To demonstrate the excellent functional outcome following posterior spinal decompression and fusion. In December 2012, a 72-year-old male patient, who was diagnosed with hyperostosis of anterior and posterior longitudinal ligament 6 months ago, presented with rapidly increasing motor deficit of the left arm and unsecure gait pattern. X-rays, CT, and MRI diagnosed DISH and OPLL. Hyperintense signal in the C1 spinal cord on T2 weighted sequence was also observed. Patient underwent decompressive foraminotomy of foramen magnum and laminectomy of C1-C4 with Occiput – C5 fusion. Neurological status and myelopathy improved to a great extent after surgical intervention. Conclusion: The current case demonstrates the scenario of DISH associated hemiplegia and the need for a posterior spinal decompression and fusion.