Meenakshi Super Speciality Hospital (MSSH) successfully treated spinal tuberculosis in a 28-year-old pregnant woman through a challenging spinal surgery performed at 28 weeks of pregnancy, with the patient positioned prone throughout the procedure. The surgical team used specialised abdominal and fetal shielding techniques to ensure the safety of both mother and fetus. The team also took meticulous measures to minimise fetal radiation exposure during intraoperative C-arm imaging. The woman recovered well and recently delivered a healthy baby after completing her full term of pregnancy.
The patient had experienced neck pain for nearly a year. However, she was admitted to the hospital within days of developing progressive sensory loss, difficulty walking and loss of sensation below the chest.
MRI revealed spondylodiscitis, an infection involving the spinal bones and the disc between them at the T1-T2 level; severe gibbus deformity, a hump-like deformity of the spine, and compressive myelopathy, a dysfunction of the spinal cord caused by pressure on it. All these symptoms raised strong clinical suspicion of spinal tuberculosis - also known as Pott’s spine. The progressive neurological deficit and spinal instability necessitated immediate surgical intervention.
The surgical team performed T1-T2 decompressive laminectomy to relieve pressure on the spinal cord, along with biopsy and removal of infected tissue from the affected spinal segment. This was followed by C3-T4 spinal fusion using metal implants and the patient’s own bone graft to stabilise the spine. The tissue and vertebral fragments obtained during surgery were sent for histopathological evaluation. The examination revealed acute inflammation along with a small focus of epithelioid granuloma, an immune response commonly associated with tuberculosis, thereby supporting the clinical suspicion of spinal tuberculosis.
Following surgery, the patient was closely monitored in the ICU with regular fetal surveillance and liver function monitoring during antitubercular treatment. She showed significant neurological and clinical improvement and was discharged in a stable condition. She subsequently completed her pregnancy and delivered a healthy baby. Both mother and baby are doing well.
The surgical procedures were led by Dr. K. Selvamuthukumaran, Senior Consultant - Neurosurgery, with the assistance of Senior Consultant Dr. K. Senthil Kumar and Dr. K M Kaveeze, Associate Consultant, Neuro Endovascular surgeon. Specialists in Obstetrics & Gynaecology also worked closely with the neurosurgical team throughout the treatment to ensure the safety of both mother and fetus.
In his comments, Dr. K. Selvamuthukumaran said, “Spinal TB is a bacterial infection that affects the vertebrae and surrounding spinal structures. When the infection destroys bone, causes spinal deformity and compresses the spinal cord, surgical intervention becomes necessary. While such procedures are routinely performed, operating on a pregnant woman with progressive neurological deterioration presented a unique challenge. The surgery involved keeping the patient in the prone position for several hours, requiring careful positioning and special precautions to protect both mother and fetus. We had to relieve the spinal cord compression and stabilise the spine while minimizing fetal radiation exposure during intraoperative imaging. The procedure therefore required meticulous planning and close coordination with the Obstetrics & Gynaecology team. We are pleased that the patient made significant neurological recovery and subsequently delivered a healthy baby.”
This case highlights the importance of early recognition of spinal infection, timely decompression and stabilization, meticulous fetal protection and coordinated multidisciplinary care in managing complex spinal disease during pregnancy. The successful outcome for both the mother and baby demonstrates what can be achieved when specialized teams work together with careful planning and a shared focus on maternal and fetal safety.
Dileep from the hospital was also present during this press meet.