A bone anchor assembly comprising: a bone anchor having a proximal head and a distal shaft configured to engage bone, a receiver member for receiving a spinal rod to be coupled to the bone anchor, the receiver member having a proximal end having a pair of spaced apart arms (42A, 42B) defining a recess therebetween, a distal end having a distal end surface defining an opening through which at least a portion of the bone anchor extends, a bearing positioned in the distal end of the receiver member, the bearing having a proximal end (62A, 62B) defining a U-shaped seat for receiving the spinal rod and a distal end (64A, 64B) positioned about the proximal head of the bone anchor, the distal end having a distal opening that aligns with the distal opening in the distal end of the receiver member, at least a portion of the bone anchor extending through the distal opening in the bearing and the distal opening in the distal end of the receiver member, at least a portion of the distal end of the bearing interposed between the proximal head of the bone anchor and the distal end surface of the distal end of the receiver member, an insert positioned in the proximal end of the receiver member, the insert having a pair of spaced apart insert arms (28A, 28B) defining a U-shaped recess therebetween, the recess being sized and shaped to receive the spinal rod, each insert arm aligned with and positioned against an interior surface of a respective arm of the receiver member and including an internal thread on an interior surface of the arm and an annular shaped distal end, the annular shaped distal end being positioned about a portion of the bearing and engaging the bearing when the spinal rod is fixed to the receiver member, and a set screw positionable between and engaging the internal thread of the insert arms to capture the spinal rod within the recess of the insert and fix the spinal rod with respect to the receiver member. a bone anchor having a proximal head and a distal shaft configured to engage bone, a receiver member for receiving a spinal rod to be coupled to the bone anchor, the receiver member having a proximal end having a pair of spaced apart arms (42A, 42B) defining a recess therebetween, a distal end having a distal end surface defining an opening through which at least a portion of the bone anchor extends, a proximal end having a pair of spaced apart arms (42A, 42B) defining a recess therebetween, a distal end having a distal end surface defining an opening through which at least a portion of the bone anchor extends, a bearing positioned in the distal end of the receiver member, the bearing having a proximal end (62A, 62B) defining a U-shaped seat for receiving the spinal rod and a distal end (64A, 64B) positioned about the proximal head of the bone anchor, the distal end having a distal opening that aligns with the distal opening in the distal end of the receiver member, at least a portion of the bone anchor extending through the distal opening in the bearing and the distal opening in the distal end of the receiver member, at least a portion of the distal end of the bearing interposed between the proximal head of the bone anchor and the distal end surface of the distal end of the receiver member, an insert positioned in the proximal end of the receiver member, the insert having a pair of spaced apart insert arms (28A, 28B) defining a U-shaped recess therebetween, the recess being sized and shaped to receive the spinal rod, each insert arm aligned with and positioned against an interior surface of a respective arm of the receiver member and including an internal thread on an interior surface of the arm and an annular shaped distal end, the annular shaped distal end being positioned about a portion of the bearing and engaging the bearing when the spinal rod is fixed to the receiver member, and a set screw positionable between and engaging the internal thread of the insert arms to capture the spinal rod within the recess of the insert and fix the spinal rod with respect to the receiver member.