Flexible expansive tubular endoscopic (Flextube) spine surgery for lumbar disc herniation: a case series of 35 patients with 6-month follow-up

Purpose This study aimed to investigate the safety, efficacy, and clinical outcomes of Flexible Expansive Tubular Endoscopic (Flextube) spine surgery—a novel, non-rigid, air-medium endoscopic technique—for the treatment of single-level lumbar disc herniation (LDH). Methods A retrospective case series was conducted on 35 consecutive patients with single-level LDH treated with Flextube surgery between January 2025 and June 2025. All procedures were performed using a flexible, atraumatic, expandable working tube. Clinical outcomes were evaluated preoperatively and at 1, 3, and 6 months postoperatively using the Visual Analogue Scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and modified MacNab criteria. Perioperative parameters including operative time, blood loss, length of hospital stay, and complications were analyzed. Results A total of 35 consecutive patients (mean age 47.2 ± 12.3 years) with single-level lumbar disc herniation underwent Flextube surgery. All patients completed the 6-month follow-up. The mean operative time was 49.3 ± 11.7 min, and mean intraoperative blood loss was 14.8 ± 6.5 mL. The mean hospital stay was 1.7 ± 0.6 days. Clinical outcomes improved significantly at each postoperative follow-up compared with baseline. VAS back, VAS leg, and ODI scores improved significantly at each follow-up time point ( P < 0.05). At 6-month follow-up, the excellent-good rate was 94.3% (33/35). No major complications such as dural tear, nerve root injury, or surgical site infection occurred. Conclusion Flextube spine surgery is a safe and feasible minimally invasive procedure for single-level LDH, with satisfactory short-term clinical outcomes and a favorable safety profile. Further studies are needed to confirm its long-term efficacy and comparative advantages.