Like the brain, the spinal cord is subject to trauma, infection, ischemia, hemorrhage, and compression. Early diagnosis is the key to preventing significant morbidity in the form of permanent disability. MR imaging is the gold standard for assessing acute injury to the spinal cord, intervertebral discs, ligaments, and surrounding soft tissues. In this article we systematically review the MRI findings in spinal cord trauma, ligamentous injury, epidural hematoma, epidural abscess, and metastatic disease.