Embodiments of a geared 
spinal implant inserter-distractor disclosed herein provide a greater 
mechanical advantage in delivering an intervertebral 
implant via an anterior, anterior-lateral, or 
posterior approach. The geared 
spinal implant inserter-distractor comprises an inserter, a distractor structured to slidably receive the inserter with a collar and an intervertebral 
implant attached thereto, and a gear mechanism arranged to translate a surgeon's rotational motion into 
linear motion, allowing the surgeon to have a greater control and feedback when placing an 
implant within an 
intervertebral disc space. The gear arrangement comprises a 
pinion inside the distractor and a rack on the inserter. The 
pinion can be driven by a shaft connected to a knob or 
handle. With the gear mechanism, a surgeon can turn the knob or 
handle to drive the inserter in and out of the distractor in a quantifiable manner, which facilitates the desirable precision delivery of the intervertebral implant.