A spinal implant (200, 300) to be placed into a disc space by a clinician using an insertion instrument proximal of the implant, the implant having a proximal region (200a, 300a) and a distal region (200b, 300b), the spinal implant comprising: an upper body (210, 310) including an outer surface (216, 316) and an inner surface (218, 324); a lower body (230, 330) including an outer surface (236, 336) and an inner surface (238, 340), the inner surfaces of the upper and lower bodies disposed in opposed relation relative to each other; a proximal adjustment assembly (250, 350) disposed between the upper and lower bodies at the proximal region of the spinal implant and adjustably coupled to the upper and lower bodies; and a distal adjustment assembly (270, 370) disposed between the upper and lower bodies at the distal region of the spinal implant and adjustably coupled to the upper and lower bodies, wherein the proximal and distal adjustment assemblies are independently movable when the implant is in the disc space, to change a vertical height of at least one of the proximal region or the distal region of the spinal implant, and wherein the distal adjustment assembly includes a pivot linkage assembly (275, 375) including an upper pivot linkage (276, 376) pivotably connected (253, 351) to the inner surface of the upper body and a lower pivot linkage (278, 378) pivotably connected (255, 353) to the inner surface of the lower body, the upper and lower pivot linkages pivotably connected (257, 357) to each other and movable with respect to each other to change the vertical height of the distal region of the spinal implant, characterized in that the distal adjustment assembly further includes a threaded post (272, 372), wherein axial movement of the threaded post effects movement of the upper and lower pivot linkages with respect to each other, and wherein a distal end of the threaded post is movable into and out of contact with the pivot linkage assembly, and the distal adjustment assembly further includes an expander (274, 374) including a body portion (280, 380) defining a cavity (280a, 380a) therein and a distal end including a double ramped inner surface (280c, 380c), wherein the pivot linkage assembly extends through the cavity of the expander such that the upper and lower pivot linkages contact the double ramped inner surface of the expander when moved by the threaded post. an upper body (210, 310) including an outer surface (216, 316) and an inner surface (218, 324); a lower body (230, 330) including an outer surface (236, 336) and an inner surface (238, 340), the inner surfaces of the upper and lower bodies disposed in opposed relation relative to each other; a proximal adjustment assembly (250, 350) disposed between the upper and lower bodies at the proximal region of the spinal implant and adjustably coupled to the upper and lower bodies; and a distal adjustment assembly (270, 370) disposed between the upper and lower bodies at the distal region of the spinal implant and adjustably coupled to the upper and lower bodies, wherein the proximal and distal adjustment assemblies are independently movable when the implant is in the disc space, to change a vertical height of at least one of the proximal region or the distal region of the spinal implant, and wherein the distal adjustment assembly includes a pivot linkage assembly (275, 375) including an upper pivot linkage (276, 376) pivotably connected (253, 351) to the inner surface of the upper body and a lower pivot linkage (278, 378) pivotably connected (255, 353) to the inner surface of the lower body, the upper and lower pivot linkages pivotably connected (257, 357) to each other and movable with respect to each other to change the vertical height of the distal region of the spinal implant, characterized in that the distal adjustment assembly further includes a threaded post (272, 372), wherein axial movement of the threaded post effects movement of the upper and lower pivot linkages with respect to each other, and wherein a distal end of the threaded post is movable into and out of contact with the pivot linkage assembly, and the distal adjustment assembly further includes an expander (274, 374) including a body portion (280, 380) defining a cavity (280a, 380a) therein and a distal end including a double ramped inner surface (280c, 380c), wherein the pivot linkage assembly extends through the cavity of the expander such that the upper and lower pivot linkages contact the double ramped inner surface of the expander when moved by the threaded post.