A minimally invasive fixation system and installation method is provided. The system includes a rod having an anchor fixation head, an anchor system for anchoring the rod using the anchor fixation head, and a guide system configured to attach to the anchor fixation head of the rod for the insertion of the additional anchor systems. In one embodiment, a method for placing a spinal fixation element relative to a vertebra is provided. The method includes inserting the spinal fixation element relative to the vertebra; connecting the spinal fixation element to a first vertebra with a first anchor; manipulating the spinal fixation element relative to the first anchor to align the spinal fixation element with a second vertebra; fixing the position of the spinal fixation element relative to the first bone anchor; determining an anchor site on a second vertebra using a guide system connected to the spinal fixation element; inserting a second anchor at an anchor site on second vertebra; and connecting the second anchor to the spinal fixation element to fix the spinal fixation element relative to the first vertebra and second vertebra.