I would offer ESI all day, with discussion that it's not great but it's so low risk that it's reasonable. Some do really well for a decent amount of time. Some respond better to IL, some to TF.
I also offer intradiscal BMAC. I go over the literature, my success rates and those of my partners. I go over risks, including discitis thoroughly. It's a last resort for me. These people are getting fusions if I can't help, and most are young. Not as low risk as ESI obviously, and very painful initially, but can be life changing when successful.
I also do Intracept when there are Modic changes, and pain seems more vertebrogenic than actual discogenic. This is one of the most game changing procedures. Success rates consistent with the studies. If there are Modic changes I always do Intracept before offering intradiscal, and have never had to do intradiscal as a plan B. Very low risk, well tolerated, post-op course very short. Doesn't burn holes like someone else said, structure is intact. No hesitation to do younger patients, and so much better than fusion.
I think not discussing or offering/ referring out for these things is a disservice. I don't push anything, I just lay out the options, risks, success rates. Patient chooses. This is how I would like to be treated.