This disclosure describes example an surgical fixation anchor and methods for implanting the surgical fixation anchor on the spine as part of a spinal fixation construct. The surgical fixation anchor can be coupled to a spinal rod. The coupling between the spinal rod and the anchor can be offset from an axis of the anchor. The position and orientation of the coupling to the spinal rod can also be transnationally and rotationally adjusted relative to the anchor to facilitate the coupling and/or to optimize space usage adjacent to the fixation construct.