Introduction: Low back pain (LBP) patients who have persistent LBP with radiculopathy following back surgery are among the most difficult to treat. Prior studies have shown that botulinum toxin type A (BoNT-A) is efficacious for LBP. Methods: We retrospectively reviewed charts of 26 consecutive patients who had prior lumbar surgery with persistent somatic and radicular pain, who had failed multiple other treatments. and who were treated with repeated BoTN-A injections every 3 months for over 3 years. Pain ratings included the Visual Analogue Scale (VAS), the Short Form McGill Pain Questionnaire (SF-MPQ) and Present Pain Intensity (PPI) before injection and at 4 to 8 weeks post-injection. Patients received 300 to 400 units of BTX in the paralumbar muscles. Most patients received BoNT-X injections via an 1 ½ inch, 27 gauge needle Occasional injections were perfomred using EMG guided technique usually with a 26-gauge, 37 mm needle to ensure intramuscular injection when the post-operative scaling is such that it is dificult to determine the injection site location without EMG guideance. Results: These patients had significant pain reduction and functional improvement sustained with BoNT-A. Pre-treatment VAS was 73.9 with a post-treatment VAS is 57.2 (p=0.001). SF-MPQ mean was 19.4; post-treatment SF-MPQ mean was 17.7 (p=NS). Pre-treatment PPI mean was (3.0); post-treatment PPI mean was 2.4 (p=NS.). Side effects were limited to transient injection site discomfort. No patient developed weakness. Most patients continued to have BoNT-A injections at 3 month intervals with continuing, and usually, increasing benefit. BoNT-A appears to be effective in a high percentage of patients with significant, long-term LBP who have failed surgery and multiple other modalities of treatment. No significant side effects occurred in any of our patients.