Central Cord Syndrome: A Reconsideration from Clinical Phenotype to Mechanism-Based Classification

Central cord syndrome (CCS) is the most common incomplete traumatic spinal cord injury; however, it remains poorly defined, with no consensus diagnostic criteria, an ambiguous and variable clinical presentation, and significant overlap with other incomplete spinal cord injuries. The available evidence indicates that CCS is best understood, not as a discrete anatomic lesion, but as a clinical phenotype arising from distinct pathophysiologic mechanisms. Management decisions should be driven by structural stability, injury severity, and underlying cord substrate. Patients presenting with structural instability, severe cervical traumas (ASIA C or worse), or progressive deficits should be treated with early surgical decompression.