The interlaminar and transforaminal approaches are commonly employed in full endoscopic lumbar spine surgery. Both approaches are well-suited for addressing specific types of lumbar disc herniation, particularly at the L4/5 level.  This article compares the clinical outcomes of full endoscopic discectomy for L4/5 central-paracentral disc herniation between the interlaminar and transforaminal approaches.  Sixty patients were randomly assigned to either a full endoscopic interlaminar discectomy group or a full endoscopic transforaminal discectomy group, with 30 patients each. The procedures were performed by a single spine surgeon at our institution between 2017 and 2019. Over a 2-year follow-up period, various parameters, including operative time, postoperative hospitalization duration, Visual Analog Scale (VAS) scores for leg and back pain, Oswestry Disability Index (ODI), and modified MacNab criteria, were assessed and compared between the two groups. Additionally, the complication rates were documented.  The two full endoscopic approaches resulted in significant improvements in back-leg pain measured by the VAS and in the ODI scores postsurgery. A comparison between the two approaches revealed a significant difference in the ODI score at the 6-week postoperative mark (  = 0.02). However, other clinical outcome parameters did not show significant differences at the other follow-up time points. Postoperative dysesthesia was more prevalent in patients who underwent endoscopic transforaminal discectomy (  < 0.05). The operative time was notably longer for the interlaminar approach compared with the transforaminal approach (62.6 ± 18.0 vs. 37.0 ± 13.6). Postoperative hospitalization time did not exhibit significant differences between the two groups.  Both the interlaminar and transforaminal approaches demonstrate similar clinical outcomes in treating central-paracentral L4/5 disc herniation. Each technique presents distinct advantages and disadvantages regarding operative time and postoperative dysesthesia. The full endoscopic interlaminar and transforaminal approaches have proven to be safe and effective methods for addressing L4/5 central-paracentral disc herniation.