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

## TL;DR

A 13-year-old girl with congenital scoliosis experienced IVC compression during surgery, highlighting the need for careful monitoring and preoperative planning in such cases.

## Contribution

This case report highlights the risk of IVC compression during congenital scoliosis surgery and emphasizes the importance of preoperative vascular imaging and intraoperative vigilance.

## Key findings

- The patient experienced hemodynamic instability during rod derotation, likely due to IVC compression.
- Postoperative imaging showed a 60% reduction in IVC lumen at the L3 level.
- Switching to an in situ rod contouring technique helped manage the hemodynamic risks.

## Abstract

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.