Cervical Spondylotic Myelopathy

65yo Male presents complaining of neck pain. In further questioning he admits to difficulty writing and two recent falls due to unsteady gait. Examination shows atrophy of hand muscles, widened and slower gait, diminished reflexes over brachioradialis, positive supinator reflexes, and hyperreflexia over triceps and lower extremity MSRs. Hoffman’s and Babinski are both positive bilaterally. If the doctor orders an MRI the patient will ask if really necessary.