13 months. Of the 6 patients with unifocal carcinoma 5 (i.e. 83%) had no recurrences at 7 months, while of the 44 patients with multifocal carcinoma 30 (i.e. 68%) were free of tumor at 13 months. In conclusion, the above reported data show that the best results were obtained in patients treated with Doxorubicin instillations, without significant difference between the results of unifocal and of multifocal carcinoma. Intermediate results were obtained in patients treated with B.C.G., with a moderate but significant difference between unifocal and multifocal carcinoma. The patients treated with Mitomycin C yielded the worst results, and the difference between unifocal and multifocal carcinoma was substantial

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Learning Curve of Microendoscopic Discectomy in Single-Level Prolapsed Intervertebral Disc in 120 Patients

Global Spine Journal ◽

10.1177/2192568219866169 ◽

2019 ◽

Vol 10 (5) ◽

pp. 571-577

Author(s):

Sanyam Jain ◽

Zahir Merchant ◽

Neil Kire ◽

Jwalant Patel ◽

Ankit Patel ◽

...

Keyword(s):

Blood Loss ◽

Learning Curve ◽

Operative Time ◽

Guide Wire ◽

Clinical Parameters ◽

Dural Tear ◽

Significant Difference ◽

Microendoscopic Discectomy ◽

Prolapsed Intervertebral Disc

Study Design: Retrospective study of prospectively collected data. Objective: To evaluate learning curve of tubular microendoscopic discectomy (MED) in lumbar prolapsed intervertebral disc (PIVD) patients based on surgical and clinical parameters and delineate the challenges faced in early cases while practicing MED in large series of patients. Methods: This study was an institutional review board–approved retrospective study of the first 125 consecutive patients with single-level lumbar PIVD managed with tubular MED from 2008 to 2016 with a minimum 2-year follow-up. A total of 120 patients available at final follow-up were divided into quartiles (30 each) as per the date of surgery, with each consecutive group serving as a control for the previous group. Preoperatively and postoperatively clinical parameters (pain scores [Visual Analogue Scale; VAS], functional disability [Oswestry Disability Index; ODI] score, modified MacNab criteria), perioperative parameters (operative time, blood loss, hospital stay), technical issues (guide wire migration, tube docking–related problems, dural tear), and postoperative complications (postoperative leg pain, neural injury, infection, recurrence) were evaluated. Statistical analysis—logarithm curve-fit regression analysis and ANOVA test. Results: The sample consisted of 75 males and 45 females (mean age: 42.54 years) with no significant difference among the quartiles. There was significant difference ( P < .005) noted in mean operative time (quartile 1, 87.33 minutes; quartile 2, 58.5 minutes) and mean blood loss (quartile 1, 76.33 mL; quartile 2, 32.66 mL) between quartile 1 and quartile 2, with no further significant reduction in quartile 3 and quartile 4. Significant difference ( P < .005) in clinical parameters (VAS preoperative/postoperative 5.28/0.99; ODI preoperative/postoperative 32.18/12.08) were noted but was not associated with surgical experience. Overall, 90% (108 out of 120) of the patients had good to excellent results according to the modified MacNab criteria. The mean hospital stay did not show any significant difference among the quartiles. Guide wire migrated issues, neural injury, dural tear, and tube docking–related problems were significantly reduced after quartile 1. However, recurrence occurred at any phase. Infection occurred in one patient in quartile 1. Although blood loss and operative time showed a declining trend, it was not significant after quartile 2. So asymptote lay in quartile 1 and we recommend that novice surgeon should perform 25 to 30 cases to achieve mastery in this technique. Conclusion: For mastering the art of tubular MED for lumbar PIVD and to reduce its learning curve, novice surgeons can avoid the challenges and problems faced during initial cases with improvement in surgical skills by practicing on cadavers, wet labs, and bone-saw models following certain recommendations that we have after achieving asymptote. Familiarity with instrumentation, communication between surgical team, and defined expectations from radiology technicians are key to reduce the learning curve.

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