@mincer I understand being caught between what your imaging report says and your surgeon's wait and see approach. I can't give you medical advice because I am a patient and not a medical professional. However, having a report that says you have severe central spinal canal stenosis and severe foraminal stenosis (where the nerves exit the spine) is a cause for concern. I have had ACDF surgery and I did not wait until my reports said I had severe stenosis. I think mine was listed as moderate and that was putting me in pain.

What are the symptoms that your surgeon is expecting you to have? Spine problems can be different for everyone and some people with compressed spinal cords do not even know they have a spine issue. Some people have a lot of pain. I had pain all over which confused a lot of surgeons and they were afraid to operate. Surgeons don't even promise that their surgery will fix pain, so I don't see that a reason to decide for or against surgery. What surgery does is decompress the spinal cord and the pressure on the nerve roots and it should be done before permanent damage happens. They are looking to preserve function and prevent further damage.

If you have a copy of your MRI on disc, you can take that to another surgeon for a 2nd opinion. Always retain a copy for yourself and they can copy it into their computer network when you are at an appointment. This surgeon may be hoping you'll go elsewhere if your case looks like it may not have a good result for him that would affect his ratings of successful procedures. That is something doctors worry about and insurance companies use this to rate surgeons as well. Surgeons also try to wait as long as possible because fusing the spine puts pressure on the discs above and below it, which can then fail and cause the need for more surgery. Those are considerations, and only you can decide what is right for you. I had 5 surgeons refuse me over 2 years time and just waste my time. that cost me some atrophied muscle in my shoulders and arms which I did not fully get back after I had surgery, but I got about 75% of what I used to have before the spine problem began. As the patient, you will need to advocate for what you think is right and not depend on the whim of a surgeon who is trying to decide if he wants you as a patient. A lot of surgeons do cherry pick the cases they want and throw the others back into the pond. I would have agreed to spine surgery much sooner if I could have found a surgeon who would help and it is very distressing to jump through hoops for 6 months doing any test a surgeon wants only to have him refuse a surgical intervention. That was what was so very different when I came to Mayo to see my 6th surgeon. There were no games, and only a couple days of testing and imaging and I was offered a solution right away. I didn't know it could be like that, and I wish I had come to Mayo first.

The spinal cord will start to die if it is compressed too much and will show up on the MRI as a whitish area inside the spinal cord as myelopathy or myelomalacia (which is damage from inflammation or if the blood supply is cut off to the spinal cord). The nerve cells just literally die and dissolve into the spinal fluid. That is what you want to prevent and the permanent disability that goes with it.

Here is some imaging that you can scroll through to understand in 3 D to see spinal cord damage. Click on one of the images and then drag the slider up or down on the right side. These images represent the same location in different planes or slices through the spinal cord.
https://radiopaedia.org/cases/cervical-myelopathy?lang=us
Have you considered a second opinion? or more?