The use of spinal endoscopy has become increasingly common in recent years; however, recently it has become possible to treat various degenerative spinal diseases such as spinal stenosis and foraminal stenosis, and the range of treatment has expanded from the lumbar spine to the cervical and thoracic regions. However, as endoscopic spinal surgery and its indications have developed, the incidence of complications has also increased. The most common complications associated with endoscopic spinal surgery include dural opening, perioperative hematoma, transient dysesthesia, nerve root injury and recurrence. Furthermore, endoscopic spinal surgery, which includes fully endoscopic transforaminal, interlaminar, and unilateral biportal approaches, is a safe and effective treatment method for spinal disorders such as disc herniation, spinal stenosis, foraminal stenosis, recurrent disc herniation and even spinal tumors. In this article, we review the complications that may occur with spinal endoscopy and their management.