The diagnosis and treatment of osteophyte-induced dysphagia can be both challenging and frustrating. DISH is a common finding in the adult population and, like the complaint of dysphagia, increases with age. Clearly, it is a small percentage of cervical osteophytes that present upper aerodigestive difficulties. After excluding other causes of dysphagia, conservative treatment is indicated in the initial management of this disorder and should relieve symptoms in the majority of patients. Surgical management should be reserved for severe and recalcitrant symptoms, and the patient must understand that surgery does not guarantee complete resolution of symptoms. Special thanks to Jerry Basto for his assistance in manuscript preparation.