Inferior Vena Cava Elongation and Collapse During Congenital Scoliosis Surgery: A Case Report.

Correction of congenital scoliosis presents unique challenges due to anatomical distortions that may compromise vascular structures. Vascular complications during scoliosis correction are rare but potentially life-threatening. We report the case of a 13-year-old female individual with severe congenital lumbar scoliosis attributed to an L3 hemivertebra fused with L4. The patient underwent posterior spinal instrumentation using pedicle screws and an attempted convex rod derotation. During derotation, the patient developed profound hypotension and tachycardia, with immediate restoration of blood pressure and heart rate upon reversal. Owing to the recurrence of these hemodynamic disturbances, the surgical team opted for an in situ rod contoured technique, achieving partial deformity correction. Postoperative CT angiography revealed a significant reduction of approximately 60% in the inferior vena cava (IVC) lumen at the L3 level, although no thrombus was identified. This case illustrates the significant hemodynamic challenges that can arise from altered vascular anatomy in severe congenital scoliosis. It emphasizes the need for heightened awareness and careful preparation to manage vascular complications that may occur during complex spinal procedures. Comprehensive preoperative vascular imaging, combined with meticulous intraoperative monitoring, is essential for the early identification and management of risks such as IVC compression. Ultimately, the ability to promptly detect hemodynamic instability and adapt the surgical strategy is crucial in preventing potentially catastrophic outcomes during spinal deformity correction.