Maternal and fetal outcomes of spinal tuberculosis in pregnancy: A systematic review and descriptive pooled analysis

Spinal tuberculosis (TB) in pregnancy is rare and poses diagnostic, neurological, and obstetric challenges. Data are limited to isolated case reports and small series, precluding evidence-based guidance on management and outcomes. This review aims to systematically review reported cases of spinal TB in pregnancy, summarize maternal and fetal outcomes, and perform a descriptive pooled synthesis of reported live births and maternal neurological recovery.

A systematic search of PubMed, Embase, and Scopus, (inception-October 2025) identified case reports and series reporting spinal TB in pregnancy with patient-level data on management and outcomes. Quality was assessed using Joanna Briggs Institute (JBI) checklists. Descriptively pooled reported proportion for live births and full maternal neurological recovery were estimated using a random-effects model with Freeman-Tukey double arcsine transformation. Heterogeneity was evaluated via I².

Twenty-three case reports and small case series (no controls) encompassing 36 pregnancies were included. All patients received standard Anti Tubercular Therapy (ATT); 26 (72%) underwent surgery, mostly postpartum. Pooled live birth proportion was 0.77 (95% CI: 0.63-0.88). Full maternal neurological recovery was achieved in 0.85 (95% CI: 0.74-0.94). Overall, maternal complications were infrequent (14%), and neonatal outcomes were generally favorable with no congenital TB reported.

In published cases, timely ATT and selective surgical intervention were associated with high reported rates of live birth and maternal neurological recovery; however, these findings likely reflect selected best-case scenarios and require confirmation in prospective registries.