Rheumatoid arthritis (RA) is a progressive symmetrical, deforming inflammatory polyarthropathy with numerous extra-articular features. The skeletal effects of RA are characterized by an inflammatory synovitis with progressive destruction of cartilage. This chapter presents a case study of a 62-year-old female with seropositive rheumatoid arthritis presented for anterior cervical discectomy and fusion for long-term progressive pain and upper extremity myelopathy. Preoperative imaging consisted of plain radiographs and magnetic resonance imaging of the cervical spine. This case illustrates several important issues that must be considered when identifying the airway management options for patients with cervical spine pathology. When considering the airway options for a patient with disease at the occipito-atlanto-axial (OAA) complex an appreciation of the importance of this area in overall airway management is necessary. Careful preoperative evaluation and planning are essential; adequate time and personnel should be allocated to securing the airway in a controlled and safe manner.