Brief Answer:
Explanation as follows.

Detailed Answer:
I read your question carefully and I understand your concern.

Looking at that report level after level it is obvious that there chronic spinal degenerative changes, with bony spurs (osteophytes) and disc bulges at several levels. At the first 3 levels described (C2-3, C3-4 and C4-5) these changes though do not seem to cause cord or nerve root compression which might indicate need for surgery.

At the level between C5 and C6 vertebrae the combination of osteophytes and disc bulging does cause significant narrowing of the foramina, the canal where the nerve root traverses. That could potentially cause nerve root compression.

At the level between the C7 and T1 vertebrae there is a small perineural cyst (Tarlov cyst). For the most part Tarlov cysts are not symptomatic, they do not cause any issues and need no treatment, so are left as they are. Only in rare cases do they compress nerve root causing symptoms.

So the question for your doctors to clear out is whether your pain is due to widespread chronic changes, with local inflammation and muscle spasm (case in which only physical therapy and painkillers are used, no surgery) or whether it is due to a localized nerve compression either at C6 from the disc-osteophyte complex or C8 from the Tarlov cyst.
That distinction is attempted through clinical neurological exam. Neurological exam should analyze pain distribution, changes in the reflexes, sensation and muscle strength, in order to determine whether they respond to a certain nerve root and if yes which one (C6 or C8). Of course things are not always clear cut, pain irradiation and anatomical variations between individual may make that distinction difficult at times. So when in doubt nerve conduction studies may be done as well. Depending on findings if it is concluded that symptoms are due to a nerve compression then local injections or surgery may be considered.

I remain at your disposal for other questions.

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Brief Answer:
Read below

Detailed Answer:
I am sorry I wasn’t able to make things more clear. A MRI alone doesn’t make the decision. Of course it’s a vital tool but together with the rest of the clinical findings.
If I were to judge by the MRI alone I wouldn’t go for surgery, not unless the symptoms were clear for a nerve compression confirmed by nerve conduction studies. Meanwhile the MRI report mentions pain more diffuse than the territory of a single nerve.
So I would be cautious before looking for surgery, it isn't a decision that you can take, as you yourself say even trained professionals vary in opinion. If symptoms are due to diffuse arthritis, surgery might not help at all. The same goes if there are symptoms indicating complex regional pain syndrome. For that reason, it must be carefully considered before having unnecessary costly procedures. Fusion is a procedure which might bring relief only to symptoms related to the intervened level. It doesn’t help other levels, if anything it adds the risk long-term as when one levels is fused, those other levels will be under increased strain and arthritic changes at those levels may be accelerated.

Let me know if I can further assist you.

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Brief Answer:
My thoughts as follows.

Detailed Answer:
I view SCS as an option when other possibilities have been exhausted. That is when the patient has tried physical therapy, non-steroid anti-inflammatory pain killers, medication for chronic pain (anticonvulsants like gabapentin, Pregabalin or antidepressants like amitriptyline, duloxetine). In a few patients traction therapy has also been successful, though less proven.

If the patient has tried the above options, symptoms persist for above a year and as I said before there is not a removable compression source which could be addressed by surgery, then I consider symptom control through SCS. It is not curative as you may well know, it simply alters pain perception.

I have to be realistic as like the neurosurgeon told you not all patients benefit, about 60% of them do. By benefit it is meant a reduction by at least half of the pain intensity, not necessarily disappearance of the pain. However even that reduction by half or more may make the pain more controllable by pain killers and facilitate daily function. So since other options have been exhausted one hasn't much to lose. Complications are usually related to device issues, physical complications like hemorrhage infection etc are rare, so generally considered safe.

I hope to have been of help.

Brief Answer:
Hope you will feel better soon.

Detailed Answer:
You're welcome. Hope you will feel better soon.

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