Fat-suppression MR techniques have been useful in imaging both the head and neck and the orbit. The lumbar spine is not as complex as the head and neck and does not contain as much fat as the orbit. Nevertheless, high signal from epidural and marrow fat in the lumbar spine can make it difficult to detect and define pathologic processes. In addition, the administration of gadopentetate dimeglumine can cause some infectious and neoplastic lesions of the spine to become isointense with fat on T1-weighted images. Compared with conventional MR imaging without fat suppression, contrast-enhanced fat-suppression MR imaging can better differentiate these enhancing lesions from surrounding fat. In this essay, we illustrate the findings of fat-suppression MR imaging in a variety of diseases of the lumbar spine.