Dr. Kennedy is a Clinical Associate Professor and the Program Director of the PM&R Residency program in the Department of Orthopaedics at Stanford University, where his practice focuses on non-operative and interventional spine. He is currently a Member at Large on the Board of Directors for the American Academy of Physical Medicine and Rehabilitation (AAPM&R) and is also on the steering committee for the Joint AANS and AAPM&R Spine Registry. He additionally serves on the Board of Trustees for the Association of Academic Physiatrists (AAP) as chair of the Membership Committee, and he is the Treasurer on the Board of Directors for the Spine Intervention Society. He has published over 60 peer reviewed journal articles and over 20 book chapters. He is a Senior Editor for the PM&R Journal, and on the Editorial Board for Pain Medicine.

Academic Appointments

Administrative Appointments

  • Board of Trustees, Association of Academic Physiatrists (2011 - 2017)
  • Member at Large - Board of Governors, American Academy of Physical Medicine and Rehabilitation (2015 - Present)
  • Treasurer, Spine Interventional Society (2015 - 2017)
  • Senior Editor, PM&R Journal (2014 - Present)
  • Editorial Board, Pain Medicine Journal (2012 - Present)

Honors & Awards

  • Chief Resident, University of Washington (2007-2008)
  • America's Top Physicians, Consumers' Research Conucil (2010, 2011, 2012)
  • Patient's Choice Award, National Recognition for Patient Satisfaction (2008, 2009, 2010, 2011, 2012)
  • Outstanding Educator, University of Florida (2011)
  • Best Clinical Paper, International Spine Intervention Society (2013)
  • Best Papers Award, North American Spine Society (2013)
  • Teacher of the Year, Stanford University PM&R (2013)
  • Best Clinical Abstract, American Association of Physical Medicine and Rehabilitation (2013)

Boards, Advisory Committees, Professional Organizations

  • Board of Trustees, Association of Academic Physiatrists (2010 - 2017)
  • CIGH Fellow, Center for Innovation in Global Health (2016 - Present)
  • Board Of Directors, Spine Intervention Society (2014 - Present)
  • Board of Governors, AAPM&R (2015 - Present)

Professional Education

  • Fellow, Rehabilitation Institute of Chicago, Spine and Sports Medicine (2009)
  • Chief Resident, University of Washington, Physical Medicine and Rehabilitation (2008)
  • Residency, University of Washington, Physical Medicine and Rehabilitation (2008)
  • Internship, Tulane University, Transitional Internship (2005)
  • M.D., University of Florida, Medical Doctor (2004)
  • B.A., Florida State University, Biology (1999)

Community and International Work

  • Racing the Planet


    Ultramarathon Event Coverage



    Ongoing Project


    Opportunities for Student Involvement


Research & Scholarship

Current Research and Scholarly Interests

My research focuses on the safety and efficacy of common spine and peripheral joint injections.


2017-18 Courses


All Publications

  • A Paradigm Shift? Pain medicine (Malden, Mass.) Schneider, B. J., Levin, J., Kennedy, D. J. 2017

    View details for DOI 10.1093/pm/pnx093

    View details for PubMedID 28431156

  • Possibility and Risk of Medication Vial Coring in Interventional Spine Procedures PM&R Kordi, R., White, B. F., Kennedy, D. J. 2017; 9 (3): 289-293
  • Possibility and Risk of Medication Vial Coring in Interventional Spine Procedures. PM & R : the journal of injury, function, and rehabilitation Kordi, R., White, B. F., Kennedy, D. J. 2016


    When a needle is inserted into the stopper of a medication vial, small pieces of the stopper could be "cored" inside the bore of the needle, consequently aspirated, and then injected into the body. Reported coring rates vary from 3.1% to 97%. This article reviews the literature surrounding this topic and covers the rate of coring, its risk factors, and particle size, as well as prevention techniques to maximize safety during interventional procedures.

    View details for DOI 10.1016/j.pmrj.2016.09.003

    View details for PubMedID 27639650

  • Second-Order Peer Reviews of Clinically Relevant Articles for the Physiatrist: Naproxen with Cyclobenzaprine, Oxycodone/Acetaminophen, or Placebo to Treating Acute Low Back Pain: A Randomized Clinical Trial. American journal of physical medicine & rehabilitation Schneider, B. J., Kennedy, D. J., Kumbhare, D. 2016: -?

    View details for PubMedID 27610552

  • Safety of epidural steroid injections. Expert opinion on drug safety Schneider, B., Zheng, P., Mattie, R., Kennedy, D. J. 2016; 15 (8): 1031-1039


    Epidural steroid injections (ESI) are a commonly utilized treatment for cervical and lumbar radicular pain. All medical procedures and medications carry an inherent level of risk, that must be balanced with the effectiveness of the treatment to determine the risk to benefit ratio for a patient.This article will outline the risks of ESIs and in doing so help shed light on the procedural risks versus the risks of the medication. Additionally, it will help differentiate minor adverse events from significant permanent complications.Catastrophic complications of ESI such as paralysis and stroke unquestionably warrant the recent increased attention given to the safety of these injections. While a single major complication is unacceptable, the relative rate of these major complications must be put in prospective. The true rate is small enough that it is impossible to calculate. All cases are limited to case reports and not detected in even the largest published cohorts of ESI. Moreover, recent advances in medication selection and technique have further reduced the incidence of these very rare complications. Conversely, the more common adverse events are rather minor, generally transient, and mostly occur at incidences of less than 1%.

    View details for DOI 10.1080/14740338.2016.1184246

    View details for PubMedID 27148630

  • Detection of Intravascular Injection During Lumbar Medial Branch Blocks: A Comparison of Aspiration, Live Fluoroscopy, and Digital Subtraction Technology. Pain medicine Kennedy, D. J., Mattie, R., Scott Hamilton, A., Conrad, B., Smuck, M. 2016; 17 (6): 1031-1036


    Medial branch blocks may have unrecognized vascular uptake potentially resulting in false- negative results.To determine the rate of unintended vascular injection of contrast medium during medial branch blocks (MBB) with digital subtraction (DS) technology in the context of negative vascular uptake as determined by live fluoroscopy.Prospective Study in an academic medical center.344 consecutive MBBs in 80 subjects.The presence of vascular flow as determined by live fluoroscopy and DS technology.Unintended vascular injection of contrast medium was determined on 344 consecutive MBBs in 84 subjects, first using live fluoroscopy followed by DS. If live fluoroscopy initially detected vascular uptake, the needle was repositioned until no vascular flow was detected. Once no vascular uptake was confirmed by live fluoroscopy, a contrast medium was then injected while being visualized with DS to again assess the presence or absence of vascular flow undetected by live fluoroscopy.Live fluoroscopy revealed inadvertent vascular uptake in 38 of the 344 blocks [11% (95% CI 8.0-15%)]. DS uncovered an additional 27 of the 344 blocks [7.8% (95% CI 5.3-11.4%)] with evidence of vascular uptake that were not detected with conventional live fluoroscopy.DS enhances the ability to detect inadvertent vascular flow during medial branch blocks. This study demonstrates that standard live fluoroscopy can miss a small percentage of cases with unintentional vascular uptake during MBB when compared with DS and may contribute to occasional false-negative responses.

    View details for PubMedID 26814308

  • Importance of Image Guidance in Glenohumeral Joint Injections Comparing Rates of Needle Accuracy Based on Approach and Physician Level of Training AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION Mattie, R., Kennedy, D. J. 2016; 95 (1): 57-61

    View details for DOI 10.1097/PHM.0000000000000338

    View details for Web of Science ID 000366818100007

    View details for PubMedID 26135365

  • Differential Rates of Inadvertent Intravascular Injection during Lumbar Transforaminal Epidural Injections Using Blunt-Tip, Pencil-Point, and Catheter-Extension Needles PAIN MEDICINE Smuck, M., Paulus, S., Patel, A., Demirjian, R., Ith, M. A., Kennedy, D. J. 2015; 16 (11): 2084-2089
  • Fluoroscopically Guided Diagnostic and Therapeutic Intra-Articular Sacroiliac Joint Injections: A Systematic Review PAIN MEDICINE Kennedy, D. J., Engel, A., Kreiner, D. S., Nampiaparampil, D., Duszynski, B., MacVicar, J. 2015; 16 (8): 1500-1518

    View details for DOI 10.1111/pme.12833

    View details for Web of Science ID 000360053100008

  • Glenohumeral Joint Pain Referral Patterns: A Descriptive Study PAIN MEDICINE Kennedy, D. J., Mattie, R., Quang Nguyen, Q., Hamilton, S., Conrad, B. 2015; 16 (8): 1603-1609

    View details for DOI 10.1111/pme.12797

    View details for Web of Science ID 000360053100017

  • Changes in gait kinematics and lower back muscle activity post-radiofrequency denervation of the zygapophysial joint: a case study SPINE JOURNAL Stegemoeller, E. L., Roper, J., Hass, C. J., Kennedy, D. J. 2015; 15 (6): E21-E27
  • Morphologic changes in the lumbar spine after lumbar medial branch radiofrequency neurotomy: a quantitative radiological study SPINE JOURNAL Smuck, M., Crisostomo, R. A., Demirjian, R., Fitch, D. S., Kennedy, D. J., Geisser, M. E. 2015; 15 (6): 1415-1421


    Medial branch radiofrequency neurotomy (RFN) is a common treatment for zygapophyseal joint pain. The lumbar medial branch innervates these joints and adjacent structures. The impact of the intended neurotomy on these structures remains unclear. No studies have yet verified quantitatively the effect of medial branch RFN on intervertebral discs, facet joints, and multifidus cross-sectional area.The aim of this study was to determine, using objective radiographic measures, whether there is a quantitative difference in the lumbar multifidus muscle cross-sectional area, facet joint degeneration, or intervertebral disc degeneration after segmental medial branch RFN.This is a retrospective single-cohort study performed at a university spine center.The patient sample consisted of 27 patients treated with lumbar medial branch RFN, with pre- and posttreatment magnetic resonance images available for analysis.The primary study outcome measure was interval change in fat-subtracted multifidus cross-sectional area, and intervertebral disc and zygapophyseal joint degeneration grade.In this retrospective study, segmental levels unaffected by RFN treatment were used as controls to compare against levels affected by treatment.Levels affected by RFN demonstrated a significantly greater amount of disc degeneration compared with unaffected levels (14.9% vs. 4.6%; p=.0489). There was no statistical difference in the multifidus cross-sectional area or rates of deterioration in the zygapophyseal joints observed.The full impact of RFN on multifidus function, morphology, and segmental anatomy is unknown. This retrospective study indicates that measurable changes in segmental morphology may occur after lumbar medial branch RFN. These findings require validation in a prospective, controlled study.

    View details for DOI 10.1016/j.spinee.2013.06.096

    View details for Web of Science ID 000354875700043

    View details for PubMedID 24239488

  • Epidural Steroid Injections are Safe and Effective: Multisociety Letter in Support of the Safety and Effectiveness of Epidural Steroid Injections PAIN MEDICINE Kennedy, D. J., Levin, J., Rosenquist, R., Singh, V., Smith, C., Stojanovic, M. P., Vorobeychik, Y. 2015; 16 (5): 833-838


    In April 2014, the Food and Drug Administration (FDA) issued a Drug Safety Communication requesting that corticosteroid labeling include warnings that injection of corticosteroids into the epidural space of the spine may result in rare but serious adverse events, including loss of vision, stroke, paralysis, and death.The International Spine Intervention Society spearheaded a collaboration of more than a dozen other medical societies in submitting the letter below to the FDA on November 7, 2014. We are publishing the letter to ensure that the readership of Pain Medicine is aware of the multisociety support for the safety and effectiveness of these procedures. A special note of thanks to all of the societies who signed on in support of the message.

    View details for DOI 10.1111/pme.12667

    View details for Web of Science ID 000354742300001

    View details for PubMedID 25586082

  • The Use of Moderate Sedation for the Secondary Prevention of Adverse Vasovagal Reactions PAIN MEDICINE Kennedy, D. J., Schneider, B., Smuck, M., Plastaras, C. T. 2015; 16 (4): 673-679


    Vasovagal reactions can occur with spine procedures and may result in premature procedure termination or other adverse events.To evaluate if moderate sedation is an effective means of secondary prevention for vasovagal reactions.Prospectively collected data on 6,364 consecutive spine injections.Of the 6,364 spine injections, 6,150 spine injections were done without moderate sedation and resulted in 205 vasovagal reactions (3.3% [95% confidence interval {CI} 2.9-3.8%]). One hundred thirty-four spine procedures were performed on patients that had a history of prior vasovagal reaction during a spine procedure. Of these, 90 procedures were performed without moderate sedation, and 21/90 (23.3% [95% CI 15.2-32.1%]) were complicated by a repeat vasovagal reaction. None of 44 repeat injections that utilized moderate sedation experienced a repeat vasovagal reaction (0% [95% CI 0-9.6%]) (χ(2)  = 12.17, P < 0.00048). The rate of vasovagal reaction in patients with a history of prior reaction undergoing repeat injection without conscious sedation was significantly higher (23.3% [95% CI 15.2-32.1%]) than the rate in patients with no such history (3.0% [95% CI 2.6-3.5%] [χ(2)  = 113.4, P < 1.78E-26]).A history of vasovagal reaction is a strong predictor of experiencing a vasovagal reaction on subsequent procedures. No vasovagal reactions occurred with the use of moderate sedation, including in the 44 injections in patients that had a history of vasovagal reaction during spine procedures. The overall low rate of vasovagal reactions is low, and greater benefits of moderate sedation were observed when utilized as secondary prevention of repeat vasovagal reactions.

    View details for DOI 10.1111/pme.12632

    View details for Web of Science ID 000352617600009

    View details for PubMedID 25529469

  • Advanced knee osteoarthritis in an active male: biologics or total knee replacement. PM & R : the journal of injury, function, and rehabilitation Colizza, W. A., Ibrahim, V., Kennedy, D. J. 2015; 7 (4): S60-5

    View details for DOI 10.1016/j.pmrj.2015.02.009

    View details for PubMedID 25864662

  • Return to Play Considerations for Cervical Spine Injuries in Athletes PHYSICAL MEDICINE AND REHABILITATION CLINICS OF NORTH AMERICA Paulus, S., Kennedy, D. J. 2014; 25 (4): 723-?
  • Return to play considerations for cervical spine injuries in athletes. Physical medicine and rehabilitation clinics of North America Paulus, S., Kennedy, D. J. 2014; 25 (4): 723-733


    Injuries to the cervical spine during sports are relatively common, depending on the specific sport. Given the adjacent neurovascular structures, any injury to the cervical spine must be evaluated with caution to assess its severity. With proper management, most injuries resolve quickly and allow for rapid return to play (RTP). The purpose of this article is to synthesize the current literature on the most common cervical spine injuries in athletes, including injury prevalence, mechanisms of injury, and RTP decision-making processes.

    View details for DOI 10.1016/j.pmr.2014.06.005

    View details for PubMedID 25442156

  • A Quantitative Study of Intervertebral Disc Morphologic Changes Following Plasma-Mediated Percutaneous Discectomy PAIN MEDICINE Smuck, M., Levin, J., Zemper, E., Ali, A., Kennedy, D. J. 2014; 15 (10): 1695-1703

    View details for DOI 10.1111/pme.12525

    View details for Web of Science ID 000344244800005

  • Trainee Involvement in Transforaminal Epidural Steroid Injections Associated With Increased Incidence of Vasovagal Reactions PM&R Schneider, B., Kennedy, D. J., Casey, E., Smuck, M., Conrad, B. 2014; 6 (10): 914-919
  • The value of maintaining primary board certification in physical medicine and rehabilitation. PM & R : the journal of injury, function, and rehabilitation Crew, J., Gittler, M., Kennedy, D. J. 2014; 6 (7): 650-655

    View details for DOI 10.1016/j.pmrj.2014.06.007

    View details for PubMedID 25059899

  • Reply to letter to the editor "Morphologic changes in the lumbar spine following lumbar medial branch radiofrequency neurotomy: a quantitative radiologic study". spine journal Smuck, M., Crisostomo, R. A., Demirjian, R., Fitch, D. S., Kennedy, D. J., Geisser, M. E. 2014; 14 (6): 1089-1090

    View details for DOI 10.1016/j.spinee.2014.02.001

    View details for PubMedID 24851740

  • Should antiplatelet medications be held before cervical epidural injections? PM & R : the journal of injury, function, and rehabilitation Furman, M. B., Plastaras, C. T., Popescu, A., Tekmyster, G., Davidoff, S., Kennedy, D. J. 2014; 6 (5): 442-450

    View details for DOI 10.1016/j.pmrj.2014.04.012

    View details for PubMedID 24863733

  • Not All Injections Are the Same ANESTHESIOLOGY Engel, A. J., Kennedy, D. J., MacVicar, J., Bogduk, N. 2014; 120 (5): 1282-1283

    View details for DOI 10.1097/ALN.0000000000000197

    View details for Web of Science ID 000335175100034

    View details for PubMedID 24755794

  • Medical marijuana for failed back surgical syndrome: a viable option for pain control or an uncontrolled narcotic? PM & R : the journal of injury, function, and rehabilitation Aggarwal, S. K., Pangarkar, S., Carter, G. T., Tribuzio, B., Miedema, M., Kennedy, D. J. 2014; 6 (4): 363-372

    View details for DOI 10.1016/j.pmrj.2014.03.006

    View details for PubMedID 24766854

  • Original Research Articles Comparative Effectiveness of Lumbar Transforaminal Epidural Steroid Injections with Particulate Versus Nonparticulate Corticosteroids for Lumbar Radicular Pain due to Intervertebral Disc Herniation: A Prospective, Randomized, Double-Blind Trial PAIN MEDICINE Kennedy, D. J., Plastaras, C., Casey, E., Visco, C. J., Rittenberg, J. D., Conrad, B., Sigler, J., Dreyfuss, P. 2014; 15 (4): 548-555


    Lumbar transforaminal epidural injections are commonly utilized to treat radicular pain due to intervertebral disc herniation.This study aims to determine if there was a major difference in effectiveness between particulate and nonparticulate corticosteroids for acute radicular pain due to lumbar disc herniation.A multicenter, double blind, prospective, randomized trial on 78 consecutive subjects with acute uni-level disc herniation resulting in unilateral radicular pain. All subjects received a single level transforaminal epidural steroid injection with either dexamethasone or triamcinolone. Repeat injections were allowed as determined by the blinded physician and subjects. Primary outcomes included: number of injections received, surgical rates, and categorical pain scores at 2 weeks, 3 months, and 6 months. Secondary outcomes included mean Oswestry Disability Index.Both triamcinolone and dexamethasone resulted in statically significant improvements in pain and function at 2 weeks, 3 months, and 6 months, without clear differences between groups. The surgical rates were comparable with 14.6% of the dexamethasone group and 18.9% of the triamcinolone group receiving surgery. There was a statistically significant difference in the number of injections received, with 17.1% of the dexamethasone group receiving three injections vs only 2.7% of the triamcinolone group.Transforaminal epidural corticosteroid injections are an effective treatment for acute radicular pain due to disc herniation, and frequently only require 1 or 2 injections for symptomatic relief. Dexamethasone appears to possess reasonably similar effectiveness when compared with triamcinolone. However, the dexamethasone group received slightly more injections than the triamcinolone group to achieve the same outcomes.

    View details for DOI 10.1111/pme.12325

    View details for Web of Science ID 000334111300007

  • Do Physiatric Procedures Represent a Value or Liability? PM&R Furman, M. B., Melvin, J. L., Kennedy, D. J. 2014; 6 (1): 85-85

    View details for DOI 10.1016/j.pmrj.2013.12.002

    View details for Web of Science ID 000330552100016

    View details for PubMedID 24439151

  • Vasovagal Rates in Flouroscopically Guided Interventional Procedures: A Study of Over 8,000 Injections PAIN MEDICINE Kennedy, D. J., Schneider, B., Casey, E., Rittenberg, J., Conrad, B., Smuck, M., Plastaras, C. T. 2013; 14 (12): 1854-1859


    To determine the rate of vasovagal (vv) complications in fluoroscopically guided interventional procedures.Retrospective case series analysis of prospectively collected data from March 8, 2004 to January 30, 2009.A single academic medical center.Four thousand one hundred eighty-three subjects undergoing 8,010 consecutive injections.Pearson's chi-square test was used to determine the relationship between categorical variables.A total of 8,010 injections, including epidural steroid injections, radiofrequency nerve ablations, medial branch blocks, hip injections, knee injections, and glenohumeral injections were performed. Overall vv reaction rate was 2.6%, with 0.8% of procedures resulting in early terminated due to vv reaction. Peripheral joint injections had a vv rate of 0.2%, all occurring in hip injections. Transforaminal epidural steroid injections had a vv rate of 3.5%. Diagnostic blocks of the medial branches had the highest rate of vv (5.1%). Other predictors of vv reactions were identified including preprocedure pain score visual analog scale <5 (P = 0.004), male gender (P < 0.001), and age less than 65 years old (P < 0.001).vv reactions have an overall low occurrence rate (2.6%) in interventional procedures ranging from 0% in peripheral knee and shoulder injections to 5.1% in medial branch blocks. Conservative treatment of vv reaction and willingness to terminate procedures resulted in no serious adverse events related to vv reaction in 8,010 procedures.

    View details for DOI 10.1111/pme.12241

    View details for Web of Science ID 000328349400010

    View details for PubMedID 24118835

    View details for PubMedCentralID PMC3887554

  • Patient satisfaction surveys: tools to enhance patient care or flawed outcome measures? PM & R : the journal of injury, function, and rehabilitation Esselman, P. C., White, B. F., Chimes, G. P., Kennedy, D. J. 2013; 5 (12): 1069-1076

    View details for DOI 10.1016/j.pmrj.2013.10.012

    View details for PubMedID 24332230

  • Compounding Pharmacies: A Viable Option, or Merely a Liability? PM&R O'Brien, D. 2013; 5 (11): 974-976

    View details for DOI 10.1016/j.pmrj.2013.10.001

    View details for Web of Science ID 000327579600010

    View details for PubMedID 24247017

  • Use of Spinal Injections for Low Back Pain JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Kennedy, D. J., Baker, R. M., Rathmell, J. P. 2013; 310 (16): 1736-1736

    View details for DOI 10.1001/jama.2013.277957

    View details for Web of Science ID 000325948500033

    View details for PubMedID 24150473

  • Corticosteroid choice for epidural injections. PM & R : the journal of injury, function, and rehabilitation DePalma, M. J., Stout, A., Kennedy, D. J. 2013; 5 (6): 524-532

    View details for DOI 10.1016/j.pmrj.2013.05.017

    View details for PubMedID 23790821

  • The Need for Magnetic Resonance Imaging Before Epidural Corticosteroid Injection PM&R Cohen, S. P., Maus, T., Kennedy, D. J. 2013; 5 (3): 230-233

    View details for DOI 10.1016/j.pmrj.2013.02.002

    View details for Web of Science ID 000316433300011

    View details for PubMedID 23481331

  • Programmatic Design for Teaching the Introductory Skills and Concepts of Lumbar Spine Procedures to Physiatry Residents A Prospective Multiyear Study AMERICAN JOURNAL OF PHYSICAL MEDICINE & REHABILITATION Visco, C. J., Kennedy, D. J., Chimes, G. P., Rittenberg, J., McLean, J., Dawson, P., Margolis, S., Lento, P., Ihm, J., Sliwa, J., Smeal, W., Sorosky, B., Plastaras, C. 2013; 92 (3): 248-257


    The objective of this study was to determine the effectiveness of a 2-day course teaching the introductory skills and concepts of lumbar spine procedures to physiatry residents.This is a 3-yr prospective study of a 2-day musculoskeletal course teaching the introductory skills and concepts of lumbar spinal procedures to the residents at a large academic physical medicine and rehabilitation program. The residents attending the course took multiple-choice pretests and posttests as well as participated in a procedural skills competency demonstration.Forty-two residents participated. The results were stratified according to the level of training and repetition of the material and revealed gains of medical knowledge at each level of residency training (P < 0.001). The postgraduate year 2 residents seemed to have the greatest overall improvement (P = 0.04). Half of the residents scored lower than 65% on the pretest, and these residents ultimately had the largest posttest gains. Forty (95.2%) residents achieved a grade of pass in the skills-based test. The residents felt that the course was valuable or extremely valuable.The comprehensive 2-day course teaching the skills and concepts of spinal interventions for physiatry residents enhances medical knowledge as an introduction to interventional spine care. Those who benefited the most were the residents who had the greatest deficit of medical knowledge on this topic before the course. This course curriculum does not replace fellowship training or closely monitored mentorship in the performance of spinal procedures.

    View details for DOI 10.1097/PHM.0b013e31826eda9e

    View details for Web of Science ID 000315185400008

    View details for PubMedID 23051759

  • Associations of self-report measures with gait, range of motion and proprioception in patients with lumbar spinal stenosis. Gait & posture 2013


    Spinal stenosis is defined as neurogenic claudication due to narrowing of the spinal canal lumen diameter. As the disease progresses, ambulation and gait may be impaired. Self-report measures are routinely used in the clinical setting to capture data related to lumbar pain symptoms, function and perceived disability. The associations between self-report measures and objective measures of physical function in patients with lumbar spinal stenosis are not well characterized. The purpose of this study was to determine the correlation between self-reported assessments of function with objective biomechanical measures of function.25 subjects were enrolled in this study. Subjects completed self-report questionnaires and biomechanical assessments of gait analysis, lumbar 3D ROM and lumbar proprioception. Correlations were determined between self-report measures and biomechanical data.The Oswestry Disability Index (ODI) was strongly correlated with stride length and gait velocity and weakly correlated with base of support. ODI was also weakly correlated with left lateral bending proprioception but not right lateral bending. The SF12 was not significantly correlated with any of the biomechanical measurements. Pain scores were weakly correlated with velocity, and base of support, and had no correlation any of the other biomechanical measures.There is a strong correlation between gait parameters and functional disability as measured with the ODI. Quantified gait analysis can be a useful tool to evaluate patients with lumbar spinal stenosis and to assess the outcomes of treatments on this group of patients.

    View details for DOI 10.1016/j.gaitpost.2013.05.010

    View details for PubMedID 23810090

  • It is the most common form of arthritis and the leading cause of disability in older persons, affecting an estimated 27 million adults in the United States alone. Introduction. PM & R : the journal of injury, function, and rehabilitation Kennedy, D. J., Fredericson, M. 2012; 4 (5): S1-2

    View details for DOI 10.1016/j.pmrj.2012.03.003

    View details for PubMedID 22632686

  • Conclusion. PM & R : the journal of injury, function, and rehabilitation Kennedy, D. J., Segal, N. A. 2012; 4 (5): S174-5

    View details for DOI 10.1016/j.pmrj.2012.03.004

    View details for PubMedID 22632697

  • The Role of Core Stabilization in Lumbosacral Radiculopathy PHYSICAL MEDICINE AND REHABILITATION CLINICS OF NORTH AMERICA Kennedy, D. J., Noh, M. Y. 2011; 22 (1): 91-?


    Lumbosacral radiculopathy is relatively common, and most cases resolve with appropriate conservative management. Along with pain control, the mainstay of treatment is a comprehensive rehabilitation program to correct for biomechanical factors that adversely affect spinal stability and predispose the patient to recurrent pain. Developing an appropriate treatment plan depends on thorough understanding of the structures providing core stability and the exercises to correct identifiable deficits. A comprehensive rehabilitation program includes postural training, muscle reactivation, correction of flexibility and strength deficits, and subsequent progression to functional exercises. This article reviews the current concepts regarding core stability and rehabilitation in lumbosacral radiculopathy.

    View details for DOI 10.1016/j.pmr.2010.12.002

    View details for Web of Science ID 000288228700008

    View details for PubMedID 21292147

  • Pharmaceutical Therapy for Radiculopathy PHYSICAL MEDICINE AND REHABILITATION CLINICS OF NORTH AMERICA Visco, C. J., Cheng, D. S., Kennedy, D. J. 2011; 22 (1): 127-?


    Pharmaceutical treatments for radiculopathy include opioid, antiinflammatory (steroidal and nonsteroidal), neuromodulating, topical, and adjuvant treatments. These medications act locally, peripherally, or centrally on the neural axis. This article reviews the history of medication use for radiculopathy and the available literature along with the breadth of current treatment and indications.

    View details for DOI 10.1016/j.pmr.2010.11.003

    View details for Web of Science ID 000288228700010

    View details for PubMedID 21292149

  • Preface Radiculopathy Physical Medicine and Rehabilitation Clinics of North America. Kennedy DJ 2011; 22 (1): xii-xiv
  • Sacroiliac Joint and Lumbar Zygapophysial Joint Corticosteroid Injections PHYSICAL MEDICINE AND REHABILITATION CLINICS OF NORTH AMERICA Kennedy, D. J., Shokat, M., Visco, C. J. 2010; 21 (4): 835-?


    The sacroiliac joint and the lumbar zygapophysial joints are both known pain generators with demonstrated pain-referral patterns. They are both amenable to image-guided intraarticular injection of corticosteroids, a procedure that is commonly performed for pain. The literature on the efficacy of intraarticular corticosteroid injections for these joints is currently limited. This article covers the diagnostic dilemmas associated with these joints, the utility of anesthetic blocks, and the literature on the efficacy of intraarticular corticosteroid injections.

    View details for DOI 10.1016/j.pmr.2010.06.009

    View details for Web of Science ID 000284790100014

    View details for PubMedID 20977966

  • Utility of the anesthetic test dose to avoid catastrophic injury during cervical transforaminal epidural injections SPINE JOURNAL Smuck, M., Maxwell, M. D., Kennedy, D., Rittenberg, J. D., Lansberg, M. G., Plastaras, C. T. 2010; 10 (10): 857-864


    Reports of serious complications from cervical transforaminal epidural corticosteroid injections often consider accidental intra-arterial injection the most likely mechanism of injury. As a result, many physicians have instituted methods to prevent intravascular injections. Routine use of the anesthetic test dose is one such method. The utility of the anesthetic test dose in this function has not been characterized in the current literature.The aim of this study was to determine the utility of injecting an anesthetic test dose before cervical transforaminal epidural corticosteroid injection and estimate the rate of false-negative intravascular contrast injection using live fluoroscopy and digital subtraction angiography (DSA).Two-center retrospective study.A consecutive cohort of men and women, ages of 23 to 83, who underwent cervical transforaminal epidural injection and received the anesthetic test dose after contrast injection was negative for vascular uptake, observed using live fluoroscopy or DSA.Response to the anesthetic test dose was documented in each procedure note and recorded as either positive or negative.Records of three physiatrists at two academic spine centers (Center A and Center B) were reviewed to identify all patients who received a cervical transforaminal epidural injection during the preceding 5 years, resulting in a cohort of consecutively treated patients at each center. Each patient record was reviewed for demographics, indication for injection, procedure level and side, needle gauge, use of DSA, volume and type of anesthetic test dose used, and result of test dose injection. The test dose was considered positive if the following occurred: agitation or other sudden central nervous system change; gross motor deficits and/or paresthesias in the trunk, legs, or contralateral arm; systemic symptoms of anesthetic toxicity including cardiac arrhythmia, perioral numbness, metallic taste, dizziness, and/or ringing in the ear. For analysis, injections were separated into groups to compare results at Center A to Center B and to compare injections that used DSA to those that did not. The incidence of a positive response was calculated as a percentage from the total number of injections in the group. Differences between groups were analyzed for statistical significance using the Fisher exact test.Six hundred seventy-eight injections were included. Of these, 349 were performed at Center A with test doses given after contrast injection under live fluoroscopy. The remaining 329 were performed at Center B, 183 also using live fluoroscopy, and 146 using DSA. The overall incidence of a positive anesthetic test dose was 0.59% (4/678). There was no significant difference between the incidence at each of the two centers (0.86% [3/349] vs. 0.30% [1/329]; p=.63). The overall incidence after live fluoroscopy was 0.75% (4/532) and after DSA was 0% (0/146), but this difference was not statistically significant (p=.58). Positive symptoms elicited by test dose administration included midneck and contralateral arm pain, metallic taste, dizziness, tachycardia, full body paresthesias, auditory changes, slurred speech, and motor ataxia. In all four cases with a positive response, the procedure was immediately terminated, symptoms resolved, and no lasting complications were observed.The routine use of an anesthetic test dose appears to be safe and capable of detecting potentially dangerous intravascular injections undetected by conventional techniques. Positive responses occur in a small portion of those who receive the test dose injection. Further studies are required to determine the optimal dose and concentration of anesthetic to be used and the time required for observation after test dose administration.

    View details for DOI 10.1016/j.spinee.2010.07.003

    View details for Web of Science ID 000283190400002

    View details for PubMedID 20692210

  • Utility of the Anesthetic Test Dose to Avoid Catastrophic Injury During Cervical Transforaminal Epidural Injections The Spine Journal Smuck M, Maxwell MD, Kennedy DJ, Rittenberg JD, Maarten GL, Plastaras CT 2010: 857-864
  • Paraplegia Following Image-Guided Transforaminal Lumbar Spine Epidural Steroid Injection: Two Case Reports PAIN MEDICINE Kennedy, D. J., Dreyfuss, P., Aprill, C. N., Bogduk, N. 2009; 10 (8): 1389-1394


    To present two case reports of a rare but devastating injury after image-guided, lumbar transforaminal injection of steroids, and to explore features in common with previously reported cases.Image (fluoroscopic and computed tomography [CT])-guided, lumbar transforaminal injections of corticosteroids have been adopted as a treatment for radicular pain. Complications associated with these procedures are rare, but can be severe.An 83-year-old woman underwent a fluoroscopically guided, left L3-L4, transforaminal injection of betamethasone (Celestone Soluspan). A 79-year-old man underwent a CT-guided, right L3-L4, transforaminal injection of methylprednisolone (DepoMedrol). Both patients developed bilateral lower extremity paralysis, with neurogenic bowel and bladder, immediately after the procedures. Magnetic resonance imaging scans were consistent with spinal cord infarction. There was no evidence of intraspinal mass or hematoma.These cases consolidate a pattern emerging in the literature. Distal cord and conus injury can occur following transforaminal injections at lumbar levels, whether injection is on the left or right. This conforms with the probability of radicular-medullary arteries forming an arteria radicularis magna at lumbar levels. All cases used particulate corticosteroids, which promotes embolization in a radicular artery as the likely mechanism of injury. The risk of this complication can be reduced, and potentially eliminated, by the utilization of particulate free steroids, testing for intra-arterial injection with digital subtraction angiography, and a preliminary injection of local anesthetic.

    View details for DOI 10.1111/j.1526-4637.2009.00728.x

    View details for Web of Science ID 000208125100007

    View details for PubMedID 19863744

  • Current Concepts for Shoulder Training in the Overhead Athlete CURRENT SPORTS MEDICINE REPORTS Kennedy, D. J., Visco, C. J., Press, J. 2009; 8 (3): 154-160


    Nontraumatic shoulder pain in the adult overhead athlete is a common problem. The exact biomechanical adaptations that predispose the overhead athlete to injury can be multifactorial in nature, including range of motion deficits, muscular imbalances, and scapular dyskinesis. It is imperative that the rehabilitation professional not only correctly identify and treat the direct cause of the pain, but also initiate a rehabilitation program aimed at improvement of the underlying biomechanical deficits that predispose the overhead athlete to shoulder injury. This only can be accomplished through a better understanding of the most common biomechanical deficits that the overhead athlete develops and how to treat them. This article focuses primarily upon shoulder training in the adult baseball pitcher as a classic example of an overhead athlete.

    View details for DOI 10.1249/JSR.0b013e3181a64607

    View details for Web of Science ID 000275664900011

    View details for PubMedID 19436172

  • Functional rehabilitation of lumbar spine injuries in the athlete SPORTS MEDICINE AND ARTHROSCOPY REVIEW Krabak, B., Kennedy, D. J. 2008; 16 (1): 47-54


    Athletic injuries to the lumbar spine are relatively common, depending upon the specific sport. With proper management, the majority of injuries resolve quickly and allow for rapid return to sport. However, some of these injuries occur because of improper mechanics that adversely affect the core stability of the spine, or conversely these injuries cause instability of the spine through disruption of the spinal support mechanisms. Development of an appropriate treatment plan depends on a thorough understanding of the structures providing core stability and the exercises to correct identifiable deficits. A comprehensive rehabilitation program should include correction of flexibility and strength deficits, with subsequent progression to functional and sports-specific exercises. The purpose of this paper is to review current concepts regarding core stability and rehabilitation in the athlete.

    View details for Web of Science ID 000253278100008

    View details for PubMedID 18277262