The present invention provides spinous process implants and associated methods. In one aspect of the invention, the implant includes a first extension and a second extension. The first extension has a spacer extending from a medial facing side along a longitudinal axis. The second extension has an aperture that slidingly receives the spacer. Accordingly, the second extension is moveable relative to the spacer along the longitudinal axis. The second extension includes a threaded bore in communication with the aperture. A set screw is threadably received in the threaded bore of the second extension. The set screw can be tightened against an outer surface of the spacer to lock the second extension in place relative to the longitudinal axis.
