When is it time to have surgery with cervical spinal stenosis?

Easy question: It's YOUR call. The best way to handle this (surgery for low back/sciatica pain works the same) is to keep following conservative measures (meds, aquatherapy/PT, thermal therapy, etc.) until as Popeye says, "I caint takes it no more!" Pain, numbness/tingling will drive you to the point where you'll be PLEADING for the surgeon. Then, it's time. Weakness/atrophy in Upper Extremities? - Do it NOW.