Dear Admins, Moderators and Members,
Please advice whether I need 4 level ACDF or 2 level ACDF?
Below are my MRI reports taken on 02-OCT-2015 and 08-DEC-2016.

HISTORY
C Sondylosis
MRI, Cervical Spine of 02-OCT-2015:
Sagittal Me2D, T1w and T2w and axial Me2D images of the cervical spine from C2-3 to C7-T1 were obtained. Radiographs performed previously.
The cervical spinal alignment is preserved. The cervical vertebrae return a normal signal. The cervical cord show normal signal.
No significant spinal canal stenosis at C2-3.
At C3-4, there is a mild osteochondral bar which is effacing the anterior CSF space without significant canal stenosis.
At C4-5, there is a large central osteochondral bar which is indenting the cord centrally. There is bilateral exit foraminal stenosis due to uncovertebral hypertrophy.
At C5-6, there is a moderate-sized osteochondral bar which is contacting cord and causing mild canal narrowing. There is also bilateral exit foraminal stenosis. Cord returns normal signal.
At C6-7, there is a small osteochondral bar which is effacing the anterior CSF space without significant canal stenosis. There is bilateral exit foraminal stenosis due to uncovertebral hypertrophy.
The C7-T1 disc space is unremarkable.
There is no prevertebral soft tissue swelling and craniocervical junction appears unremarkable.
IMPRESSION
Severe canal stenosis with central cord indentation at C4-5. No evidence of cord edema or gliosis.

MRI, Cervical Spine of 08-DEC-2016:
HISTORY: Known cervical spondylosis on conservative management. Now with worsening neck pain.
TECHNIQUE:
Sagittal T1W, T2W and GRE; and axial T2w and GRE sequences of the cervical spine were obtained. Comparison was made with the prior MRI study date 02 Oct 2015.
FINDINGS:
There is normal alignment of the cervical spine. The craniocervical junction and cervical cord are normal in appearance. Several osteophytes are note.
At the level of C2-3, no significant stenosis is noted.
At the level of C3-4, there is a left paracentral dice bulge narrowing the spinal canal. The disc abuts the cord, but the adjacent cord signal is normal. There is mild narrowing of the left neural foramen.
At the level of C4-5, there is a central disc protrusion with thickening of posterior longitudinal ligament. This disc-ligamentous complex impinges the cervical cord (Se4/13). The cord is not atrophied and no abnormal cord signal is seen. The neural foramina are narrowed by the bilateral uncovertebral hypertrophy.
At the level of C5-6, there is a broad-based left paracentral disc protrusion. Together with osteophytes the disc osteophyte complex results in severe asymmetric left sided spinal canal narrowing. This appears more severe than in the last study. The cord is deformed with no visible surrounding CSF space. However, no abnormal cord signal is noted. Both neural foramina are preserved.
At the level of C6-7, there is a broadbased central disc bulge. The disc-osteophyte complex causes mild narrowing of the spinal canal. The cord is spared. The neural foramina are preserved.
IMPRESSION:
Spinal canal stenosis at C4-5 and C5-6 levels, appearing to have progressed.
No evidence of cord edema or myelomalacia.

Thanks and Best Regards,
kimheng