Abstract: Alignment apparatuses, methods, and systems for positioning guidewire insertion devices into a patient's vertebrae. The alignment apparatus can facilitate insertion of a guidewire insertion device through a stab incision made in a patient's skin and into target vertebrae of the patient in a spinal fixation procedure. The apparatus may comprise a housing having at least one opening. The housing can be positionable against the patient's skin proximate to the target vertebrae. The opening may be configured to receive the guidewire insertion device so that it directs the advancement of the guidewire insertion device through the opening and the stab incision.