Aim:In recent years, there have been extensive studies using diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) to reveal the relationship between brain or cervical intramedullary lesions and neural pathways. However, there is a lack of sufficient research investigating the relationship between cervical extramedullary tumors and the spinal cord.This study aims to evaluate the contribution of DTI and DTT in assessing the relationship between cervical extramedullary tumors and the spinal cord, particularly in terms of diagnostic accuracy, clinical outcome prediction, and treatment planning.Material and Methods:Fifteen patients diagnosed with cervical extramedullary tumours were included in this prospective study. All underwent conventional 3T MRI, DTI and DTT to assess microstructural changes and neural tract displacement. Fractional anisotropy (FA) values were analysed, and tractography findings were correlated with clinical presentation and outcome.Results:FA values showed significant reductions in lesion areas compared to normal tissue and displaced spinal cord (DSC), indicating microstructural disruption. DTT showed deviations or deformations of neural tracts in all patients, which correlated with the severity of clinical symptoms. ROC analysis demonstrated the high diagnostic accuracy of FA in differentiating lesions from normal tissue (AUC=0.880) and DSC (AUC=0.840). Conclusion:DTI and DTT offer critical insights into the microstructural changes and spatial dynamics of cervical extramedullary tumors, aiding in the differentiation of lesions from normal tissue and DSC. This study highlights their potential to enhance diagnostic accuracy, improve clinical outcome prediction, and increase precision in neurosurgical planning for better patient outcomes.