UMBOSACRAL SPR aims to achieve a balance between elimination of lower-limb spasticity and augmenta- tion of motor function in ambulatory children with spastic CP. Important efforts to evaluate functional out- comes, rather than just changes in the underlying impair- ments of CP, are necessary to evaluate fully the benefits of surgery. Using both subjective and objective parameters, authors of early follow-up evaluative studies reported re- duction of spasticity as well as substantial progress in gait and other aspects of functional mobility. 3,8,10,16,17,23,25,27,37,40,42, 44,51,53–56 Suprasegmental benefits after SPR have also been reported. These include improved upper-limb coordina- tion and function, positive changes in oral motor skills, and enhancement of visual attention, cognitive function, and speech. 5,7,9,14,15,26,28,29,47 Unfortunately, only a handful of groups have described the outcomes of SPR beyond 3 years. 2,4,18,20,21,30,41,43,50 Even fewer researchers have used sta- tistical analysis of standardized functional assessment tools to determine long-term outcomes. 21,50 We believe that a thorough analysis of pertinent objective outcome scales, especially those focused on enhancement of function rather than simple elimination of spasticity, is critical to determine the true benefits of the EMG-guided procedure. We previously demonstrated that motor respons- es to orthodromic stimulation of posterior nerve roots are consistent and easily reproducible by both EMG and phys- iotherapy assessments. 32 Recently, we determined that sta- tistically significant improvements in lower-limb spasticity, passive range of motion, strength, and motor function occur up to 5 years following EMG-guided SPR (unpublished data). In this study, we examine the effects of SPR at 3 and 5 years postoperatively by using a rigorous analysis of quantitative functional outcome measurements of ADL. A number of different tools have been used to study the effects of dorsal rhizotomy on ADL in children with spas- tic CP; however, to date no group has reported measures of functional skills beyond 2 years postoperatively in this pop- ulation. Therefore, the purpose of this prospective investi- J Neurosurg 97:510–518, 2002 510 Functional performance following selective posterior rhizotomy: long-term results determined using a validated evaluative measure SANDEEP MITTAL, M.D., JEAN-PIERRE F ARMER, M.D., BORHAN AL-ATASSI, B.SC., KATHLEEN MONTPETIT , M.SC., O.T., NATHALIE GERVAIS, M.SC., O.T., CHANTAL POULIN, M.D., THIERRY E. BENAROCH, M.D., AND MARIE-ANDRÉ CANTIN, M.D. Divisions of Neurosurgery, Neurology, Orthopedics, and Occupational Therapy, Montreal Children’s Hospital, McGill University Health Centre; and Shriners Hospital for Children, Montreal, Quebec, Canada Object. Selective posterior rhizotomy (SPR) may result in considerable benefit for children with spastic cerebral palsy. To date, however, there have been few studies in which validated functional outcome measures have been used to report surgical results beyond 3 years. The authors analyzed data obtained from the McGill Rhizotomy Database to determine long-term functional performance outcomes in patients who underwent lumbosacral dorsal rhizotomy performed using in- traoperative electrophysiological monitoring. Methods. The study population was composed of children with debilitating spasticity who underwent SPR and were evaluated by a multidisciplinary team preoperatively and at 6 months and 1 year postoperatively. Quantitative standard- ized assessments of activities of daily living (ADL) were obtained using the Pediatric Evaluation of Disability Inventory (PEDI). Of 57 patients who met the entry criteria for the study, 41 completed the 3-year assessments and 30 completed the 5-year assessments. Statistical analysis demonstrated significant improvement in the mobility and self-care domains of the functional skills dimension at 1 year after SPR. The preoperative and 1-, 3-, and 5-year postoperative scaled scores for the mobility domain were 56, 64, 77.2, and 77.8, respectively. The scaled score for the self-care domain increased from 59 presurgery to 67.9, 81.6, and 82.4 at the 1-, 3-, and 5-year postoperative assessments, respectively. Conclusions. The results of this study support the presence of significant improvements in functional performance, based on PEDI scores obtained 1 year after SPR. The improvements persisted at the 3- and 5-year follow-up examinations. The authors conclude that SPR performed using intraoperative stimulation is valuable in the augmentation of motor func- tion and self-care skills essential to the performance of ADL. KEY WORDS • cerebral palsy • spasticity • dorsal rhizotomy • activities of daily living • functional outcome • children L J. Neurosurg. / Volume 97 / September, 2002 Abbreviations used in this paper: ADL = activities of daily liv- ing; CP = cerebral palsy; EMG = electromyography; PEDI = Pediatric Evaluation of Disability Inventory; SPR = selective pos- terior rhizotomy; WeeFIM = Functional Independence Measure for Children.