1. Nineteen patients with classical rheumatoid arthritis complicated by severe subluxation of the cervical spine are reported.

2. Thirteen patients had atlanto-axial subluxation. This was the only level ofinvolvement in ten.

3. The next most frequent level to be involved was C.4-5. This occurred in five patients.

4. Eleven patients required surgery for symptoms or signs of spinal cord compression or vertebral artery insufficiency.

5. Operations included six posterior fusions, three anterior fusions and two laminectomies.

6. The differential diagnosis, the radiological findings, the indications for surgery and the results of treatment are discussed.