Objective:

To present a case of spontaneous spinal epidural hematoma (SSEH) treated with unilateral biportal endoscopy (UBE) and to review the existing literature on this surgical approach.

Approach:

• Surgical Technique: The patient underwent UBE for decompression and hematoma evacuation at the C7-T2 level under general anesthesia, involving specific steps such as skin incision, portal creation, and careful dissection of the hematoma.

Key Findings:

• UBE was completed successfully in 90 minutes with an estimated blood loss of 50 mL.
• The patient achieved significant neurological improvement, ambulating independently by postoperative day 3.
• At the 6-month follow-up, the patient attained ASIA grade E with minimal residual lower limb muscle tone increase.

Interpretation:

UBE provides a minimally invasive alternative to open surgery for SSEH, allowing for effective decompression with reduced surgical trauma and quicker recovery.

Limitations:

• The application of UBE for SSEH is rarely reported, limiting broader conclusions and understanding of its effectiveness.
• Long-term outcomes and comparative effectiveness with traditional methods require further investigation.

Conclusion:

UBE is a viable option for SSEH evacuation, offering benefits such as excellent visualization and preservation of spinal stability.