Segmental spinal fixation using sublaminar or interspinous stainless steel wire has been successfully used for many years. Stainless steel cables have been developed that are stronger and more flexible, allowing for shorter operative time and decreased risk of neurological deficit. However, stainless steel implants create significant artifact on magnetic resonance imaging (MRI), reducing the postoperative usefulness of this imaging modality. Titanium instrumentation has the advantage of producing minimal MRI artifact. Recently, a braided titanium cable has been developed that has the advantages of strength and flexibility as well as minimal production of MRI artifact. We present a series of 50 patients who underwent internal fixation of the spine using a braided titanium cable either alone or in combination with supplementary titanium instrumentation. No instrument failures have occurred to date. Postoperative MRI scans have revealed minimal implant-related artifact, allowing for high-resolution, noninvasive postoperative imaging of the neuraxis. We conclude that braided titanium cable has significant advantages over stainless steel cable or monofilament wire and is a valuable instrument for segmental spine fixation.