In concluding this phase of the discussion of lesions of the lumbosacral spine, which deals only with destruction of the intervertebral disc, the author wishes to add that lumbosacral fusion is not a panacea for all low-back troubles. In his experience it has afforded relief from symptoms in those patients who suffered only from a traumatic destruction of the lumbosacral intervertebral disc, and who had not experienced segmental symptoms. Lumbosacral fusion, combined with facetectomy, has given relief to those who suffered only from a traumatic destruction of the lumbosacral disc and who had experienced segmental symptoms.
Surgery should never be employed until a thorough conservative program has overcome a fixed lumbosacral lordosis and lengthened the short hip-flexor muscles. If this is not accomplished preoperatively, the patient will be liable to develop symptoms just above the graft a few months after becoming ambulatory. It has been the writer's experience that a well-planned conservative program will eliminate the need for surgery in most cases.