Background: We evaluated whether preoperative functional status influenced surgical outcomes for patients with intramedullary spinal cord tumors (IMSCT). Methods: We analyzed whether lower preoperative McCormick scores impacted primary outcomes for 78 consecutive patients with IMSCT of World Health Organization (WHO) grades I and II undergoing tumor resection between 2010 and 2018. Results: Patients averaged 33.6 years of age, 57.5% were male, and lesions predominantly involved the cervical 23 (29.5%) followed by the thoracic spine 19 (24.3%). Over the average follow-up interval of 69.83 months, IMSCTs recurred in 11.5% of patients, with 6.4% showing functional deterioration. At follow-up, 73.5% of patients with a preoperative modified McCormick score of two or one showed better functional improvement. Conclusion: The WHO pathological grades I and II did not significantly influence outcomes for patients with intramedullary spinal cord lesions. However, patients with low preoperative McCormick scores (two or one) demonstrated better functional outcomes.