Interspinous implants (ISP) represent a contemporary non-fusion surgical option in the treatment of lumbar segment disease. Several devices have been developed within the last two decades and have been variously supported by investigations into their clinical and biomechanical efficacy. Spinal stenosis and facet arthropathy are reported as the primary clinical indications for their use, with degenerative disc disease and segmental instability recently extending their application. The principle common to all interspinous systems is an induced distraction of the interspinous space, resulting in reduced approximation of pain-sensitive and space-occupying tissue. Collectively, these devices are considered to prevent adjacent segment overload by restoring physiologic load transmission. This review article summarizes existing published literature, describes four different interspinous implants — the DIAM, Wallis, X-Stop and Coflex systems, and outlines clinical trials in progress. The design and surgical technique characteristics, mechanism of action, and clinical indications for interspinous implants are reviewed. Recommendations for future research of interspinous implants in the treatment of lumbar segment disease are made.