The cervical spine is commonly affected in patients with rheumatoid arthritis. Erosive synovitis of the joints of the cervical spine can result in various types of subluxations. Subluxations and pannus formation can cause significant pain and neurological compromise. Surgery is an important treatment modality for patients with intractable neck pain and neurological deficits. This article reviews the indications for surgery and surgical procedures of decompression and arthrodesis. New surgical fixation techniques have resulted in improved arthrodesis rates. However, long-term effects on adjacent motion segments is not known. The cornerstone of good surgical outcome remains careful selection of patients and appropriate choice of surgical decompression and fusion.