In regard to spine care an updated reality check indicates that the most valuable diagnostic and screening test is the magnetic resonance imaging (MRI) exam. Unfortunately this test has become a "dirty word" in the third party payor lexicon. "Experts" are now being quoted as stating that the MRI "should never be used as a screening test" and "a quarter of the people with no history of back trouble have ruptured discs" on MRI examination.  How medical data is interpreted has a great deal to do with one's frame of reference.  In spine early screening represents the primary "window of opportunity" to really do something meaningful about preventing disability by identifying potential liabilities and thus eliminating the need for surgery down the road. The chevronesque bleating of the health care industry that the only response to increasing costs is to increase premiums is, quite frankly, obscene. 

X-ray screening examinations for the early detection of infirmities such as tuberculosis are well known but the use of MRI for this purpose is, as yet, basically unexplored.  Yet, low-cost screening MRIs (as opposed to complete high-resolution studies), as a means of early identification of genomic spinal disease (i.e. juvenile discogenic disease) are important and cost-effective means of achieving early identification and prevention of future incapacitation in many individuals.  At this time there are but few efforts being made to address these important needs.

The opportunity exists to improve the quality of care while also decrease costs. This is simply something which is not being grasped at this time.