Rheumatoid arthritis causes synovitis in the cervical spine and injures skeletal structures at any level. Subluxations occur with pain and spinal cord dysfunction. Subluxations are common; neurological problems are less so, but death from subluxations is not common. However, once myelopathy is established, the natural history is poor. Advances in radiologic imaging through computed tomography and magnetic resonance imaging greatly assist anatomic assessment. Neurologic deterioration and pain are indications for surgery. Preoperative skeletal traction is often required to align the spine, and fusion techniques are used for stabilization.