DEAR DR. ROACH: I am a 66-year-old female with degenerative disk disease. I have had two spinal fusions. One at age 44, at the L-5 S-1 level, and the other at age 64, at the L-4 L-5 level. I am being X-rayed yearly for signs of degeneration at the L-3 L-4 level. I am doing exercises prescribed by my physical therapist and keeping my weigh under control. Can disks be regenerated, or is there anything I can do to try to slow down the rate at which the next disk degenerates? I would appreciate any suggestions you might have. Also, do you know the status of disk replacements versus spinal fusions? — S.T.

ANSWER: The intervertebral disks are structures that separate the vertebrae from one another, acting as shock absorbers as well as spacers, and allow for side-to-side and front-and-back movement of the spine. The separation between the vertebrae is critical, because the spinal nerve roots come off the spinal cord and go through a bony canal. In many older adults, the intervertebral disks degenerate, causing a loss of height, and allow the two vertebrae to come close to each other, which puts pressure onto the nerve root. This causes pain, not only in the back, but also in the area the nerve root serves. In your case, the L3/L4 nerve root compression usually causes pain in the front of the thigh, the inside of the lower leg and down toward the arch of the foot. In more severe cases, the thigh muscles can become weak, and the reflex of the patella (the standard reflex hammer, which causes the leg to jerk) can be lost.

Nonsurgical treatment includes medication, and the weight control and physical therapy you are doing. For people who still have symptoms, especially those with weakness, surgical options become worth considering. As an internist, it’s not up to me to recommend what surgery to do, but there are a couple of points I might make.

The standard surgical treatment is a laminectomy, which involves removing part of the lamina, the bony process of the vertebra that compresses the nerve. A fusion, where one vertebra is fused to the one above or below it, is done sometimes, especially when there is spondylolisthesis (which means that one vertebra is in front of the one above or below it), as this puts further pressure on the spinal cord itself or the nerve roots.

There is a device, called the X-STOP, which is essentially a titanium intervertebral disk, that has shown some benefit in decompressing the nerve. However, it has not been definitively compared with standard technique, and I lack the expertise to recommend one versus the other.

DEAR DR. ROACH: My husband is 85 and has developed a crusty, scabby condition on his scalp, which bleeds when scratched. I have tried several remedies, but none has helped. What should I try? — E.D.

ANSWER: There are several possibilities, including psoriasis and seborrheic dermatitis, but bleeding makes me worried about skin cancer, which is common on the scalp in older adults. He needs an evaluation by his regular doctor or a dermatologist. Only with a correct diagnosis can he get proper treatment.

READERS: Many headache questions reach me on a regular basis. For a general explanation of headaches and their treatment, consider the booklet on that topic. It presents a comprehensive view. To order a copy, write:

Dr. Roach

Book No. 901

628 Virginia Dr.

Orlando, FL 32803

Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.

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