Central Cord Syndrome: Surgical vs Conservative Management

Central cord syndrome (CCS) represents the most prevalent type of incomplete traumatic spinal cord injury and is characterized by disproportionately greater motor impairment in the upper extremities compared to the lower extremities. Despite its high prevalence, the optimal therapeutic approach remains controversial, particularly regarding the choice between surgical and conservative management. A scoping review of the literature was conducted using PubMed, Scopus, ScienceDirect, and Elsevier databases, including studies published between 1954 and 2026. After the application of predefined inclusion and exclusion criteria, 20 studies were included in the final analysis. The available evidence suggests that conservative management remains a safe and effective option in selected patients, particularly in the absence of spinal instability or significant spinal cord compression and in cases with mild neurological deficits demonstrating early improvement. In contrast, surgical decompression appears to provide superior neurological and functional outcomes in patients with mechanical compression, spinal instability, or progressive neurological deterioration. Early surgical intervention has been increasingly associated with improved recovery, although the literature remains heterogeneous. In conclusion, the management of CCS should be individualized and guided by clinical and imaging findings. While conservative treatment remains appropriate in selected cases, current evidence supports an expanding role for early surgical intervention in appropriately selected patients.