Abstract This study demonstrated that frameless stereotaxy can be applied safely to cervical disorders caused by rheumatoid arthritis (RA). Sixteen patients with cervical instability including atlantoaxial instability due to RA underwent instrumentation surgery under an image-guidance system from February 2000 through May 2001. Neural and vascular injuries were evaluated, and postoperative computed tomography (CT) was used to determine the accuracy of screw placement. There were no neurovascular complications, and screw placement was highly accurate. Image-guidance systems are useful tools for preoperative planning and application of transarticular and pedicular screw placement in the cervical spine of patients with RA.