A spinal fixation system is provided that, in one form, includes a coupling member having a cam lock member that is fixed against translation as it is turned with turning of the cam lock member causing an elongate member such as a spinal rod to be pushed downward in the coupling member for fixing the rod therein. In another aspect, the rod is fixed against a low profile insert that seats in a recess formed in the head of an anchor member projecting from the coupling member. The insert has an upper surface against which the rod is fixed. In one form, the insert upper surface is flat to provide for line contact against the rod so as to minimize damage thereto. In another form, the cam lock member cams against a clamping member driving it downward in the coupling member for fixing the rod therein.