Rheumatoid arthritis in the cervical spine results in anatomicabnormalities as a consequence of the destruction of synovial joints,ligaments, and bone, resulting in pain, instability, bony subluxations, andultimately spinal cord or brainstem compression. Although much isknown about the natural history, pathophysiology, pharmacologicmanagement, and operative stabilization of patients with rheumatoiddisease in the cervical spine, the clinically relevant question of when toundertake operative intervention in the cervical spine remains somewhatunclear. Therefore, some light was thrown in this essay on the predictorsof paralysis as well as the predictors of the potential for neurologicrecovery after operations in patients with rheumatoid disease in thecervical spine. After such an analysis was undertaken, a rational schemethen was devised to monitor patients safely and cost effectively, and tooffer recommendations for the timing of operative stabilization.