The paraspinal muscles are elevated subperiosteally from the underlying laminae, using a Cobb elevator. Dissection is performed along the spinous processes, lamina, and lateral mass (bilaterally).
Review preoperative images to verify whether the tumor invades the lamina. In such cases, exposure of the posterior elements should be performed with great care and the use of Cobb elevators should be avoided.
The use of a subperiosteal dissection minimizes bleeding and muscle damage.