Spinal tuberculosis (TB) in pregnancy is rare, and even more infrequent is the acute onset of paraplegia when it occurs in the late second trimester. Here, we reviewed the case of a 26-year-old female, 23 months pregnant, who only underwent a preoperative X-ray along with a magnetic resonance imaging (MRI), and subsequently had decompressive spinal surgery with fusion performed without fluoroscopic guidance. The pregnancy was complicated at presentation with severe intra-uterine growth restriction (IUGR), the fetus spontaneously aborted 1 month postoperatively.