Introduction: Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory skeletal disorder characterised by ossification, usually of the anterior spinal ligament and osteophyte formations. Its prevalence increases after the 6th decade of life and is often asymptomatic, though it causes dysphagia in 0.6-1% of cases. Results: We report a rare case of an 83-year-old male who presented with stridor due to a large osteophyte complex involving C5-T2, resulting in tracheal narrowing of approximately 60%. The patient’s airway was able to be managed conservatively while facilitating transfer to a neurosurgery service, where they underwent bronchoscopy and joint ENT/Anaesthetics intubation prior to ACDF and surgical resection. The patient was extubated in theatre on post-operative day one without issue. Clinically, the patient fully recovered, though soft tissue changes persist on follow up imaging 5 months post operation, which is appreciable on flexible nasendoscopy. Such presentations of stridor due to DISH are rarely reported, and cases reported in the literature have required emergency tracheostomy. In addition to the case presentation, we reviewed the existing literature on airway obstruction due to DISH, focussing on acute management, intubation considerations, treatment and long-term outcomes. Conclusion: This case demonstrates successful conservative airway management of DISH-related stridor prior to definitive surgical intervention. Early cross-speciality consultation and advanced airway planning can facilitate safe surgical management while avoiding emergency tracheostomy, thereby reducing morbidity and optimising patient outcomes with excellent functional recovery.