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On 5/2/21, Claimant was injured in a fall from a second story window during a training exercise as a volunteer firefighter. On 9/12/22, Claimant filed a Petition seeking pre-authorization of a single level lumbar fusion surgery recommended by Dr. Yalamanchili during his first visit with the claimant on 9/7/22.
The Board found that the proposed surgery was not reasonable and necessary treatment at this time, accepting the opinion of defense medical expert, Dr. Close, over Dr. Yalamanchili.
The Board agreed with Dr. Close that the claimant had not exhausted conservative care. Claimant had not received steroid injections, which could be both diagnostic and therapeutic. Further physical therapy could benefit the claimant, especially as she had experienced good relief with this particular modality in the past. Anti-neuropathy medications should be trialed. An EMG would be of diagnostic utility. Claimant should have a second opinion.
The Board was also not comfortable with the risks associated with the surgery. Even Dr. Yalamanchili testified that claimant’s chances of success were 60-70% at best. Even with the surgery, the balance of patients do not improve and may even get worse. Dr. Close testified credibly that there were several factors that caused him to question Dr. Yalamanchili’s projections. Specifically, Claimant’s imaging findings were degenerative, common in patients in her age group, and showed no spinal instability. There was a bulge without any cord compromise. Fusion surgery is not effective for predominantly axial low back pain. Claimant conceded that she had predominantly low back pain and her leg pain was only intermittent. Fusion surgery would predispose Claimant to developing adjacent segment problems, especially as she already had pathology in at least one adjacent level.
Should you have any questions regarding this decision, please contact Greg Skolnik or any other attorney in our Workers’ Compensation Department.
Jesika Martin v. State of Delaware, IAB Hrg. No. 1511181 (Mar. 6, 2023).