| CPC A61B 17/7037 (2013.01) [A61B 17/7034 (2013.01); A61B 17/7035 (2013.01); A61B 17/708 (2013.01); A61B 17/7085 (2013.01); A61B 17/7086 (2013.01)] | 20 Claims |

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1. A bone anchoring device for coupling a rod to a bone anchoring element comprising a shank for anchoring to bone and a head, the bone anchoring device comprising:
a receiving part configured to receive the head of the bone anchoring element, the receiving part having a first end and a second end below the first end, a central axis extending through the first end and the second end, and two legs at the first end for receiving the rod therebetween;
a pressure member movable in the receiving part and configured to directly contact the head to exert pressure on the head, the pressure member comprising a top end defining a rod engaging surface, an opposite bottom end, an outer surface and an inner surface each extending between the top and bottom ends, and at least one opening that extends from the outer surface to the inner surface, wherein at least part of the opening is located at an axial height that is below a bottom of the rod engaging surface; and
an insert that is insertable laterally from the outer surface of the pressure member into the opening, wherein the insert is configured to reach the inner surface of the pressure member in a lateral direction when inserted in the opening;
wherein when the pressure member is in the receiving part and the insert extends into the opening of the pressure member, at least part of the insert is configured to extend radially outwardly from the pressure member into at least part of the receiving part, while the pressure member is adjustable from a non-locking position in which an inserted head is adjustable relative to the receiving part to a locking position in which the inserted head is clamped.
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