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Edwards v. State of Delaware IAB Hearing No. 1164832 (Nov. 14, 2014).

The Board rejects a claimant’s theory that “adjacent segment degeneration,” resulting from a spinal fusion, can skip the adjacent level, and concludes that two low back surgeries at L2-3 were not causally related to four, prior compensable surgeries at L4-S1.

The claimant, Gloria Edwards, injured her low back in a compensable work accident on February 7, 2000. She later underwent four compensable surgeries, including a spinal fusion at L4-5 and L5-S1 and hardware removal, performed by Dr. Kalamchi in 2005-2006, followed by a revision surgery at L5-S1 and an augmentation of the fusion at L4-5, performed by Dr. Rudin in 2009 and 2010. The claimant was significantly improved following the fourth surgery and was released from Dr. Rudin’s care in 2011. However, in March 2013, she began experiencing new pain going into the groin area and the legs. Dr. Rudin attributed these symptoms to L2-3 spinal stenosis. He then performed two additional surgeries that addressed that level, in May 2013 and December 2013. The employer denied that the 2013 surgeries were causally related to the work accident or the previous four surgeries, so the claimant filed a petition with the Board.

At the hearing, Dr. Rudin testified for the claimant and Dr. Keehn testified for the employer. The Board found Dr. Keehn’s causation opinions more persuasive for several reasons: (1) there was no evidence that the claimant injured her spine at L2-3 in the work accident, (2) the claimant did not present with symptoms consistent with L2-3 pathology until 2013, (3) L2-3 showed signs of slowly progressive degeneration between 2007 and 2009 and (4) claimant had significantly improved by 2011 with regards to her L4-S1 symptoms. The Board rejected Dr. Rudin’s testimony that “adjacent segment degeneration” resulting from a spinal fusion can skip the adjacent level (L3-4 here) and affect a level above. Dr. Keehn acknowledged that a high rate of degeneration can develop one level above a fusion, but he was aware of no medical literature accepting the theory proffered by Dr. Rudin that “adjacent segment degeneration” can skip a level.

The Board agreed with Dr. Keehn and concluded that it was likely that L2-3 simply deteriorated naturally between 2007 and 2013 and that the very rapid degeneration at L2-3 took place after the May 2013 surgery, so that surgery was the likely trigger, rather than the prior fusion two levels below. Accordingly, the Board determined that the Claimant had failed to show a causal relationship between the work accident and the 2013 surgeries, so the petition was denied.

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