Navigating Vascular Anomalies in Alif: Successful L3-L4 and L4-L5 Exposure in a Patient With Double Inferior Vena Cava

Duplicated inferior vena cava (IVC) is a rare congenital vascular anomaly that may complicate retroperitoneal surgical approaches, particularly anterior lumbar interbody fusion (ALIF), due to altered venous anatomy and increased risk of vascular injury. A 30-year-old male with chronic refractory low back pain and multilevel disc degeneration underwent three-level ALIF. Preoperative imaging identified a duplicated IVC (Type 2a). An extraperitoneal retroperitoneal approach was performed, allowing exposure of the L3–L4 and L4–L5 levels through the intercaval corridor. Although increased vascular complexity and enlarged venous tributaries were encountered, meticulous dissection and selective ligation enabled safe mobilization and adequate exposure. Estimated blood loss was 150 mL, operative time was 2 hours and 50 minutes, and the postoperative course was uneventful, with discharge on postoperative day three. Duplicated IVC does not represent a contraindication to ALIF, even in multilevel procedures. Careful preoperative identification, detailed anatomical understanding, and appropriate surgical technique are essential to minimize complications and achieve favorable outcomes.