1. A conservative regimen which includes manipulative treatment of lower lumbar intervertebral disc syndrome under anaesthesia eventuates in a sufficiently high percentage of satisfactory results to warrant its use as an essential part of conservative therapy.
2. Treatment by manipulation should be given precedence over surgical intervention, except in those cases in which there is a definite contra-indication.
3. Satisfactory results, if obtainable, are to be expected after one or, at the most, two manipulations; repeated manipulation is not justified. Successful treatment is predicated upon a prompt loss of sciatic pain.
4. Failure to respond to an organized regimen of conservative treatment, including manipulation under anaesthesia, warrants the recommendation for prompt surgical intervention, provided the incapacity is sufficiently pronounced.
5. A certain percentage of cases are not amenable to manipulation, but premanipulation differentiation is impossible in the light of our present knowledge.
6. This series reveals a higher percentage of complete symptomatic relief following manipulation and its accompanying regimen than that following surgery, with a lesser amount of permanent disability in those cases in which residual disability persists.
7. Substantiating the premise that disc herniation is on the basis of disc disease, 23 per cent. of the patients in this series showed demonstrable roentgenographic disc changes prior to the beginning of treatment.
8. The apparent discrepancies in end results between the private and the industrial patient can be explained by the monetary factor and the larger percentage of the latter patients engaged in heavy labor.
San Francisco, California