Apparatuses and methods for inserting elongated fixation elements into screw implants include one or components for visualizing the insertion process from a unique vantage point. One apparatus features a steering apparatus for adjusting the position of a receiver element on a screw implant, so that an elongated fixation element, such as a rod, can be inserted through a transverse passage in the receiver element. The steering apparatus may include an extension tube and a steering control member coupled to the extension tube. The extension tube may be configured for coupling to the receiver element, and the steering control member may be configured for coupling to the extension tube. The steering control member may include an opening for receiving an endoscope. The endoscope may be used to visually monitor the elongated fixation element as it is inserted into the transverse passage of the receiver element.