Disclosed are devices, methods and systems for manipulating a pedicle screw assembly and for inserting and reducing a rod relative to the pedicle screw assembly. The system can include a cannula assembly having a reduction cannula with an internal bore extending between a proximal region and a distal region and an insertion cannula co-axially positioned within the internal bore of the reduction cannula. The insertion cannula includes a pair of opposed prongs extending distally from a distal region of the insertion cannula, wherein each prong is interposed between a pair of flexible projecting elements. The pair of opposed prongs of the insertion cannula and the distal region of the reduction cannula are aligned to collectively define an opening that is sized and shaped for receiving a spinal rod. The device also can include an annular collar mounted on the proximal region of the reduction cannula and rotatably coupled to a proximal region of the insertion cannula. The cannula assembly can also be a pivoting cannula assembly.
