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Concerned

I am a 50 year old male, have had 2 major back surgeries including a 360 fusion from T10 to L2.  I have had nerve issues ever since & have always been hypereflexive in both upper & lower every since.  I do have a slight foot drop in my left foot & cannot stand on my tip toes or doe calf lifts with my right foot, not have I been able to do so since my last surgery 7 years ago.  I recently started having twitching in my right buttock, which I have had before, but it is an every day thing now and a little in my right hamstring. I am also having twitching in my right thumb and forearm, mainly in the thumb.  No noticeable weakness but my right arm, wrist and hand do feel weird at times, like a sore muscle, no cramping just sore which comes and goes.  I have a positive Hoffman's test and have had that for at least 2 years now.  No sign of atrophy in my arm or leg.  I am also getting fasciltations in my back, left leg and left arm, just not as frequently as my left.  I am concerned that all of this could be early ALS and was wondering if anyone could give their opinion on if I am over reacting or justified.  I am hydrated, swim laps 2-3 times a week but am under stress from all of this.  Thank you for your comments.
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Hoffmann is not as specific as Babinski (the toe curl test). In fact, it can commonly found in people who have a hyperreflexia not caused by ALS, while Babinski always means upper motor neuron damage. Do you have the Hoffmann in both hands? ALS rarely presents with fasciculations, and those cases are usually inherited.
I suggest an EMG checkup to take your mind off ALS, and some blood work/whatever the doctor orders to find the cause of the twitching (e.g. low magnesium)
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