Bio

Clinical Focus


  • Physical Medicine and Rehab

Academic Appointments


Administrative Appointments


  • Chair Standards Division, International Spine Intervention Society (2013 - Present)
  • Editor Point-Counter Point Section, PM&R Journal (2012 - Present)
  • Board of Trustees, Association of Academic Physiatrists (2011 - 2015)
  • Editorial Board, Pain Medicine Journal (2012 - Present)
  • Annual Assembly Program Director, International Spine Intervention Society (2013 - 2014)
  • Medical Education Committee - Director of Maintenance of Certification 3 and 4, American Academy of Physical Medicine and Rehabilitation (2012 - Present)
  • Guest Editor-Osteoarthritis Supplement, PM&R Journal (2012 - 2012)
  • Chronic Osteoarthritis Management Initiative (COAMI) AAPM&R Representative, US Bone and Joint Initiative (USBJI) (2012 - Present)
  • Guest Editor-Radiculopathy Issue., Physical Medicine and Rehabilitation Clinics of North America. (2008 - 2009)
  • Director - Pain and Spine National Journal Club, American Academy of Physical Medicine and Rehabilitation (2012 - 2012)
  • Program Planning Committee 2012 Annual Scientific Meeting, International Spine Intervention Society (2011 - 2012)
  • Program Planning Director 2013 Annual Scientific Meeting, International Spine Intervention Society (2012 - 2013)
  • Medical Education Committee-Member at Large, American Academy of Physical Medicine and Rehabilitation (2010 - 2012)
  • Knowledge Now Curriculum Development Co-Leader of Musculoskeletal Medicine advisory group, American Academy of Physical Medicine and Rehabilitation (2010 - 2010)
  • Research Committee Member, International Spine Intervention Society (2009 - Present)
  • Standards Committee Member, International Spine Intervention Society (2008 - 2009)

Honors & Awards


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

Professional Education


  • Fellowship:Rehabilitation Institute of Chicago (2009) IL
  • Residency:University of Washington (2008) WA
  • Board Certification: Physical Medicine and Rehab, American Board of Physical Medicine and Rehab (2009)
  • Board Certification: Sports Medicine, American Board of Physical Medicine and Rehab (2009)
  • Internship:Tulane University (2005) LA
  • Medical Education:Univeristy of Florida College of Medicine (2004) FL
  • 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

    Topic

    Ultramarathon Event Coverage

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    No

Research & Scholarship

Current Research and Scholarly Interests


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

Publications

Journal Articles


  • 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

    Abstract

    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

  • 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

    Abstract

    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 Conrad, B. P., Shokat, M. S., Abbasi, A. Z., Vincent, H. K., Seay, A., Kennedy, D. J. 2013

    Abstract

    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 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-?

    Abstract

    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-?

    Abstract

    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-?

    Abstract

    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

    Abstract

    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

    Abstract

    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

    Abstract

    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

    Abstract

    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

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