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Transcranial engine evoked possibilities, somatosensory evoked possibilities, and free run electromyography were utilized for IONM with caution models. Patient record were audits with preoperative and postoperative neurological result estimations; Frankel Grading, McCormick Score, Karnofsky Performance Status (KPS) Scale, American Spinal Injury Association (ASIA) Grading, and The Japanese Orthopedic Association (JOA) Score at 1, 6, 12, and 24 months after surgery 104 patients were operated on in total. 77.4 % activities were utilized IONM. 70.2 and 16.7% of tumors were found in the intradural extramedullary (IDEM) space, respectively. All follow-up time in the IONM group showed a statistically significant improvement (p-value 0.050) between preoperative and postoperative neurological outcomes. Alarm IONM had a sensitivity of 66.7 percent and a specificity of 88.7 percent, respectively, for predicting early worsening of the neurological outcome following surgery. Surgery for IDEM spinal cord tumors is linked to a favorable neurological outcome (OR 0.187, 95% CI 0.05–0.71); p-value of 0.014 The use of IONM in intradural spinal tumor surgery resulted in a statistically significant improvement in neurological outcomes and a decrease in neurological deficits following the procedure. With fair sensitivity and high specificity, IONM can identify neurological deficits and poor outcomes following surgery. In particular, using IONM in IDEM results in better neurological outcomes after surgery.