Spine specialist explains what may lie ahead for Robert Wickens' recovery

Jim Ayello | IndyStar

Show Caption Hide Caption IndyStar's Jim Ayello breaks down Pocono race Motor sports reporter Jim Ayello discusses Robert Wickens' harrowing crash and Alexander Rossi's victory at Pocono Raceway. Aug. 19, 2018

INDIANAPOLIS – Titanium rods and screws were placed in IndyCar driver Robert Wickens' spine during surgery Monday to stabilize a thoracic spinal fracture associated with a spinal cord injury sustained during a terrifying wreck at Pocono Raceway on Sunday.

While the surgery was successful, the severity of the spinal cord injury remains undetermined. According to an IndyCar news release, the 29-year-old Canadian driver is expected to undergo further surgeries to treat fractures in his lower extremities and right forearm. The Schmidt Peterson Motorsports driver remains in stable condition. The team released an additional statement Tuesday afternoon that Wickens' No. 6 car will not be entered in this weekend's race at Gateway Motorsports Park.

Following IndyCar's update, IndyStar spoke with Dr. Camden Burns, an orthopedic surgeon and assistant professor in the department of surgery at the IU School of Medicine.

Burns, who specializes in spine surgery and orthopedic trauma, provided some background on what Wickens and his doctors at Lehigh Valley Hospital–Cedar Crest could be dealing with. However, he strongly stressed that without having physically examined Wickens himself or seen his imaging (MRIs, CT Scans, etc.), all he could provide was background — nothing specific.

Insider: Robert Wickens can battle back from spinal injury suffered at Pocono

He first addressed the surgery Wickens underwent Monday, saying the titanium rods and screws were inserted simply to stabilize his injury. He then discussed what damage to the thoracic spine, which is located in the chest area and contains 12 vertebrae, could mean.

"The thoracic spine houses the spinal cord as it travels through the chest inside the thoracic spine, and any type of fracture or dislocation, in addition to any injury of the bones, has a chance to injure the spinal cord as well," Burns said.

"At the level of the spinal cord, we're talking about the area that sends nerves to affect motor and sensory to the lower extremities as well as (supplying nerves) to certain organs and things like that, that could control bowel and bladder function, etc. Any of those things could be injured whenever you have a spinal cord injury at those levels."

Paralysis, Burns said, is a possibility when dealing with a spinal cord injury at the thoracic level. However, Burns warned that has not seen or examined Wickens and knows only as much as Tuesday morning's statement provided.

He also said it's possible, if Wickens was intubated and sedated upon being admitted into the hospital, that doctors might not have immediately known his neurological status, since a physical exam would have been challenging to complete.

"Absent of that, (doctors) would start looking at the nature of the injury, the morphology of the injury, what the imaging looks like," Burns said. "Then they'd try to determine the stability of the injury and what needs to be addressed to decompress the neurologic elements and stabilize the injury, whether that's the spinal cord or the nerves to give chance for a recovery. That's a very general statement, but again, we don't know what's going on, because they haven't released that information."

As far as the timing of the surgery, which the statement said took place Monday, Burns said there are numerous factors that go into when it's appropriate to operate.

"We just don't know," he said. "There are various types of spinal cord injuries. Some of them are complete. Some of them are incomplete, meaning you still have some partial motor or sensory or bowel and bladder function. Depending on how you present, what type of injury it is and also whether or not you plateaued versus neurologically you're improving from the time you arrive, all of those things go into an algorithm of how quickly patients need to be taken to the operation room.

"In general, other injuries a patient has sustained could be more severe or life-threatening, and those would have to be addressed first. It really just depends, especially for a person who sustained polytrauma."

Burns added that little can be read into the fact the statement said Wickens is expected to undergo surgery to repair his non-spinal injuries (fractures in his lower extremities and right forearm). Doctors would tend to those injuries for multiple purposes, including both the potential of future function as well as for general nursing and physician care.

As far as recovery, assuming that's possible, there was not much specific Burns could add at this point since details about Wickens' current neurologic status have not been released. Neurological recovery from a spinal cord injury could take anywhere from days to years.

Wickens involved in horrific crash IndyCar driver Robert Wickens was involved in a horrific crash at Pocono Speedway.

Rehabilitation for those who have suffered an injury to the spinal cord can be extensive. Patients not only need to recover from the spinal injury itself but the body also needs times to repair the damage done to the neurological system. Burns said muscle, skeletal and other organ systems could be affected by an injury like this.

There are facilities that have dedicated spinal cord injury units for patients to rehab once they've been released from the hospital, including the IU Health-St. Vincent collaboration, Rehabilitation Hospital of Indiana.

According to Schmidt Peterson team's Twitter account, fans wishing to send their best wishes to Wickens via traditional mail can do so by sending letters or cards to Veronica Knowlton at the team's headquarters at 6803 Coffman Rd Indianapolis, IN 46268.

Follow IndyStar Motor Sports Insider Jim Ayello on Twitter and Facebook: @jimayello.