This thesis presents a literature review of the diagnosis and treatment of lumbar spinal stenosis (LSS), including a brief description of the patient history and non-surgical options while focusing mainly on the current array of surgical techniques. LSS is defined as a narrowing of any part of the lumbar spinal canal. This narrowing places excessive pressure on both the spinal cord and peripheral nerves resulting in pain, numbness and weakness in the lower extremities. LSS has a large spectrum of potential treatment options since the disease itself has a wide range of severities. An extensive physical exam, using the appropriate clinical surveys, physical manipulations, and imaging studies, is of paramount importance in the successful diagnosis. Currently, conservative treatment, while an important first step in managing LSS, seems to be limited to a first line of defense, lasting only a short period of time. Physical therapy results appear to be beneficial for only six months to a year, and despite their increased usage in recent years, management through the use of non-steroidal anti-inflammatory drugs, opiates, and corticosteroid injections seem to provide very little benefit. Surgical treatment for LSS ultimately appears to be the most effective method in reducing pain and disability for the patient who fits the clinical and radiological findings indicative of LSS. Although current surgical options available are numerous, including different types of fusion, bone grafts, and innovative joint replacements, the most promising procedures appear to be minimally invasive lumbar disk replacement surgery and dynamic stabilization. These procedures offer the benefits of a minimally invasive surgical approach, while reducing stenosis though hardware that not only reduces pain but also allows patients to maintain spinal flexibility and natural functional motion.

Background. Carotid stenosis is an important cause of stroke. Carotid endarterectomy is a means of reducing the burden of stroke but is of marginal benefit in individuals with asymptomatic carotid stenosis. The identification of factors associated with increased risk of cerebral ischemic events would help select individuals who may obtain a greater benefit. / Methods. A comprehensive search was performed to identify studies examining risk factors for cerebral ischemic events in patients with asymptomatic carotid stenosis. Inclusion criteria were defined a priori. Relevant studies were reviewed, assessed for quality, and data were extracted. / Results. Thirty-four studies met the inclusion criteria. There was a suggestion of increasing neurological events with increasing severity and progression of carotid stenosis. There was some evidence for an association with carotid plaque morphology. No consistent association was found with clinical factors, impaired cerebral vasoreactivity, or cerebral embolic signals. / Conclusions. The evidence is insufficient to reliably identify individuals with asymptomatic carotid stenosis who are at a higher risk of cerebral ischemic events.

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