Congenital coagulation Factor deficiency is a rare coagulation disorder, and standardized perioperative management for this congenital deficiency has not been studied. We report on the anesthetic management of a patient with congenital Factor deficiency who underwent cervical spine surgery. By measuring Factor levels and having replacement therapy as preoperative preparation, we kept the Factor level high enough to avoid induction of massive bleeding during the operation. Although we completed the operation without any complications, including hemorrhage, we noticed that the practical level of Factor had decreased more than expected after the operation. Anesthesiologists should remain cognizant of the possibility of decreasing levels of Factor .