Weight-bearing magnetic resonance imaging (MRI) is a unique modality in diagnostic imaging that allows for the assessment of spinal pathology in ways considered previously inaccessible or insufficient with the conventional MRI technique. Due to limitations in positioning within the MRI machine itself, difficulties would be posed in determining the underlying cause of a patient's pain or neurological symptoms, as the traditional supine position utilized can, in many cases, alleviate the severity of presented symptoms. Weight-bearing MRI addresses this concern by allowing a clinician to position a patient (to a certain degree) into flexion, extension, rotation, or side-bending with an axial load that can mimic physiologic conditions in order to replicate the conditions the patient experiences in order to give clinicians a clearer understanding of the anatomical relationship of the spine and surrounding tissues that may lead to a particular presentation of symptoms. These findings can then guide treatment approaches that are better tailored to a patient's needs in order to initiate treatment earlier and shorten the duration of treatment necessary for patient benefit. The goal of this review is to describe and differentiate weight-bearing MRI from conventional MRI as well as examine the advantages and disadvantages of either imaging modality. This will include assessing cost-effectiveness and improvements in clinical outcomes. Further, the advancements of weight-bearing MRI will be discussed, including potentially unique clinical applications in development.