The advantages of the upright, open, multi-positional MRI, i.e. functional MRI (fMRI) are presented with illustrative cases and the literature is reviewed. In cases of not explained and especially in position-dependent spinal and/or neurological pain and/or dysfunction functional or dynamic MRI is able to reveal dynamic compressions/stenosis, as well as segmental dysfunction and instabilities in a noninvasive way. This new technology could become mandatory for the preoperative investigation of unexplained, mainly "dynamic, mobile or unstable" spinal pathologies. Allowing a better correlation of signs and symptoms with the imaging findings and thus a more targeted treatment, fMRI could help to decrease the rate of failed back surgery syndrome in the near future.