Background: Resection significantly improves the clinical symptoms and functional outcomes of patients with intradural extramedullary tumors. However, patient quality of life following resection has not been adequately investigated. Objective: The purpose of our study was to improving outcomes of patients with intradural extramedullary spinal tumors. Patients and methods: A prospective study of 20 cases with intradural extramedullary spinal tumors treated by using intraoperative neurophysiological monitoring (IOM) in Neurosurgery department, Zagazig University Hospitals, Egypt, from March 2021 to February 2022. All patients were subjected to complete clinical examination according to medical research council scale (MRC) and modified McCormick scale (MMS) and MRI Imaging. Results: This study showed that 90% of patients had total extent of resection with only 10% of patients had immediate neurological deficit. The intraoperative neurophysiological recovery monitoring to predict immediate neurological deficit had 66.7% sensitivity and 94.12% specificity with 90% accuracy. While intraoperative neurophysiological recovery monitoring to predict neurological deficit at 3 months had 100% sensitivity and 89.47 % specificity with 90% accuracy. Conclusion: A reliable prediction of clinical improvement could be made based on pre-operative clinical status. The use of intraoperative neurophysiological monitoring leads to better neurological outcomes at discharge and follow-up.