Do Occult Spinal Abnormalities on MRI Affect Constipation Outcomes?

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R Bolia et al. J Pediatr Gastroenterol Nutr. 2025;81:262–265. Open Access! Impact of occult spinal abnormalities on clinical outcomes in children with refractory constipation

Methods: This was a retrospective review of records of children (n=54, median age 9 years) who underwent MRI of spine between January 2021 and December 2023 for evaluation of refractory constipation (RC). RC was defined as constipation not responding to optimal conventional treatment for at least 3 months. Conventional treatment included—education, disimpaction (if required), osmotic and stimulant laxatives, timed‐toileting and biofeedback.

Key findings:

  • Thirteen children (24%) had an abnormal MRI. Findings included—syringomyelia‐8,sacral canal meningeal cyst‐2, filum terminale lipoma‐1,spina bifida occulta‐1 (SBO‐1), and Schmorl’s node‐1. None of these patients had a tethered cord
  • Only one patient with a Chiari malformation and syrinx required a neurosurgical intervention. The surgery did not improve his constipation
  • On a median follow‐up duration of 677 (range181–1240) days, constipation resolved in 48% (n = 26) of the entire cohort
  • There was no difference in the number of patients or time to constipation resolution between those with and without abnormal MRI respectively

My take: In children with refractory constipation who do not have abnormal cutaneous/abnormal neurological exam, an MRI is unlikely to be helpful.

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