• - Persistent lumbar radiculopathy after conservative treatment in the case of a contained disc protrusion with nerve root compression demonstrated at CT and coherence with clinical findings.
  

Target: Intervertebral disc space

Procedure:

• - I.v. injection of cefazolin
  - Patient in prone position with i.v. drip
  - Axial scan (generally on the lower three lumbar levels)
  - Posterolateral approach
  - Local anesthesia from facet joint to skin
  - CT fluoroscopic guidance for disc puncture with an 18 gauge needle
  • . straight needle at the L3L4 level
  • . curved needle at the L4L5 and L5S1 level
• - Needle tip should be centered at the level of the nucleus in all planes
• - Disc decompression with laser fibre or RF probe according technique
• - Bedrest for 4 hours
  

Danger:

• - Avoid nerve root damage as it exits the neuroforamen
  - Thermal endplate damage if unproper needle positioning
• - Spondylodiscitis: maximum sterility is mandatory