Sixty-four patients undergoing cervical spine surgery with intraoperative neurophysiological monitoring were randomized to receive either propofol-based TIVA (n=33) or remimazolam-based TIVA (n=31), both with remifentanil. The primary outcome was the change in N20 SEP latency from baseline to 30 minutes after anesthetic induction. Secondary outcomes included changes in P37 latency, SEP amplitudes, motor-evoked potential (MEP) amplitudes, anesthetic and vasopressor use, and postoperative neurological function. Outcomes were assessed intraoperatively at five time points up to surgical closure, and neurologic function was evaluated one day pre- and postoperatively. Overall, the results revealed no significant differences in SEP latency or most MEP amplitudes between groups, except for a transient difference in the right abductor pollicis brevis muscle. The study concluded that remimazolam provides stable IONM comparable to propofol, suggesting it may be a viable alternative anesthetic for spine surgery.