A 42 years old gentleman presented with predominant low back pain associated with bilateral lower limb neurological deficit leading to an initial diagnosis of lumbar stenosis. Further history taking and examination revealed upper limb neurological deficit, and the lower limbs actually presented with upper motor neuron instead of lower motor neuron signs. Imaging studies confirmed the clinical findings with presence of both cervical and lumbar spinal stenosis. Twostage decompression procedures were performed at 6 monthintervals starting with cervical decompression. Postoperative improvement was noted on follow-up. This case highlights the importance of accurate diagnosis of cervical pathology for patients presenting with or referred for predominantly lumbar symptomology