Purpose: To discuss the complex management of hyperkyphotic spinal deformity in the setting of rheumatoid arthritis and propose a novel surgical technique. Methodology: We report the case of a 75 year old female with rheumatoid arthritis and multi-level subaxial cervical spine subluxation with resultant cord compression and myelopathy who presented with T1/2 severe hyperkyphosis due to a bony chance pedicular fractures 6 months after her index operation. The angulation precluded an anterior approach. A novel posterior modified trans-pedicular and trans-facet approach was utilized to access the disc space, release the anterior ligamentous structures and place a cervical interbody cage without any nerve root sacrifice. There was excellent correction of the deformity and clinically her mobility improved as a result of her spinal cord decompression. Results: Rheumatoid arthritis severe manifestations in the cervical spine have become less prevalent since the introduction of disease modifying medications. Nonetheless, the consequences of subaxial subluxations and potential for cord compression leading to myelopathy are significant and often demand complex surgical decompression and fixation. We demonstrate for the first time a sole posterior only approach is feasible. Conclusion: This is the first report of a posterior thoracic discectomy and fusion performed without nerve root sacrifice and we posit this is viable surgical technique. Various transpedicular and trans-facet approaches have been employed but only to perform discectomies. We discuss the novel technique of successful placement of an interbody device in order to facilitate correction of a hyperkyphotic thoracic deformity in a patient with rheumatoid arthritis.