Formal consensus guidelines for return to competitive play after spinal injuries in elite athletes remain lacking. This chapter reviews the current literature on the epidemiology of cervical spine, brachial plexus, and lumbar spine injuries in athletes, as well as clinical and radiographic return-to-play (RTP) criteria following nonsurgical or operative management. RTP after cervical injuries, treated nonoperatively or with single-level procedures, is feasible and safe given appropriate clinical and radiographic clearance. RTP after lumbar disc herniation is common and safe. Further study is needed to assess the safety of return to play after lumbar fusion and following emerging techniques, including cervical arthroplasty.