Of 53 severely rheumatoid patients, 43% had cervical spine involvement, Six major categories were found: a) C1-C2 subluxation; b) serial subluxation; c) upward translocation of the odontoid; d) odontoid erosion; 3) apophyseal joint fusion; and f) miscellaneous findings of osteoporosis, endplate erosion, and disk space narrowing without osteophytosis. Although disease duration and activity appeared to correlate somewhat with the development of cervical spine disease, this was by no means universal. Rheumatoid cervical spine disease may be dangerous even in the absence of clinical signs and symptoms. It is therefore recommended that the cervical spine be evaluated in patients with severe rheumatoid disease before general anesthesia is scheduled irrespective of cervical spine complaints recorded in the chart.