Thirty-two patients with failed back syndrome received a trial of spinal cord stimulation. Stimulators were internalized in 26; long-term follow-up was available for 23 of these patients. Seventy-six percent of the 22 patients with stimulators still present at 1 year and 74% of the 19 patients with stimulators still present at 2 years were receiving 50% or better pain relief. Patients routinely underwent pain team evaluation and therapy, psychological testing and a transcutaneous electrical nerve stimulator trial prior to consideration of spinal cord stimulation. The most common complication was electrode migration. Spinal cord stimulation should be considered as an important therapeutic modality in carefully selected patients with failed back syndrome.