A surgical ratchet tool and system along with associated methods are disclosed. The surgical ratchet tool can include a relatively simple encompassing member that included a pawl extending into the opening for directly contacting a nut during surgery. The ratchet tool and system can be used for various types of surgery in which easy sterilization and a reduced profile for a ratchet tool is desired. For example, the ratchet tool can be used during surgery for adjustment of a spinal implant, where manipulation of a nut located on a downtube connected to a screw and/or spinal rod is desired. The encompassing member and pawl can be constructed/molded as a single piece unitary structure. A first handle and possibly a second handle can extend from an outer periphery of the encompassing member.
