The defect of cervical spine in rheumatoid arthritis (RA) is the second most frequent localization. Vertical shift is the least frequent, but most severe type of defect in the area of C1–C2. Radiologic demonstration of vertical shift may be negative in the beginning of the defect as well as in positive clinical findings. Evoked potentials may help in the determination of subclinical lesion, but may be completely physiological if a distinct structural dysfunction is not yet present. The case report demonstrates a vertical shift with the development of dangerous symptomatology of posterior cranial fossa, which was successfully treated by stabilization.

        Key words: rheumatoid arthritis – atlantoaxial subluxation – cranial settling