Surgery outcomes for rheumatoid cervical spine were clinically evaluated in twenty patients. Eighteen patients complained of pain in the nape and occipital region, and neural deficit was noted in seventeen patients. We performed posterior fusion for nineteen patients and anterior fusion for one patient. Surgical outcomes were evaluated with Ranawat's classification. Nape and occipital pain improved in sixteen patients, and neural deficit improved in six patients, one improved from class III A to II. Five patients improved from class III B to III A. Three III B patients improved to III A by the operative treatment for rheumatoid cervical spine and total knee or hip arthroplasty. Two III B patients, who could not anbulate within four months, improved to III A by the operative treatment for rheumatoid cervical spine. Other III B patients, who had not been able to walk for several years, did not show improvement in their neural deficits. Neural deficit can be improved by the operative treatment for rheumatoid cervical spine at an early stage.