Alignment clamps, extension caps, and systems, with associated methods, for pedicle screw extension alignment in an orthopedic patient are described. An alignment clamp for alignment of pedicle screw extensions includes a clamp having a hollow interior. The clamp can receive a pedicle screw extension through the hollow interior. The clamp includes opposing open ends in communication with the hollow interior. A straightening rod receptacle is on a side of the clamp. The straightening rod receptacle is oriented to receive a straightening rod therethrough. The straightening rod receptacle can be substantially perpendicular to a direction of the clamp through which the pedicle screw extension is receivable.