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Introduction: Spinal hemangiomas are benign vascular tumors commonly found in vertebral bodies, incidence 10 to 12 percent. This tumor, during pregnancy poses unique challenges due to potential changes in vascular dynamics. Aims and objectives: This is a case report of a symptomatic spinal hemangioma in pregnancy. The objectives are to review the clinical presentation, discuss diagnostic and ethical challenges, evaluate treatment modalities and prognosis of this tumor when diagnosed antenatally. Materials and methods: We present the case report of a 23-year-old primigravida at 25 weeks period of gestation who presented with insidious onset neurological deficit -left lower limb weakness. Neurological and orthopaedic evaluation was done. MRI of the spine, revealed an aggressive spinal hemangioma at the lumbar level. Result: The option of surgical management after terminating pregnancy due to progressive neurological deficit vs continuing pregnancy and post-natal surgical management clearly explained after discussion with a panel of obstetricians, orthopedicians, neurosurgeons .Informed decision to go ahead with MTP was made by patient and bystanders was done and patient was referred to a higher center for further management where she underwent stepwise treatment-decompression laminectomy and CT guided vertebroplasty followed by endovascular embolization. Conclusion: During pregnancy, hormonal changes, particularly increase in estrogen and blood volume expansion, influences the behavior of generally asymptomatic spinal hemangiomas and causes significant morbidity like spinal cord compression or vertebral fractures. Management is typically conservative during pregnancy, with surgical intervention reserved only for cases involving neurological compromise or progressive symptoms. Multidisciplinary care is essential in the management of these rare cases, involving obstetrics, neurology, and spinal surgery teams.