For surgeons, Mark A. Prevost II, MD, and his younger brother Matthew A. Prevost, MD, there was never any question they would follow in their father’s footsteps and join his successful practice at the Alabama Back Institute in Jasper, Alabama.
“It’s always been the plan that we work with our dad [Mark A. Prevost Sr., MD],” Matthew said. “The three of us get along really well, and it offers the best benefit to patients who are getting three surgeons' opinions and expertise on their case.”
Now, the brothers have introduced a new, cutting-edge approach to spine surgery, never before available in their rural community.
Endoscopic spine surgery is an ultra-minimally invasive procedure using a specially designed device that is about the width of a pencil tip, allowing surgeons to avoid large incisions and minimize damage to the muscles and bone around the spine.
The approach can lead to a faster recovery¹, fewer postoperative complications and shorter hospital stays.2-4
“Not every case can be done endoscopically, sometimes we have to do big open surgeries,” Mark said. “But we’ve now repaired several disc herniations endoscopically and all the patients have done incredibly well.”
Mark and Matthew are among a wave of younger surgeons who recently completed a specialized fellowship in spine surgery. They received hands-on training in endoscopic surgery at the prestigious Texas Back Institute under Arthrex faculty member and renowned spine surgeon Peter Derman, MD, MBA (Dallas, TX).
“Endoscopic surgery has all the upside of spine surgery – ridding people of soul-crushing pain – without as much risk for the potential downside, which can include long hospital stays and the need for narcotics,”5 Dr. Derman said. “I have done more than 500 endoscopic cases, and I still can’t believe that it’s real. Patients go home the same day and by the next, they practically forget they had surgery.”
This ultra-minimally invasive surgical technique requires specialized training, and Dr. Derman says the learning curve is real.
“I tell surgeons that it’s more technically difficult and initially it will take more time,” Dr. Derman said. “But we’re doing this because we genuinely care about our patients, and it makes us proud and happy to get up every morning and do what we do.”
Mark and Matthew say support from Arthrex and Dr. Derman has been pivotal in their ability to bring endoscopic surgery to their patients.
“We operate in a smaller hospital, in a small town in Alabama,” Matthew said. “It’s so cool that we are able to be at the forefront of this technology and bring it to our rural area.”
And even better, Mark said, is how their practice is growing by word of mouth from satisfied patients.
“It’s awesome when we are able to tell a new patient that they will literally have a 7-millimeter-long incision and can go home 90 minutes after surgery,” Mark said. “It’s an amazing feeling and patients love it.”
The two brothers recently traveled to Arthrex global headquarters in Naples, Florida, to build on their knowledge at the largest endoscopic spine surgery course in the Western Hemisphere, along with more than 400 other people, including representatives from six different countries, 175 health care professionals, 17 Arthrex faculty members and over 150 Arthrex Technology Consultants.
Spine Evolutions is a two-day course guided by internationally recognized faculty, exploring the latest advancements in the Arthrex Spine and Orthobiologics portfolios. Attendees heard from expert panels, participated in didactic sessions, and learned the latest techniques in endoscopic spine surgery with live demonstrations by Arthrex faculty and in the lab.
“The peer-to-peer interaction at this course is just outstanding,” said Mark Binning, Spine Manager and Technology Consultant at Arthrex Alabama in Birmingham, who works with the Prevosts. “The training at Arthrex helps bring down the learning curve for surgeons who are new to endoscopic procedures. The hands-on work with other experienced clinicians is invaluable.”
Arthrex Spine has also recently launched a new, patient-facing website designed to increase awareness of ultra-minimally invasive surgical procedures for the spine.
ArthrexEndoscopicSpine.com addresses the fact that eight out of ten adults will experience back pain in their lifetime 5,6 and explains that ultra-minimally invasive treatment options are designed to restore function, preserve motion and minimize back pain.
“The primary barrier to broader adoption of endoscopic spine surgery has been education,” said Arthrex Director – Global Spine Zak Kemp. “Most spine surgeons do not receive endoscopic training during their residency or fellowship. Arthrex helps minimize the time commitment for surgeons by offering world-class medical education at our locations on both the East and West Coasts in the United States and (beginning in April 2025) in Germany.”
The access to specialized training, in addition to combining forces, is making all the difference for the Prevost brothers and their patients.
“We also have a cheat code with the learning curve, because Matthew and I are doing all the cases together,” Mark said.
And while not every surgeon has the benefit of working closely with a sibling, Dr. Derman says they should all be taking the time to learn from their peers.
“The endoscopic community is a very collegial group of surgeons,” he said. “This wave of ultra-minimally invasive surgery is coming, and if you don’t adopt it, you’re going to get left behind.”
Disclaimers
As with all endoscopic spinal surgeries, the risks include neurological injury, vascular injury, visceral injury, recurrence, dysesthesia, and incomplete decompression. Additional complications may occur, that include dural tear, hematoma, infection, instability, and facet joint injury.
The Arthrex endoscopes and instrumentation are indicated for visualization of the intraoperative site and surgical intervention during endoscopic procedures and minimally invasive surgery involving the spine. Endoscopic spine surgery is generally not intended for patients who have experienced or are experiencing spinal trauma, infection, instability, severe scoliosis, or have a present pathologic issue.
This is not medical advice and is not meant to be a substitute for the advice provided by a surgeon or other qualified medical professional on the use of these products. You should talk with your physician or health care provider for more information about your health condition and whether Arthrex products might be appropriate for you. The surgeon who performs any surgical procedure is responsible for determining and using the appropriate techniques for surgical procedures on each individual patient. Arthrex recommends that surgeons be trained on the use of any particular product before using it in surgery. A surgeon must always rely on their own professional medical judgment when deciding whether to use a particular product when treating a particular patient. A surgeon must always refer to the package insert, product label, and/or directions for use before using any Arthrex product. Postoperative management is patient-specific and dependent on the treating professional’s assessment. Individual results will vary and not all patients will experience the same postoperative activity level or outcomes. Products may not be available in all markets because product availability is subject to the regulatory approvals and medical practices in individual markets. Please contact Arthrex if you have questions about the availability of products in your area.
Peter Derman, MD, MBA is a paid consultant for Arthrex, Inc.
References
1. Gadjradj PS, Broulikova HM, van Dongen JM, et al. Cost-effectiveness of full endoscopic versus open discectomy for sciatica. Br J Sports Med. Published online February 20, 2022. doi:10.1136/bjsports-2021-104808
2. Ruetten S, Komp M, Merk H, Godolias G. Use of newly developed instruments and endoscopes: Full-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach. J Neurosurg Spine. 2007;6(6):521-530. doi:10.3171/spi.2007.6.6.2
3. Polikandriotis JA, Hudak EM, Perry MW. Minimally invasive surgery through endoscopic laminotomy and foraminotomy for the treatment of lumbar spinal stenosis. J Orthop. 2013;10(1):13-16. doi:10.1016/j.jor.2013.01.006
4. Page PS, Ammanuel SG, Josiah DT. Evaluation of endoscopic versus open lumbar discectomy: a multi-center retrospective review utilizing the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database. Cureus. 2022;14(5):e25202. doi:10.7759/cureus.25202
5. Zhou T, Salman D, McGregor AH. Recent clinical practice guidelines for the management of low back pain: a global comparison. BMC Musculoskelet Disord. 2024;25(1):344. doi:10.1186/s12891-024-07468-0
6. Urits I, Burshtein A, Sharma M, et al. Low back pain, a comprehensive review: pathophysiology, diagnosis, and treatment. Curr Pain Headache Rep. 2019;23(3):23. doi:10.1007/s11916-019-0757-1