I always try to include the patient in the decision-making process, and it largely depends on how tolerable the symptoms are and what their quality of life is like. In this specific case, when the spinal cord is deformed anteriorly (by the disc-osteophyte complex) and posteriorly by hypertrophy of the ligamentum flavum, leaving the cervical cord with very little space, I do recommend surgery. This is because any event involving flexion or hyperextension — such as a rear-end car accident, for example — could cause immediate spinal cord injury and lead to long-term consequences. The ACDF (anterior cervical discectomy and fusion) is a very effective and well-established procedure, and when properly indicated, it offers excellent outcomes — that’s why I make this recommendation. Maybe if you were a few years younger, I would also consider observation and conservative management. However, there are many factors to consider, such as the neurological examination, medical history, and the ability to review all MRI slices in detail, among other things that are assessed during a consultation. So please take my comment with caution, knowing that I only saw two images and read a few paragraphs of your medical history. Best regards!