The poster does not mention what symptoms were present when originally presenting to the physician. Much of the treatment plan for such problems comes from clinical presentation, not just MRI's and / or other diagnostics. In fact, clinical presentation is the first line in diagnosis. Standards of care in virtually any of these situations will be conservative types of treatment, just as the poster describes. Subsequent MRI's or other diagnostics cannot relate when an event occurred. To think that this individual definitively had the condition shown on the later MRI's at the initial presentation is unfounded. By the same token, I have seen appropriate surgical decisions made based on clinical symptomatology when MRI did not seem to warrant the same decision. Lastly, having worked in a neurological and trauma intensive care unit for 5 years with some exceptional neurosurgeons, I've never heard of this Japanese whatever scale. Not that it may not have validity, I simply think physicianreviewer has some ulterior motives by having read several of his / her replies. lkc15507