A rod inserter, system and method can include an inserter that has a handle and an extension structure extending from the handle. A knob and a lever can be located adjacent the handle. A rod connection structure can be located at the distal end of the extension structure, and configured to rotate with respect to the extension structure. The rod connection structure can include a first clamshell structure and a second clamshell structure configured to move towards and away from each other in order to connect and disconnect from a rod, such as a spinal rod. The knob can be configured such that when actuated the first clamshell structure and second clamshell structure move with respect to each other. The lever can be configured such that when actuated the first clamshell structure and second clamshell structure are prevented from rotating with respect to the extension structure.
