Article Reviewed Camino-Willhuber G, Tani S, Kelly MJ, Schonnagel L, Caffard T, Chiapparelli E, Gorgy G, Dalton D, Zhu J, Shue J, Zelenty WD, Cammisa FP, Girardi FP, Hughes AP, Sama AA, Sokunbi G. Discrepancies in recommendations for return to regular activities after cervical spine surgery: A survey study. N Am Spine Soc J. 2024 Feb 23;18:100316. doi: 10.1016/j.xnsj.2024.100316. PMID: 38572467; PMCID: PMC10987327. Commentary The study under review is by Camino-Willhuber, et al., that was published in the North American Spine Society Journal. It reports on recommendations from a series of surgeons related to the timing of returning to daily activities after different types of elective cervical spine surgery. In the literature, there is a notable absence of standardized guidelines for the timing of return to daily activities after spinal interventions. In an attempt to address this deficiency, the authors conducted a global survey of spine surgeons to evaluate their recommendations for the timing of returning to activities such as showering, driving, running, sex, swimming, and sedentary and non-sedentary work after anterior cervical discectomy and fusion (ACDF), cervical disc arthroplasty (CDR), posterior cervical decompression and fusion (PCDF), and laminoplasty. The survey was administered between July 2022 and November 2022. An electronic survey was sent to spine surgeons identified through contact lists and an institutional listserv. In addition to asking about demographics, the poll included surgeon-specific advice regarding resumption of regular activities following four distinct cervical spine operations. The survey included responses from 91 surgeons, 87 orthopedic spine surgeons and 4 neurosurgeons. The denominator—how many surveys were sent out—was not included in the study. Of those who returned the survey, a majority practiced in the United States. There was a mix of board-certified, board-eligible, and non-board-certified surgeons. Years in practice varied between groups from 0-5 years in practice to greater than 15 years in practice. Results of recommended time to return to activities were reported by type of surgery. For ACDF and CDR, showering was most frequently allowed by postoperative day three, followed by driving, having sex, and sedentary work by week two, and running, swimming, biking, and non-sedentary work by week six. For PCDF, showering was most frequently permitted by postoperative day three, followed by driving, swimming, biking, and sedentary work by week six, and running and non-sedentary work by 3 months. For laminoplasty, showering was allowed by postoperative day three, followed by driving, running, swimming, sex, sedentary work, and non-sedentary work by week six. The authors also discussed stratified responses by years of experience. No significant differences were found in recommendations for ACDF and PCDF. However, for CDR, the subgroup with 10-15 years of experience recommended a later return to non-sedentary work compared to other subgroups. Similarly, for laminoplasty, the 10-15 years-in-practice subgroup recommended later return times for biking, sedentary work, and non-sedentary work compared to other subgroups. Overall, this is an interesting study that aims to quantify recommended timing of return to different activities after various elective cervical spine surgeries. While several variations in recommendations were highlighted, there were also many similarities in the recommendations made by those surveyed. In reviewing the current study, it was interesting to consider one’s own practice in light of the findings reported. On the average, recommendations from those surveyed were self-care after a few days, light activities after a few weeks, and more strenuous activities by six weeks. It was interesting that there were greater variations in recommendations for the non-fusion procedures (CDR and laminoplasty), and that more years in practice seemed to correlate with later recommended return to activities. The primary strength of the study is the interesting topic they studied. Given the lack of scientific evidence for the measured outcomes, the survey format worked well for the study objectives. Furthermore, the results are very applicable to routine spine practices. Limitations to the study are primarily related to its survey design. Response rates, non-responses-biases, etc., can affect study results. There was also very little representation of neurosurgery in the study. The influence of factors other than years in practice were not as explored. These factors can affect the findings’ external validity and generalizability. Additionally, the survey questions concentrated on general guidelines for getting back to activities following cervical spine procedures, possibly ignoring particular details or unique patient circumstances that could have had an impact on guidelines. The results of the study provide recommendations from a series of surgeons about the timing of returning to daily activities after different types of elective cervical spine surgeries. Ideally, these data would serve as a tan initial step on which additional work could be based.