One hundred patients with single-level lumbar disc herniation were randomized to receive either biportal endoscopic discectomy (BED; n = 50) or microscopic discectomy (MD; n = 50). The primary outcome of interest was the Oswestry Disability Index (ODI) at 12 months. Secondary outcomes included surgical site pain, scar appearance (POSAS), serum creatine phosphokinase (CPK) ratio, and rates of wound complications. Outcomes were assessed at 2 weeks, 3 months, 6 months, and 12 months. Overall, the results of the study revealed that ODI scores were equivalent between the two groups at 12 months. BED was associated with reduced early postoperative pain, better cosmetic scarring, lower CPK levels, and fewer wound dehiscence events. These findings support BED as a safe and effective alternative to MD, offering added benefits from its minimally invasive approach.