We describe a 67 year-old gentleman who presented with severe dysphagia, hoarseness, dysarthria, left ptosis and unintentional 30 lbs weight loss over 7 months. He was evaluated by an otolaryngologist and was treated for GERD. He was evaluated by multiple neurologists and was given multiple diagnoses including bulbar MG and bulbar onset motor neuron disease. He was given Mestinon without any benefit. His symptoms continued to progress requiring a PEG tube placement. When presented to our service, his neurological exam was significant for partial left ptosis, dysphonia, hoarseness, left hemi-tongue weakness, atrophy and fasciculations, left hemi-palate weakness with a negative jaw jerk. He was evaluated by a speech pathologist. Videostroboscopy and MBS suggested questionable left vocal cord weakness. Brain MRI was normal other than severe C1-2 degenerative joint disease with large osteophytes that impinge upon the left carotid sheath. Neck MRI showed atrophy of the tongue on the left with evidence of vocal cord dysfunction. A large C1-2 osteophyte was seen again displacing the digastric muscle and the carotid artery on the left. EMG/NCS showed fibrillation and fasciculation potentials in the left tongue. Neurosurgery was consulted. A decision was made to proceed with high cervical osteophyte resection. Anterior cervical approach was performed along the medial border of the SCM muscle. The left carotid sheath and left hypoglossal nerve were noted to be impinged by C1-2 complex osteophyte. The osteophyte was resected. On one month follow up, the patients’ symptoms significantly improved. He has gained 20 lbs, his voice has returned close to normal and the ptosis resolved. PEG tube was removed and the patient resumed normal diet.