Congenital spinal anomalies include mostly neural tube defects together with hemivertebra, diastematomyelia, tethered cord syndrome and kyphosis and scoliosis. While alpha-fetoprotein was used as a screening test in the past, fetal ultrasound is getting wider acceptance in contemporary screening in the first and second trimesters. Post diagnosis counseling is the major part of the approach in these patients. In serious anomalies that are not compatible with life, termination is the first option. In selected patients with myelomeningocele, intrauterin surgery became an option. These patients have to be followed up and the delivery has to take place in experienced tertiary centers.