The skin and subcutaneous tissue is infiltrated with a 1:500,000 epinephrine solution to achieve hemostasis.
A midline skin incision is made centred over the involved segment. The length of the incision depends on the number of levels to be instrumented. For a short segment fixation, one level above and below the affected vertebra is exposed.
It is necessary to confirm the correct level of the approach with fluoroscopy.