decisions--what basis
 

Suggested questions to ask yourself sorted in the order that I would suggest you address them in.
1st - Do surgery or wait? - How bad are you now? Are you so debilitated that there's very little risk from having a botched surgery? That is, you're so bad now, that you can't really get all that worse. Which way are you trending? Are you getting noticeably worse day by day? How much do you want out of life? How old are you compared with the normal lifespan of your family? How much will this/could this affect your work? Can you remain employed without surgery or do you need a higher level of physical fitness?

2nd Which surgeon? - Used to be this was simple: go to the best, most experienced surgeon you can both afford and get to. Use the disk he/she wants to use because you're better off with a really good surgeon and old model ADR over an inexperienced surgeon and a new model ADR. There's still a whole lot of truth to that even now. In general, desperate, really messed-up people can afford to go to inexperienced docs. Don't be the trial subject for a new doc unless you're so bad that a botched surgery will not mess you up more than you already are.

3rd - Which disk? - After you found your surgeon, ask this. Also understand that there is essentially zero medical proof that the marketing claims of this ADR being better than that one are actually true. There is some analytical work that could suggest better or worse but the assumptions in those analytical models are often jiggered to get a particular answer. It's not bad science; it's science being abused for the purpose of bad marketing. But, if offered two disks from a good surgeon, ask which one addresses your condition better. There isn't a one-size-fits-all ADR. Some are better for motion, some are better for bad facets, etc. Ask the doc.

4th - one level or two - More than likely, your condition will answer this for you. See the reasons for having surgery vs. waiting. Can you afford to risk two surgeries or do you need to be done after only one? How bad are the adjacent structures to your two bad disks? If they're both showing damage to the facets or osteophytes, then you're probably going to need both fixed.

5th - Go to Germany? - See the questions about picking your surgeon. Balance the costs vs. access to your surgeon vs. who is local to you. Germany isn't even the only overseas option. Just remember that most people are now going overseas because of cost for procedures insurance will not cover. We went overseas because Laura needed the ADRs back before they were FDA approved - pretty easy decision for us.

6th How to pay - Really, this is mixed into all of the other decisions. For Laura, she needed her first ADR at about 33 years old. We figured that, if we could keep her working for one more year with the ADR, her earning rate was enough to pay back the cost of the ADR. Other people have other needs and other uses for money so there's really no one way to look at this question.

Based on my experiences, I'llgive you a couple of things I would think of.

If you have a lot of degeneration / spurring, what's you Dr's thought's on the ADR fusing regardless?

If he was going to fuse your symptomatic level would he still recommend a 2 level procedure? Or wait and see for the next level? Usually less is best.

If you have any thoughts about going overseas get a few opinions from surgeons before you travel. Remember you want to set up follow up care back home.

My experience - 2 Germany ADR's, big mistake (46K). 1 ADR here in the States (17K), no problems at all, my Surgeons first. 1 Germany ADR removed and fused. My surgeons first.

Please explain which are better for the facets?

There's some thought that the degree to which the ADR moves freely improves it's tendency to overload adjacent disks and the degree to which the ADR tends to center itself or resist movement tends to aid the facets. That came out of the analytical work where multiple ADRs were simulated in computer models and the loads calculated. I'm sure I don't 100% believe it but the finite element simulations weren't all done by people paid to support a particular result so they're probably far more unbiased than you'd otherwise expect. You do have to watch the assumptions that went into those models but there's enough truth in there that it's worth asking your surgeon if you should be lucky enough to have multiple ADRs to choose from.