Patients with rheumatoid arthritis suffer frequently from instabilities and deformities of the cervical spine which require surgical treatment. The most frequent indication for surgery represents the transverse atlantoaxial instability. As long the atlantoaxial instability remains reducible in extension a limited posterior exposure and screw fixation is adequate. Only situations with fixed dislocations and signs of myelopathy require anterior transoral decompression with simultaneous occipitocervical fusion. In the lower cervical spine, kyphotic deformities require anterior decompression and posterior stabilization in the case of electrophysiologically confirmed neurological deficits. A combined procedure with anterior vertebrectomy and decompression and posterior plate fixation is indicated since the poor bone quality rarely allows anterior stable fixation.