Unilateral biportal endoscopy (UBE) is a surgical method widely used in clinical practice, which provides a better surgical view, reduces blood loss, and shortens hospital stay. A dural tear (injury to the covering of the spinal cord) is a common complication of this procedure, which, when combined with the high-pressure irrigation system, can become a serious patient safety issue. A retrospective analysis included 5 cases of severe irrigation-related complications during UBE performed between August 2024 and July 2025. Patients presented with symptoms such as increased blood pressure, rapid heart rate, postoperative agitation, headache, and back pain. Treatment included sedation, analgesia, control of high blood pressure and tachycardia, as well as administration of drugs such as mannitol, furosemide or methylprednisolone. All patients successfully recovered after comprehensive treatment. The study emphasizes that anesthesiologists must be alert to these symptoms and actively manage complications associated with dural injury during UBE.