RECEIVING PART FOR COUPLING A BONE ANCHOR TO A ROD AND BONE ANCHORING DEVICE WITH SUCH A RECEIVING PART

[0001] The present application claims the benefit of U.S. Provisional Application Ser. No. 62/082,517, filed Nov. 20, 2014, the contents of which are hereby incorporated by reference in their entirety, and claims priority from European Patent Application EP 14 194 064.3, filed Nov. 20, 2014, the contents of which are hereby incorporated by reference in their entirety.

[0002] The invention relates to a receiving part for coupling a bone anchor to a rod and to a bone anchoring device including such a receiving part. More specifically, this invention relates to a receiving part having a recess for receiving a rod therein and at least one resilient retention element for temporarily holding the rod in the recess. The bone anchoring device is particularly suitable for the use in spinal stabilization systems.

[0003] The process of stabilizing the spinal column using a spinal stabilization system involves the placement of bone anchors, for example pedicle screws, and a rod connecting the bone anchors. During the surgical procedure, the receiving parts of the bone anchors have to be aligned so that the rod can be inserted and finally fixed. It may happen that a rod once inserted in one of the receiving parts slips out again before it is fixed. This can render the procedure difficult and time consuming and is therefore not desirable.

[0004] From U.S. Pat. No. 7,731,736 B2 a receiver of a bone fixation system is known that automatically provisionally retains a rod when the rod is inserted into the receiver. The receiver includes a rod seat and spaced apart legs that further include provisional retention structures in the form of opposing tabs. The tabs project laterally into a pocket of the receiver. Prior to insertion of the rod, the legs of the receiver are in a non-deflected orientation. As the rod is pressed downwardly in the pocket, it causes the legs to deflect apart to accommodate the rod. In certain embodiments the partially deflected legs apply a clamping force to the rod.

[0005] It is the object of the invention to provide an improved receiving part for coupling a rod to a bone anchor and a bone anchoring device including such a receiving part that allows to temporarily hold the rod and that is applicable to various types of receiving parts independent of their specific design.

[0006] The object is solved by a receiving part according to claim 1 and a bone anchoring device according to claim 15. Further developments are specified in the dependent claims.

[0007] According to the present invention, a receiving part for coupling a bone anchor to a rod is provided that includes a recess for receiving the rod and a bore for inserting a fixation device wherein a bore axis is substantially perpendicular to a longitudinal axis of the rod to be inserted and wherein the recess comprises opposing sidewalls and a resilient retention element protruding from at least one of the opposing sidewalls. When the rod is inserted into the recess, it can be held temporarily in the recess by the at least one retention element.

[0008] Because the retention element is provided on a sidewall of the recess and not within the bore that accommodates the fixation element, any hitherto known design of a receiving part that has a recess for the rod can be provided with such a retention element without substantially changing the design of the receiving part and of other parts interacting therewith. The function of the retention element will be the same in all types of receiving parts, such as receiving parts of monoaxial bone anchoring devices, of polyaxial bone anchoring devices of the top-loading type or the bottom-loading type and receiving parts wherein the clamping and locking of the head is effected by means of an outer locking ring. After final fixation of the rod with the fixation device, the retention element may have no further function.

[0009] The retention element prevents the rod from slipping out of the recess, in particular, from inadvertently slipping-out during steps of inserting the rod into a plurality of bone anchoring devices or adjustment of the position of a bone anchoring device relative to the rod.

[0010] The retention element may be provided at such a position that it exerts a frictional force onto the rod for provisionally holding the rod in a position.

[0011] In a further aspect, the receiving part with the retention element can be configured in such a manner that rods of different diameter can be held. To achieve this, a bottom of the recess that forms a rod seat may have a specific shape, such as a V-groove. This allows to use one and the same the bone anchoring device with rods having different diameters.

[0012] In a further aspect, the retention element may be provided on one sidewall of the recess only and an insertion portion for the rod may be offset from the bore axis of the receiving part, whereas the rod seat in the bottom of the channel may be substantially symmetrical to the bore axis. The retention function of the retention element may be enhanced by this construction.

[0013] In a still further aspect, the retention element is formed by a separate part that is connectable to the sidewall of the recess. Thereby, a material for the retention element can be used that renders the retention element particularly elastic. The material of the retention element may be different from the material of the receiving part.

[0041] An embodiment of the receiving part is depicted in FIGS. 1 to 3 that illustrate a monoaxial bone anchoring device 1. The bone anchoring device 1 has a shank 2 with a bone thread section and a tip (not shown) and a receiving part 3 rigidly connected to the shank 2, for receiving a rod 100 connecting the bone anchoring device to another bone anchoring device. The term monoaxial means that the shank axis extends at a fixed angle with respect to the receiving part 3. In the embodiment, the angle is zero degree but it may be another angle. The receiving part 3 comprises a first end 3a and an opposite second end 3b, wherein the second end 3b is adjacent to the shank 2. At the first end 3a a channel for the rod in the form of a recess 4 is provided that has a substantially U-shaped cross-section with the bottom 4a of the recess forming a seat for the rod 100. By the recess 4 two free legs 5, 6 are formed. A bore 7 extends from the first end 3a to a depth below the bottom 4a of the recess 4. Adjacent to the first end 3a an internal thread 8 is provided on the legs 5, 6. The internal thread 8 cooperates with a corresponding external thread of a fixation element 9. In the embodiment shown the fixation element 9 is a set screw. The bore 7 has a bore axis C that is coaxial to the axis of rotation of the threaded shank 2. Opposing sidewalls 4b of the recess 4 are formed on either side of the bore 7, hence, one pair of opposing sidewalls 4b is arranged on each side of the bore 7.

[0042] On each of the sidewalls 4b of the recess 4 a retention element 40 is provided that is configured to reduce a width of the substantially U-shaped recess 4 in a direction perpendicular to the bore axis. The retention element 40 protrudes into the recess 4 such that the distance between two opposing retention elements 40 is smaller than the width of the rod 100. In the case of the cylindrical rod 100 according to the embodiment, the distance between the retention elements 40 of opposing sidewalls 4b is smaller than a diameter of the rod 100. The retention elements 40 have the shape of ribs that extend perpendicular to the bore axis C and parallel to a longitudinal axis L of the rod 100. The position in an axial direction of the bore axis C is such that they are positioned at or above the center of the rod 100 measured from the bottom 4a of the recess 4 when the rod 100 is inserted and supported on the bottom 4a.

[0043] The retention elements 40 are resilient. In particular, they are formed as a monolithic piece with the respective sidewall 4b. The resiliency of the retention elements 40 is such that when the rod 100 is inserted, the retention elements are configured to move outward, i.e. away from the bore axis C so that the distance between the retention elements 4 increases so that the rod 100 can pass between them. When the rod 100 is removed and pressure is no longer exerted onto the retention elements 40, they return to their original shape, thereby restricting the width of the recess again.

[0044] The resiliency of the retention elements 40 is achieved by providing an angled slit or recess 41 in each of the sidewalls 4b that completely extends through the respective sidewall 4b from the outside of the receiving part 3 into the bore 7 in a direction substantially perpendicular to the bore axis. Hence, the recess 41 is open at two sides. A cross-section of the recess 41 resembles a V-shape with an obtuse angle between the legs of the V. By means of the recess 41, the rib that forms the retention element 40 can be pressed outward as it has space to move into the recess 41.

[0045] The size, the shape and the position of the recess 41 can be selected so as to obtain a desired flexibility of the retention elements 40.

[0046] The outer shape of the receiving part 3 may be substantially cylindrical but any other shape may be contemplated.

[0047] The parts of the bone anchoring device are made of a body-compatible material, for example, a body-compatible metal or a body-compatible metal alloy, or a body-compatible plastic material. Examples of such materials are stainless steel, titanium, nickel titanium alloys NiTi, for example Nitinol, β-titanium or PEEK (polyether ether ketone). In particular, the portion including the retaining elements 40 may be made from a material that provides highly elastic properties, such as, for example, super-elastic shape memory alloys, like Nitinol or β-titanium. Additionally, the bone anchoring device or parts thereof can be at least partially made of biodegradable materials. In particular, such materials include a degradable polymer, such as, for example, PLLA (poly-L lactide) or a degradable metal such as, for example, magnesium or a degradable metal alloy, for example a magnesium-based or an iron-based alloy.

[0048] In use, once the bone anchoring device 1 is anchored in a bone or in a vertebra with the shank 2, the rod 100 can be inserted and can be held in the receiving part 3 as depicted in FIGS. 4a to 4d. As can be seen in FIG. 4a, in their resting position, the retention elements 40 narrow the channel for the rod 100 so that the distance between the innermost surfaces of opposing retention elements 40 is smaller than a diameter of the rod 100. Next, as shown in FIG. 4b, when the rod 100 is inserted, it cannot automatically pass between the retention elements 40. If the rod 100 is pressed downward, the rod 100 exerts a transverse force onto the retention elements 40, as depicted in FIG. 4c. The retention elements 40 are deflected outward and widen the passage to let the rod 100 pass. Finally, when the rod 100 is seated on the bottom 4a of the recess 4, the retention elements 40 tend to return to their original shape due to their resiliency, thereby exerting a transverse frictional force onto the rod 100 that holds the rod 100 provisionally. The rod 100 may be held not only in the vertical position, i.e. in the rod seat at the bottom 4a of the recess 4 but also in the horizontal position, i.e. its position along the length of the channel.

[0049] Because the position of the ribs is such that in a non-deflected condition the retention elements 40 are at or above an area with the greatest diameter of the rod, i.e. at an axial position at or greater than the radius of the rod 100 measured from the bottom 4a of the recess 4, the rod 100 is prevented from moving out through the first end 3a once it is seated.

[0050] A modified embodiment of a receiving part is explained with reference to FIGS. 5 and 6. Parts and portions that are identical or similar to the parts and portions of the previous embodiment are described with the same reference numerals and the detailed description thereof is not repeated. An exemplary polyaxial bone anchoring device 1′ includes a bone anchor 2′ that has a shank 2a and a head 2b, usually a spherical segment-shaped head. A receiving part 3′ comprises additionally to the portions of the previous embodiment an opening 3c at the second end 3b and a seat 3d for the head 2b of the bone anchor 2′. The seat 3b can be a spherically-shaped seat or any other seat that allows the head 2b of the bone anchor 2′ to pivot therein. The seat 3b is in communication with the bore 7. The exemplary polyaxial bone anchoring device is of the top loading type, i.e. the bone anchor 2′ is inserted from the top or first end 3a into the receiving part 3′. A pressure element 10 is provided that is arranged in the bore 7 and that is configured to exert pressure onto the head 2b of the bone anchor 2′ to lock the head 2b in a desired angular orientation with respect to the receiving part 3′. Hence, the term polyaxial means that the shank 2a can assume various angles with respect to the receiving part 3′. Furthermore, the pressure element 10 provides a support surface 10a for the rod 100 which forms the rod seat in this embodiment. The retention elements 40 are identical or similar to the retention elements 40 of the previous embodiment. In the assembled state, as shown in FIG. 6, when the head 2b is in the seat 3d and the pressure element 10 is on top of the head 2b of the bone anchor 2′ and the rod 100 is inserted, the position of the retention elements 40 is such that the ribs are at a an axial distance from the rod support surface 10a of the pressure element 10 that is equal to or more than the radius of the rod 100.

[0051] A further modified embodiment will be explained with reference to FIGS. 7 and 8. Parts and portions that are identical or similar to parts and portions of the previous embodiments will be described with the same reference numerals and the description thereof is not repeated. The bone anchoring device 1″ shown in FIGS. 7 and 8 is an exemplary polyaxial bone anchoring device of the bottom loader type. It includes a separate bone anchor 2′ as in the previous embodiment and a receiving part 3″. The receiving part 3″ includes an opening 3c″ at the second end 3b that is larger than the diameter of the head 2b of the bone anchor 2′. Furthermore, the receiving part 3″ comprises an accommodation space 3c″ that narrows in a narrowing portion 3d″ towards the lower opening 3c″. The accommodation space 3c″ serves for accommodating the head 2b and a cap-like pressure element 11 including a cap-like portion 11b that is flexible due to slits 11c and extends over the area with the greatest outer diameter of the spherical segment-shaped head 2b. Opposite to the cap-like portion 11b, the pressure element 11 comprises a rod support surface 11a for supporting the rod which forms a rod seat in this embodiment. The dimensions of the receiving part 3″ and the pressure element 11 are such that when the pressure element 11 is placed in the receiving part 3″, it can assume an inserting position in which the cap-like portion 11b can expand in the accommodation space 3c″ to allow insertion of the head 2b. Next, the pressure element 11 can assume a pre-locking position in which the pressure element 11 is moved downward once the head 2b is inserted so that the cap-like portion 11b is clamped in the narrowing portion 3d″ to prevent removal of the inserted head 2b. Finally, the pressure element 11 can assume a locking position, in which the pressure element 11 and the inserted head 2b are moved downward to such an extent that the head 2b is locked by the clamping force exerted by the narrowing portion 3d″ onto the cap-like portion 11b and the head 2b. As in the previous embodiments, the retention elements 40 are provided in the sidewalls 4b of the recess 4 of the receiving part 3″. The retention elements 40 are located at such a height that an inserted rod 100 that is placed onto the rod support surface 11a is held in this position by the retention elements 40.

[0052] A still further modified embodiment will be explained with reference to FIGS. 9 and 10. The bone anchoring device 1′″ is a bottom-loading polyaxial bone anchoring device, wherein the head 2b of the bone anchor 2′ is clamped by means of an outer ring. The receiving part 3′″ comprises a rod-receiving portion 31 that includes the recess 4 forming the channel for the rod 100, the retention elements 40 and the bore 7. Adjacent to the rod-receiving portion 31 a head-receiving portion 32 is provided that comprises a hollow interior 33 with an opening towards the second end 3b and a flexible wall that is flexible due to slits 36 that are open to the second end 3b. The hollow interior 33 is sized and shaped so as to accommodate the head 2b therein. The head 2b may be held in the head-receiving portion 32 by friction. A locking ring 12 is provided that extends around the head-receiving portion 32. Two opposite projections 12a on the locking ring 12 may form the rod seat in this embodiment. The locking ring 12 can be moved from a first position closer to the rod-receiving portion 31 which allows insertion of the head 2b through the lower opening 34 until the head-receiving portion 32 covers the head 2b through pressure with the rod 100 to at least a second position in which the locking ring 12 is closer to the second end 3b than in the first position and in which the head 2b is prevented from moving out through the lower opening 34. The locking ring 12 may further assume a third position even closer to the second end 3b than the second position in which it compresses the head-receiving portion 32 such that the head 2b is locked.

[0053] A further embodiment is shown in FIGS. 11, 12a and 12b. The bone anchoring device is shown as a monoaxial bone anchoring device 110 with a shank 2 rigidly connected to a receiving part 30. The receiving part 30 is similar to the receiving part 3 of FIGS. 1 to 3. Identical or similar parts and portions are indicated with the same reference numerals and the description will not be repeated. The receiving part 30 differs in the design of the retention elements. The retention elements 400 each are shaped as resilient flaps having a free end 400a and being monolithically connected at their end opposite to the free end 4a to the sidewall 4b. A recess or slit 401 provides space for deflection of the retention elements 400. The orientation of the flaps is such that the free end 400a is directed toward the second end 3b of the receiving part 30. As can be seen in FIG. 11, the recess 401 is open toward three sides. Adjacent to the second end 3b an inner surface portion 400b, i.e. a surface portion pointing toward the inside of the channel for the rod is concavely shaped with a shape matching the shape of the rod. The retention elements 400 protrude into the channel such that when the rod 100 is not inserted, a shortest distance between the retention elements 400 is smaller than the diameter of the rod 100 to be inserted.

[0054] In use, when the rod 100 is inserted it slides along the inner surface of the retention elements 400 and deflects the retention elements 400 outward into the recess 401. When the rod 100 is seated in the bottom 4a of the U-shaped recess 4, it is clipped-in between the retention elements 400 and provisionally and temporarily held there by the friction between the rod surface and the concave surface portion 400b of the retention elements 400.

[0055] A modified embodiment is shown in FIGS. 13 to 16. The monoaxial bone anchoring device 110′ is configured to be use with at least two rods 100, 1000, having different diameters. The receiving part 30′ differs from the receiving part 30 in the shape of the retention elements and in the shape of the bottom of the recess forming the channel. The recess 4′ forming the channel has a bottom 4a′ that is not substantially circular. More specifically, the bottom 4a′ is substantially V-shaped. This allows to place rods 100, 1000, in particular cylindrical rods, with different diameters in the channel. When a cylindrical rod is used, it has at least two lines of contact in a direction parallel to the longitudinal axis of the rod so that the rod is safely supported by at least two lines of contact, regardless of the diameter of the rod. The retaining elements 400′ are formed as flaps like in the previous embodiment. The flaps extend inward into the channel so that a cross-section of the recess 401′ is substantially triangular. A closed end portion 401a′ of the recess 401′ may be enlarged, for example may have the cross-section of a portion of a circle to facilitate bending of the flaps. By means of this, the inwardly protruding flaps reduce the width of the channel for the rod in such a manner that also rods with a smaller diameter can be used and temporarily held. An inner surface of the retention elements 400′ that faces toward the inside of the channel may have several concave surfaces portions 400b′ at different positions to grip a corresponding rod.

[0056] As depicted in FIG. 15, when a first rod 100 with a smaller diameter is used, for example a rod of a diameter of 4.5 mm, the retention elements 400′ are only slightly deflected outward into the recess 401′. As the rod 100 is supported along at least two contact lines in the base of the channel, the rod is safely provisionally held by the retention elements 400′ and the bottom 4a′ of the channel. As illustrated in FIG. 16, when a rod 1000 with a larger diameter, for example a rod with a diameter of 5.5. mm, it deflects the retention elements 400 outward to a greater degree compared to the smaller rod. Due to the resiliency of the retention elements 400′ the angle of outward deflection when inserting the rod can vary in a stepless manner. Hence, a variety of rods that differ in respect of their diameter can be temporarily held in the receiving part.

[0057] A still further embodiment will be explained with respect to FIGS. 17 to 19b. The monoaxial bone anchoring device 110″ includes a shank 2 that is monoaxially connected to a receiving part 30″. The receiving part 30″ differs from the receiving part of the previous embodiments with respect to the arrangement of the recess for insertion the rod and the retention elements. As in the previous embodiments, the receiving part 30″ comprises a bore 7 with the bore axis C that is coaxial with the shank axis. A recess 4″ starts from the first end 3a of the receiving part 30″ and ends in a bottom portion 4a forming a rod seat that is located at a distance from the second end 3b. The bottom portion 4a″ has a substantially circular segment-shaped cross-section with a center of the circle lying in a plane that extends through the bore axis C. Furthermore, the recess 4″ comprises an insertion portion 4c″ with a substantially rectangular cross-section. The insertion portion 4c″ goes over into the bottom portion 4a″ whereby a slightly protruding rib 402 is formed on one of the sidewalls 4b. The center plane of the insertion portion 4c″ is offset from the bore axis C, as depicted in particular in FIGS. 19a and 19b. On the sidewall 4b opposite to the protruding rib 402, a resilient retention element 400″ is formed that has a free end 400a″ facing the first end 3a of the receiving part 30″. The resilient retention element 400″ has an inner contour 400b that is substantially cylindrical and adapted to the size of the rod to be received therein. Also, a cylinder segment-shaped recess 401″ provides space for the outward deflection of the resilient retention element 400″. Hence, in this embodiment, there is one rigid retention element 402 in the form of the rib on one sidewall 4b and one resilient retention element 400″ on an opposite side wall 4b.

[0058] In use, as shown in FIG. 19a, when the rod is inserted through the offset insertion portion 4c″, the resilient retention element 400″ is deflected outward until the rod 100 can pass and snap into the bottom portion 4a″. The rod 100 is then temporarily held in the bottom portion 4a″ by the retention elements 400″, 402. Because the insertion portion 4c″ is offset from a center of the bottom portion 4a″, the free end 400a″ may be directed toward the insertion portion 4c″ for the rod without providing an obstacle then the rod 100′ is inserted. The gripping of the rod 100 may be enhanced thereby.

[0059] It shall be noted that the rigid retention element 402 can also be omitted.

[0060] A still further embodiment will be explained with reference to FIGS. 20 to 22b. A monoaxial bone anchoring device 110′″ according to this embodiment includes a shank 2 rigidly connected to a receiving part 30′″. The receiving part 30′″ comprises the bore 7 with the bore axis C being coaxial to the shank axis and a substantially U-shaped recess 4′″ with a bottom 4a′″ for providing a rod seat. In this embodiment, the recess 4′″ forming a channel for the rod 100 may be symmetrical to a plane extending through the bore axis C and containing the rod axis. Each of the sidewalls 4b formed by the substantially U-shaped recess 4′″ comprises a substantially U-shaped groove 401′″ that serves for receiving a separate retention element 400′″. The separate retention element 400′″ is formed as a substantially U-shaped clip with an outer contour fitting into the groove 401′″ and an inner contour that comprises a substantially cylinder segment-shaped bottom portion 400a′″ serving as a rod seat and between the bottom portion 400a′″ and the free ends a gripping contour 400c′″ that may be, for example, a teeth-like structure with teeth facing upward to the first end 3a of the receiving part 30′″. The gripping structure 400c′″ serves for slightly clamping the rod in the channel. In the embodiment shown, the separate retention elements 400′″ are provided on either side of the bore 7. The retention elements 400′″ may be designed such that when the rod is inserted, the arms of the retention elements 400′″ are slightly bent outward and thereby clamped in the groove 401′″. The material of the retention elements 400′″ may be a material that has a greater elasticity compared to a retention element made of the same material as the receiving part 30′″. For example, the separate retention elements 400′″ may be made from a super-elastic body-compatible metal alloy or from a body-compatible plastic material.

[0061] In use, when the rod 100 is inserted, it presses the arms of the separate retention element 400′″ outward so that they become clamped in the groove 401′″. The rod 100 is then held in the rod seat 400a′″ by the gripping contour 400c′″.

[0062] It shall be mentioned, that each of the embodiments described can be realized also in the receiving part of a polyaxial bone anchoring device as exemplary depicted in FIGS. 5 to 10.

[0063] A further embodiment of a bone anchoring device 1″″ is shown in FIGS. 23 through 24b. The bone anchoring device″″ is similar to that shown in FIGS. 9 and 10, and is formed as a bottom-loading polyaxial bone anchoring device, wherein the head 2b of the bone anchor 2′ is clamped by means of an outer locking ring 12. Only those parts differing from the embodiment of FIGS. 9 and 10 will be explained in the following, while a detailed description of the identical or similar features is not repeated herein.

[0064] The receiving part 3″″ comprises a rod-receiving portion 31 that includes the recess 4 forming the channel for receiving the rod 100. Moreover, the rod-receiving portion 31 has two legs 5, 6 separated from each other by the recess 4. The two legs 5, 6 include the first end 3a of the receiving part 3″″ at respective upper tips. However, before removal thereof, break-off extension tabs 50, 60 monolithically extend from the first end 3a at each of the legs 5, 6, respectively. The use of break-off extension tabs is generally well known in the art. The breakoff extension tabs 50, 60 of this embodiment among others help in guiding an inserted rod towards the rod receiving portion 31 of the receiving part 3″″. Once a rod has been guided through the inner side walls 4c of the break-off extension tabs 50, 60, and a fixation element 9 (not shown in FIGS. 23 -24b) has been threaded through an inner thread 80 of the break-off extension tabs 50, 60, these tabs may be removed by them bending away around predetermined breaking points 51, 61,which are formed as thinned wall portions of the receiving part 3″″ at the first end 3a. In this embodiment, the predetermined breaking points 51, 61 are formed as circumferential grooves or cutouts in an outer wall surface of the receiving part 3″″.

[0065] Due to the predetermined breaking points 51, 61, the break-off extension tabs 50, 60 are resiliently bendable prior to undergoing a bending force sufficient to break-off the extension tabs 50, 60. Further, the opposed inner side walls 4c of the break-off extension tabs 50, 60 include a mutual distance, which is the same as that between the opposed side walls 4b of the legs 5, 6 to allow the rod to be guided through to a position in which it rests on the projections 12a of the retaining ring 12. However, one or more retention projections 62 may be formed on each of the opposed side walls 4c, which narrow the width of the recess 4 in this upper portion. Due to the resiliency of the tabs 50, 60, the rod 100 may upon insertion be temporarily held in a flat portion 63 of the side wall 4c between each two of the retention projections 62, wherein the tabs 50, 60 bend away from each other when the rod 100 passes opposed retention projections 62 urging the same outwards.

[0066] It may be noted that the retention projections 62 may be provided also on just one of the two side walls 4c. Moreover, the retention projections 62 may form a regular pattern, wherein for example 4 to 6 retention projections 62 are formed on each side wall 4c, such that a ratchet-like holding mechanism may be established for the rod 100. This may give a tactile response to the operator and further allows to hold the rod 100 at a number of possible vertical positions above the rod receiving portion 31 according to the specific needs. As the upper ends of the tabs 50, 60 move further away from each other at given bending force as compared with portions close to the breakage points 51, 61, the holding force for temporarily holding the rod 100 increases at retention projections 62 positioned closer towards the rod receiving portion 31 (towards the bottom end) allowing the operator to select a temporary holding force for the rod 100 as desired. In this embodiment, the bendable extensions tabs 50, 60 including the retention projections 62 form resilient retention elements.

[0067] Further modifications of the embodiments described are possible. The retention elements are not restricted to the specific shape shown in the embodiments. Deviations therefrom are possible as long as the same function is achieved.

[0068] Although the embodiments describe bone anchoring devices wherein the rod is loaded from the top side of the receiving part into the receiving part, the invention can also be realized in a side-loading device wherein the rod is insertable from the side into the receiving part, i.e. the insertion direction of the rod includes an angle, for example 90°, with the bore axis.

[0069] For the fixation device all kinds of known fixation devices can be used such as dual-part fixation devices, outer nuts, bayonet fixation devices and others.

[0070] For the bone anchor all kinds of bone anchors can be used, such as a screw-type bone anchor having a threaded shank, a nail-type bone anchor with or without barbs, a cannulated bone anchor, hooks, etc.

[0071] Although the rod is shown exemplary as a cylindrical rod, it needs not necessarily to be cylindrical, but can also have another cross-section such as rectangular, square-shaped, oval-shaped, etc. The cross-section needs not to be constant over the whole length of the rod. The rod may be smooth or may be roughened or otherwise structured. Also multi-piece and curved rods may be contemplated.

[0072] A number of different embodiments are disclosed herein. It is appreciated that the components of the different embodiments can be mixed and matched to produce other different embodiments.

[0073] While the present invention has been described in connection with certain exemplary embodiments, it is to be understood that the invention is not limited to the disclosed embodiments, but is instead intended to cover various modifications and equivalent arrangements included within the spirit and scope of the appended claims, and equivalents thereof.