A 74-year-old man had acute complete dysphagia due to esophageal compression cause by a degenerative osteophye on C4-C5. Functional improvement was immediate after surgical removal of the osteophyte via an anterior cervical approach. Reports in the literature show that vertebral hypertrophic spurs causing dysphagia result from bony degeneration or idiopathic causes (diffuse idiopathic skeletal hyperosteosis: DISH). Surgery is mandatory if medical care fails and dysphagia is complete. Discetomy-graft is indicated for degenerative lesions and simple removal of the bony spur for ossification of the anterior longitudinal ligament in DISH. In DISH, the cervical disc is not implicated but in degenerative disease it is the most important factor in the development of osteophytes.