<s>[INST] I awake with both hands asleep. It started with my left arm aching and my thumb and pointing finger getting a numb sensation.  Now I awake at night and both hands are asleep (4-5 times a week).  An MRI revealed moderate right C3-4 foraminal stenosis which could compromise existing right C4 nerve root.  Severe let C4-5 foraminal stenosis which could compromise the exiting left C5 nerve root.  Multilevel degenerative disc disease, spondolylosis and facet degenerative change.  What treatment would you suggest? [/INST] Hi there, welcome to HCM, thanks for your question.Your symptoms suggest compression of nerves supplying both your uppper limbs.Such a compression moat commonly can happen in your neck or your arms at the carpal tunnel.The neck compression is seen in your MRI report and it correlates with your symptoms.But the carpal tunnel symptoms  need to be ruled out by your physician  by clinch examination and nerve conduction tests.If carpal tunnel syndrome is ruled out and your symptoms are present for more than 12 weeks with no response  to conservative measures then as per your MRI and your clinical presentation you would need surgery at C5C6 level of your spine which will include discectomy and fusion  with a cage and other levels depending on what is seen in the MRI.The Conservative measures to be tried before surgery is considered include: physiotherapy,  exercises,medications, rest, guided inejections by experts.Presence  of any kind of weakness or new onset numbness would be a nice absolute indication  for more urgent surgery.Considering your symptoms and radiology  finding's I would suggest you to follow up regularly with a spine surgeon and get appropriately  treated.Hope this answers your question.All the best.Thank you.with best regards. Dr.SBK </s>