Surgical treatment of tuberculous paraparesis in the third trimester: a report of two cases and review of the literature.

BACKGROUND: Tuberculous paraplegia as a consequence of spinal infiltration in pregnancy is reported to be rare. Analysis of the current literature produces few case studies that report successful outcomes. Delay in diagnosis and treatment may ultimately result in an irreversible neurological deficit. The potential implications of progression are paraplegia and a significant associated morbidity to the fetus if delivered premature. METHODS: Two cases of spinal tuberculosis in pregnancy are reported with description of clinical presentation, neuroradiographic findings and treatment. RESULTS: Both patients made good recoveries after undergoing cesarean section followed by urgent spinal cord decompression and fixation for progression of neurology. On review at 2 years, neither patient had any permanent neurological deficit. Both children suffered no deleterious effects from treatment of the mothers. CONCLUSIONS: A treatment strategy to successfully treat this group of patients is recommended. Although there is a place for both chemotherapeutic and surgical intervention in the treatment of spinal tuberculosis, the authors suggest initiation of treatment with chemotherapy and close neurological monitoring of the patient, unless deterioration in neurological status mandates surgery. Furthermore, the use of steroids for fetal maturation should be used with caution.