Spinal gout is a rare manifestation of crystal arthropathy that can cause spinal cord compression. It frequently presents a diagnostic challenge as it mimics infectious spondylodiscitis or metastatic spinal disease, particularly in the thoracic spine. This report illustrates a unique case of thoracic spinal gout presenting as a "double crush" phenomenon in a patient with concurrent cervical myelopathy. A 62-year-old male with underlying chronic kidney disease and no prior history of gout presented with progressive paraparesis and a sensory level at T12. He was initially under management for cervical myelopathy secondary to ossification of the posterior longitudinal ligament (OPLL). However, the discordance between his stable upper limb signs and rapidly deteriorating lower limb neurology prompted further investigation. Imaging revealed an erosive extradural mass at T9-T12 with bony destruction, initially suggestive of metastatic disease. Emergency decompressive laminectomy and posterior instrumentation were performed. Intra-operatively, chalky white tophaceous material was found compressing the dura, which was confirmed histopathologically as gouty tophi. Post-operatively, the patient was started on urate-lowering therapy and achieved partial neurological recovery. Spinal gout should be considered in the differential diagnosis of extradural spinal masses, even in patients without a prior history of peripheral gout. This case highlights the importance of recognizing "double crush" pathology, where a second, distal site of compression may be the primary cause of acute deterioration in patients with known cervical spine disease. A high index of suspicion is required, particularly in patients with metabolic comorbidities, to avoid misdiagnosis and ensure appropriate surgical management.