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.