Iatrogenic aortic injuries that occur during spinal procedures are rare but potentially lethal. When the posterior spinal approach is used, prone positioning and the need to prevent contamination of exposed bone and hardware adds complexity to the management of significant aortic injuries. We present a case of an intraoperative aortic injury that occurred during reoperative all-posterior vertebral column resection surgery that was successfully treated with emergent endograft deployment. The patient recovered without significant clinical sequelae. To our knowledge, this is the first reported case of intraoperative endovascular repair of a thoracic aortic injury incurred during posterior approach spinal surgery.