[bombcar]

I would consult with a few additional vets, perhaps some further out in the countryside and/or older.

You need to balance the quality of life of your dog, the cost, the change of death or other complications, along with alternative options (such as switching food when it gets worse).

[ajju]

Thanks. While steep, I’ll happily pay for the procedure if the risks are minimal and the impact on his quality of life is likely to be meaningfully positive.

[bombcar]

Yeah, I'd be less inquisitive about price and more asking the other vets to "level with you on the risks".

And the risks may be acceptable, especially if it comes down to "dog continues to live with ever increasing pain" vs "99% chance of pain free vs 1% chance of peacefully passes away on the operating table".