FAQs

Frequently Asked Questions

What is a neurosurgeon?

A neurosurgeon is a highly trained and specialist surgeon dedicated to problems related to the brain and spine. All neurosurgeons are trained to perform both brain surgery and spine surgery, with most performing both, but some performing more of one or the other. In the NHS neurosurgeons work within large Regional Neurosciences Centres, serving a large population area, usually 2 million or more, with emergency cases referred from a number of district general hospitals. Not all spinal surgeons are neurosurgeons (see below).

Mr Wadley is one of the most experienced and senior neurosurgeons in the country. He has been a consultant neurosurgeon for nearly 25 years. He is the senior consultant neurosurgeon in the Bart’s Health Regional Neurosciences Centre at St Bartholomew’s Hospital and the Royal London Hospital, the former one of the the oldest and one of the most famous hospitals in the world, founded by the monk Rahere in 1128, and the latter one of the leading teaching hospitals in the country and the busiest MTC (Major Trauma Centre) in Europe, with two emergency helicopters (HEMS). He has performed several thousand brain and spinal operations over more than 30 years, from straightforward minimally invasive keyhole procedures to major, complex operations.

Currently Mr Wadley is very busy indeed and much in demand. He performs about 250 spinal procedures of all sorts, both NHS and private, each year. He has a vast amount of clinical and surgical experience, and is renowned for his technical surgical skill, excellent results and very low incidence of complications. He consistently has very high ratings from his patients in both GMC Revalidation assessments and patient assessments on the Private Healthcare Information network (PHIN).

It is confusing that in this country, as well as many countries abroad, spinal surgery is performed both by neurosurgeons and orthopaedic spine surgeons. Whilst both are trained in spinal surgery, there are many distinct differences. All neurosurgeons in their training specialise in both brain surgery and spinal surgery, as well as peripheral nerve surgery; orthopaedic spinal surgeons will have spent the majority of their training in general orthopaedics, and then at a later stage spend several years doing extra training in spinal surgery. The neurosurgical tradition, additionally, is for surgery through small incisions (‘keyhole’) with minimally invasive techniques, using micro-instruments and a powerful operating microscope for magnification and illumination, as befits surgeons who also perform very delicate brain surgery as well. There are many spinal procedures that are wholly or principally are the preserve of neurosurgery, such as cervical spine (the neck) surgery, craniocervical junction surgery, and surgery within the membrane of the spinal cord (intradural procedures) to remove tumours, vascular malformations, etc, and highly delicate surgery on the spinal cord itself. Neurosurgeons also work in large Regional Neuroscience Units covering extensive population areas of 2 million people and more, principally in major Teaching Hospitals and Major Trauma Centres (MTC’s), typically with 12 or more consultant neurosurgeons as well as a large cohort of trainee neurosurgeons, physiotherapists and occupational therapists, and specialist nurses. In large units there may be 20 or more neurosurgeons, providing the full range of specialist brain surgery and spinal surgery.

Please see the contact details on this website, to get in touch with Mr Wadley’s private PA Jane, who has many years experience of dealing with patients with spinal problems. Patients will find her extremely helpful and knowledgeable. Although Mr Wadley is extremely busy and his services are in great demand, generally he is able to see private patients within a week or two. If patients have had a MRI scan performed already, Jane would find it extremely helpful if they would be able to tell her where the scan was performed, so that we may transfer the scan by ‘IEP’ to Springfield Hospital ready for Mr Wadley. This will help prevent any delays in the appointment being made.

It is extremely important that patients obtain authorisation from their private medical insurance company, otherwise they may well be liable for the cost of the consultation themselves. They will need to obtain an authorisation number, which Mr Wadley’s private PA Jane will require at first contact, as well as the other insurance details, such as a membership number.

Yes, Mr Wadley is recognised as a leading neurosurgeon and is recommended and fee-assured by all the major medical insurance companies. He is also a BUPA ‘Platinum Consultant’, a prestigious rating confirming the highest level of approval and feedback by BUPA customers and covered by all of BUPA Healthcare policies and schemes.

Yes, absolutely. Mr Wadley is delighted to see private patients on a self-funding basis. This is becoming for more common as patients seek much quicker opinions and surgical treatment at a time when there are continually increasing NHS waiting lists and failures. Mr Wadley’s private PA Jane will be delighted to discuss the ins and outs of the various costs with self-pay patients. Likewise, Springfield Hospital is extremely experienced in offering self-pay patients competitive packages, and they will find the welcome, medical and nursing care, and the environment whilst they are in hospital of the highest standard.

First consultation: £275

Follow-up consultation: £225

Mr Wadley’s PA would be delighted to discuss the potential costs of self-funding surgery with private patients. These fees are quite variable according to the neurosurgical procedure required, hospital arrangements and equipment, and occasionally other specialist arrangements that might need to be made.

In general it is very helpful to have a referral letter from the patient’s GP or an alternative, such as a physiotherapist or osteopath therapist. However, this is not vital, and it is an important principle of private practice that patients may choose to see whichever surgeon of their choice, so at first contact his private PA Jane will take down some basic details about the problem with which the patient is presenting.

Mr Wadley will ask detailed questions to get an idea of the presenting problem, and sometimes a neurological examination will be carried out, but in many cases this is not needed with the sophisticated investigations that we have available today. If a MR scan has been performed, Mr Wadley will carefully explain to the patient the relevant findings and show the scan images to them. If a scan has not been performed, or alternatively if further investigations such as electrical nerve tests (neurophysiology) are required to make a diagnosis, these will be organised by Mr Wadley. For self-pay patients his PA Jane will be able to tell them the cost of these further investigations.

If the patient already has had a scan performed, it may be possible for Mr Wadley to make a diagnosis at that time and he will then discuss all of the alternative treatment choices, one of which, of course, may involve neurosurgical intervention (an operation).

In the case where patients have been sent off for a scan or further investigations, a follow-up appointment will then be organised by his PA for a date after the tests have been performed, to further discuss the findings and the diagnosis before any treatment can be formulated.

Mr Wadley has an excellent reputation for explaining matters very clearly and in simple terms to his patients, including a very honest appraisal of all of the alternative potential medical managements and treatments, about which he always has a duty of care to explain to every patient. This may be evidenced by the large number of positive patient testimonials in this regard, which will be seen in another section of this website. If surgery is indicated, Mr Wadley will explain why, and also outline the details of the proposed surgery, the chances of success and the chances of any potential risks and complications.

Naturally, for some patients, a neurosurgical operation will not be indicated in terms of not being likely to help the patient, or possibly being unrealistic in a situation where a patient maybe very elderly or frail, for example, or who might have significant other medical problems that might make surgery or anaesthesia hazardous. If there are other potential treatment alternatives apart from surgery, Mr Wadley will endeavour to recommend this to your GP, and possibly recommend he himself referring you to a consultant in another speciality, if the problem may seem to be outside the spine, or if other specialist treatment as indicated, such as pain management. This, of course, all will draw upon his vast experience in neurosurgery with nearly 25 years as a consultant, and having performed several thousand neurosurgical brain and spine procedures.

Although in most cases an MR scan, and sometimes a CT scan, are required to make a diagnosis of a spinal problem and guide further management, if a patient has not had a scan already then Mr Wadley will be able to organise such an investigation at Springfield Hospital having first seen the patient, who then will be reviewed at a follow-up appointment when the scan has been performed. If the patient has any doubts at all, Mr Wadley’s privately PA Jane will be delighted to discuss the situation with them and offer further advice.

Upon the occasion Mr Wadley may need to organise further tests or investigations to help make a diagnosis and guide management, often this may be electrical nerve tests (neurophysiology). These tests, conveniently, will be performed at Springfield Hospital. If this is the case, he will explain very carefully why these tests are required, and it is important that private patients then obtain the private medical insurance authorisation for these further tests. If the patient is self-paying, Mr Wadley’s private PA Jane will be able to advise on the fees for these further test tests and the fees for follow-up appointments.

One of the reasons why patients opt for private medical treatment is considerably shorter waiting lists than the NHS is able to offer, even more so at the current time, and of course a more comfortable and conducive environment to medical care that private hospitals are able to offer. Therefore the waiting list for private spinal surgery under Mr Wadley is very favourable, and even though he is very busy indeed and much in demand, generally this is counted in weeks and not many months as with NHS waiting lists. Mr Wadley’s private PA Jane will be able to give patients a very good idea of the potential timings of any planned neurosurgery.

Naturally, there may be many situations where a surgical operation is unlikely to help a patient, or alternatively a patient may not want an operation may not be fit for surgery, or this all this may be precluded on the basis of their age (rarely) or medication that they are taking.

Mr Wadley will give a very honest appraisal of the situation, and if surgery is not indicated he will clearly explain why. Common such situations may be where a patient only has musculoskeletal back pain or neck pain, without any neurological (nerve) symptoms (ie: brachalgia in the arms or sciatica in the legs).  Patients should be extremely cautious if any other spinal surgeon has offered a surgical procedure only for back pain or neck pain in these situations, particularly if this involves ‘spinal fusion’. There is no evidence that these operations work, and carry a higher than usual burden of complications.

If referral to a different consultant in another speciality is likely to help, Mr Wadley will explain this and offer to organise onward referral for the patient. This may, for example, be for a shoulder problem or a hip problem, with referral to an orthopaedic colleague, or often if there is only musculoskeletal neck or back pain, in which case Mr Wadley will recommend a referral to his senior pain management consultant colleague Dr Victor Mendis.

Yes, Mr Wadley will write a clinic letter back to the patient’s GP, explaining everything in detail, and his private PA Jane invariably gets these letters out extremely quickly, within a few days. All private patients will receive a copy of this letter for their records.

If patients are seeking self-funding private treatment, both in terms of clinical fees and the costs of potential surgical operations, Mr Wadley’s private PA Jane will be able to explain this all in great detail. Fees for private surgery will be in several categories, with the fee for the surgeon, the consultant anaesthetist, and the hospital fees. Whilst quoted fees for different consultants may vary, it should be remembered that often, higher fees may well reflect the seniority, experience, and additional specialisation of that consultant. Cheaper costs rarely go along with superior treatment.

Mr Wadley is extremely fortunate in that his PA, Jane, has an excellent reputation for being very approachable and explaining everything very clearly and in a very friendly manner to patients. Patients regularly tell him how excellent she is! She will very carefully go through all of the arrangements, be that with a private medical insurance company or a self-paying patient, explaining all of the stages leading up to surgery, and what to expect from Springfield Hospital as well. A patient information letter sent to them before surgery will also accompany this, and, of course, Jane always is delighted to be contacted at any stage to answer further questions if patients have any additional queries or points to be clarified. Patients should not hesitate to contact her if they are uncertain about anything at all.

Mr Wadley understands that even if matters have been explained clearly, sometimes it may be a lot to take in if surgery has been proposed. In most situations Mr Wadley’s PA Jane will be able to answer most queries and questions, given her huge experience, but if the questions are of a more medical / technical nature then it may be that another appointment needs to be arranged to discuss this further with Mr Wadley. It is extremely important that all patients feel that they are fully informed and the decision to proceed with surgery is a joint one between patient and consultant surgeon, with all questions and queries fully answered.

Historically there are various different types of injections into the spine that have been used to treat symptoms, principally musculoskeletal lower back pain, but sometimes also radicular symptoms (brachalgia in the upper limbs or sciatica in the lower limbs). They have their place, certainly as part of specialist holistic management to treat musculoskeletal lower back pain, for which there is no surgical procedure that is indicated by national guidelines nor should be performed in Mr Wadley’s opinion, such as non-evidenced based ‘fusion’ operations for simple back pain in the lower spine, with insertion of screws or other metalwork.

These injections may help in the early stages of nerve root compression causing brachalgia or sciatica, but if these particular symptoms are not improving after 2–3 months, and an MRI confirms nerve root compression in the spine, then neurosurgical intervention may well be indicated. It must also be borne in mind that the most up-to-date guidelines, in the form of the National Spine Framework 2024, now specifically recommend two types of injections (medial branch blocks or nerve root injections) but no longer approve other injections which are ineffective (facet joint injections or caudal epidural steroid injections). Therefore, it is vital that if spinal injections have been proposed to you, you ask the doctor or spinal surgeon (personally, Mr Wadley feels that these procedures should be performed by pain management experts and not spinal surgeons) involved whether the interventions that are being recommended adhere to the National Guidelines, and also ask them how effective are these procedures are in their hands, and how many they have performed. The patient must also be very cautious about doctors who recommend repeated rounds of injections into the lower back, in breach of national guidelines.

Sciatica it is the medical term used to describe symptoms resulting from nerve root compression in the lower (lumbosacral) spine. Sciatica pain typically begins in the lower back or buttock, and radiates down the back of the leg, often to the foot. The pain may be sharp, a dull ache, or cramping, and often is accompanied by sensory disturbance (pins and needles, numbness, and sometimes odd sensations). The most common causes are a disc prolapse (‘slipped disc’) or narrowing of the spinal canal (spinal stenosis or lateral recess stenosis) in which case the sciatica is often claudicant, meaning coming on with walking a certain distance and relieved with stopping and resting, or with prolonged standing, and sometimes in both legs.

Compression of the large nerve roots coming off the cervical spine in the neck, in contrast to sciatica in the legs caused by compression of a nerve root(s) in the lower spine, causes similar symptoms of pain and sensory disturbance (paraesthesia) to radiate down one or both arms, and often into the hand and fingers. This usually is caused by formation of bony spurs (disc-osteophyte bars) on the vertebral bodies in the spine as part of the ‘wear and tear’ process (spondylosis), or in the younger age group, a soft disc protrusion. The symptoms in the arm are known as brachalgia. Alternatively, if the symptoms are only in the forearm or hand, the problem may lie with compression of a peripheral nerve in the wrist/hand (median nerve neuropathy or carpal tunnel syndrome) or at the elbow (ulnar nerve neuropathy).

There is no medical evidence at all that operations on the cervical spine (neck) or the lumbosacral spine (lower back) have any beneficial effect on what is known as musculoskeletal or mechanical lower back pain, in the absence of nerve root pain (brachalgia or sciatica respectively). In particular Mr Wadley would caution patients with isolated neck or back pain about accepting offers of ‘spinal fusion’, involving insertion of large metal screws, in the neck or lower back, operations that rarely are performed by neurosurgeons and which generally are not authorised on the NHS.

These procedures never have been proven to work for purely lower back or neck pain, and carry a high burden of complications. Most lower back pain and neck is muscular origin, or comes from degenerative wear and tear in the small facet joints at the back of the spine, and this needs to be treated in a different way, mostly with holistic pain management input from an expert pain management consultant. This may involve various types of spinal injections, only two of which are authorised by the NHS, and also various types of medication as well as therapies. There may be important benefits in other more generalised actions such as improving posture and muscular strength, stopping smoking, workplace environment adaptations, avoiding aggravating factors, losing weight, and increasing levels of physical fitness. Courses of physical therapy, with a physiotherapist or osteopath, may also have a role.

In a proportion of patients musculoskeletal back pain may improve when an operation to relieve sciatica caused by nerve root compression has been performed, although this likely is a result of relief of muscular spasm and is regarded as a bonus to the original aim of the operation. Mr Wadley would be delighted to have a consultation with patients who might have been offered such non-evidence-based ‘fusion’ procedures, and are unsure whether to proceed. He will give a very honest appraisal of the situation in these cases.

Carpal tunnel syndrome is a fairly common condition where the large nerve that runs from the forearm into the hand (the Median Nerve) and controls many of the muscles of hand movements, becomes compressed by thickening of the soft tissue over the nerve, over a passage formed by the bones of the wrist on the other sides, and therefore often referred to as the carpal ‘tunnel’. Compression of this nerve causes the gradual development of pain, numbness and pins and needles in the hand and the thumb and finger digits. The hand may feel weak, patients may drop objects and have difficulty with daily tasks, and in advanced cases there may be a significant wasting of the small muscles of the hand. Classically the symptoms are worse at night, when patients often have to shake their hands to obtain relief. The condition is diagnosed with neurophysiological investigations (nerve conduction studies) and if the symptoms and the neurophysiological tests confirm the diagnosis, then a straightforward local anaesthetic day-case operation stands an extremely high chance of resolving the symptoms.

Mr Wadley performs a significant number of these operations per year, and even though the surgery actually is in the hand, neurosurgeons specialise in this as well as several other types of procedure since it is surgery on a nerve. Personally, Mr Wadley does not advocate other treatments such as splinting the wrist, which is pretty impractical for most patients, or injection of steroid around an already compressed nerve, which seems not a sensible thing to do. None of these other treatments will sort the problem out in the long-term and there is always the risk of progressive nerve damage without relief of the compression. If you have carpal tunnel syndrome, Mr Wadley would be delighted to see you to give a further opinion and advice.

A spondylolisthesis means a very slight irregularity of one vertebral in the lower spine on top of the other, some authorities describe this as a ‘slip’, but nothing has slipped as such and these minor defects almost never are ‘unstable’ as some claim. Typically this is very minor and of the order of a few millimetres or so, and invariably has no functional or surgical implications. However, if there already is narrowing in the spinal canal, this may exacerbate the situation and contribute to a patient’s symptoms of sciatica or neurogenic claudication in the legs.

The type of minimally invasive, delicate spinal surgery performed by neurosurgeons does not cause any problems in the vast majority of patients if a spondylolisthesis is present, and although some other spinal surgeons advocate insertion of big metal screws into the lower back if a spondylolisthesis is present, Mr Wadley has never done this in his entire career as a consultant neurosurgeon and invariably such proposals overcomplicate the surgical process and lead to a higher risk of complications. The only exception to this experience is the extremely rare situation where a patient may have failure of development of the bony arch at one level in the lower spine, with which they were born, on both sides and known as a ‘pars defect’, and in these exceptional circumstances instrumentation of the spine with metalwork may be indicated. Mr Wadley would be delighted to see patients in this situation and give his highly experienced advice, in particular if they may have been offered major and unnecessary ‘fusion’ surgery by a different spinal surgeon. He will show them their MR scans and clearly explain the situation.

In general, with the minimally invasive techniques and delicate surgery performed by consultant neurosurgeons, patients invariably recover very quickly from spinal procedures. Nevertheless, it is common sense that Mr Wadley advises patients to be very gentle with physical activities for a period of time after spinal surgery, to avoid undoing all of his good work. This may well vary depending upon the individual patient and their age, the type and level of physical activity in which they engage, and also what type of occupation they have, or are retired. In general patients should refrain from significant physical activity such as playing sports, going to the gym, and heavy recreational activities such as digging in the garden, or occupations or jobs that involve significant physical exertion, for 1-2 months after any spinal surgery. Naturally Mr Wadley will discuss this in detail both before and after surgery with his patients, and generally he reviews private patients three times over a three month period in clinic to ensure that they are progressing well and clear instructions are given at each stage for gradually increasing levels of physical activity back to normal, usually at the three-month stage after surgery. In some patients their recovery and rehabilitation may be helped by a course of physiotherapy, in which case Springfield Spinal Unit’s and Mr Wadley’s very experienced team of spinal physiotherapists at Springfield Hospital will give the appropriate advice and make the appropriate arrangements after surgery.

In line with the advice to ‘take it easy’ for a period of time after any spinal surgery, Mr Wadley generally advises at least 2 weeks off work for some smaller procedures, and perhaps up to 4 weeks of work for more significant operations. However, of course, this advice will vary depending upon the age of the patient, how physically active their job is, and perhaps whether they commute significant distances either by driving a car or on a train or other public transport. Mr Wadley will always advise patients appropriately depending upon their individual circumstances and the planned surgery that is to be performed.

In general with Mr Wadley’s advice to patients after spinal surgery to be very gentle with physical activities for several months afterwards, in general he would advise any patients who have had cervical spine or lumbosacral spine surgery not to drive a car for at least two weeks afterwards to let any postoperative discomfort settle down and the healing process to proceed. Patients after cervical spine surgery often are sent home with a soft collar to wear for two weeks, to prevent overt movements of the neck, and in this case driving would not be sensible.

In line with the advice to ‘take it easy’ for a period of time after any spinal surgery, Mr Wadley generally advises not to fly on an aeroplane for at least a month after any spinal surgery. This is not so much to do with any particular danger caused by travelling on an aeroplane, but more to do with the significant physical exertion of travelling with luggage and for sitting for many hours at a time. Please advise Mr Wadley when you first see him, or his private PA Jane when you first talk to her, if you have any plans for holidays or air travel which might clash with either the date for surgery, or the period of recovery required afterwards.

No, most neurosurgical spinal operations are performed with minimally invasive techniques, through quite small incisions and careful, delicate microneurosurgical skills with a large, sophisticated operating microscope and small, specialist instruments.

The vast majority of patients usually only have an overnight stay with most of the spinal neurosurgical operations performed by Mr Wadley. This very brief stay in hospital is the result of minimally invasive techniques, through quite small incisions and careful, delicate microneurosurgical skills with small, specialist instruments. Occasionally, patients may need to say stay in slightly longer if there are social situations at home, and this will not cause any problem with Springfield Hospital if this has been previously planned, or if there have been any issues with surgery that may rarely require a slightly longer period of recovery. It is interesting to point out that most private medical insurance companies expect patients to stay in for longer after surgery than usually is the case when Mr Wadley is the surgeon.

Yes, of course, patient follow-up is vital for any surgeon to assess his patient’s progress after surgery, to ensure that there are no problems or complications, and naturally to be able to assess over a number of years his results, outcomes, and rate of success. Typically Mr Wadley sees private patients three times for follow-up, the first time a few weeks after surgery to make sure they have come through the operation without problems and to assess wound healing, the second appointment at two months, and the final at three months after surgery, by which time the vast majority of patients should be back to normal physical activities. Careful advice is given at each stage regarding gradually increasing levels of physical activity, and answering any questions that the patients may have about their recovery. Patients who have had cervical spine surgery and insertion of instrumentation / implants, will also have an x-ray of the neck at this three-month stage at Springfield Hospital just before they come up to see Mr Wadley in his clinic for the final time.

Neurosurgical operations to treat brachalgia in the arm and sciatica in the leg invariably carry a very high chance of success, and a very low chance of potential risks and complications, when the neurosurgeon is experienced in such techniques. However, naturally no surgeon can claim to have 100% chance of success. In the majority, approximately 70–80%, the symptoms will resolve either immediately or within a short period of time of several days or weeks after surgery, but as might be imagined in conditions where compression of nerve roots has caused a degree of damage in many nerve fibres, in some patients this recovery maybe slow and gradual, occasionally taking several months. It is impossible to predict patterns of recovery in individual patients, and Mr Wadley will always encourages patience after any spinal operation.

In general, with the minimally invasive techniques and delicate surgery performed by consultant neurosurgeons, patients invariably recover very quickly from spinal procedures and generally do not complain of significant levels of pain. Of course, after surgery, there will be a degree of discomfort as the healing process proceeds, but patients always receive appropriate pain-killing medication after surgery whilst in hospital, and will be sent home with appropriate analgesia (painkillers), but may well find that if their pre-operative symptoms have been relieved they are quickly less reliant anyway on this type of medication than they were before surgery.

Of course, this very much depends on who is performing the surgery! In the modern era, spinal neurosurgery is extremely safe and reliable in experienced hands, utilising sophisticated technology both for diagnosis and in the various types of advanced equipment and technology used in the operating theatre. Neurosurgeons in particular utilise minimally invasive techniques (‘keyhole surgery’) through small incisions and often only with an overnight stay in hospital, using powerful operating microscopes, delicate micro-instruments, and sophisticated high-speed drills. With appropriate training and over many years experience, this has resulted in very high levels of success and good outcomes with spinal surgery performed by neurosurgeons, and a very low rate of potential risks and complications. It should be remembered that neurosurgeons are both spine and brain surgeons, and that not all spine surgeons are neurosurgeons.

Mr Wadley is always very happy indeed to see patients for second or even further opinions. No surgeon should be unhappy about a patient seeking advice elsewhere. Mr Wadley sees many patients who may have been offered controversial types of surgery and frequently seek out his extremely experienced opinion, or where patients may feel that the details of their case have not adequately been explained to them. Additionally, Mr Wadley will always tell patients when he feels that surgery is unlikely to help, and never advocates surgery unless there is an extremely high chance of success and the operation clearly is indicated.

Every patient should feel free to ask detailed questions to their surgeon about the type of operation that has been proposed, what the alternative treatments are as well as surgery (every surgeon has a legal obligation to explain these alternatives to their patients) and additionally to ask their surgeon about their level of experience and how many of these operations he or she has performed, what their success rate is, and what their rate of complications has been and details of the various potential risks and complications.