Objective: The aim of this study is to describe a novel minimally invasive technique using unilateral biportal endoscopy (UBE) for the posterior reduction of irreducible cervical facet dislocation caused by a fractured articular process. Methods: We present the surgical technique conducted in a patient with irreducible C4–5 facet dislocation refractory to closed traction. The patient underwent posterior UBE in the prone position. Through standard UBE portals, partial resection of the C5 superior articular process and removal of the fractured C4 inferior articular process fragment blocking reduction were performed under direct endoscopic visualization. Gentle manipulation then achieved anatomical reduction. Subsequently, the patient underwent standard C4–5 anterior cervical discectomy and fusion in the supine position. Results: UBE successfully facilitated anatomical reduction by addressing the bony obstruction. Postoperatively, the patient mobilized early and demonstrated full motor power recovery at a 1-month follow-up, with no UBE-related complications. Conclusion UBE-assisted posterior reduction is a feasible technique for select cases of irreducible cervical facet dislocation with bony obstruction. It enables direct visualization and targeted removal of impediments with minimal soft tissue disruption prior to definitive anterior stabilization, offering a potential alternative to open posterior reduction.

Postoperative thoracic epidural hematoma (PTEH) is a rare and complex condition that can lead to significant neurological deficits, persistent pain, and reduced functional abilities. Despite advancements in minimally invasive techniques such as unilateral biportal endoscopic (UBE) decompression, recurrence of PTEH remains a challenging clinical issue. This case report describes the innovative application of unilateral biportal endoscopy-assisted thoracic interbody fusion to manage recurrent thoracic idiopathic epidural hematoma. We discuss the surgical technique, clinical outcomes, and potential benefits of this method in reducing recurrence and stabilizing the thoracic spine. A 78-year-old woman without comorbidities underwent UBE decompression for symptomatic D11–12 and L1–2 spinal stenosis. She later developed delayed postoperative spinal epidural hematoma (SEH), causing paraparesis and bowel/bladder dysfunction. Despite 2 successful emergency hematoma evacuations with magnetic resonance imaging-confirmed clearance and symptom improvement, recurrences continued to take place, each occurring within shorter intervals. At the third recurrence, occult spinal microinstability was suspected as the cause of persistent bleeding. Unilateral biportal endoscopy-assisted thoracic interbody fusion was performed to address this issue. After fusion surgery, the patient experienced no further hematoma recurrences and fully regained neurological and functional capabilities at the 9-month follow-up. While surgical decompression is the standard for SEH, recurrent or delayed postoperative cases require a tailored approach. This case underscores the importance of considering thoracic interbody fusion for recurrent SEH to address microinstability and ongoing bleeding. Unilateral biportal endoscopy-assisted fusion offers a minimally invasive yet definitive solution, highlighting the need for individualized surgical strategies to achieve optimal outcomes.