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Traumatic central cord syndrome, the most common spinal cord injury syndrome, typically presents in elderly patients after a hyperextension injury. It is a clinical diagnosis, defined by weakness involving the upper more than lower extremities following a hyperextension cervical injury. Its etiology has been the subject of various pathophysiological hypotheses. The neurologic outcome for this disease is generally favorable, with the majority of patients showing significant neurological improvement over time. There is, however, continued debate over the optimal timing of surgical intervention. This review focuses on the pathophysiology, surgical and medical management, and outcomes of traumatic central cord syndrome.