Early and ultra-early surgical decompression for acute spinal cord injury: bracing for the winds of change.

Until recently, there has been no consensus on the optimal operative window for decompressive surgery in acute spinal cord injury (aSCI). However, recent evidence is now supporting a role for early intervention in improving outcomes in this type of patients. The purpose of this letter is to discuss the implications for clinical practice within the European community. Critical appraisal and interpretation of these results for clinical implementation. Leveraging on the evidence that early (< 24 h), and possibly ultra-early (< 8 h), decompressive spinal surgery in aSCI affords better neurological outcomes, the next challenge for our community will be to ensure that spinal surgery services can accommodate this caseload. Here, we discuss the challenges that will be faced by spinal surgeons and draw parallels between the scaling of these services and the implementation of mechanical thrombectomy for acute ischaemic stroke. We outline key lessons that have been learnt from the rapid scaling of mechanical thrombectomy services and highlight the provisions in infrastructure, education, and staffing that will be required. This is a call for hospital systems to swiftly restructure spinal services in order to meet the need for early, and possibly ultra-early, spinal decompression in aSCI cases in the near future.