Abstract The purpose of this study was firstly to evaluate the optical instrument tracking system integrated to the MRI scanner as a guidance facility in performing bone biopsy and secondly to develop and evaluate clinical musculoskeletal applications of interventional MRI at 0,23T. The clinical results and feasibility of MR-guided bone biopsy (n=14), periradicular nerve root therapy (n=61), discography (n=12) and percutaneous laser therapy of osteiod osteomas (n=5) were studied. Bone biopsies were performed with the optical instrument tracker and bone biopsy set modified for the tracker system. The biopsy system and optical tracker mounting proved to be safe and reliable tool for bone biopsies. 14 consecutive bone biopsies and 13 fine needle aspirations were performed under MR-guidance. The clinical accuracy of MR-guided bone biopsy was 95%. The periradicular therapy was applied to the anatomical region of lumbosacral area of 61 consecutive patients with sciatic pain. Procedural success rate was 98,5%. Of patients, 51,5% had good or excellent effect with regard to radicular pain from procedure. The therapy effect achieved with MR-guided procedure was comparable to that achieved with conventional techniques. MR-guided discography technique and imaging protocol was developed as part of diagnostic pain provocation for patients suspected for intervertebral pain source at lumbosacral area. 34 MR-guided discographies were performed on 12 patients. In all patients positive or negative pain provocation response was obtained. Laser induced thermal therapy for osteiod osteoma was studied in MRI. The initial guidance of the instrument and monitoring of the thermal procedure were done under MRI control. All the 5 patients were successfully treated. The MR-guidance in musculoskeletal applications seems safe and accurate.