Vertebral anomalies and neural tube defects are relatively common conditions, and some of these can be identified in the prenatal period. Recent progress in three-dimensional (3D) and four-dimensional (4D) ultrasound has provided an added value in the vertebral column and spine assessment. This narrative review examines the applications, techniques, and clinical benefits of 3D/4D ultrasound in diagnosing congenital spine abnormalities during fetal development through a comprehensive analysis of advanced ultrasound techniques including volume acquisition, multiplanar imaging, render view, volume contrast imaging, and other 3D modalities. Moreover, it provides an embryological classification of spinal and vertebral column defects, with emphasis on the features of normality and clinical examples of abnormality.