Spinal tuberculosis (Pott's disease) during pregnancy is rare and poses diagnostic challenges due to overlapping symptoms with pregnancy-related changes, potentially leading to severe neurological deficits if untreated. We report an 18-year-old primigravida at 32 weeks gestation presenting with progressive lower limb weakness, urinary incontinence, and upper back pain. Neurological examination showed bilateral lower limb paralysis, hypertonia, exaggerated reflexes, and sensory loss up to T10. Contrast-enhanced MRI revealed tubercular spondylo-discitis at T3-T5 with partial T4 collapse, paravertebral phlegmon, and rim-enhancing epidural abscess. Initially managed as acute transverse myelitis with methylprednisolone, the diagnosis shifted to Pott's disease based on MRI. Antituberculosis therapy with initial methylprednisolone led to rapid improvement within 4 weeks, with full neurological recovery, independent mobility, and normal delivery of a healthy infant. This case underscores MRI's pivotal role in timely diagnosis and the efficacy of conservative medical management in late pregnancy to avert irreversible complications.