It is known that cervical spine involvement occurs in over half of patients with rheumatoid arthritis (RA). This involvement is over 70% in Tunisia. The majority of our patients are seen at Ranawat's stage III with spinal cord injury. We report a series of 28 patients treated in our institution for RA with atlantoaxial dislocation with several degrees of spinal cord injury (Ranawat's stage II and III). Even though overshadowed by major impairments related to severe peripheral joint disease, 60% of our patients presented a good functional result at the average of 10 years follow up.