Surgical fusion of the upper cervical spine was used to treat atlanto-axial subluxation in 7 patients with rheumatoid arthritis. Postsurgical follow-up was 3 to 16 yr. Despite progressive and often severe radiological changes in the cervical spine, no patient has had a clinical recurrence of neck symptoms requiring further surgery. These results suggest that surgical fusion is successful in the longterm, despite the often dramatic radiological changes which occur in the cervical spine with the passage of time.