A spinal fixation system includes an elongated rod sized to extend between at least two vertebrae and a number of anchor devices for anchoring the rod to the spine. The anchor devices include a bone engaging fastener having a head defining a spherical socket. A ball insert is configured to be placed within the socket and rotated so that a spherical surface of the ball insert is juxtaposed with the spherical surface of the socket. The insert has a first dimension less than the socket opening and a second dimension that upon rotation causes the insert to be captively retained in the socket. The anchor device further includes a yoke defining a yoke channel for receiving the rod and including a stem that is engaged to the ball insert when the insert is captured within the socket. A sleeve is disposed between the yoke channel and the fastener head for supporting the rod thereon. A set screw is threaded into the yoke channel for clamping the rod against the sleeve. The set screw further operates to draw the ball insert into clamped engagement within the socket.