A polyaxial screw assembly includes a pedicle screw, a coupling, an insert, and a housing. The pedicle screw includes a shank having a helical thread formed thereon and a head at one end. The coupling is positioned on top the pedicle screw and releasably engages portions of the head. The coupling and pedicle screw are positioned within a distal portion of the housing. The pedicle screw is slid through an opening in the insert and the insert is thread into the distal portion of the housing to retain the coupling and the pedicle screw within the housing. The pedicle screw is rotatable and pivotable relative to the housing. Compressing the coupling within the housing locks the pedicle screw in a desired orientation.