Took a long call from Dr Z. of Alphaklinik this afternoon who has looked at my MRI and suggests I take a trip to Munich to investigate my back further. He thinks there's a chance that I might only need a 1-level ADR (or two possibly) but that discography will be needed to decide- OOCH! I can sense the pain already (where did I put those aspirins?).
Impressed again with his comms skills in English. I trust this guy not to urge me to go for the full ADR set (3) at 35K UKP just to line his pockets. Plan to go just after Easter if I can get a cheap flight.

Decided to approach Alpha-Klinik, Munich- Dr Zeegers and filled in the online web form and also sent an introductory letter and the latest MRI scan summary and bone density results. Amazed that within 24 hours the phone rang and it was Dr Zeegers! Wow! I was surprised that they got onto my case so quickly. I suspect that it is a policy to get back within 24hrs as a "Good PR/Good Comms" policy and I certainly was impressed- especially when he and his secretary speak good English. (I hear that Alpha charge 10K UKP less for a 3-level than Pro-Spine.) though that is not my primary motivation for a second approach. I need a second opinion on my suitability for ADR. I expect to take the Alpha approach further by sending my MRI CDROM over the weekend and see what transpires. It's great that I can read daily update blogs on 2 American patients both of whom are under the knife this week with 2-level ADR's- one with Pro-Spine and the other with Alpha!

Had an X-Ray bone density scan today and readings were taken of hip-bone and 4 vertebrae. Clever machine. According to technician my bones are OK density-wise for a guy of my age- whatever that means! Sent copy to Pro-Spine, Germany for their comments.

I've received a response from Germany:-
Meanwhile I have now received (and attached as a jpg image) the consultant radiologist's report on my recent scan (you have the MRI images on CDROM) and would like to ask you to comment on his findings particularly regarding items
1. Are the presence of chronic and acute reactive endplate changes a contra-indicator for successful ADR?
Not at all – as long as they are not fully destructive. End plate changes are on the contrary a sign of clear discogenic degeneration – and thus confirm the expectation of ADR addressing your predominant pain generation.

2 & 3 The report mentions twice "facet joint hypertrophy". I believe that pre-operation condition of facets are critical for ADR success and have heard that the thickness of the discs of less than 5mm are a contra-indicator for ADR success. What is your own view of the indications in my case?
Facet joint degenration is one item, that we closely evaluate when deciding on ADR. Facet joints physiologically only take over a minor share of axial spinal load. Disc height collaps brought about by disc degeneration will massively overload them. And foster degeneration.
ADR implantation is capable to restore disc height and renormalize the segmental movement pattern from what it has become by disc degeneration. So in our experience your degree of facet degeneration will be positively addressed by ADR. This biomechanical consideration is confirmed by Dr. Bertagnolis long-standing experience in his case series. Of course high-grade facet destruction would speak against ADR. Which is not at stake in you acc. to Dr. Bertagnoli`s judgment. I hope I could help you on.
I find this response curiously unhelpful. Maybe it's due to the problems of interpretation from German to English but I end up with the impression that whatever I raise as a possible problem the answer is "Don't worry!" Makes me question still further the quality of the answers and advice from the clinic.

Interestingly I am in contact with a fellow sufferer who is awaiting his operation date for a 3-level ADR (similar in position of discs, his age 7 years younger) at the Alphaklinic in Germany with the other top surgeon Dr Zeegers. He has been on the same journey of doubt over ADR over a similar time period but has concluded he must have the op in order to regain his former active life-style. It will fascinating to hear how his operation goes and to talk in real time to him in his hospital bed about the experience via Instant Messenger. He will also maintain a blog (like this one) so others may learn. I have heard also from woman who had a 3-level ADR around March of last year and who is only just getting her life back- in her case the recovery was much slower than she had anticipated.

Watched today for the first time an online "live" single-level lumbar ADR operation lasting about 100 minutes at a USA hospital in early 2005- The Beth Israel Hospital in which a Charite disc (there are several different designs in common used worldwide) was implanted in a middle-aged female. The video can be seen at any time at-
http://www.or-live.com/bethisrael/1245/
The skill required by the surgeon is clear to see particularly in the preparation of the patient's disc-space by clearing out all of the old disc and then the care with which the top and bottom plates of the titanium artificial disc are sited with great accuracy before the plastic core is inserted. The doctor commentating stressed that the op is not suitable for everyone and that those with scoliosis (me) are not suitable candidates! That was just a single-level ADR and I can't imagine how much greater is the complexity of a 3-level ADR (which is what I need). As a advert for the hospital the broadcast was impressive and I imagine their phones were red hot with prospective new customers. I couldn't see any report of how this patient has fared since the operation. Having seen the way in which the device is implanted I can imagine removal of a failed device is horrendous.