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Bone Cysts

By Michael J. Joyce, MD, Associate Clinical Professor, Orthopaedic Surgery, Cleveland Clinic Lerner School of Medicine at Case Western Reserve University ; Hakan Ilaslan, MD, Associate Professor of Radiology;Staff Radiologist, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University;Imaging Institute, Diagnostic Radiology

Many noncancerous (benign) bone abnormalities may resemble bone tumors but are not.

Aneurysmal bone cysts

Aneurysmal bone cysts usually develop before people reach age 25, and the cause is not known. These cysts are made up of multiple blood-filled sacs that are packed together. These cysts usually occur near the sides of the long bones (upper arm and thigh bones), but almost any bone may be affected. The cysts tend to grow slowly. Pain and swelling are common. The cyst may be present for a few weeks to a year before diagnosis.

To diagnose aneurysmal bone cysts, doctors usually do x-rays and magnetic resonance imaging (MRI).

Surgical removal of the entire cyst is the most successful treatment, but sometimes the cysts return, particularly if they are not removed completely. Radiation should be avoided when possible because cancerous tumors occasionally develop later. However, radiation may be the treatment of choice for cysts that cannot be treated surgically and are putting pressure on the spinal cord.

Unicameral bone cysts (simple bone cysts)

Unicameral bone cysts occur near the growth plates in the arms or legs in children. Growth plates are what enable children to grow.

The cysts often cause nearby bones to thin, which can lead to a break (fracture). Cysts that are less than 2 inches (about 5 centimeters) long or wide may heal and may disappear as the fracture heals. Cysts that are more than 2 inches (about 5 centimeters) long or wide, particularly in children, may require treatment.

To diagnose unicameral bone cysts, doctors usually do x-rays.

Most often, these cysts are treated with injections of corticosteroids (often repeatedly), with processed bone putty, or with synthetic bone substitutes. Sometimes treatment is surgery to remove the contents of the cyst from the bone by scraping it with a scoop-shaped instrument (curettage) and transplantation of bone from one site to another (bone grafting). Regardless of treatment, the cyst remains or returns in about 10 to 15% of people.

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