The present invention includes pin guides and methods for placing pins in adjacent vertebrae. The present invention also includes methods for placing pins in adjacent vertebrae using the pin guides described herein. The present invention also includes an intervertebral implant insertion and alignment instrument, a distraction instrument, an intervertebral implant insertion guide, and methods for inserting an implant into an intervertebral space. Despite existing tools and techniques, present positioning of implants in intervertebral spaces and pins in adjacent vertebrae often depend on a surgeon's skill, experience and technique. Practice of the present invention can aide in the placement of an implant into an intervertebral space and placement of pins in adjacent vertebrae, e.g., midline to the coronal plane spine and / or parallel to vertebral endplates that abut the intervertebral space.