The spinal column has a propensity for lesions to manifest in a multifocal manner, and identification of the lesions can be difficult. When used to image the spine, magnetic resonance imaging (MRI) most accurately identifies the presence and location of lesions, guiding the treatment plan and preventing potentially devastating complications that are known to be associated with unidentified lesions. Certain conditions clearly warrant evaluation with whole-spine MRI, whereas the use of whole-spine MRI with other conditions is more controversial. We suggest whole-spine MRI when evaluating and treating any spinal infection, lumbar stenosis with upper motor neuron signs, ankylosing disorders of the spine with concern for fracture, congenital scoliosis undergoing surgical correction, and metastatic spinal tumors. Use of whole-spine MRI in patients with idiopathic scoliosis and acute spinal trauma remains controversial.