1. Four patients with tetraplegia from rheumatoid subluxation occurring in the lower cervical spine are described and the common features are noted.

2. Compression appeared to be responsible for the cord damage, although it was not necessarily directly related to vertebral subluxation. The lesions causing the compression were varied.

3. Forcible attempts to reduce vertebral subluxation may be harmful. Two patients were improved by posterior decompression.

4. A suggested programme for the treatment of such patients is outlined.