Bone anchoring device

1. A bone anchoring device comprising:

a receiving part having a first end, a second end below the first end, a central axis extending between the first and second ends, and a coaxial passage extending therethrough, wherein the receiving part is configured to pivotably receive a head of an anchoring element such that the anchoring element can assume a plurality of angular positions relative to the receiving part;

a pressure member positionable and movable in the passage; and

an insert member positionable at least partially in the pressure member and movable axially relative to the pressure member between a first position and a second position for exerting an adjustable pressure on the head of the anchoring element to lock the head relative to the receiving part;

wherein when the pressure member is in the passage and the insert member is in the pressure member, a first engagement structure of the insert member that has at least one of an upwardly facing engagement surface or a downwardly facing engagement surface is configured to engage a second engagement structure of the pressure member to releasably hold the insert member at the first position against movement towards the second position and to releasably hold the insert member at the second position against movement towards the first position.

2. The bone anchoring device of claim 1 , wherein the pressure member defines a central bore and the insert member is movable at least partially in the central bore.

3. The bone anchoring device of claim 1 , wherein the first and second engagement structures form an advancement structure between the pressure member and the insert member.

4. The bone anchoring device of claim 3 , wherein the advancement structure comprises threads.

5. The bone anchoring device of claim 1 , wherein the pressure member is movable axially in the passage, and wherein the receiving part comprises an abutment that restricts upward movement of the pressure member to provide a counterforce when the insert member presses onto an inserted head.

6. The bone anchoring device of claim 1 , wherein the pressure member comprises a support surface for a rod, and wherein an opening is provided in the support surface to provide access to the insert member when a rod is not inserted in the receiving part.

7. The bone anchoring device of claim 1 , wherein the pressure member further comprises a stop that is different from the second engagement structure for limiting upward movement of the insert member relative to the pressure member.

8. The bone anchoring device of claim 1 , further comprising the anchoring element comprising a head and a shank for anchoring in bone.

9. The bone anchoring device of claim 8 , wherein the insert member comprises a head contacting surface configured to facilitate pivoting of the head relative to the insert member for the shank to assume a plurality of angular positions relative to the receiving part.

10. The bone anchoring device of claim 9 , wherein the insert member exerts a first pressure on the head at the first position to hold the head at an angular position that can be adjusted by overcoming the first pressure, and wherein the insert member exerts a second pressure on the head that is greater than the first pressure at the second position to provisionally lock the angular position of the head.

11. The bone anchoring device of claim 8 , wherein the insert member comprises a head contacting surface with a shape configured to provide a connection with the head so that the shank is held at a set angular position relative to the receiving part.

12. The bone anchoring device of claim 11 , wherein the set angular position is a zero angle position where the shank is substantially aligned with the central axis.

13. The bone anchoring device of claim 11 , wherein the shape of the head contacting surface is configured to provide a form-fit connection with the head.

14. The bone anchoring device of claim 11 , wherein the head contacting surface comprises an edge configured to provide feedback when the head is pivoted in and/or out of the set angular position.

15. The bone anchoring device of claim 14 , wherein the edge is formed at a lower end of the insert member and is configured to contact a free end surface of the head.

16. The bone anchoring device of claim 8 , wherein the pressure member comprises flexible legs configured to be resiliently compressed by a portion of the receiving part to exert a biasing force on the head.

17. The bone anchoring device of claim 8 , wherein the anchoring element is insertable from the first end of the receiving part and the pressure member is configured to exert pressure on an upper side of the head.

18. The bone anchoring device of claim 8 , wherein the anchoring element is insertable from the second end of the receiving part and the bone anchoring device comprises a compressible portion configured to exert lateral pressure on the head.

19. The bone anchoring device of claim 8 , further comprising a locking member configured to act directly or via an inserted rod on the pressure member to lock the head relative to the receiving part.

20. A kit comprising the bone anchoring device of claim 8 , wherein the insert member is a first insert member, and further comprising a second insert member interchangeable with the first insert member, wherein the first insert member has a head contacting surface that permits polyaxial movement of the head relative to the receiving part, and the second insert member has a head contacting surface configured to hold the head in a monoaxial position relative to the receiving part.

21. A bone anchoring device comprising:

a receiving part having a first end, a second end below the first end, a central axis extending between the first and second ends, and a coaxial passage extending therethrough, wherein the receiving part is configured to pivotably receive a head of an anchoring element such that the anchoring element can assume a plurality of angular positions relative to the receiving part;

a pressure member positionable and movable in the passage; and

an insert member engageable with and positionable at least partially in the pressure member;

wherein when the pressure member is in the passage, the insert member is in the pressure member, and while the pressure member remains stationary at a same axial position in the receiving part, the insert member is movable axially relative to the receiving part, while a first engagement structure of the insert member that has at least one of an upwardly facing engagement surface or a downwardly facing engagement surface is configured to engage a second engagement structure of the pressure member for releasably holding the insert member at at least three distinct axial positions relative to the receiving part.

22. A method of coupling a rod to a bone using a bone anchoring device comprising an anchoring element comprising a head and a shank for anchoring in bone, a receiving part having a first end, a second end below the first end, a central axis extending between the first and second ends, and a coaxial passage extending therethrough, wherein the receiving part is configured to pivotably receive the head such that the anchoring element can assume a plurality of angular positions relative to the receiving part, a pressure member positionable and movable in the passage, an insert member positionable at least partially in the pressure member and movable axially relative to the pressure member between a first position and a second position for exerting an adjustable pressure on the head of the anchoring element to lock the head relative to the receiving part, wherein a first engagement structure of the insert member that has at least one of an upwardly facing engagement surface or a downwardly facing engagement surface is configured to engage a second engagement structure of the pressure member to releasably hold the insert member at the first position against movement towards the second position and to releasably hold the insert member at the second position against movement towards the first position, and a locking member, the method comprising:

anchoring the shank of the anchoring element in bone;

adjusting the angular position of the receiving part relative to the shank when the head is in the receiving part, the pressure member is in the passage, and the insert member is at the first position in the pressure member;

adjusting the insert member to the second position to lock the angular position of the receiving part relative to the shank;

connecting the rod to the receiving part;

inserting the locking member into the receiving part; and

advancing the locking member in the receiving part to lock the rod relative to the receiving part.