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The multivariate logistic regression analysis showed that the preoperative ADI ( 7.92mm) defined in the receiver-operating characteristic curve analysis was an independent predictive factor for the increase in the T1 slope 1year after atlantoaxial fusion (odds ratio, 4.59; 95% confidence interval, 1.34-15.73; p = 0.015). We found an association between the preoperative ADI and difference in the T1 slope after atlantoaxial fusion in the patients with RA. A preoperative ADI ( 7.92mm) was an independent predictor f