An elongate flexible steerable guidewire for facilitating placement of a medical implement is described having a proximal section, an intermediate section, and a distal steerable section. In embodiments the distal steerable section comprises a rotatable swivel member, and an elongate directional tip extending distally from the swivel member. At least one manipulation wire is secured to the swivel member and extends proximally to the proximal section. Axial movement of manipulation wires rotates the swivel member, thereby deflecting the directional tip. An actuator or handle may be incorporated with the guidewire. Methods include placing medical implements in target regions. Exemplary applications include guiding and placement of electrical leads in the spine, and placement of angioplasty devices in the vasculature.
