Evidence to date shows that fMRI of the spinal cord (spinal fMRI) can reliably demonstrate regions involved with sensation of tactile, thermal, and painful stimuli, and with motor tasks. Spinal fMRI acquisition methods based on BOLD contrast have been recently optimized. Results have demonstrated the ability of spinal fMRI to provide objective assessments of sensory and motor function, and discriminate responses when modulated by cognitive/emotional factors. Studies have been also carried out with patients with cord trauma, and in people with multiple sclerosis (MS). The availability of essentially automated analysis, large extent coverage of the spinal cord, and spatial normalization to permit comparisons with reference results and labeling of active regions are being implemented with the aim to translate the method into a practical clinical assessment tool. The research completed so far indicates that spinal fMRI will be able to demonstrate where the neuronal activity is altered at any level (cervical, thoracic, lumbar, or sacral), whether or not information is reaching the cord from the periphery, and whether or not there is descending modulation of the response. It may also be able to provide an objective measure of pain, and to demonstrate the extent and mechanism of changes over time after an injury.