Diffuse idiopathic skeletal hyperostosis (DISH) is a common disorder among the elderly. The diagnosis is made on radiological findings and most of the cases are asymptomatic. In the cases with spinal involvement, bridging ossification of the anterior longitudinal ligament is a common finding. We report a case of DISH, who developed respiratory distress after bilateral total knee arthroplasty operation. The acute occurrence of symptoms after general anesthesia is a rare manifestation of the disease. Radiological findings and the result of surgical resection of anterior cervical osteophytes are discussed.