An improved apparatus for maintaining spinal elements in a desired spatial relationship includes a plate and a fastener having a first threaded end portion for engaging a spinal element, a second threaded end portion and a seat portion. The seat portion of the fastener is received in a recess of a plate. The plate has an elongated slot for receiving the fastener that extends along one side of the longitudinal axis of the plate. A circular opening for receiving another fastener is located on the other side of the longitudinal axis and adjacent the slot. The slot extends through the plate in a first direction and the circular opening extends through the plate in a second direction at an angle to the first direction. The slot is defined by opposed slot surfaces extending longitudinally of the plate and arcuate recesses in the opposed slot surfaces and spaced therealong. The recesses in the opposed slot surfaces define a plurality of locations for receiving the fastener. The plurality of locations have centers that are offset from the center of the circular opening. A nut threadably engages the first fastener and engages the arcuate recesses in the opposed slot surfaces to clamp the plate between the seat portion of the fastener and the nut.