Polyaxial bone anchoring device and system including an instrument and a polyaxial bone anchoring device

A method of coupling a rod to a bone using a polyaxial bone anchoring device comprising a bone anchoring element comprising a shank and a head, a receiving part configured to receive the head, the receiving part having a first end and a second end, a central axis extending through the first end and the second end, and two legs defining a recess at the first end for receiving the rod, a pressure member movable in the receiving part to exert pressure on the head, the pressure member comprising at least one engagement portion, and a fixation member, the method comprising:

• anchoring the shank of the bone anchoring element to the bone or vertebra;
• pivoting the receiving part relative to the bone anchoring element when the head and the pressure member are in the receiving part, and when the engagement portion is directly engageable from outside the bone anchoring device by an instrument;
• moving the engagement portion axially with the instrument to adjust the pressure member from a non-locking position in which the head is pivotable in the receiving part to a locking position in which the head is clamped;
• adjusting the rod in the recess;
• and
• advancing the fixation member in the receiving part to fix the rod in the recess.