Surgical Management of Pott's Paraplegia in a 27-Week Pregnant Woman with Continuation of Pregnancy: A Case Report.

INTRODUCTION

Spinal tuberculosis is primarily managed with antitubercular therapy, while surgical intervention is reserved for cases with neurological compromise or spinal instability. The occurrence of Pott's paraplegia during pregnancy is rare and presents unique diagnostic and therapeutic challenges due to concerns regarding fetal safety, imaging limitations, and surgical risks. Management during the second trimester is particularly complex, as options, such as medical termination or delivery are not feasible. Only a limited number of case reports describing Pott's paraplegia during pregnancy exist in the literature, with very few addressing surgical management during the second trimester while continuing the pregnancy.

CASE REPORT: We report the case of a 18 year-old woman of Indian origin, primigravida at 26 weeks of gestation, who presented with acute-onset paraplegia preceded by mild upper thoracic back pain. Neurological examination revealed spastic paraplegia with sensory deficits below the T3 level. Magnetic resonance imaging of the thoracic spine demonstrated pathological collapse of the T2 vertebra with an epidural abscess causing spinal cord compression. In view of acute neurological deterioration, urgent posterior decompression and stabilization were performed with meticulous obstetric and anesthetic pre-cautions to ensure fetal safety. Histopathological examination and Gene Xpert confirmed tuberculous infection, and antitubercular therapy was initiated post-operatively. Neurological recovery was progressive, and the pregnancy was successfully continued. The patient delivered a healthy neonate by cesarean section at 36 weeks of gestation. At 1-year follow-up, the patient had complete neurological recovery with radiological evidence of spinal healing, and the child demonstrated normal developmental milestones.

CONCLUSION

This case highlights that timely surgical decompression and stabilization for Pott's paraplegia during the second trimester of pregnancy can be safely performed with a multidisciplinary approach, allowing for neurological recovery and successful continuation of pregnancy. This manuscript is an original case report of particular relevance to orthopedic spine surgery, neurosurgery, obstetrics, and anesthesiology, while also carrying broader clinical significance across medicine.