When performing unilateral biportal endoscopic (UBE) surgery in the cervical and thoracic areas, special considerations are required compared with UBE surgery in the lumbar area. According to a 2023 systematic review by Ju et al. [1], potential complications of posterior cervical UBE surgery include dural tears, transient motor weakness, transient hypesthesia, and remnant nucleus pulposus. Although no systematic reviews specifically addressing complications in cervical and thoracic UBE surgery have been published, surgeons occasionally encounter complications such as postoperative epidural hematoma, incomplete decompression or discectomy, and missed levels during this procedure. This chapter aims to describe potential issues and solutions for UBE surgery in the cervical and thoracic areas based on previously published studies and the authors’ experiences.