Abstract Spinal surgery encompasses a wide variety of procedures (elective and emergency) in a range of patients from the very young to the elderly. Patients may suffer from multiple co-morbidities and systemic diseases (e.g. rheumatoid arthritis, ankylosing spondylitis) which will be addressed within the scope of this article. Anaesthetic management of these cases includes thorough pre-operative assessment and optimization and careful perioperative management with particular attention being paid to anticipate and minimize potential complications of each procedure.