OBJECTIVE: Minimally invasive spinal techniques have been developed for years in an attempt to minimize trauma. However, most endoscopic techniques have been unable to address uncontained or large contained disc herniations. The aim of this prospective study was to compare the results of microendoscopic discectomy (MED) and microsurgical discectomy in the treatment of patients with uncontained or large contained disc herniations. METHODS: An independent observer reviewed the treatment of 28 patients. The study group included 14 consecutive patients who underwent MED and 14 consecutive patients who underwent microsurgical discectomy for radicular pain secondary to uncontained or large contained disc herniations during the same period. Patients were followed up for an average of 12 months. They were assessed by use of Oswestry disability questionnaire and low back pain outcome score. RESULTS: The average outcome score improvement was of clinical significance in both patient groups. No difference in the scores was found between the two groups. Patients in the MED group required less postoperative analgesia during their stay. One patient in the MED group had a dural tear. CONCLUSION: MED is at least as effective as microsurgical discectomy for treatment of uncontained or large contained disc herniations, although the advantages over the open technique are short lived and did not reach significance. Nonetheless, for the surgeon accustomed to endoscopic techniques, MED seems to be a safe procedure.