AIM: To evaluate the complications associated with Unilateral Biportal Endoscopy (UBE) in spinal surgery, highlighting the risks and outcomes of this minimally invasive approach.

MATERIAL and METHODS: A retrospective analysis was conducted on 374 patients who underwent UBE at three centers from 2022 to 2023. The study included cases of lumbar disc herniation, recurrent disc herniation, and lumbar stenosis. All procedures were performed by experienced surgeons, with a minimum postoperative follow-up of one year for each patient.

RESULTS: A total of 374 patients were included: 224 underwent UBE discectomy, 115 underwent UBE decompression for lumbar stenosis, and 35 underwent surgery for recurrent herniation. Overall, 178 patients (47.5%) were female and 196 (52.4%) were male. Complication rates differed across cohorts: 19 complications occurred in primary discectomy cases (8.4%), 12 in stenosis cases (10.4%), and 5 in recurrent cases (14.2%). The most common complications were dural tear (n=8), recurrence (n=7), and root injury (n=6). Less frequent events included retinal hemorrhage (n=2) and hydroperitoneum (n=1).

CONCLUSION: The findings suggest that while UBE is generally safe, it is associated with a notable complication rate, including dural tears and root injuries. Continuous efforts to refine surgical techniques and enhance training may further mitigate these risks, ensuring better patient outcomes.