A spinal rod implantation system may be used with pedicle screws to be secured to respective pedicles of a patients spine, each pedicle screw having a spinal rod channel therethrough. The system may include extenders each including an inner member having a distal end, and an outer member surrounding the inner member and being slidable relative thereto to permit removable coupling of the distal end to a respective pedicle screw. The inner and outer members may include respective features defining a first joint permitting at least partial relative rotation to provide a first degree of rotational freedom. The system may further include extender heads each pivotally coupled to a proximal end of a respective outer member to define a second joint providing a second degree of rotational freedom. A spinal rod insertion assembly may be coupled to the extender heads for guiding the spinal rod through the spinal rod channels.
