BACKGROUND: This study aimed to investigate the medical expenses and outcomes of central cord syndrome (ccs), comparing patients who received surgical and non-surgical management. METHODS: using a 14-year nationwide database in Taiwan, this study followed-up all patients of ccs at least 5 years. The incidence rates, medical expenses, permanently disabled spinal cord injury (sci), and mortality rates were compared for patients who underwent surgery and those who were managed conservatively. All CCS patients were further stratified by the level of injury (C1-4 vs. c5-7) in the cost analysis. RESULTS: a total of 1,753 patients with ccs were followed and the incidence of ccs was the highest among males aged between 60 and 70 years, at 42.4 per 1,000,000 person-years. The total medical expenses were higher in the surgery than the non-surgery group (46,586.9 vs. 28,472.4, P<0.001) because of rehabilitation. The surgery group had a significantly lower rate of mortality (Odds Ratio= 0.34, P<0.05) and lower rates of permanently disabled SCI (OR= 4.92, all P<0.001). coNclusioNs: The highest incidence rates of ccs were observed among males aged between 60 and 70 years. The expenses were higher but the mortality rate was lower for surgically managed patients. further investigation is required to correlate the neurological outcomes to the management of ccs.