A 72-year-old man, with no medical history of interest and under treatment with anti-inflammatory drugs since 2011 for chronic cervical pain, attended the emergency department reporting significant gait disturbance and progressive loss of strength in the limbs over the last 6 months accompanied by dysphagia for solids and moderate dyspnoeic symptoms. Physical examination revealed spastic left hemiparesis, generalised hyperreflexia, positive Romberg's sign and ataxia. MRI showed soft tissue thickening around the odontoid process leading to severe stenosis of the spinal canal, especially in the left half, with involvement of the bulbomedullary junction and voluminous anterior syndesmotic proliferations at C2-C6, predominantly at C4-C5, which deformed and partially obliterated the airway.

With a diagnosis of Forestier's disease, the patient initially underwent transoral surgery, with resection of the anterior arch of the atlas and the odontoid process without neurological improvement, so an external anterolateral cervical approach and resection of the anterior osteophytic projections of C3-C4-C5 were performed. Postoperative evolution showed progressive clinical improvement of dysphagia and hemiparesis with absence of respiratory symptoms.