Traction‐Induced Avulsion of an Iliocaval Venous Branch During Multilevel OLIF for Degenerative Scoliosis: Case Report

ABSTRACT Adult degenerative scoliosis can be effectively treated with lateral or oblique lumbar interbody fusion (LLIF/OLIF), but vascular injury remains a rare and potentially catastrophic complication. We report the case of a 78‐year‐old woman with long‐standing degenerative scoliosis who underwent multilevel OLIF from L2 to L5. During trial cage placement at L2–3, massive venous hemorrhage occurred, with an estimated blood loss of approximately 3750 mL. Intraoperative angiography showed no arterial extravasation, suggesting a venous source. The wound was packed, and the patient was stabilized with aggressive resuscitation. Reexploration 3 days later, performed with a vascular surgeon, identified an avulsed iliocaval venous branch at the anterior aspect of the L2 vertebral body. Hemostasis was achieved using a fibrin sealant patch and sustained compression. After recovery, staged posterior fixation was completed without further complication. The patient recovered without neurologic deficit and maintained satisfactory alignment at follow‐up. This case highlights a rare indirect vascular injury mechanism during deformity correction, likely caused by traction on a stiff iliocaval venous branch during multilevel distraction. Careful preoperative vascular assessment, gradual disc‐space distraction, readiness for staged management, and early vascular surgery involvement are essential to improve safety in complex OLIF procedures.