Researchers from AO Spine and Praxis Spinal Cord Institute in Vancouver, Canada, have published a new set of clinical practice guidelines for the treatment of acute spinal cord injury (SCI). These guidelines play a major role in making treatment decisions for example in the timing of surgical decompression and the hemodynamic management in cases of acute SCI. Despite the mounting evidence, implementing guidelines into daily clinical practice is challenging—given biases towards clinicians’ hardened routines or material deficiencies in different global health contexts.