SCI - mixed messages

Hi

I have a patient that has been given 2 very different opinions by 2 neurologists and I need some advice.

It's a 60 year old patient who had a spinal contusion at approx. level C5-6 (judging from my assessment) 4 months ago with no bony involvement. He lost all motor control from the neck down (and some sensory loss) and was lying in bed for 3 weeks doing nothing until we started treatment. He is now independently mobile and has some use of his upper limbs. He still suffers from weakness throughout his body but is gaining finer control of his movements and strength day by day.

About 1 month ago he started getting extensor spasms in LLs and Uls but predominantly in his ULS. This is often accompanied or preceded by a burning sensation throughout his arms (travelling down to hands in glove distribution). He also at times gets a feeling of numbness in his arms. These symptoms mainly occur at about 2 -3 am and are affecting his sleep++. His hand movements are also much more difficult on waking and gradually get easier during the day.

He went to see a neurologist 2 weeks ago who sent him for an MRI which came back with the following results:
- posteromedial disc protusions at C3-C4 and C6-C7 with the latter having a narrowed spinal canal, therefore pressing on the dural sac (not a lot)
- bulging disc C4-5, C5-6
- severe arthritic changes of the facet joints C3-7.

prescribed wearing a soft collar for 2 weeks and that's it. This patient used to singlehandedly carry 65kg bags of coffee right up until the accident so the arthritic changes are hardly surprising but the symptoms that he's suffering from don't seem consistent with the disc changes. Though I was wondering about the C6-7 protusion.

A week later he went to see another neurologist who said that the original lesion had not yet resolved and that he should wear the collar for another 3 months.

To me it seems that the most likely scenario is that he's suffering the secondary effects of the damage caused by the initial inflammation but that it is highly unlikely that there is a continuing inflammatory process. Is the collar at this stage likely to be beneficial at all?

The patient is on carbamazepine & biperidene and these meds have not been changed by either neruologist.

To sum up what I'm looking for advice about is the following:
- is the collar going to be helpful or is it just going to restrict movement and bring no postive effects?
- any advice on how to reduce spasms as the medics are not assisting in this. He already has advice on positioning to break the extensor pattern and weightbearing prior to sleeping and on weight-bearing?
- is it likely that C6-7 protrusion is at all responsible for any of the symptoms?

I am based in Mexico so every time their family go to the medics they have to pay for it and they now have 2 very different pieces of advice neither of which I believe is the solution so I would like to be able to give them the best possible advice taking into account that I will be conflicting with at least 1 doctor if not 2 and that I cannot prescribe anything.

Thanks for your help. I would really appreciate all opinions and advice