About

Zachary L. McCormick, MD, is a board-certified specialist in Pain Medicine and Physical Medicine & Rehabilitation (PM&R). He focuses on the diagnosis and treatment of spine and musculoskeletal pain conditions, with an emphasis on improving function and quality of life. His expertise includes care for neck and back problems, such as disc herniations, spinal stenosis, and degenerative conditions of the cervical, thoracic, and lumbar spine. Dr. McCormick's approach is grounded in a multi-modal, comprehensive, and customized treatment philosophy aimed at helping each patient achieve their specific goals. He received his MD from the University of Pennsylvania and completed a PM&R residency and fellowship at Northwestern University (The Rehabilitation Institute of Chicago). Following his training, he served as a faculty member at the University of California San Francisco. Currently, Dr. McCormick is a Professor and Vice Chair of PM&R, Ambulatory Chief Value Officer, Chief of the Division of Spine and Musculoskeletal Medicine, Co-Director of the Endoscopic and Percutaneous Spine (EPS) Destination Care Program, and the Founding Director of the Interventional Spine and Musculoskeletal Research (INSPIRE) program at the University of Utah. He founded the Interventional Spine and Musculoskeletal Medicine (ISMM) Fellowship Program at the university and previously directed it for six years. As an active researcher, Dr. McCormick's work concentrates on the diagnosis and treatment of spine and joint pain, including radicular, discogenic, vertebrogenic, zygapophyseal joint, sacroiliac joint, and knee joint pain. He has published over 250 peer-reviewed journal articles and has received research awards from prominent institutions such as the Howard Hughes Medical Institute, the National Institutes of Health, and the US Department of Defense. He serves as Deputy Editor-in-Chief for Pain Medicine and is on the editorial boards of The Spine Journal, Interventional Pain Medicine, and Physical Medicine and Rehabilitation. His leadership efforts are dedicated to educating and training physicians in the safe, appropriate, and effective management of spine and musculoskeletal pain disorders, and he regularly lectures on these topics nationally.

Research topics

• Medicine
• Internal medicine
• Surgery
• Physical therapy
• Intensive care medicine
• Nursing
• Family medicine
• Pathology
• Library science
• Psychology
• Engineering
• Psychiatry
• Medical education
• Physical medicine and rehabilitation
• Virology
• Gerontology
• Anesthesia
• Radiology
• Emergency medicine

Selected publications

• A Modified Percutaneous Spinal Cord Stimulation Implant Approach to Target the Ventral Spinal Cord

  medRxiv · 2026-04-10

  article

  Abstract Objectives Epidural spinal cord stimulation (SCS) is an emerging therapy for motor rehabilitation following spinal cord injury (SCI) and other motor disorders. Conventionally, SCS leads are placed along the dorsal spinal cord (SCS D ), where stimulation activates large diameter afferent fibers, which indirectly activate motoneurons through reflex pathways. This leads to broad activation of flexor and extensor muscles and limited fine-tuned control of motor output. Targeting the ventral spinal cord (SCS V ) may enable more direct activation of motoneuron pools, potentially improving the specificity of muscle activation; however, there is currently no established method to place leads ventrally. To address this, we evaluated the feasibility of four modified percutaneous implantation techniques to target the ventrolateral thoracolumbar spinal cord. Materials and methods Percutaneous SCS V implantation was performed in three human cadaver torso specimens under fluoroscopic guidance. The following approaches were evaluated: sacral hiatus, transforaminal, interlaminar contralateral, and interlaminar ipsilateral. The leads in the latter 3 approaches were inserted between L1 and L5. Eighteen implants were attempted, with nine leads retained for analysis. Lead and electrode position were assessed using computed tomography (CT) with three-dimensional reconstruction, along with anatomical dissection to verify lead and electrode placement within the epidural space. Results Successful ventral epidural lead placement was achieved using all four implantation approaches. The sacral hiatus (16/16 electrodes) and transforaminal (8/8 electrodes) approaches resulted in exclusively ventrolateral placement. The interlaminar contralateral approach led to 27/32 electrodes positioned ventrolaterally and 5/32 dorsally. The interlaminar ipsilateral implantation approach led to 14/32 electrodes positioned ventrolaterally and 18/32 positioned ventromedially. Conclusions These findings demonstrate that ventral epidural SCS lead placement can be achieved using modified percutaneous implant techniques. The four approaches outlined here provide a clinically feasible pathway to SCS V and establishes a foundation for future clinical studies investigating SCS V for motor rehabilitation following SCI.

  PublisherDOI

• The Effectiveness of Sacral Lateral Branch Radiofrequency Neurotomy for Posterior Sacroiliac Joint Complex Pain in Patients Selected by Dual Sacral Lateral Branch Blocks; A Retrospective Cohort Study Update

  Interventional Pain Medicine · 2025-01-01

  articleOpen access
  PublisherDOI

• Spinal cord stimulation plus conventional medical management versus conventional medical management alone for severe, non-surgical, refractory back pain: a randomized clinical trial followed by crossover

  Regional Anesthesia & Pain Medicine · 2025-10-05 · 1 citations

  articleOpen access

  INTRODUCTION: Chronic low back pain is a major contributor to long-term disability. Many patients lack a clearly identifiable source for their pain on physical examination or imaging or present with multiple pain generators. This subset of patients, who do not have surgical pathology, relies on conservative medical management (CMM) in the absence of effective and lasting treatment alternatives. For those who fail to respond to CMM, spinal cord stimulation (SCS) should be considered as an effective adjunctive therapy for improving pain, disability and health-related quality of life. METHODS: SOLIS is a prospective, multicenter trial that randomized patients with non-surgical, refractory back pain (with or without leg pain) to receive either SCS combined with CMM or CMM alone. The primary endpoint at 3 months compared the proportion of patients with ≥50% overall pain relief without an increase in mean daily opioid use between the SCS+CMM and CMM groups. Three months after treatment activation, patients initially randomized to receive CMM alone had the option to cross over and add SCS to their pain management regimen. Patients in both randomized groups underwent 12-month follow-up visits to assess long-term effects on pain relief, disability, health-related quality of life, global impression of change, and treatment satisfaction. RESULTS: 147 patients were randomized to SCS+CMM (n=79) or CMM alone (n=68). At the 3-month follow-up, 89.5% of patients who received SCS+CMM (including subperception and paresthesia-based programming modalities) and 8.1% who received CMM alone were classified as study responders (≥50% pain relief without an increase in mean daily opioid use; modified intention-to-treat analysis, p<0.0001). The level of disability due to low back pain improved significantly: the Oswestry Disability Index score decreased by -27.5±15.9 points in the SCS+CMM group versus -7.2±9.9 points in the CMM alone group (p<0.0001). Health-related quality of life also improved at 3 months: the EuroQol 5 Dimension 5 Level questionnaire index score increased by 0.247±0.164 points in the SCS+CMM group versus 0.031±0.151 points in the CMM alone group (p<0.0001). The benefits of SCS were sustained until the 12-month visit. Seven patients experienced serious adverse events related to SCS, including 5 (3.6%) implant site infections resulting in explant. CONCLUSION: SCS relieved pain and resulted in clinically significant improvements in functional disability and health-related quality of life in patients with non-surgical, refractory back pain with or without accompanying leg pain. TRIAL REGISTRATION NUMBER: NCT04676022.

  PublisherOA PDFDOI

• Patient selection, clinical outcomes, associated healthcare utilization, and cost-effectiveness of basivertebral nerve ablation for the treatment of vertebrogenic low back pain: A narrative review

  North American Spine Society Journal (NASSJ) · 2025-09-09

  reviewOpen accessSenior author

  Background: Chronic low back pain (cLBP) represents a significant burden to global health, with a prevalence projected to reach 843 million individuals by 2050. Vertebrogenic cLBP, a distinct phenotype, is mediated by nociception transmitted through the basivertebral nerve. Advances in basic and translational science have established clinical imaging biomarkers of vertebrogenic cLBP, such Type 1 and 2 Modic changes, to more reliably identify this condition. Additionally, medical technology advances have provided the ability to selectively disrupt pain signaling from painful vertebral endplates by interosseous basivertebral nerve ablation (BVNA). The objective of this review is to highlight appropriate patient selection, clinical outcomes, associated healthcare utilization, and cost-effectiveness of BVNA in the treatment of vertebrogenic cLBP. Methods: PubMed, EMBASE, and Google Scholar databases were queried for articles published before September 2024. Two authors reviewed references for eligibility, extracted data, and appraised the quality of evidence. Results: Patient selection criteria include the presence of Type 1 or Type 2 Modic changes on MRI in the context of clinical suspicion of anterior element spinal pain based on clinical evaluation. BVNA was found to result in clinically significant and sustained pain relief and functional improvements in individuals with vertebrogenic cLBP. Randomized controlled trials and systematic reviews demonstrate long-term efficacy, with clinically meaningful benefits sustained up to 5 years postprocedure. Healthcare utilization analyses indicate that BVNA significantly reduces low back pain-related healthcare utilization, opioid use, and surgical intervention rates. Economic analysis indicates that BVNA is cost-effective when compared to conventional management of vertebrogenic cLBP. Conclusions: In appropriately selected patients, the overall body of evidence demonstrates that BVNA is an effective and durable treatment for vertebrogenic cLBP.

  PublisherDOI

• Discrepancies of calculated percentage pain reduction versus patient reported percentage perceived reduction in pain intensity after axial spine medial branch block

  Pain Medicine · 2025-04-12

  article

  OBJECTIVE: This study compares 2 pain intensity metrics, calculated percentage pain reduction (CPPR) and patient-reported percentage pain reduction (PRPPR), in patients undergoing medial branch nerve blocks (MBB) to determine their comparability and agreement. METHODS: A retrospective review of prospectively enrolled consecutive MBB patients with axial spine pain from multiple centers. Data were collected via self-report pain diaries and analyzed using linear regression models, concordance correlation coefficients (CCC), and Bland-Altman plots. RESULTS: One hundred and fifty pain diaries yielded 1182/1350 (88%) valid comparisons between CPPR and PRPPR. The CCC was lowest immediately and at 0.5 hours post-injection (0.44 and 0.47) and ranged from 0.58 to 0.62 at later times. Precision, measuring correlation, was poor, while accuracy, measuring the degree of deviation from perfect agreement, was greater than 0.90. Bland-Altman plots showed PRPPR indicated greater pain relief than CPPR at all times, with bias decreasing as pain relief increased. Agreement was higher at 0% and 100% improvement compared to 50% on Bland-Altman plots. CONCLUSIONS: The CCC ranged from 0.44 to 0.62 between PRPPR and CPPR in patients with chronic axial pain undergoing diagnostic MBB. PRPPR scores showed greater pain relief than CPPR scores, especially over time. Agreement was higher at extremes of pain relief, while partial average pain relief demonstrated less agreement. Clinicians should therefore not assume equivalence between CPPR and PRPPR. More importantly, there is significant variability in how a patient is categorized for MBB success depending on the measure employed.

  PublisherDOI

• FactFinders for patient safety: Do epidural steroid injections increase the risk of fracture or lumbar surgical site infection?

  Interventional Pain Medicine · 2025-07-30

  articleOpen access
  PublisherDOI

• Consensus practice guidelines on sacroiliac joint complex pain from a multispecialty, international working group

  Pain Medicine · 2025-09-18 · 3 citations

  articleOpen access1st authorCorresponding

  BACKGROUND: The past two decades have witnessed tremendous growth in the appreciation and treatment of sacroiliac joint (SIJ) complex pain, including anatomical dissections that shed light on innervation, an appreciation for the contribution of extra-articular components to SIJ complex pain, the advent of radiofrequency ablation (RFA) and a host of minimally invasive surgical techniques. Yet, there is no standardization on diagnosis and treatment paradigms. METHODS: In February 2023, the Boards of Directors for the American Academy of Pain Medicine (AAPM) and American Society of Regional Anesthesia & Pain Medicine (ASRA-PM) approved the development of multispecialty guidelines on SIJ complex pain. Thirty partner organizations with clinical and scientific interests in SIJ complex pain were identified, and formal letters of request-for-participation were sent to each, along with a request for nominees to serve on the committee. Twenty five organizations agreed to participate in addition to the Departments of Defense and Veterans Affairs. A steering committee developed 21 questions, which spanned criteria for diagnosis, non-interventional and interventional treatments including surgery, technical parameters on how to optimize results, and what constitutes positive outcomes. Questions were methodically assigned to specialized modules comprising 4-5 members with complementary expertise, who collaborated with the Subcommittee Lead and one of three Committee Chairs to develop preliminary drafts. Following thorough revisions, these drafts were subsequently submitted to the full committee for comprehensive review. A modified Delphi method was used in which the answers to questions were sent to the committee en bloc and comments were returned in a non-blinded fashion to the Chairs, who incorporated the comments and sent out revised versions until consensus was achieved. During a committee meeting before commencement, it was agreed that recommendations would be noted when there was >50% agreement among committee members, but that a formal recommendation would require ≥75% consensus. RESULTS: Twenty-one organizations formally endorsed the guidelines. The American Society of Anesthesiologists, and American Academy of Physical Medicine & Rehabilitation, and the North American Spine Society affirmed the benefit of the guidelines but did not officially endorse them. The American Academy of Neurology declined to affirm the benefit of the guidelines citing "lack of relevance to their membership." Per policies, while the Departments of Defense and Veterans Affairs did not formally review the guidelines for endorsement, their representatives approved them. In addition to being endorsed or the benefit affirmed by all voting organizations, complete consensus from committee members was obtained on all 21 questions. On 2 recommendations, there were dissensions from 3 societies who thought that selecting patients for sacral lateral branch RFA and minimally invasive fusion should be based on ≥75% relief from 2 blocks instead of at least 50% relief from a single block before RFA, and greater than 50% pain relief with documented functional improvement after a single block before fusion. One additional society (Latin American Society of Regional Anesthesia) abstained on the statement that the evidence is stronger for extra-articular than intra-articular injections. The committee found that a battery of physical exam tests has reasonable sensitivity, but lower specificity, for identifying intra-articular but not extra-articular pathology, with negative tests having greater predictive value than positive ones. Intra-articular injections have diagnostic validity for SIJ intra-articular, but not extra-articular pain. There is unclear or negative evidence for imaging. The prevalence rates of intra-articular and extra-articular pathology are comparable, with both intra- and extra-articular steroid injections providing at least 4 weeks of relief in well-selected patients. However, the evidence is slightly stronger for extra-articular corticosteroid injections to provide short-term relief. The evidence base for non-interventional therapies is indirect, extrapolated mostly from low back pain studies. There is weak evidence supporting dextrose-based prolotherapy and platelet-rich plasma to provide at least 3 months of pain relief. There is strong evidence for sacral lateral branch RFA to provide relief for at least 6 months in individuals with extra-articular pathology, with face validity and indirect evidence from randomized trials supporting sacral lateral branch blocks as a prognostic tool. There is stronger evidence for larger lesions or more aggressive lesioning strategies than for less stringent techniques. There is weak evidence to support non-steroidal anti-inflammatory drugs to prevent neuritis after RFA, and in most cases anticoagulation does not require cessation in the periprocedural perioid. With an aggressive lesioning strategy, sensory stimulation provides minimal therapeutic benefit, with weak, extrapolated evidence that motor stimulation can provide safety benefit. The cutoff to designate diagnostic or prognostic blocks as positive is most commonly set at 50%, with higher values not shown to improve outcomes for more definitive procedures; for therapeutic treatment outcomes, the evidence supports a lower threshold of ≥30% pain relief or meaningful benefit on non-pain outcomes (eg, opioid cessation) for designation of a positive response. For carefully selected patients with intra-articular SIJ complex pain based on controlled blocks who have failed conservative therapies, there is weak or very weak evidence that minimally invasive SIJ fusion can provide benefit for at least one year. CONCLUSIONS: SIJ complex pain remains an underappreciated source of chronic low back pain, affecting between 15% and 30% of patients with axial pain predominantly below L5. Answers to many questions were limited by low-quality evidence, indicating the need for better research. SIJ complex pain is a multifarious condition (ie, pain can be from different portions of both the intra- and extra-articular components of the joint) for which an interdisciplinary, multimodal treatment plan can optimize treatment outcomes.

  PublisherOA PDFDOI

• Consensus practice guidelines on sacroiliac joint complex pain from a multispecialty, international working group

  Regional Anesthesia & Pain Medicine · 2025-11-29 · 1 citations

  articleOpen access1st authorCorresponding

  Background The past two decades have witnessed tremendous growth in the appreciation and treatment of sacroiliac joint (SIJ) complex pain, including anatomical dissections that shed light on innervation, an appreciation for the contribution of extra-articular components to SIJ complex pain, the advent of radiofrequency ablation (RFA) and a host of minimally-invasive surgical techniques. Yet, there is no standardization of diagnosis and treatment paradigms. Methods In February 2023, the Boards of Directors for the American Academy of Pain Medicine (AAPM) and American Society of Regional Anesthesia &amp; Pain Medicine (ASRA-PM) approved the development of multispecialty guidelines on SIJ complex pain. Thirty partner organizations with clinical and scientific interests in SIJ complex pain were identified, and formal letters of request-for-participation were sent to each, along with a request for nominees to serve on the committee. Twenty five organizations agreed to participate in addition to the Departments of Defense and Veterans Affairs. A steering committee developed 21 questions, which spanned criteria for diagnosis, non-interventional and interventional treatments including surgery, technical parameters on how to optimize results, and what constitutes positive outcomes. Questions were methodically assigned to specialized modules comprising 4–5 members with complementary expertise, who collaborated with the Subcommittee Lead and one of three Committee Chairs to develop preliminary drafts. Following thorough revisions, these drafts were subsequently submitted to the full committee for comprehensive review. A modified Delphi method was used in which the answers to questions were sent to the committee en bloc and comments were returned in a non-blinded fashion to the Chairs, who incorporated the comments and sent out revised versions until consensus was achieved. During a committee meeting before commencement, it was agreed that recommendations would be noted when there was &gt;50% agreement among committee members, but that a formal recommendation would require ≥75% consensus. Results Twenty-one organizations formally endorsed the guidelines. The American Society of Anesthesiologists, and American Academy of Physical Medicine &amp; Rehabilitation, and the North American Spine Society affirmed the benefit of the guidelines but did not officially endorse them. The American Academy of Neurology declined to affirm the benefit of the guidelines citing ‘lack of relevance to their membership.’ Per policies, while the Departments of Defense and Veterans Affairs did not formally review the guidelines for endorsement, their representatives approved them. In addition to being endorsed or the benefit affirmed by all voting organizations, complete consensus from committee members was obtained on all 21 questions. On two recommendations, there were dissensions from three societies who thought that selecting patients for sacral lateral branch RFA and minimally-invasive fusion should be based on ≥75% relief from two blocks instead of at least 50% relief from a single block before RFA, and greater than 50% pain relief with documented functional improvement after a single block before fusion. One additional society (Latin American Society of Regional Anesthesia) abstained on the statement that the evidence is stronger for extra-articular than intra-articular injections. The committee found that a battery of physical exam tests has reasonable sensitivity, but lower specificity, for identifying intra-articular but not extra-articular pain, with negative tests having greater predictive value than positive ones. Intra-articular injections have diagnostic validity for SIJ intra-articular, but not extra-articular, pain. There is unclear or negative evidence for imaging. The prevalence rates of intra-articular and extra-articular pathology are comparable, with both intra- and extra-articular steroid injections providing at least 4 weeks of relief in well-selected patients. However, the evidence is slightly stronger for extra-articular corticosteroid injections to provide short-term relief. The evidence base for non-interventional therapies is indirect, extrapolated mostly from low back pain studies. There is weak evidence supporting dextrose-based prolotherapy and platelet-rich plasma to provide at least 3 months of pain relief. There is strong evidence for sacral lateral branch RFA to provide relief for at least 6 months in individuals with extra-articular pathology, with face validity and indirect evidence from randomized trials supporting sacral lateral branch blocks as a prognostic tool. There is stronger evidence for larger lesions or more aggressive lesioning strategies than for less stringent techniques. There is weak evidence to support non-steroidal anti-inflammatory drugs to prevent neuritis after RFA, and in most cases anticoagulation does not require cessation in the periprocedural period. With an aggressive lesioning strategy, sensory stimulation provides minimal therapeutic benefit, with weak, extrapolated evidence that motor stimulation can provide safety benefit. The cut-off to designate diagnostic or prognostic blocks as positive is most commonly set at 50%, with higher values not shown to improve outcomes for more definitive procedures; for therapeutic treatment outcomes, the evidence supports a lower threshold of ≥30% pain relief or meaningful benefit on non-pain outcomes (eg, opioid cessation) for designation of a positive response. For carefully selected patients with intra-articular SIJ complex pain based on controlled blocks who have failed conservative therapies, there is weak or very weak evidence that minimally invasive SIJ fusion can provide benefit for at least one year. Conclusions SIJ complex pain remains an underappreciated source of chronic low back pain, affecting between 15% and 30% of patients with axial pain predominantly below L5. Answers to many questions were limited by low-quality evidence, indicating the need for better research. SIJ complex pain is a multifarious condition (ie, pain can be from different portions of both the intra- and extra-articular components of the joint) for which an interdisciplinary, multimodal treatment plan can optimize treatment outcomes.

  PublisherOA PDFDOI

• O039 EVALUATING SCS AND MEDICAL MANAGEMENT FOR CHRONIC PAIN WITHOUT PRIOR SURGERY: 1-YEAR OUTCOMES (SOLIS RCT)

  Neuromodulation Technology at the Neural Interface · 2025-01-01

  article
  PublisherDOI

• The effectiveness of basivertebral nerve radiofrequency ablation for the treatment of vertebrogenic low back pain: 1-year results of a prospective real-world cohort study

  Pain Medicine · 2025-08-30 · 7 citations

  articleOpen access1st authorCorresponding

  SUMMARY OF BACKGROUND DATA: Multiple clinical trials have demonstrated the effectiveness of intraosseous basivertebral nerve radiofrequency ablation (BVNA) for treating chronic vertebrogenic low back pain (vLBP). Few studies have evaluated the effectiveness in a real-world population. OBJECTIVES: To evaluate the effectiveness of BVNA for vLBP in a real-world population. METHODS: A single-arm prospective cohort study of patients with LBP ≥ 6 months and Type 1 or Type 2 Modic changes on MRI. The primary outcome was mean improvement in Oswestry Disability Index (ODI) post-BVNA. Secondary outcomes included the proportion of participants with (1) ≥30% and ≥15-point ODI improvements, (2) ≥2-point and ≥50% reductions in pain on Numerical Rating Scale (NRS), and (3) ≥ "much improved" on Patient Global Impression of Change (PGIC) at 3- and 12-month follow-up. RESULTS: In total, 60 participants were included (mean age 57.0 ± 13.4 years; 45.0% female). Mean ODI score improvement was 13.9 ± 18.7 and 14.0 ± 15.7 points at 3- and 12-month follow-up, respectively. At 12 months, 52.8% (95% CI, 39.7-65.6) of participants reported ≥30% ODI improvement and 39.6% (95% CI, 27.6-53.1) of participants reported ≥15-point improvement in ODI. Twelve-month responder rates for ≥2-point and ≥50% NRS improvement were 67.9% (95% CI, 54.5-78.9) and 49.1% (95% CI, 36.1-62.1). Moreover, 54.7% (95% CI, 41.5-67.3) of participants reported being "much or very much improved" on the PGIC at 12 months. DISCUSSION/CONCLUSION: In this real-world cohort, over half of participants with vLBP experienced clinically meaningful improvements in pain and function at 12-month post-BVNA. TRIAL REGISTRATION DETAILS: ClinicalTrials.gov (original study: NCT04449835; continuation study: NCT05660512); [original study: June 25, 2020; continuation study: December 13, 2022].

  PublisherOA PDFDOI

Frequent coauthors

• Christopher T. Plastaras

  University of Pennsylvania

  83 shared

• Cynthia Garvan

  University of Florida

  62 shared

• Anand Joshi

  Parul University

  60 shared

• Kate Sully

  49 shared

• David J. Kennedy

  Foundation for Physical Medicine and Rehabilitation

  47 shared

• Daniel M. Cushman

  University of Utah

  42 shared

• Ryan Mattie

  Total (United States)

  35 shared

• David R. Walega

  Northwestern University

  31 shared

Education

• M.D.

  University of Pennsylvania

• Other, PM&R residency and fellowship

  Northwestern University (The Rehabilitation Institute of Chicago)

• Other, Faculty member

  University of California San Francisco

• Other, Founder and Director of the Interventional Spine and Musculoskeletal Medicine (ISMM) Fellowship Program

  University of Utah

Awards & honors

• Howard Hughes Medical Institute research award
• National Institutes of Health research award
• US Department of Defense research award