Once a spinal cord tumor (SCT) is detected, it is usually removed surgically. During this process, intraoperative neurophysiological monitoring (IONM) is widely performed to detect neural insults of the spinal cord early and prevent neurological complications after surgery. This review article introduces the basic concepts and setting of the major modalities, somatosensory evoked potentials, motor evoked potentials, and direct wave and discusses the precautions, alarm criteria, and reliability associated with IONM during SCT surgery. This review emphasizes that multimodal monitoring improves the reliability of the IONM and that it is important that an experienced professional examiner continuously monitor these surgeries.