Two hundred and fifty-one patients with lumbar disc herniation scheduled for a lumbar microdiscectomy were randomized to receive ligament flavum preservation or resection during the procedure for the prevention of epidural fibrosis. Outcomes of interest included epidural fibrosis grade, pain on a Visual Analog Scale (VAS), the Oswestry Disability Index (ODI), blood loss, and operative time. Epidural fibrosis was assessed at 6 months, and VAS pain and ODI scores were assessed up to 2 years post-operation. Results demonstrated statistically significantly lower epidural fibrosis scores in the ligament flavum preservation group compared to the control group (p<0.05). Also, VAS pain and ODI scores at 6 months, 1 year, and 2 years post-operation were statistically significantly in favour of the ligament flavum preservation (p<0.05 for all). No statistically significant differences in operative time or blood loss were observed between the two groups (p>0.05 for both).