Spinal fixation systems may be installed utilizing instruments and techniques alone or in combination with selectively attached extension members mounted on vertebral anchors to extend percutaneously from the spine. The surgical procedures associated with this invention involve making small, discrete incisions for the placement of select vertebral anchors. The extension members retract soft tissue, muscle and the like to thereby provide visibility and access to the head of the anchor. Instrumentation is utilized to deliver and install components such as a spine rod, set screw and other required hardware to the anchors. Once a spine rod or other components are secured to the pedicle screws, the instrumentation and extension members are removed from the patient.