A pivotal bone anchor assembly intended for securing an elongate rod to a bone of a patient with tooling, the elongate rod including an underside portion, the pivotal bone anchor assembly comprising:
- a receiver comprising a vertical centerline axis, a base defining a cavity communicating with a bottom surface of the base through a bottom opening, and an upper portion defining a first channel extending transverse to the vertical centerline axis configured to receive the elongate rod, the cavity communicating with the first channel to define an axial bore centered about the vertical centerline axis and extending upward from the bottom opening through the first channel to a top of the upper portion, the axial bore including a discontinuous helically wound thread formed therein adjacent the top of the upper portion configured to mate with a closure top, preformed and integral opposed rotation blocking structures protruding inwardly into the axial bore beneath the discontinuous helically wound thread, and integrally-formed downwardly-facing abutment surfaces extending circumferentially above and on both sides of the opposed rotation blocking structures;
- a shank comprising a shank head at a proximal end configured for positioning within the cavity of the receiver and an anchor portion opposite the shank head configured for fixation to the bone, the shank head including an internal drive structure and a partial spherical shape for being pivotally supported in the cavity of the receiver with the shank extending downward through the bottom opening;
- and
- a pressure insert comprising a central axis, a substantially cylindrical insert body, a second channel formed between a pair of upright arms extending upward from the insert body and configured to receive at least the underside portion of the elongate rod, a central opening along the central axis configured for tooling to pass through to engage the internal drive structure of the shank head, and a lower surface configured to apply downward pressure on the shank head, each of the upright arms including an exterior partial cylindrical surface with opposite outer projections extending circumferentially around at least a portion of each exterior partial cylindrical surface, the pressure insert configured for positioning within the axial bore with the central axis of the pressure insert co-axially aligned with the vertical centerline axis of the receiver, the insert body positioned at least partially past the opposed rotation blocking structures, the second channel in a mal-aligned position relative to the first channel, and the opposite outer projections extending in the transverse direction of the first channel,
- wherein upon rotation of the pressure insert about the vertical centerline axis of the receiver within the axial bore, the opposite outer projections are configured to be at least partially rotated under the downwardly-facing abutment surfaces and initially inhibited from further rotation by engagement with the opposed rotation blocking structures until a force is applied to the pressure insert with the tooling to further rotate the second channel into alignment with the first channel and the opposite outer projections at least partially past the opposed rotation blocking structures, and
- wherein the pressure insert is inhibited from upward movement by overlapping engagement of the opposite outer projections with the downwardly-facing abutment surfaces in the axial bore of the receiver.