AUSTRALIA Patents Act COMPLETE SPECIFICATION (ORIGINAL) Class Int. Class Application Number: Lodged: Complete Specification Lodged: Accepted: Published: Priority Related Art: Name of Applicant: Roger P. Jackson Actual Inventor(s): Roger P. Jackson Address for Service and Correspondence: PHILLIPS ORMONDE & FITZPATRICK Patent and Trade Mark Attorneys 367 Collins Street Melbourne 3000 AUSTRALIA Invention Title: POLYAXIAL BONE SCREW WITH SPLINE CAPTURE CONNECTION Our Ref: 841665 POF Code: 451711/471129 The following statement is a full description of this invention, including the best method of performing it known to applicant(s): -1- POLYAXIAL BONE SCREW WITH SPLINE CAPTURE CONNECTION The present application is a divisional application from Australian patent application number 2004254171, the entire disclosure of which is incorporated 5 herein by reference. Background of the Invention The present invention is directed to a polyaxial bone screw for use in spinal surgery and the like and especially to such a screw adapted to receive a 10 rod member and secure the rod member to a vertebra or the like. A reference herein to a patent document or other matter which is given as prior art is not to be taken as an admission that that document or matter was, in Australia, known or that the information it contains was part of the common general knowledge as at the priority date of any of the claims. 15 Many spinal surgery procedures require securing various implants to bone and especially to vertebrae along the spine. For example, elongate rods are often required that extend along the spine to provide support to vertebrae that have been damaged or weakened due to injury, disease or the like. Such rods must be supported by certain vertebra and support other vertebra. One 20 mechanism for providing such structure is to implant bone screws into certain bones which then in turn support the rod or are supported by the rod. Bone screws of this type may have a fixed head relative to a shank thereof. In the fixed bone screws, the head cannot be moved relative to the shank and the rod must be favorably positioned in order for it to be placed within the head. This is 25 sometimes very difficult or impossible to do so polyaxial bone screws can be used. The polyaxial bone screws allow rotation of the head about the shank until a desired rotational position is achieved for the head relative to the shank after which the rod can be inserted and the position of the head eventually locked with respect to movement relative to the shank. 30 Because implants are for placement within the human body, it is desirable for the implant to have as little effect on the body as possible. P:\Useu lle\DDM\2004254171 DMsionaContinualton Oc0.coc 1A Consequently, it is quite desirable for the implants to have a relatively small profile both in height and width. It is also desirable that the implants be lightweight. Furthermore, it is desirable that swivel head implants be unlikely to 5 unintentionally disassemble within the body. It is very undesirable for pieces of the implant to be free to move around within the body after surgery is completed and it also assures that the implant retains an ability to correct the structural problem for which it was implanted. Furthermore, if the implant should slip or become loose for some reason, it is still desirable for all of the parts to remain together and not 10 separate. Consequently, it is desirable for there to be a lightweight, low profile polyaxial bone screw which assembles in such a manner that each subsequent piece locks proceeding pieces within the overall structure, so that there is less likelihood that the 15 various pieces of the structure will undesirably disassemble. Summary of the Invention According to the present invention, there is provided a polyaxial bone screw having a shank and a head, and including: 20 said head having a lower aperture and said shank being sized and shaped so as to allow uploading of an upper portion of said shank through said aperture into said head; and a retaining structure that is non-integral with said shank and loaded separately into said head; said retaining structure mating with and capturing said shank in said head; 25 wherein said retaining structure is secured to the shank and polyaxially pivots with the shank during positioning and wherein a top surface of said shank upper portion extends above said retaining structure so as to directly receive a downward force to lock the shank with respect to the head. 30 According to the present invention, there is also provided a polyaxial bone screw including a head for receiving an implant, a shank and a retaining structure; the shank having a portion that extends into the head during assembly and is captured in the head by the retaining structure, such that the retaining structure is thereafter 2 secured to the shank and polyaxially pivots with the shank during angular positioning of the shank relative to the head and the shank extends substantially above the retaining structure after the shank and retaining structure are joined in the head. 2a The present invention relates to a swivel head type bone screw and, in particular, to a swivel head bone screw having an open head that allows placement of the rod member within the head and then subsequent closure by use of a closure top, plug or the like to capture the rod in the head of the screw. 5 Another arrangement considered by the Applicant comprises a polyaxial bone screw including a head having a channel adapted to receive an elongate rod and having a lower aperture; a shank having a lower portion adapted to be implanted in a bone of a patient and an upper portion; said shank being sized and shaped to be uploaded into said head through said aperture; and said 10 shank upper portion being sized and shaped so as to extend into said channel after said shank is received in said head. Yet another arrangement considered by the Applicant comprises a polyaxial bone screw having a shank and a head with an upward opening rod receiving channel and a lower opening; including said shank being sized and 15 shaped to be loaded upwardly through said head lower opening; said shank being sized and shaped to extend into said channel after being received in said head. Another arrangement considered by the Applicant comprises a polyaxial bone screw and rod assembly including a head having a channel adapted to 20 receive a rod and having a lower aperture; a shank having a threaded lower portion adapted to be implanted in a bone and an upper portion with a first capture structure; said shank upper portion being sized and shaped to be uploaded through said head lower aperture; a retaining structure having a second capture structure that mates with and secures to said first capture 25 structure inside said head; said retaining structure being non integral with said shank; said retaining structure being downloaded from a top of the said head; a rod adapted to be received in said channel; and said shank upper portion further including an upper convex surface sized, shaped and positioned such that when said bone screw is fully assembled and said rod is located in said 30 channel, said convex surface engages said rod to urge said shank into a non moveable configuration relative to said head. P:\U.e ule\DDM\2004254171 Divsionl_Contnu~tIon_OO8.doc 3 Yet another arrangement considered by the Applicant comprises a polyaxial bone screw having a shank and a head having a rod receiving channel; including sizing and shaping said shank to allow uploading of said shank into said head from below and retaining structure non integral with said 5 head and said shank for capturing said shank in said head; said shank extending into said channel after assembly of said shank with said retaining structure. Another arrangement considered by the Applicant comprises a polyaxial bone screw having a shank and a head wherein said head includes a rod 10 receiving channel; further including said shank being sized and shaped to allow for said shank to be uploaded into said head; and said shank having an upper engagement region sized and shaped to project into said channel after said shank is loaded into said head. Yet another arrangement considered by the Applicant comprises a 15 polyaxial bone screw having a shank and a head with a rod receiving channel; including said head having a lower aperture and said shank being sized and shaped so as to allow uploading of an upper portion of said shank through said aperture into said head; and retaining structure that is non integral with said shank and loaded separately into said head; said retaining structure mating with 20 and capturing said shank in said head and forming a combined assembly with said shank; and wherein a portion of said assembly extends into said channel. Yet another arrangement considered by the Applicant comprises a polyaxial bone screw having a shank and a head; including said head having an inner chamber and a lower aperture having a first radius; said shank having an 25 upper portion with a second radius less than said first radius such that said shank upper portion is insertable through said aperture; a retaining structure independent of said head that is sized and shaped to mate with and be secured to said shank upper portion; said retaining structure and said shank upper portion being joined in said head to form an assembly; and a portion of said 30 assembly extending into said channel. Another arrangement considered by the Applicant comprises a polyaxial bone screw having a shank and a head having an inner chamber with a radiused surface and also having a lower aperture and a rod receiving channel; P AUswe HoDM2OW254171 DMs LContrAnOL dd 4 including said chamber surface having a larger radius than said aperture; said shank having an upper portion that has a smaller radius than said aperture to allow said shank to be uploaded through said aperture; a retaining device that loads separately from said shank into said chamber and captures said shank in 5 said chamber so as to form an assembly within said chamber; said retaining device having a lower surface sized and shaped to slidingly mate and rotate with said chamber surface during positioning; and a portion of said assembly extending into said channel. Yet another arrangement considered by the Applicant comprises a 10 method of implanting a bone screw in a patient including the steps of providing a bone screw head having a lower aperture and an implant receiving channel; providing an elongate shank having a lower threaded portion and an upper portion with said upper portion having an implant engagement end; loading said shank upper portion into said head from below and through said aperture; 15 implanting said shank into a bone of a patient; and placing said implant into said channel so that said shank engagement end abuts against said implant, so as to fix the position of said shank relative to said head. Another arrangement considered by the Applicant comprises a method of implanting a bone screw in a patient including the steps of providing a bone 20 screw head having a lower aperture and a rod receiving channel; providing an elongate shank having a lower threaded portion and an upper portion with said upper portion having a rod engagement region; loading said shank upper portion into said head from below through said aperture; capturing said shank inside said head while allowing pivoting of said shank relative to said head; 25 implanting said shank into a bone of a patient; moving said head into a selected angular configuration with respect to said shank; placing said rod into said channel so that said rod engagement region abuts against said rod; installing a closure in said head that closes said channel and biases against said rod so as to bias said rod against said rod engagement region and lock said head in said 30 selected angular configuration relative to said shank. Yet another arrangement considered by the Applicant comprises a method of implanting a polyaxial bone screw in a patient wherein the bone screw has a shank and a head that has a channel adapted to receive a rod; the P:\U6re utie\DOM\2042547 DvionlContinutonOdO8. doc 5 method including uploading said shank into said head so as to be captured therein; providing said shank with an upper engagement end; and positioning said shank upper engagement end in said channel so as to abut against a rod placed within said channel. 5 In a preferred embodiment, there is provided a polyaxial bone screw that includes a shank, a head and a retainer ring that operably cooperate with each other. The bone screw can be designed to allow the shank to be locked or secured in a selected angular configuration with respect to the head, while the head receives a rod member and while the shank is implanted in a bone, such 10 as a vertebra or vertebral body. The shank can have an implant body which includes an external helically wound thread that is in turn attached by a neck to a capture end with a capture or connector type structure. The capture structure can be positioned outside the bone in use and can have a radiused and cylindrically shaped radially outer 15 surface that has at least one radially outwardly extending non helically wound projection or spline thereon. The capture structure can also have an upper axially aligned and radiused dome that protrudes above the remainder of the shank and above the ring during use to manipulate the shank and to contact the rod. Further, in some embodiments the shank can include off axis apertures, 20 grooves, side slots or the like for use by an installation tool with a mating configured head for driving and rotating the shank into the bone. The head preferably has a generally cylindrical shaped profile with an upwardly open U-shaped channel formed therein so as to effectively produce a lower base with two upstanding and spaced arms. The inner surfaces of the 25 arms can have a threadform thereon or another suitable guide and advancement structure such as a helically wound flangeform for use in closing the upper part of the channel. Located in the interior of the base and coaxially aligned with the head, there is preferably a chamber having an interiorly facing partial spherical shaped surface. The chamber can further open onto a bottom 30 surface of the head through a head lower wall bore forming a constricted or restrictive neck which can be sized and shaped to allow passage of the capture structure therethrough. P;\U ui\DDM2004254171 DivialonalCon tnOc .dOC8 6 The retainer ring can include an external partial spherical or hemispherical surface that is sized and shaped to be seated in and slidably engage the partial spherical surface within the head, both having approximately the same radius of generation. The ring can also have an internal, centrally 5 located and axially extending ring bore sized and shaped to receive the capture structure of the shank therethrough. Further, the ring can have a series of axially extending channels positioned about and opening into the central bore that are sized and shaped to allow sliding passage of the shank splines entirely through the ring so that the shank can be inserted through the ring while the 10 ring is positioned within the chamber in the head. The channels are not helically wound about the bore and preferably extend vertically or parallel to the axis of the ring. The ring can further include a set of recesses that are circumferentially spaced from the channels and that open onto the upper part of the ring and into the bore, but do not pass entirely through the ring and that can 15 be entered by the splines by drawing the shank with the splines thereon axially downwardly with respect to the ring. In this manner, the splines can be passed upwardly or uploaded through the ring by sliding through the channels in conjunction with the remainder of the shank capture and after sliding completely through the bore, the shank can then be rotated a certain number of degrees 20 relative to the head, and then drawn back downwardly or downloaded so that the splines encounter and engage the recesses wherein the splines are captured by the ring. The splines preferably have a wedge-shaped surface thereon which pushes not only downwardly, but radially outward against the retainer or capture ring when force is applied to the top of the shank. 25 During assembly, the ring can be placed through the U-shaped channel into the chamber having the partial spherical surface and then rotated so that the ring hemispherical surface mates with and slidably engages the head partial spherical surface. Subsequently, the shank capture structure can then be uploaded into and extended through the ring central bore, while the splines 30 pass through the channels. The shank can then be rotated relative to the ring and then the shank can be moved in an axially reverse direction opposed to uploading while the splines are positioned over the recesses so as to be aligned with the recesses and not aligned with the channels and so that the splines then enter the recesses. The ring with connected shank can effectively thereafter P:\Userue DM\004254171 DMso _Cont1nution Oc1Of8doc 7 form a ball and socket joint with the head and allow free rotation to a selected angular configuration until later locked in the selected configuration. The shank, head and ring can then be placed in a bone by screwing the shank body into the bone using the apertures on the top of the shank or alternative structure such 5 as grooves or faceted surfaces on the outside of the portion of the shank extending above the ring. Thereafter, a rod can be placed in the U-shaped channel and captured therein by closing the channel by use of a closure top or plug having a threadform or other external guide and advancement structure that mates with 10 and advances along mating guide and advancement structure of the arms of the head, when the closure top is rotated. Preferably, the closure top also includes a break-off head that provides purchase for a tool for rotation and torquing of the closure top to a preselected torque and that such torque is transferred and applied as pressure against the rod received in the head. Once the preselected 15 torque is achieved, the break-off head breaks away from the closure top. Under pressure from the closure top, the rod can push against the dome of the shank that extends above the ring and thereby urges the splines downwardly. Because of the wedge shaped structure of the splines, the splines can push both downwardly and outwardly upon the retainer or capture ring, when force is 20 applied to the dome, so as to frictionally engage and positively seat the retaining ring in the cavity and prevent further rotation in conjunction with the shank dome frictionally engaging the rod under pressure. In particular, the hemispherical surface of the ring can abuttingly and frictionally mate with the integral hemispherical interior facing surface of the head, while the dome can 25 frictionally mate with the rod under pressure from the rod so as to lock the shank and ring in a selected angular configuration relative to the head. The shank, in this manner, can be locked in a configuration selected from an infinite number of angular configurations with respect to the head. Advantageously once fully assembled in this manner, unless a part breaks into pieces, the shank 30 cannot disengage from the capture ring and the head without disassembly of the device by reversing the process or breaking the parts. Advantageously, the present invention can provide a polyaxial bone screw having a bone implantable shank that can be locked in a fixed position P:\Us erdulk\D 204254171 Dv nalContnuflon _Oc8 doc 8 relative to a head of the bone screw; can provide such a bone screw having a capture or retaining ring having a partial external hemispherical surface that seats within a partial internal spherical shaped chamber surface within and integrally formed with a head of the bone screw to form a ball and socket joint 5 and wherein the shank is securable to the retaining ring; can provide such a bone screw wherein the shank has at least one spline that extends radially outward from a capture end thereof and wherein the retaining ring has a central bore that receives the capture end while a channel opening into the bore allows the spline to slide through the ring so as to pass above the ring, at which time 10 the shank can be rotated a select number of degrees and further wherein the retaining ring has a capture recess that receives the spline on further downward or reverse movement along the axis of the shank relative to the retainer ring; can provide such a bone screw wherein the shank has an upwardly protruding radiused dome which has a radius that in one embodiment is substantially less 15 than the radius of the external hemispherical surface on the retainer ring and that extends upwardly within the head chamber so as to reduce height of the screw head and further, is operably positioned so as to engage a rod member received in the head so as to receive downward pressure from the rod during assembly; can provide such a bone screw wherein a closure top is used to 20 close a channel in the bone screw head after receiving the rod and to apply pressure to the rod member that in turn, exerts pressure on the dome of the shank so as to urge each spline into an abutting and tight relationship with the retaining ring and to urge the retaining ring both downwardly and radially outwardly, so that the external hemispherical surface on the retaining ring more 25 completely contacts and frictionally engages the internal spherical surface within the chamber of the head thereby providing improved mechanical fixation to prevent further rotation of the shank relative to the head; can provide such a bone screw which has a comparatively low profile and which is comparatively light in weight; can provide such a bone screw that resists disassembly thereof 30 except by removal of the closure top; can provide such a bone screw wherein the closure top can be removed by the surgeon should disassembly be desired at which time the entire structure can be easily and quickly disassembled and removed from the bone, if necessary; can provide such a bone screw wherein the shank is locked in position relative to the head during usage in a locked or P:\UseAuie\DDM\20042547 DMionaI_Continuation_Oc 8.doc 9 fixed configuration; can provide such a bone screw wherein the shank cannot disassemble from the head and the retaining ring once the screw is fully assembled except if the closure top is removed and the device is disassembled by the surgeon; can provide such a bone screw which is easy to use and 5 extremely effective for the intended usage thereof. Other objects and advantages of this invention will become apparent from the following description taken in conjunction with the accompanying drawings wherein are set forth, by way of illustration and example, certain embodiments of this invention. 10 The drawings constitute a part of this specification and include exemplary embodiments of the present invention and illustrate various objects and features thereof. Brief Description of the Drawings 15 Fig. 1 is an exploded perspective view of three elements of a polyaxial bone screw, including a shank, a head, and a retaining ring. Fig. 2 is an enlarged top plan view of the retaining ring. Fig. 3 is an enlarged perspective view of the retaining ring. 20 Fig. 4 is an enlarged side elevational view of the retaining ring. Fig. 5 is an enlarged bottom plan view of the retaining ring. Fig. 6 is an enlarged cross-sectional view of the head, taken along line 6-6 of Fig. 1, illustrating the retaining ring being inserted into the head. Fig. 7 is an enlarged cross-sectional view of the head similar to Fig. 6, 25 showing the retaining ring seated in the head. Fig. 8 is a cross-sectional view of a vertebra illustrating the shank implanted therein. Fig. 9 is an enlarged and fragmentary perspective view of the shank, head and retainer ring during assembly and just prior to the retainer ring being 30 placed over the shank. Fig. 10 is an enlarged, fragmentary and perspective cross-sectional view of the head similar to Fig. 6, illustrating splines on a capture end of the shank P:\USerLi\DDM\2042A171 Divson_Contiuto_Oct.o 1 0 that have been inserted through channels in the retainer ring and are positioned upwardly in the head above the retainer ring. Fig. 11 is a cross-sectional view of the head, similar to Fig. 10, showing the upper capture end of the shank with the splines lowered into receiving 5 recesses in the ring and positioned therein. Fig. 12 is a cross sectional view of the head and a top plan view of the shank and ring corresponding to the positioning shown in Fig. 10. Fig. 13 is a cross sectional view of the head and a top plan view of the shank and ring corresponding to the positioning shown in Fig. 11. 10 Fig. 14 is a side elevational view of the head, ring and shank, illustrating the shank swinging or rotating from one position shown in solid lines to a second position shown in phantom lines. Fig. 15 is a fragmentary and partially exploded view of a complete polyaxial bone screw assembly, prior to final assembly and illustrating a rod 15 received in the head and a closure top with a break-off head, prior to the closure top being rotatably inserted into the head. Fig. 16 is a fragmentary and enlarged front elevational view of the bone screw assembly fully assembled and illustrating the head with the rod received therein and with the closure top fully inserted and biasing against the rod that in 20 turn biases against the top of the shank. Fig. 17 is an enlarged and fragmentary cross-sectional view of the bone screw assembly with rod inserted therein, taken along line 17-17 of Fig. 16. Fig. 18 is an enlarged cross-sectional view of the vertebra, head, rod and closure top, taken along line 18-18 of Fig. 17 showing the shank implanted 25 in the vertebra and with the bone screw assembly in a completely assembled and operational configuration with the shank locked in an angled orientation with respect to the head. Fig. 19 is a perspective view of a modified retainer ring of a first modified embodiment. 30 Fig. 20 is a perspective view of a second modified embodiment illustrating a cannulated shank having four splines and a hex tool engageable head for manipulating the shank. Fig. 21 is a perspective view of a ring for use in accordance with the second modified embodiment and the shank of Fig. 20. P:\UseNW ioDMO2 4254171 DivisionlContinuaton_Oc08 doc 1 Detailed Description of the Invention As required, detailed embodiments of the, present invention are disclosed 5 herein; however, it is to be understood that the disclosed embodiments are merely exemplary of the invention, which may be embodied in various forms. Therefore, specific structural and functional details disclosed herein are not to be interpreted as limiting, but merely as a basis for the claims and as a representative basis for teaching one skilled in the art to variously employ the 10 present invention in virtually any appropriately detailed structure. The reference number 1 generally represents a polyaxial bone screw apparatus or assembly in accordance with the present invention operably utilized by implantation into a vertebra 2 and in conjunction with a longitudinal member or rod 3 so as to operably secure the rod 3 in a fixed position relative 15 with respect to the vertebra 2. The fully assembled bone screw assembly 1 includes a shank 6, a head 7, a retainer ring 8 and a closure top 9. The shank 6 is perhaps best seen in Figs. 1 and 8. The shank 6 is elongate and has a lower body 15 ending in a tip 16. The shank body 15 has a helically wound bone implantable thread 17 20 extending from near the tip 16 to near the top 18 of the body 15 and extending radially outward therefrom. During use, the body 15 utilizing the thread 17 is implanted into the vertebra 2, as is seen in Fig. 18. The shank 6 has an elongated axis of rotation generally identified by the reference letter A. It is noted that the reference to the words top and bottom as used herein refers to 25 the alignment shown in the various drawings, as well as the normal connotations applied to such devices, and is not intended to restrict positioning of the assembly 1 in actual use. Axially extending outward and upward from the shank body 15 is a neck 20 of reduced radius as compared to the adjacent top 18 of the body 15. 30 Further extending axially and outwardly from the neck 20 is a capture end or structure 21 operably providing a connective or capture structure free from the bone or vertebra 2 for joining with the head 7. The capture structure 21 has a radially outer cylindrical surface 22. The cylindrical surface 22 has at least one non-helically wound and radially outward extending projection or spline 24 that P.\UewUuio\DDM\204254171 DMonalContnuva1b_OctO8.doc 12 extends beyond the surface 22. In the embodiment shown in Figs. 1 through 18, the capture structure 21 has three such splines 24. The splines 24 are located near an upper end 25 of the shank 6 and are equally circumferentially centered and spaced thereabout so as to be centered at approximately 120 5 degree intervals relative to each other. Each of the splines 24 has a triangular shaped profile and a front wedge forming face 27 that slopes downwardly and radially inwardly from near the upper end 25 of the shank 6. Also located on the shank upper end 25 is a centrally located, axially extending and upwardly directed projection or dome 29 that is centrally radiused so as to have a first 10 radius. The shank upper end 25 still further includes at least one tool engagement aperture for engagement by a tool driving head (not shown) that is sized and shaped to fit into the apertures for both driving and rotating the shank 6 into the vertebra 2. In the illustrated embodiment, a pair of apertures 31 15 located in spaced relationship to each other, the dome 29 and the shank axis of rotation A are located on the shank upper end 25. The apertures 31 extend into the shank capture structure 21 parallel to the axis A. It is foreseen that various numbers of apertures, slots or the like may be utilized in accordance with the invention for engaging the driving tool of suitable and similar mating shape, or 20 that the outer surface of the upper axial projection can be grooved or formed with a faceted surface that can be driven by a mating tool that goes over the surface. The head 7 has a generally cylindrical shaped profile, as is seen in Fig. 1, although the head 7 is not a solid cylinder. The head 7 has a base 33 with a 25 pair of upstanding arms 34 and 35 forming a U-shaped channel 38 between the arms 34 and 35 with a lower seat 39 having substantially the same radius as the rod 3 for operably snugly receiving the rod 3. Each of the arms 34 and 35 has an interior surface 41 that includes a partial helically wound guide and advancement structure 42. In the illustrated embodiment, the guide and 30 advancement structure 42 is a partial helically wound flangeform which will mate under rotation with a similar structure on the closure top 9, as described below. However, it is foreseen that the guide and advancement structure 42 could alternatively be a V-shaped thread, a buttress thread, a reverse angle thread or other thread like or non-thread like helically wound advancement P:Use\udle\DDM\2004254171 DvsnaConiutioMO ct8.doc 13 structures for operably guiding under rotation and advancing the closure top between the arms 34 and 35. Tool engaging apertures 44 are formed on the outsides of the arms 34 and 35 for holding the head 7 during assembly. A chamber or cavity 47 is located within the head base 33 that opens 5 upwardly into the U-shaped channel 38. The cavity 47 includes a partial spherical shaped surface 48, at least a portion of which forms a partial internal hemispherical seat 49 for the ring 8, as is described further below. A bore 52 further communicates between the cavity 47 and the bottom exterior of the base 33 and is coaxial with a rotational axis B of the head 7. The bore 52 at least 10 partially defines a restrictive neck 54 that has a radius which is smaller than the radius of the ring 8, as will be discussed further below, so as to form a restrictive constriction at the location of the neck 54 relative to the retainer ring 8 to prevent the ring 8 from passing between the cavity 47 and the lower exterior of the head 7. A bevel 55 extends between the neck 54 and the bottom exterior 15 of the base 33. The hemispherical shaped surface 48 has a second radius associated therewith. The retainer ring 8 which is best seen in Figs. 2 through 5 has an operational central axis which is the same as the elongate axis A associated with the shank 6, but when the ring 8 is separated from the shank 2, the axis of 20 rotation is identified as axis C, such as in Fig. 4. The retainer ring 8 has a central bore 57 that passes entirely through the retainer ring 8 from a top surface 58 to a bottom surface 59 thereof. The bore 57 is sized and shaped to fit snugly but slidably over the shank capture structure cylindrical surface 22 in such a manner as to allow sliding axial movement therebetween under certain 25 conditions, as described below. Three axially aligned channels 60 are spaced from the axis C and extend radially outward from the bore 57 and into the wall of the retainer ring 8 so as to form three top to bottom grooves or slots therein. Backs 61 of the channels 60 are the same radial distance from the axis C as the distance the outermost portion of the splines 24 extend from the axis A of the 30 shank 6. The channels 60 are also circumferentially angularly spaced equivalent to and have a width that corresponds with the splines 24. In this manner, the shank capture structure 21 can be uploaded into the ring 8 by axially sliding the capture structure 21 through the ring central bore 57 P:\eUserul\OM\2004254171Dvisionai Continutio.OOt.doc 14 whenever the splines 24 are aligned with the channels 60 or are in an aligned configuration, as seen in Fig. 12. The retainer ring 8 also has three capture partial slots, receivers or recesses 62 which extend radially outward from the upper part the bore 57 and 5 that do not extend the entire length from top to bottom of the retainer ring 8, but rather only open on the top surface 59 and extend partly along the height of the ring 8 thereof. The recesses 62 are sized and positioned and shaped to receive the splines 24 from above when the splines 24 are in a non-aligned configuration relative to the channels 60. That is, each of the recesses 62 has a 10 width that approximates the width of the splines 24 and has a mating wedge engaging surface 64 that is shaped similar to the spline wedge forming faces 27, so that the splines 24 can be slidably received into the recesses 62 from above by axially translating or moving the shank 6 downward relative to the ring 8 when the splines 24 are positioned above the recesses 62 in a recess aligned 15 configuration. In some embodiments, the wedge engaging faces 64 slope slightly greater than the wedge forming faces 27 on the splines 24 so that there is additional outward wedging that takes place when the splines 24 are urged downwardly into the recesses 62, as further discussed below. 20 In this manner the shank capture structure 21 can be uploaded or pushed upwardly through the retainer ring central bore 57 so as to clear the top 58 of the retainer ring 8, rotated approximately 60 degrees and then downloaded or brought downwardly so that the splines 24 become located and captured in the recesses 62. Once the splines 24 are seated in the recesses 62 25 the shank 6 cannot move further axially downward relative to the ring 8. Preferably, the retainer ring 8 is constructed of a metal or other material having sufficient resilience and elasticity as to allow the ring 8 to radially expand slightly outward by downward pressure of the splines 24 on the recesses 62 under pressure from structure above, as will be discussed further below. This 30 produces a slight outward radial expansion in the ring 8 at the location of the recesses 62. The ring 8 has a radially outer partial hemispherical shaped surface 65 sized and shaped to mate with the partial spherical shaped surface 48 and having a third radius approximately equal to the second radius associated with P:UseUulieDDM\204254171 Ovsional_ContinuaiO08 doc 15 the surface 48. The ring third radius is substantially larger than the first radius associated with the dome 29 and also substantially larger than the radius of the neck 54. The longitudinal member or elongate rod 3 can be any of many different 5 types of implants utilized in reconstructive spinal surgery and the like, but is normally a cylindrical elongate structure having a cylindrical surface 66 of uniform diameter. The rod 3 is preferably sized and shaped to snugly seat near the bottom of the U-shaped channel 38 and, during normal operation, will be positioned slightly above the bottom of the channel 38. In particular, the rod 3 10 normally engages the shank dome 29, as is seen in Fig. 16 and urges the dome 29 and, consequently, the shank 6 downwardly when the entire assembly 1 is fully assembled. The closure top 9 can be any of the variety of different types of closure tops for use in conjunction with the present invention with suitable mating 15 structure on the upstanding arms 34 and 35. The illustrated closure top 9 has a generally cylindrical shaped base 67 with an upwardly extending break-off head 68. The base 67 includes a helically wound guide and advancement structure 71 that is sized, shaped and positioned so as to engage the guide and advancement structure 42 on the arms 34 and 35 to allow the closure top 9 to 20 be rotated into the head 7 and, in particular, to close the top of the U-shaped channel 38 to capture the rod 3, see Fig. 16, preferably without splaying of the arms 34 and 35. The closure top 9 also operably biases against the rod 3 by advancement and applying pressure to the rod 7 under torquing, so that the rod 3 is urged downwardly against the shank dome 29. Downward biasing of the 25 shank dome 29 operably produces a frictional engagement between the rod 3 and dome 29 and also urges the splines 24 downwardly to both bias downwardly and radially outwardly against the retainer ring 8, so as to snugly and frictionally seat the retainer ring external hemispherical surface 65 into and quite tightly against the partial internal spherical surface 48 of the head 7 and 30 further so as to lock the shank 6 and retainer ring 8 in a fixed position relative to the head 7. The closure top break-off head 68 is secured to the base 67 at a neck 73 that is sized and shaped so as to break away at a preselected torque that is designed to properly seat the retainer ring 8 in the head 7. The break-off head P:WseANulle\DDM\2004254171 DivionalCoanb dion_OdM oc 1 6 68 includes an external faceted surface 75 that is sized and shaped to receive a conventional socket head of a driving tool (not shown) to rotate and torque the closure top 9. The break-off head 68 also includes a central bore 77 and grooves 78 for operably receiving the manipulating tools. 5 The closure top 9 also includes removal structure including a pair of off axis pass through apertures 81 that extend from top to bottom of the base 67. The apertures 81 are located parallel to an axis of rotation axis D of the closure top 9, but are radially spaced away therefrom. The apertures 81 become accessible from the top of the base 67 after the break-off head 68 breaks away 10 from the base 67, as is seen in Fig. 18. The apertures 81 are designed to receive a tool having a face that mates with and is insertable into the apertures 81 for rotating the closure top base 67 subsequent to installation so as to provide for removal, if necessary. While the embodiment illustrated in Figs. 1 through 18 includes three 15 splines 3, it is foreseen that a shank 6 with a single spline would be operable within the scope of the invention. However, in some embodiments additional splines 3 may provide a more even distribution of force upon the ring 8 and reduce the likelihood of failure because of hoop strain or the like. Paired and opposed splines in certain embodiments may provide a more even distribution 20 of forces. While any number of splines are foreseen as possible for use under the present invention, the requirement that the splines must get smaller as their number gets larger, limits the maximum number at some point. However, the concept appears viable until that point is reached. It is also noted that additional channels and recesses allow the ring to be more elastic in certain 25 embodiments. When the polyaxial bone screw assembly 1 is placed in use in accordance with the invention the retainer ring 8 is normally first slid through the head U-shaped channel 38, as is shown in Fig. 6, and into and seated in the chamber 47, as is seen in Fig. 6. Thereafter, the retainer ring 8 is rotated 90 30 degrees so as to be coaxial with the head 7 and so that the retainer ring outer surface 65 snugly but slidably mates with the head interior spherical shaped surface 48, as is seen in Fig. 7. With reference to Figs. 9, 10, and 12 the ring 8 in the head 7 is slid over the shank capture structure 21 so that the splines 24 slide upwardly through P:UsaJui\DDM\20042t4171 DMionlContinuaton_OcO8 o 1 7 and above respective channels 60 so that the splines 24 are then located, at least partially, in the U-shaped channel 38 and chamber 47 above the retainer ring 8, as is shown in Fig. 10. The shank 6 is then rotated 60 degrees relative to the head about the axis A and the translational direction of the shank 6 is 5 reversed so that it goes downwardly or axially with respect to the head 7, as is seen in Figs. 11 and 13 and the splines 24 enter the recesses 62. At this point there is no substantial outward or downward pressure on the retainer ring 8 and so the retainer ring 8 is easily rotatable along with the shank 6 within the chamber 47 and such rotation is of a ball and socket type limited by 10 engagement of the shank neck 20 with the ring restrictive neck 54. Rotation is shown in Fig. 14 where it is illustrated that the shank 6 can be rotated through a substantial angular rotation relative to head 7, both from side to side and from front to rear so as to substantially provide a universal or ball joint wherein the angle of rotation is only restricted by engagement of the neck 20 with the neck 15 54 on the head 7. The assembly 1 is then normally screwed into a bone, such as vertebra 2, by rotation of the shank 6 using a suitable driving tool (not shown) that operably drives and rotates the shank 6 by engagement thereof at the apertures 31. The relative position of the shank 6 is shown in Fig. 8 with a phantom 20 vertebra 2. Normally, the head 7 and ring 8 are assembled on the shank 6 before placing the shank 6 in the vertebra 2, but in certain circumstances, the shank 6 can be first implanted with the capture structure 21 extending proud to allow assembly and then the shank 6 can be further driven into the vertebra 2. A rod 3 is eventually positioned within the head U-shaped channel 38, as 25 is seen in Fig. 15, and the closure top 9 is then inserted into and advanced between the arms 34 and 35 so as to bias or push against the rod 3. The break-off head 68 of the closure top 9 is torqued to a preselected torque, for example 90 inch pounds, to urge the rod 3 downwardly. The shank dome 29, because it is radiused and sized to extend upwardly into the U-shaped channel 30 38, is engaged by the rod 3 and pushed downwardly when the closure top 9 pushes downwardly on the rod 3, as is seen in Fig. 16. The downward pressure on the shank 6 in turn urges the splines 24 downwardly which exerts both a downward and outward thrust on the retainer ring 8, as is seen in the configuration shown in Fig. 17. The polyaxial bone screw assembly 1 including P:\UserUue\DDM\2004254171 DvsinaComni _OcIO8.doc 18 rod 3 and shown positioned in a vertebra 2 is illustrated in Fig. 18. The axis A of the bone screw shank 6 is illustrated as not being coaxial with the axis B of the head 7 and the shank 6 is locked in this angular locked configuration. Other angular configurations can be achieved, as required during installation surgery 5 due to positioning of the rod 3 or the like. If removal of the assembly 1 is necessary, the assembly 1 can be disassembled by using a driving tool mating with the closure top apertures 81 to rotate the base 67 and reverse the advancement thereof in the head 7 and then disassembly of the remainder of the assembly 1 in reverse mode in comparison 10 to the procedure described above for assembly. Illustrated in Fig. 19 is a second embodiment of a retainer ring 88 in accordance with the present invention. The retainer ring 88 is quite similar to the retainer ring 8 of the previous embodiment except that it is noncontinuous and has a radially extending space or gap 90 from top to bottom along one side 15 thereof. The gap 90 allows for expansion without requiring stretching of the material of construction of the ring 88, as is the case with the previous embodiment. The ring 88 includes a central bore 92, spline channels 93 and spline receivers 94 which are all similar to the similar structures described for the previous embodiment. The retainer ring 88 also has a partial hemispherical 20 shaped surface 95 on the outer side thereof. Illustrated in figures 20 and 21 are elements of a third embodiment of the present invention including a shank 106 and a capture ring 107 which are used otherwise in the same manner as has been described in the first embodiment and, in particular, with a head such as head 7 which is not further described 25 herein. The shank 106 is similar to the shank 6 in that it has a body 110 with a helically round thread 111 thereon and a capture structure 114 joined to the body 110 by a neck 115. The principle differences between the present embodiment and the first embodiment is that the capture structure 114 includes four splines 120 that are similar in shape to the splines 24 of the first 30 embodiment, but the splines 120 are centered and located at 90 degrees from one another such that there is a pairing of opposed splines 120 and the dome of the prior embodiment is replaced with an axial extension 122. Each of the splines 120 includes a wedge face 121. The extension 122 has a faceted surface 123 that extends parallel to the axis of the shank 106 and that is sized P:\UseWrJulDDM\2004254171 DvisonConiuto Oi0A.oc 1 9 and shaped to receive a hex head driving tool (not shown) for driving the shank 106 into bone. The extension 123 also has a radiused upper surface 124. The shank 106 also has an axial extending cannulation or bore 125 that extends entirely through the length of the shank 106. 5 The capture ring 107, shown in Fig. 21, is otherwise similar to the retainer ring 8 except that it includes a set of four channels 126 and four recesses 127 that are sized shaped and positioned so as with respect to the channels 126 to allow the splines 120 to slidingly pass upwardly through and with respect to the recesses 127 to capture and receive the splines 120, as they 10 move axially downwardly. The ring 107 has a partial hemispherical outer surface 129 that mates with the corresponding surface in the head 7 in the manner described for the first embodiment. It is to be understood that while certain forms of the present invention have been illustrated and described herein, it is not to be limited to the specific 15 forms or arrangement of parts described and shown. PAUseP\JulieDDM20O4254171 Dsonl_ContnaionOcO o 20