Symptoms relating to the musculoskeletal system are among the most common complaints registered by pregnant women. The maternal axial skeleton is subjected to considerable gestational changes and stresses; congenital and acquired skeletal anomalies may impact both the process and outcome of gestation and labor. The most common anomaly is scoliosis, arising either in the idiopathic form or from an underlying neuromuscular disorder. Other less common conditions include symptomatic lumbar disc herniation, ankylosing spondylitis, spondylolysis, and spondylolisthesis. Most scoliotic patients will experience pregnancy, labor, and delivery with a similar incidence of complications as the general population. However, within the population of scoliotic parturients, there is a subpopulation at higher risk for morbidity and mortality. These patients include those with scoliosis resulting from neuromuscular disorders and severe restrictive pulmonary disease complicated by pulmonary hypertension. A multidisciplinary team approach best serves these patients. The obstetric and anesthetic management of patients with less common and less extreme vertebral syndromes is guided by individual case characteristics.