BACKGROUND: Traumatic central cord syndrome was first described by Schneider and colleagues as a spinal cord injury in 1954. Other definitions were not apart from the fact of greater weakness of upper limbs than lower limbs. Surgical treatment was mentioned frequently for plateaued neurological insult. OBJECT: This study aimed to examine the functional outcome of early surgical decompression for acute traumatic central cord syndrome. METHODS: After gaining ethical approval, 37 patients with acute traumatic central cord syndrome (ATCCS) were randomized into two groups, (medical and surgical group). The medical group was treated by intravenous fluids, neurotonics, and high doses of steroids. The surgical group was treated by laminectomy of the affected levels and duraplasty with fascia lata. The American Spinal Injury Association (ASIA) impairment scale, the incidence of neuropathic pain, urinary symptoms, and hospital stay were tested. RESULTS: It has been found that both the surgical group and the conservative group had a great improvement in ASIA motor function score with a highly statistically significant difference (<0.001) at 3 months follow up. Neuropathic pain showed more improvement in the surgical group and reached a dramatic response at the final visit. Urine retention declined in prevalence at discharge and the final visit was not dramatic. Hospital stay exhibited lengthy admission in the conservative group than the surgical group (p < 0.0001). CONCLUSION: Surgical decompression offers clinical improvement that might be superior to medical treatment. The decision of surgery should be closely disclosed with patients' family and relatives.