The Expert: Dr. Robert Berry Jr., an expert on physician medicine and rehabilitation, who testifies for the plaintiff, detailing injuries she suffered.
Giving testimony in a 2015 trial out of the Second Judicial District Court in Reno, Nevada, Dr. Robert Berry Jr., a physical medicine and rehabilitation physician speaks to the plaintiff’s injuries suffered when she was involved in a serious car accident as a result of a faulty brake job.
In this video clip, the doctor begins by describing the pathology noted on the patient’s neck MRI scan, which includes notation of large osteophytes, or bone spurs, found near the foramen at the C3-C4 level on the left side. These small pointed outgrowths of bone tend to develop in areas of inflammation or injury, and when they encroach on a foramen at the exit of a nerve, they can irritate or crush that nerve. Berry states that, “there is clear objective evidence that that is where her injury was.” The abnormal structures developed there over a period of three or four months after the accident. Arthritis causing similar findings takes years to develop these osteophytes, so it becomes much more likely that these are directly related to her trauma.
The doctor performed a sensory (medial) branch block of the involved nerve, which he felt demonstrated that this was the exact nerve involved in the injury. Numbing the nerve with a long acting anesthetic agent, he obtained a positive response with the pain totally alleviated for several days, then returning as one would expect. He then recommended a neuroablation procedure, which essentially destroys the medial branch of the spinal nerve at that level. This is the same sensory branch that he had previously anesthetized, but this time he would destroy the nerve branch by cauterization. The hope was that this procedure, called a rhizotomy, would give long term pain relief to the accident victim. This therapeutic procedure was then performed on the affected left side.
The pain expert felt that his patient had an excellent result from this therapeutic maneuver, although the woman did experience some hypersensitivity from her nerve being thermally stimulated during its destruction. This is not at all uncommon and lasts for about three to four weeks before wearing off. It is generally alleviated with oral pain medication and confirms that the right nerve has been treated. In follow-up, the patient continued to improve until “she was one hundred percent better.”
All of these things are confirmatory, according to the testimony. Her initial X-rays were indicative of a cervical spine problem at C3-C4 and months later the MRI showed foraminal encroachment by osteophytes at that same level. She received a positive response from her diagnostic injection with local anesthetic, and then a good therapeutic response to thermal ablation rhizotomy.
A sensory nerve will regenerate and reenvervate the affected joint after about 12 to 18 months, so the procedure will have to be repeated in the future. This in fact occurred in this case, so the patient had the same neuroablation performed a second time. This was again successful, and Berry explains that she is likely to need this done every twelve to eighteen months for the rest of her life.
The verdict for the plaintiff was accompanied by an award of $683,883.
Gary Gansar, MD, is residency-trained in general surgery. He served as Chief of Surgery and Staff at Elmwood Medical Center and on the Medical Executive Committee at Touro Infirmary and Mercy Hospital in New Orleans, LA. Dr. Gansar was Board Certified in general surgery while in active practice. He joined AMFS in 2015 as a Physician Medical Director.
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