Motor conduction tract involvement is one of the clinical manifestations caused by primary intraspinal tumors. When the cervical spinal cord is partially compressed, with the increase of tumor, the symptoms of spinal cord conduction bundle compression will gradually appear on the basis of the original symptoms, such as compression of spinal cord thalamus bundle, the pain and temperature sensation below the opposite side of the lesioned segment may be reduced or disappeared; compression of posterior bundle, deep sensory loss may appear; involvement of motor conduction bundle may produce upper motor neuron paralysis in the limbs below the ipsilateral lesioned segment and spinal cord hemisection syndrome is a specific symptom of intradural extramedullary tumor. The spinal cord hemisection syndrome is a specific symptom of extramedullary tumor. How to diagnose motor conduction tract involvement? Primary tumors in the cervical spinal canal are not uncommon, but due to the variable nature and location of the tumor, the clinical manifestations are complex and varied, which makes the diagnosis difficult. In the last decade, the emergence of new non-ionic iodine water-soluble contrast agents and the application of CT and MRI have made the site of intramedullary tumors rely mainly on adjuvant examinations such as myelography, CT scan or MRI. Especially, the accurate identification of intramedullary tumors and extramedullary tumors is more dependent on imaging means. Ni Bin et al. reported 137 cases of intramedullary tumors without complete paraplegia, and the time from onset to diagnosis was significantly shorter than in the past, and the progress of imaging means played an important role. However, any advanced instrumentation cannot replace the routine clinical examination. A comprehensive understanding of the medical history and the localization of neurological examination are of great guiding significance for the differentiation of spinal cord tumors from degenerative spinal diseases and for the determination of imaging sites and the interpretation of image information. Only by mastering the characteristics of imaging examinations, choosing to apply them according to the actual situation, and closely structuring the clinic, can imaging examinations of spinal cord tumors be more accurate. When the spinal cord is compressed, motor disorders appear before sensory disorders, plus in addition to spinal cord tissue compression, it may be accompanied by blood circulation disorders, disturbance of cerebrospinal fluid dynamics and concurrent inflammation and adhesions. Therefore, the clinical manifestations present diversity and complexity. The development of extraosseous tumor compression symptoms is generally divided into three stages: compression of early neurogenic pain; compression of progressive spinal cord hemisection syndrome (Brown-Sequard syndrome); and complete compression of the spinal cord. The first symptom is nerve conduction bundle compression syndrome in 45.9% of cases, which manifests as sensory, motor and vegetative nerve dysfunction below the plane of compression. Partial compression stage of cervical spinal cord. With the enlargement of tumor, the symptoms of spinal cord conduction bundle compression gradually appear on the basis of the original symptoms, such as compression of spinal cord thalamus bundle, which may lead to hyperalgesia or disappearance of pain and temperature sensation below the contralateral side of the lesioned segment; compression of posterior bundle, which may lead to hyperalgesia of deep sensation; involvement of motor conduction bundle, which may lead to upper motor neuron paralysis of the limbs below the ipsilateral lesioned segment. In contrast, spinal cord hemisection syndrome is a specific symptom of extramedullary tumors in the spinal canal, but it is mostly atypical. Ni Bin et al. reported 137 cases of intradural tumors, with a history of 102 cases of superior palsy and 74 cases of extramedullary tumors; 10 cases of inferior palsy and 8 cases of intramedullary tumors; and 4 cases of spinal cord hemisection injury syndrome. During the period of complete cervical spinal cord compression, the development of lesions caused transverse damage to the spinal cord parenchyma, and the pathological changes in the spinal cord gradually became irreversible. Loss of limb movement and sensation, vegetative nerve dysfunction, and urinary and fecal dysfunction appear below the lesion, which is already in the late stage of paraplegia.