Very interesting!

I have severe lumbar spinal stenosis worse at L4-5. I also have a long history of inflammatory arthritis. I was off prednisone when a large synovial cyst formed and caused a resurgence of back pain so severe I had to go back on low dose prednisone. Low dose prednisone didn't really help that much.

I know synovial cysts are usually caused by inflammation. The surgeon who wanted to fuse my lumbar spine speculated that severe osteoarthritis due to aging caused the synovial cyst.

I resisted doing the lumbar fusion because I'm fearful about the pain the surgery would cause. I also feared autoimmune flares because I probably would need high doses of prednisone on a long term basis again.

What is interesting - At the time the synovial cyst formed, I was off Actemra, a biologic that was treating my PMR. There were supply chain problems. Actemra was in short supply because it was being used to treat seriously ill patient Covid patients.

When supplies of Actemra improved, I resumed my treatment with Actemra and my back pain improved. I stopped prednisone again. My neurosurgeon didn't really believe me and "strongly encouraged" me to do the lumbar fusion. However, she didn't want to pressure me to do surgery if I wasn't ready. I said that I wanted to wait.

A year later another MRI was done. The second MRI showed the synovial cyst was gone so I had more space in my spinal canal. The neurosurgeon agreed that the lumbar fusion could wait but she didn't know for how long.

I'm inclined to believe the synovial cyst was caused by autoimmune problems when prednisone was stopped. The severe spinal stenosis didn't go away ... only the synovial cyst did.

I interviewed two surgeons and one was ortho and one was neuro, the neuro said no need to go off prednisone. The ortho, who I am going with, is adamant. It's a terrible fix to be in.