Magnetic resonance imaging of the lumbosacral spine in children with chronic constipation or non-retentive fecal incontinence: a prospective study.
OBJECTIVE
To determine the prevalence of lumbosacral spine (LSS) abnormalities in children with defecation disorders, intractable constipation, or non-retentive fecal incontinence (NRFI) and evaluate whether LSS abnormalities on magnetic resonance imaging (MRI) are clinically detected by neurologic examination.


METHODS
MRI of the LSS and complete neurologic examination by a pediatric neurologist blinded to the MRI results were performed in patients with intractable defecation disorders.


RESULTS
Patients with intractable constipation (n = 130; 76 males; median age, 11 years; range, 6-18 years), and patients with NRFI (n = 28; 18 males; median age, 10 years; range, 7-15 years) participated. One occult spina bifida (OSB) and 3 terminal filum lipomas were found in patients with a normal neurologic examination. One patient had a terminal filum lipoma and neurologic complaints. Gluteal cleft deviation was found in 3 of 4 patients with LSS abnormalities. Neurosurgical treatment was not required in any patient during the 12-week follow-up.


CONCLUSIONS
MRI showed LSS abnormalities in 3% of patients with defecation disorders and normal neurologic examination, all of whom reported symptom relief at the 12-week follow-up without neurosurgical intervention. Thus, whether or not LSS abnormalities play a role in defecation disorders remains unclear.
Bekkali
Noor-L-Houda
NL
Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands. N.Bekkali@amc.nl
Hagebeuk
Eveline E O
EE
Bongers
Marloes E J
ME
van Rijn
Rick R
RR
Van Wijk
Michiel P
MP
Liem
Olivia
O
Benninga
Marc A
MA
D000293:Adolescent; D002420:Cauda Equina; D002648:Child; D002908:Chronic Disease; D003248:Constipation / Q000209:etiology*; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D006801:Humans; D008067:Lipoma / Q000150:complications / Q000175:diagnosis*; D008159:Lumbar Vertebrae / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D009436:Neural Tube Defects / Q000150:complications / Q000175:diagnosis*; D012447:Sacrum / Q000473:pathology*; D016135:Spinal Dysraphism / Q000150:complications / Q000175:diagnosis; D013125:Spinal Neoplasms / Q000175:diagnosis*