The expanding role of neurosurgeons in the field of spinal instrumentation makes it essential that there be an understanding of the biomechanics and uses of the evolving technology. Successful lumbar pedicle fixation requires the understanding of spinal anatomy and strict adherence to surgical technique. The choice of implant constructs and implant design will depend on the pathphysiology of the spinal segment at hand. The goal of spinal instrumentation is a stable spinal fusion across a motion segment(s). Pedicle fixation alone will not in all cases yield a satisfactory fusion outcome. The reconstruction of the injured spine is also key to the success of the implant. Attention must be paid to the reconstruction of the anterior spinal column if short segment fixation is to be used. The complication rates of pedicle instrumentation are low, with screw malposition in 2.6% and symptomatic instrumentation failure in 4.8% of cases without neurologic loss.