Background <p>This study aimed to further compare subdermal needle electrodes (NE) and surface adhesive electrodes (SE) during intraoperative neuromonitoring (IONM) in spine surgeries.</p> Methods <p>We analyzed data from forty consecutive patients undergoing spine surgery. The data mainly included impedance, Root Mean Square (RMS), Tc-MEP and free-run EMG characteristics of NE versus SE with (left foot) and without (right foot) conductive paste (CP) during IONM.</p> Results <p>Results indicated that SE with CP exhibited significantly lower impedance than SE without CP and higher impedance than NE. The RMS of free-run EMG recorded by SE were found to be higher than the NE, but no significant differences were found between SE with CP and SE without CP. Furthermore, NE yielded higher MEP amplitudes and superior signal-to-noise ratios (SNR) than SE. The ratios of MEP amplitude and SNR recorded by SE to NE were not significantly different between the left and right foot. The success rate for MEP induction was significantly higher with NE than SE.</p> Conclusion <p>This research advocates for prioritizing NE in IONM during spine surgeries due to their favorable performance characteristics.</p>