A screw driving instrument is provided with a stylet holder able to retain a head of a stylet at one of multiple discrete locations. A user may vary a distance that a point of the stylet extends from a distal end of the instrument by choosing which of the discrete locations to insert the stylet head into before coupling the stylet holder to the instrument. The instrument may include a ratcheting handle capable of rotation in one direction about a central axis of the instrument relative to other components of the instrument. The stylet holder may be engageable with the handle.