Seventy-three patients with highly migrated intracanal disc herniations were randomized to receive a minimal incision, multifidus-sparing microendoscopic discectomy (n=37) or a conventional open discectomy (n=36). Outcomes of interest included surgical outcomes, pain on a Numeric Rating Scale (NRS), function on the Oswestry Disability Index (ODI), and the rate of complications, assessed up to 2 years post-operation. Results revealed a significantly lower rate of blood loss, shorter length of stay, and quicker return to work with the intervention group compared to conventional. A significant improvement from baseline in back pain, leg pain, and ODI scores was observed in the intervention group, whilst the conventional group displayed an improvement in leg pain and ODI scores only.