Cervical spinal stenosis is classified as secondary cervical spinal stenosis due to developmental, degenerative, medical, other pathologies and trauma, such as cervical spondylosis, cervical disc herniation, ossification of the posterior longitudinal ligament, cervical tuberculosis, tumors and trauma. Advanced ossification of the posterior longitudinal ligament of the cervical spine can lead to severe spinal stenosis. Surgical treatment of severe cervical stenosis is risky, especially when the patient is preoperatively in an incomplete state, and the stimulation of surgical decompression is likely to result in complete paralysis. However, for such patients, the only outcome without surgery is complete paralysis, so surgery is also an opportunity to recover the patient to different degrees with good results, or at least to avoid the outcome of complete paralysis. In severe cervical stenosis over 80 years of age, the risk of surgery is not only complete paralysis, but more likely a risk to life. Our recent surgical treatment of this 84-year-old male patient, whose cause was severe ossification of the posterior longitudinal ligament and who was already unable to stand in 2005, was refused surgery by many hospitals in Beijing because of the high degree of cervical stenosis and the risk of paralysis, and was treated conservatively. In the last year, the patient’s paralysis worsened significantly, and when he was admitted to the hospital, he could not hold a spoon to eat and was almost incontinent, so his family and the patient were determined to have surgery, otherwise he would have to spend the rest of his life in a state of complete paralysis, and the life expectancy of a senior paralyzed patient would be greatly shortened. On examination at admission, the muscle strength of both lower limbs was grade 2 to 3, the muscle strength of both upper limbs was grade 3 to 4, the muscles within the hands were atrophied, and the sensation below chest 2 was significantly decreased. MRI, CT and X-ray showed ossification of the posterior longitudinal ligament of the cervical spine from 2 to 7, and severe stenosis of the cervical spinal canal, especially at the level of cervical spine 3 and 4, with a stenosis rate of 90%. We performed posterior laminectomy and decompression surgery for cervical spinal stenosis at great risk to avoid paralysis and prolong the patient’s life. After surgery, the patient passed the perioperative period smoothly, the incision healed well, sensation in the extremities and trunk recovered significantly, and the muscle strength of the extremities improved by one level at the time of discharge. A repeat MRI showed adequate decompression of the cervical medulla.