Spine morphology has been shown in recent years to exhibit a high degree of plasticity. In developing tissue such as organotypic slice cultures, shape changes in spines as well as reorganization of the postsynaptic density (PSD) occur within minutes. Furthermore, several studies have shown that these and other changes can be induced by or are dependent on synaptic activation. Formation of filopodia, enlargement of spines, formation of spines with perforated PSDs, appearance of new spines, and formation of specific types of synapses such as multiple synapse boutons (MSBs), in which two spines contact the same terminal, have all been reported to be induced in an activity-dependent manner. The common denominator of most of these different processes is that they are calcium and NMDA receptor dependent. Their time course, however, may vary. Some appear quite rapidly after stimulation (e.g., filopodia, perforated synapses), while others are clearly more delayed (e.g., formation of spines, appearance of MSBs). How these different structural changes relate to each other, as well as their functional significance, have therefore become intriguing issues. The characteristics of these different types of morphological changes are reviewed, with a discussion of the possibility that structural plasticity contributes to changes in synaptic efficacy.