Traumatic central cord syndrome (TCCS) is the most common incomplete spinal cord injury. Early surgery (<24-48 hours) improves outcomes, but in developing countries, late presentation is frequent due to referral delays and resource constraints. The best approach for patients treated 7-14 days post-injury is unclear. This study examines neurological and functional outcomes for delayed TCCS patients who received surgical decompression during this period. This study analysed 37 patients with acute traumatic central cord syndrome who received surgical decompression 7-14 days after injury at a tertiary centre in Bangladesh (2020–2024). Included were patients with MRI-confirmed cervical spinal cord compression and TCCS-consistent neurological deficits; exclusions were complete cord injuries or prior cervical surgery. Data included demographics, injury mechanism, ASIA motor score and grade, MRI findings, surgical approach, complications, length of stay, and mJOA scores. Neurological outcomes were assessed at admission, discharge, and a minimum of 6-month follow-up. The study included 37 patients (28 men, 9 women; mean age 58.4 years). Falls caused 73% of injuries. The average time to surgery was 9.8 days. All had cervical spondylosis with stenosis; 30% had fractures. Surgical methods were posterior decompression and fusion (51%), anterior cervical discectomy and fusion (32%), and combined approaches (16%). ASIA motor scores improved from 62.4 at admission to 71.3 at discharge and 84.6 at 6 months (p<0.001). Follow-up mJOA score averaged 14.2. Admission ASIA >60 predicted greater improvement (Δ24.3 vs Δ15.8, p=0.02). MRI cord edema (41%) was linked to less improvement (Δ16.4 vs Δ23.1, p=0.03). Complications (16%) included wound infection, pneumonia, and UTI. No neurological decline occurred. Hospital stay averaged 14.3 days. Surgical decompression performed 7-14 days after injury in delayed traumatic central cord syndrome patients is safe and effective, leading to notable neurological and functional gains. Surgery within two weeks remains beneficial even with late presentation, especially for patients with higher motor scores and no cord edema. While reducing delays is important, late-presenting patients should still receive surgical intervention.