Based upon the aforementioned evidence and case law, I find that the respondent did present sufficient evidence to establish a defense based on lack of casual relationship of the lumbar spine injuries and the lack of medical necessity, and that the applicant has not satisfied its burden by presenting its own evidence of medical necessity for surgery for this sixty five year old male patient as a result of the accident on 1/30/11 in this case. North Shore University Hospital a/a/o Applicant 1 v. State Farm Mutual Automobile Insurance Company, AAA Case No.: 412012029390 (Arb. A. Russo, 2013) affirmed by North Shore University Hospital a/a/o Richard Massari v. State Farm Mutual Automobile Insurance Company, AAA Case No.: 17991R1854613 (Master Arb. P. Merani, 2013).