Time is Spine: Moving Evidence into Practice Across Canada
For people who sustain an acute traumatic spinal cord injury (SCI), timely access to appropriate surgical care can have a significant impact on recovery and outcomes.
In 2024, the AO Spine-Praxis Clinical Practice Guidelines for the Management of Acute Spinal Cord Injury strengthened recommendations for early surgical intervention, recommending that decompressive surgery within 24 hours of injury be offered as an option for adults who sustain an acute SCI, when medically feasible. With growing evidence supporting the benefits of early intervention well established, the challenge is increasingly one of implementation: translating evidence and recommendations into consistent practice across healthcare settings and systems.
Known as “Time is Spine,” this work is now moving from evidence to action. Praxis supported complementary projects to address barriers to timely decompression and help advance more consistent acute SCI care across Canada.
From evidence to a provincial approach in Alberta
In Alberta, Dr. Kiran Pohar Manhas and Dr. Chester Ho of the University of Alberta led Advancing Consensus on the Provincial Approach to Early Decompression Surgery in Acute Traumatic Spinal Cord Injury in Alberta. Working closely with spine surgeons and other clinical partners, the project brought together multidisciplinary partners from across the province to develop consensus on how the evidence for early decompression could be operationalized within Alberta’s health system.
The result is more than a recommendation. The team co-developed a suite of practical tools and approaches to support implementation, monitoring and continuous learning, including a provincial best-practice recommendation for decompression within 24 hours where medically appropriate; a provincial Time to Decompression dashboard to support near-real-time monitoring and case-level learning; and an Alberta traumatic SCI pathway outlining recommendations across the acute patient journey.
The project has also helped build the infrastructure needed to sustain change. Education and knowledge-mobilization activities are reaching rural and urban healthcare teams; a provincial SCI community of practice for nurses and allied health is being established, with operational leadership committing ongoing clinical nurse educator support; and an evaluation framework will help assess implementation and inform ongoing improvement.
Building momentum for broader adoption
Complementing the Alberta work, Dr. Michael Fehlings of University Health Network is leading Code Spine: A Multi-Faceted Knowledge Translation Initiative for “Time is Spine.” The project focused on building awareness, engagement and pathways for broader implementation of early surgical decompression.
The initiative includes development of an educational video communicating the evidence and benefits of early decompression to healthcare funders and system leaders; collaboration with Canadian professional societies, including the Canadian Spine Society, on webinars and educational activities; and engagement with the American College of Surgeons to begin exploring development of a “Time is Spine” care pathway.
Connecting local implementation with national change
Together, these projects demonstrate how change can move from evidence to implementation to broader system adoption. The Alberta project provides a real-world model for operationalizing early decompression across a provincial health system, while Code Spine is helping build the professional and system-level awareness needed to advance the approach more broadly.
By supporting complementary work across provinces and connecting researchers, clinicians, health system leaders and professional organizations, Praxis is helping translate evidence into practical approaches that can support more consistent, timely and evidence-informed SCI care across Canada.
Time is Spine Workshop: Moving Evidence Into Practice
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