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STUDY DESIGN: A case of cervical cord compression in an elderly lady with Hurler's syndrome is reported. OBJECTIVE: To report the occurrence of cervical cord compression in a 56-year-old patient of Hurler's syndrome, making her the oldest patient with Hurler's. The case report also highlights the appropriate management that could be given to this group of difficult patients. SUMMARY OF BACKGROUND DATA: The literature on Hurler's syndrome is reviewed in terms of long-term survival and surgical management of spinal compression. No report in the literature describes cervical spine decompression in Hurler's syndrome in a patient this old. METHOD: Clinical and radiologic features of Hurler's induced cervical cord compression are described. Pathologic changes of Hurler's myleopathy are also reported. RESULTS: The patient underwent cervical spine decompression and tolerated the procedure well. The patient was able to mobilize free of the wheel chair and showed significant neurologic recovery. CONCLUSION: The case report highlights the success of surgery in Hurler's induced cervical cord compression. It also adds to the literature the oldest patient of Hurler's syndrome to undergo any form of spinal surgery.We present here a 59-year-old lady with Hurler's syndrome, who underwent a successful cervical spine decompression and stabilization for cervical myelopathy. At 59 years of age, she was the oldest case of Hurler's to undergo spinal surgery. The case highlights the importance of undertaking major spinal surgeries in these difficult inherited disorders with reasonable success, as against common belief. [ABSTRACT FROM AUTHOR]