There was just the one change - Aaron Lennon starting in place of the injured Andy Reid. His inclusion offered the opportunity for the wideman to sometimes act as a supporting striker.
There was a let off for Birmingham as early as the second minute when a slip by Matthew Upson caused the defender to produce a poor backpass which Lennon latched on. The ball would just not sit right for him to strike and the defender made a last-gasp recovery tackle to deny Lennon.
Goalkeeper Maik Taylor needed to save well to prevent the deadlock being broken on 37 minutes when he saved well from Ledley King. Following a deep Carrick corner, the Spurs skipper’s shot from six yards was struck straight at Taylor.
Paul Robinson was forced into action for the first time as Birmingham looked sharpest just after the break. His smart near post save from Julian Gray led to a corner. Birmingham were unlucky as Mido forced the header over his own crossbar to avert Upson’s headed effort.
Both sides lacked the killer pass as the game turned stale. That was until referee Phillip Dowd awarded Spurs a penalty in the 57th minute when Upson, who had been playing well to deny Mido even a sniff at goal, clumsily upended Keane inside the area. After missing his last one, Keane took the resulting spot-kick himself and made no mistake this time firing to Taylor's bottom left hand side with the keeper guessing the wrong way.
Keane then almost doubled Spurs' lead when Edgar Davids played him in on goal with a perfect pass but under pressure from Lazaridis the striker's tame rising shot easily reached the clutches of Taylor.
Then an even bigger blow than the conceded goal unduly arrived for Birmingham on 65 minutes. Muzzy Izzet did appear to be caught by Michael Dawson but the referee adjudged the attacking player to have gone to ground and was shown a second yellow card.
King then hobbled off with what looked like a knee problem, which signalled a return to first team action for Noe Pamarot.
Substitute Jermain Defoe nearly added to their misery when he skipped past the sluggish Stan Lazaridis heading for goal but the striker was not able to find a way past Taylor with an effort he could not get enough purchase on.
However, in injury time Jermaine Jenas broke clear brilliantly before quickly feeding Defoe, who ran at Kenny Cunningham. The defender backed off allowing Defoe to rifle his shot from the tightest of angles and make sure of the result and secure another important win for Spurs despite an otherwise dire game to watch.