Spinal cord (SC) MRI in multiple sclerosis (MS) has significant usefulness in clinical and investigational settings. Conventional MRI of the SC is used in clinical practice, because it has both diagnostic and prognostic value. A number of advanced, quantitative SC MRI measures that assess the structural and functional integrity of the SC have been evaluated in investigational settings. These techniques have collectively demonstrated usefulness in providing insight into microstructural and functional changes relevant to disability in MS. With further development, these techniques may be useful in clinical trial settings as biomarkers of neurodegeneration and protection, and in day-to-day clinical practice.