title: Tuberculosis of spine with neurological deficit in advanced pregnancy: a report of three cases.
abstract: BACKGROUND
  Early decompression in spinal tuberculosis (TB) with complete paraplegia has a better prognosis in relation to the neurological recovery and deformity progression. Advanced pregnancy can complicate this picture in view of the various fetomaternal factors. The prevalent literature is inconclusive regarding the time and extent of surgical intervention. Delay in the surgical intervention may adversely affect the prognosis.
  
  
  OBJECTIVE
  To emphasize the importance of early decompression in spinal TB complicated by neurological deficit in advanced pregnancy.
  
  
  METHODS
  A case report of three patients to analyze the surgical management of neurological deficit because of spinal TB in pregnancy.
  
  
  METHODS
  Neurological recovery, progression of deformity, healing of the TB lesion, and outcome of the pregnancy.
  
  
  METHODS
  Three patients presented with spinal TB with neurological deficit complicating third trimester of pregnancy. The first patient was initially managed conservatively but was operated after a spontaneous abortion. The remaining two patients were managed by urgent Caesarean section followed by spinal decompression and fusion.
  
  
  RESULTS
  The first patient who underwent delayed decompression showed good healing of the TB lesion but continued to have spastic paraparesis with kyphosis. This was later managed by repeat decompression and instrumented fusion, without neurological recovery. The other two patients treated by early decompression and fusion showed complete healing with neurological recovery.
  
  
  CONCLUSIONS
  Early decompression and instrumented fusion in spinal TB, complicated by neurological deficit in advanced pregnancy, can give good results with respect to neurological recovery, healing of the lesion, and arrest of deformity progression. Neonatal prognosis depends on the fetal maturity. Antitubercular therapy is an essential component of the management; it poses little hazard of inducing congenital anomalies, but possibility of maternal drug toxicity should be considered.
authors.affiliation: Department of Orthopaedics, T.N. Medical College & BYL Nair Hospital, Mumbai, India. siddharthbadve@hotmail.com
authors.forename: Siddharth A
authors.initials: SA
authors.lastname: Badve
authors.forename: Sushant D
authors.initials: SD
authors.lastname: Ghate
authors.forename: Manasi S
authors.initials: MS
authors.lastname: Badve
authors.forename: Tarush
authors.initials: T
authors.lastname: Rustagi
authors.forename: Tauseef
authors.initials: T
authors.lastname: Macchiwala
authors.forename: Aseem N
authors.initials: AN
authors.lastname: Parekh
authors.forename: Shrenik V
authors.initials: SV
authors.lastname: Shah
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D010147:Pain Measurement; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D011859:Radiography; D013123:Spinal Fusion; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*
chemical_list: D000995:Antitubercular Agents