The McCulloch retractor generates a higher IMP than the Norfolk and Norwich retractor. However, postoperative improvement in VAS, ODI, and SF-36 scores in these patients was associated with a shorter duration of muscle retraction and not the degree of IMP or IPP generated. In this respect, periodic relaxation of the paraspinal muscle retractors during surgery to allow muscle perfusion may help to reduce postoperative back pain and disability.
Although histologically there was a reduction in muscle damage in patients that underwent intermittent retraction, there was no benefit on clinical outcome. Paraspinal muscle shows evidence of reinnervation after surgery.
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