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.