501 patients with intervertebral disc herniation were randomized to receive standard open discectomy with examination of the irritated nerve root or non-operative care. Symptom severity improved significantly more in the surgery group than the non-operative group at 3 months, 1 year and 2 years. Self-reported improvement was also significantly better in the surgery group than in the non-operative group. There were slight but non-significant differences in favour of the surgery group over 2 years for pain, function, disability scores, and patient satisfaction. Although several significant differences were found between the two groups, adherence to the assigned treatment was not optimal and firm conclusions cannot be made.