Five-Star Rated Neurosurgery for Neck and Back

Tier 1 Neurosurgery brings state-of-the-art neurosurgical techniques to the Upper Cumberland and surrounding areas for the diagnosis and treatment of diseases and disorders affecting the brain, carotid artery, spinal cord and nervous system, as well as degenerative spine conditions.

Our Mission

  • Providing comprehensive, state-of-the-art neurosurgical care in a local setting for the patients of our region. These services include microneurosurgery, minimally invasive spine surgery, stroke surgery and advanced spine surgery, as well as brain and spine trauma care.
  • Providing neurosurgical update information for physicians and allied health professionals, and providing a dependable source of neuro education for patients and the regional community.

We look forward to building productive, enduring relationships with our community’s neurosurgical patients.

Meet Our Physicians

Joseph Jestus, MD

Joseph Jestus, MD

Walter Jermakowicz, MD, PHD

Walter Jermakowicz, MD, PHD

Neurological Conditions

  • Brain Tumors
  • Spinal Tumors
  • Herniated Discs
  • Spinal Stenosis
  • Degenerative Disc Disease
  • Chiari Malformations
  • Carpal Tunnel Syndrome
  • Ulnar Neuropathy
  • Peroneal Neuropathy
  • Carotid Occlusive Disease
  • Cerebral Aneurysms
  • Trigeminal Neuralgia

Specialties & Procedures Videos

Choose your topic below to learn more about our specialties and procedures.

Cervical (Neck)

  • Anterior Cervical Discectomy and Fusion
  • Anterior Cervical Corpectomy
  • Cervical Laminectomy
  • Cervical Foraminotomy

Peripheral Nerve Surgery

  • Carpal Tunnel Release
  • Ulnar Nerve Release
  • Peroneal Nerve Release


  • Carotid Endarterectomy


  • Aneurysm Clipping
  • Burr Hole Drainage for Subdural Hematoma
  • Craniotomy for Intracerebral Hematoma
  • Craniotomy for Subdural Hematoma
  • Craniotomy for Tumor
  • Craniectomy for Chiari Malformation
  • Stereotactic Biopsy
  • Microvascular Decompression for Trigeminal Neuralgia
  • Transsphenoidal Surgery for Tumor
  • Ventriculoperitoneal Shunt for Hydrocephalus

Lumbar (Lower Back)

  • Lumbar Microdiscectomy
  • Lumbar Laminectomy
  • Percutaneous Kyphoplasty
  • Posterior Lumbar Interbody Fusion (PLIF)
  • Transforaminal Lumbar Interbody Fusion (TLIF)
  • Anterior Lumbar Interbody Fusion (ALIF)
  • Minimally Invasive Lumbar Microdecompression
  • Minimally Invasive Transforaminal Spinal Fusion (TLIF)

More Helpful Information

Because our patients are, first of all, your patients, we are dedicated to communicating with referring physicians in a timely, professional way. We strive to provide updates on the status and treatment of your patients efficiently and quickly through written correspondence, phone calls and faxed information. Dr. Jestus welcomes your calls for consultation. Please do not hesitate to let us know how we can better serve you and your patients.

To refer a patient for an appointment, your office may call us at (931) 372-7716 between 8 a.m. and 5 p.m. Monday through Friday. Patients may register and complete their new patient forms at any time before their visit through our online patient portal. If forms are not completed before the first visit, the patient will be given forms to fill out during their visit.

If hospitalization is required, patients will be admitted to Cookeville Regional Medical Center (CRMC) with continued care from our physicians. CRMC has undergone rapid growth, especially in the area of specialty surgical services. CRMC’s available specialties include vascular surgery, cardiac surgery and plastic surgery, in addition to neurosurgery, complementing the larger practices of general, orthopedic and urologic surgery.

If patients encounter an emergency at a time other than regular office hours, they should call 911 or proceed directly to the emergency room of Cookeville Regional Medical Center.

We want to answer as many questions as possible during your visit. Please prepare for this by bringing the following:

  • list of all medications you are taking
  • list of your questions/concerns for the physician
  • copy of your X-rays/CT/MRI scans (not the reports – please get the actual films copied onto a CD) unless they were performed at Cookeville Regional Medical Center or Premier Diagnostic in Cookeville. In this case, we will obtain copies prior to the day of your appointment.
  • If needed, a friend or family member to take notes/help with questions
  • Your health insurance card(s)
  • Your co-payment

Because insurance networks change frequently, we have listed the insurance companies and networks that we are presently in. Please check back often for updated information and plans we may have joined since your last visit.

Medicare Advantage Plans

Due to the ever-changing array of Medicare replacement policies you have to choose from, we suggest you call your plan directly to see if our physicians are contracted.

Partial list of insurance we accept:

  • Medicare (traditional)
  • Blue Cross PPO
  • Cigna PPO
  • United Healthcare (most plans; call your insurance for verification)
  • PHCS
  • First Health
  • Blue Grass Family Health (including Signature Health Alliance)
  • Prime
  • Workers comp (Your adjuster must initiate your first appointment; call Darlene at (931) 372-7716 or email her at darlene@t1institute.com.)
  • Humana (Medicare only) HMO/POS/PPO/PFFS
  • Health Spring (Medicare only)

Office hours are 8 a.m. until 5 p.m. Monday through Friday. The office is closed on all legal holidays: New Year’s Day, Memorial Day, July 4th, Labor Day, Thanksgiving and the day after, Christmas eve and Christmas day.