Abstract Objective To discuss the correlation between diffusion tensor imaging (DTI) measurements, diffusion tensor tractography and the clinical symptoms of cervical spondylotic myelopathy. Methods Based on the Japanese Orthopedics Association (JOA) score, 104 cervical spondylotic myelopathy cases were first divided into four groups: mild, moderate, severe and serious groups. According to lesion signal characteristics, all cases were again divided into three groups: A(N/N): normal signal in both T1WI and T2WI; B (N/H): normal signal in T1WI but high signal in T2WI; and C (L/H): low signal in T1WI and high signal in T2WI. The apparent diffusion coefficient (ADC), fractional anisotropy (FA), λ1, λ2, and λ3 were measured and diffusion tensor tractography was performed in the seriously compressed section of the spinal cord. Results The FA values were positively correlated with JOA scores ( r = 0.883, P < 0.05), and significantly different among four JOA groups ( P < 0.05). The ADC, λ2, and λ3 were significantly different among the moderate, severe and serious groups as well as among the A, B, and C groups ( P < 0.05). Declining FA values were found associated with increasing fiber bundle damage. Conclusions The FA values and the change patterns of fiber bundle were more sensitive than T2WI for spinal cord lesion, and were positively correlated with clinical symptoms.