A guide device is provided for use with a spinal fixation element that has at least one pair of thru bores formed therein. The guide device generally includes an elongate shaft having a proximal end and a distal end. A guide member is coupled to the distal end of the elongate shaft and it includes at least one pathway extending therethrough, and at least one alignment element that is positioned distal of the guide member. Each alignment element(s) is adapted to interact with a spinal fixation element to position the guide member with respect to the spinal fixation element such that the each pathway in the guide member is aligned with a corresponding thru bore formed in the spinal fixation element. The guide member can then be used to guide tools, devices, and/or implants through each pathway in the spinal fixation element and into bone.