Here's my X-rays and MRI-Safe to Sq and DL?

[billy1edwards]

I have psoriatic arthritis. When I had some numbness and tingling down my leg my doc sent me to a back surgeon who obviously recommended total fusion of the L4&5 after spending about 12 seconds with me. She says I have spondylolisthesis. She also accidentally stabbed herself with her pen while we talked so I don't like the thought of her near my spinal cord.

Here are some links to my mri and X-ray photos. The first two are easiest to see whats going on.

529-C83-F8-5096-4-CD1-BB7-F-B084-F8418-F23 — ImgBB
1-DC048-E8-0-D2-A-4067-AA56-7-BF12-CC050-B1 — ImgBB
6-C0-F2-DC3-A8-D1-483-E-B65-A-F484-FCEACFE9 — ImgBB
1-AD0081-F-0-E9-E-4-C58-B6-F2-611-C23-A504-D4 — ImgBB


My chiropractor has the same pics and is catering his treatment to them. Doc said I have a resting 10mm shift of spondylolisthesis and 16 when in extension (which freaks me out now to do overhead presses, I've done zero since the X-rays last week.)

I'm deadlifting and squatting low and slow 135 with the best form I can muster and recording every time to check. I still feel discomfort but think it's just my psoriatic arthritis flaring around the injury post workout. I feel relatively fine at this low weight during and for an hour after the lifts (I start humira next month and think if it helps with the inflammatory pain, who cares if my back is a little shifted?). I am also having to modify my bench back arch or prop up my feet.

The question: do you think I'm safe to add weight back to the bar? I feel kinda puny taking so much weight off the bar. Surgeon says don't lift. Chiro says be certain of perfect form. Oddly enough lifting feels Ok, but walking works up the pain and numb feeling more than anything else.

32 yo male, 5'7"� 180lbs (down from 210 since spring time when numbness started)

[Mark Rippetoe]

Get a second opinion from a different neurosurgeon. You haven't provided enough information about the case, your situation, or the surgical options, but these can be serious, so surgery might be an option, depending on the grade of the lesion. They can also be trained through very successfully.

[billy1edwards]

Get a second opinion from a different neurosurgeon. You haven't provided enough information about the case, your situation, or the surgical options, but these can be serious, so surgery might be an option, depending on the grade of the lesion. They can also be trained through very successfully.

I’ll get started on a second opinion asap. By way of more info, here it is.

I’ve had nagging SI joint pain off and on but the numbness started spring 2022. I recall rushing through a heavy DL session and then a light squat when I felt a “shift” sensation on the lower right side while at the bottom prior to pushing back up. The pain set in later that day and the numbness followed. The numb feeling has subsided but sometimes a “warm” or “prickly” feeling sets it but lately these coincide with a relief in the acute pain between L4&5 and the right SI. The pain is worst at work when I am bending and twisting, but thank God I landed a desk position at work. I start in Oct which should eliminate all awkward positions while carrying boxes, etc. A light deadlift session leaves me feeling great, but inflammation all around my lower back starts that evening or next day which I tend to believe is related to the psoriatic arthritis and not the spondylolisthesis.

Back in March I was ~210-215 having reached the tail end of NLP with 320x5x3 squat and DL, 180x5x3 OP and 215x5x3 bench. My press and bench have stayed decent but the others suffered. Once I saw the X-rays I haven’t OPed at all. At 5’7” I took the opportunity to lose some excess body fat hoping it’d help my back—it didn’t. Not sure if the lifts helped speed along the slippage but back in 2004 I was first told I had spondylolisthesis but kinda forgot as I got older, more active and the pain only came and left a few times a year (another reason I hope it’s psoriatic arthritis related).

In the past, prednisone and immunosuppressants made all swelling go away and back pain ease, so I hope the humira will help. But with the obvious nerve stuff going on I’m not sure humira will help that UNLESS the nerves are being pressed on either directly or indirectly by inflammation.

MRI and X-rays suggest a stress fracture on the spinous process that allowed the slippage.
Transverse processes on right side of L4&5 are likely pinching a nerve along with the vertebral foramen compressing the nerves that run inside the vertebrae. She said my symptoms match those issues perfecting—the tingling running down the anterior thigh and front of shin.

What makes me wary is 1. she kept saying the surgery would help the pain in my leg. But I kept saying the pain is radiating around the lower back and around the SI joint. 2. I have no pain in the leg. 3. The tingling ceases when I sit after 1-2 minutes but also when I stretch in flexion or even just bend over. 4. She did not assign a “grade” but from what I gather, more serious cases invoke weakness in thighs and legs, loss of bladder control, and other things. I don’t wanna develop that stuff, but right now it is just tingling, tight hamstrings and pain in lumber region —stuff associated with grades 1&2. I also do tend to walk with my butt out and have a pronounced arch in my lower back which I always assumed was just my cursed gait but may be a symptom of the spondylolisthesis. 5. Finally, once they’re fused, she did say the top and bottom vertebrae would now carry more stress and may need addressed later.

She also explained how the pictures I posted above show compression of all my lumbar discs. I think maybe the prolonged inflammation is the cause.

The procedure she wants to do is a total fusion of the L4&5 and use bone grafts and donor bone to encase the screws she would use. No other options were given and she suggested surgery by year end.

In the meantime I will hope the new meds, chiropractor and new job getting off the factory floor will give me some life back. I suppose until then I will not add too much weight to the bar?

[Mark Rippetoe]

This is definitely NOT a chiropractic situation. If I were you, I would stop that shit right now.