140 patients with single-level lumbar disc herniation were randomized to either transforaminal endoscopic discectomy or microdiscectomy. Patients were evaluated over a 2-year follow-up for back pain on a visual analog scale (VAS), leg pain on a VAS, disability on the Oswestry Disability Index (ODI), and health-related quality-of-life on the Short Form 36. The results of this trial indicated that disability and back pain were similar between the two groups over the 2-year follow-up, while leg pain severity at 2 years was significantly lower among those who were treated with transforaminal endoscopic discectomy. Radiation exposure during surgery was significantly higher, while length of hospital stay was significantly shorter, in patients treated with transforaminal endoscopic discectomy.