20. A medical implant assembly comprising: a) first and second bone anchors cooperating with a longitudinal connecting member having a central core, each of the first and second bone anchors having: i) a receiver with inner surfaces and a first pair of opposed upstanding arms; and iii) an insert positioned within a respective receiver and having an insert channel formed by a second pair of upstanding arms; b) a sleeve for attachment to the first bone anchor having a first end and a second end, the sleeve being positionable between the inner surfaces of the first pair of opposed upstanding arms of a respective bone anchor receiver and having an elongate solid rod portion on and extending from the second end of the sleeve, and a longitudinal bore extending into a sleeve body and a central extension on the sleeve first end for receiving the central core therethrough, the sleeve body including first and second body portions, the first body portion sized and shaped for being closely received within the insert channel and the second body portion being sized and shaped to be received between the first pair of opposed upstanding arms of the respective bone anchor receiver, the second body portion also engaging top surfaces of the second pair of upstanding arms of a respective insert; and c) a spacer engages the central extension.
20. A medical implant assembly comprising: a) first and second bone anchors cooperating with a longitudinal connecting member having a central core, each of the first and second bone anchors having: i) a receiver with inner surfaces and a first pair of opposed upstanding arms; and iii) an insert positioned within a respective receiver and having an insert channel formed by a second pair of upstanding arms; b) a sleeve for attachment to the first bone anchor having a first end and a second end, the sleeve being positionable between the inner surfaces of the first pair of opposed upstanding arms of a respective bone anchor receiver and having an elongate solid rod portion on and extending from the second end of the sleeve, and a longitudinal bore extending into a sleeve body and a central extension on the sleeve first end for receiving the central core therethrough, the sleeve body including first and second body portions, the first body portion sized and shaped for being closely received within the insert channel and the second body portion being sized and shaped to be received between the first pair of opposed upstanding arms of the respective bone anchor receiver, the second body portion also engaging top surfaces of the second pair of upstanding arms of a respective insert; and c) a spacer engages the central extension. 25. The medical implant assembly of claim 20 , wherein the tensioned cord extends through the spacer through an off axis through bore, the off axis through bore being spaced from a central point on a side of the spacer.