The paraspinal muscles are elevated subperiosteally from the underlying laminae, in distal to proximal direction, using a Cobb elevator. Dissection is done along the spinous process and lamina.
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.