Complication and Prevention of Unilateral Biportal Endoscopy

Unilateral biportal endoscopy (UBE) has emerged as a minimally invasive surgical technique offering effective decompression across cervical, thoracic, and lumbar spinal regions with reduced tissue trauma and faster recovery. However, the technique presents distinct complication profiles that require specific preventive strategies. This chapter comprehensively reviews UBE-related complications—including dural tears, neural injuries, epidural hematomas, inadequate decompression, iatrogenic instability, and irrigation-related effects—across spinal regions. Risk factors, intraoperative mechanisms, and evidence-based preventive measures are discussed in detail. Emphasis is placed on surgical technique refinement, intraoperative decision-making, and learning curve progression to improve safety and outcomes in UBE procedures.