This song was inspired by the neck surgery that frontman Neil Fallon
underwent in 2013 when doctors used dead men's bones to fuse his vertebrae. He explained in a commentary video: "I think it's a great premise for a horror movie, so don't steal it because I've got first dibs. The discs in my neck were replaced with cadaver bones. There's this new process where it's not just from one cadaver. It was from many dozens, or perhaps hundreds, that they created a composite to conform it to any size."
"I started thinking about these stories where people get an organ transplant and they start taking on the affectations of the donor. What if you have hundreds of thousands of these donors suddenly in your neck – and they start speaking to you? That's where you get the line, 'A congress of corpses is always in session, debating the wisdom of my current direction.'"