Objectives <p>This study aimed to evaluate procedural pain during CT-guided percutaneous lumbar discectomy (PLD) under local anesthesia to treat disc herniation and assess patient satisfaction at 6 months post-treatment.</p> Materials and methods <p>This prospective observational study enrolled patients who underwent the procedure between December 2019 and April 2021. Patients were selected based on lumbar radiculalgia refractory to medical treatment and infiltrations, with disc herniation confirmed via MRI. Procedural pain was assessed using a visual analog scale (VAS) and a questionnaire immediately after the procedure, while patient satisfaction was evaluated through a questionnaire at 6 months post-treatment. Pain perception during the intervention, tolerability, and willingness to undergo the procedure again were examined. Data were analyzed using descriptive statistics, appropriate tests for variable types, and multivariable logistic regression to identify predictors of procedural pain (VAS &gt; 5).</p> Results <p>90 patients (mean age, 56 ± 16; 43 men) were enrolled. The median pain reported during the procedure was 5, and 87% of patients rated the experience as tolerable or perfectly tolerable. Disc degeneration (Pfirrmann grades 3 and above) was significantly correlated with increased pain intensity during the procedure (<i>p</i> &lt; 0.05). At the 6-month follow-up, 81% of patients expressed satisfaction with the treatment outcomes, and 94% indicated they would recommend the procedure to others with similar conditions.</p> Conclusion <p>CT-guided percutaneous discectomy under local anesthesia is well-tolerated, with manageable procedural pain and high levels of patient satisfaction. The use of local anesthesia enables real-time clinical evaluation, enhances procedural safety, and minimizes the risk of nerve injuries.</p> Key Points <p><Emphasis Type="BoldItalic">Question</Emphasis> <i>CT-guided PLD is a minimally invasive technique that can be performed under local anesthesia; however, studies have not evaluated per-procedural pain or long-term satisfaction</i>.</p> <p><Emphasis Type="BoldItalic">Findings</Emphasis> <i>Patients treated under local anesthesia reported a median pain score of 5/10 during the procedure, with 82,7% expressing satisfaction with the outcomes at 6 months</i>.</p> <p><Emphasis Type="BoldItalic">Clinical relevance</Emphasis> <i>CT-guided PLD is a procedure that can be performed under local anesthesia, offering acceptable tolerance and a high rate of patient satisfaction for those suffering from radiculalgia related to a disc herniation refractory to infiltrations</i>.</p> Graphical Abstract <p></p>