What is a bone cyst?

A bone cyst is a benign tumor-like bone lesion that presents a fluid-filled cavity in the bone. As a lesion (Latin laesio) damage, injury or disturbance of an anatomical structure or physiological function is called. Mostly, bone cysts occur in childhood and/or early adulthood.

There are two types of bone cysts: The so-called juvenile (solitary) bone cyst manifests itself mainly in the growth age, found mostly in the long bones (legs and arms). This cyst does not cause any pain - that is why it is mostly incidental. That is to say: It is discovered in the context of a fracture of the cyst - radiologically it can be seen through the X-Rays. In fact, the most common complication caused by a bone cyst is a rupture (fracture). If the cyst is active and growing slowly, then a slight, insignificant stroke is enough to cause a fracture. The so-called aneurysmal bone cyst is less common than the juvenile bone cyst. It occurs not only in the long bones and in the pelvis, but also in the area of ​​the spine (vertebral body, vertebral arch). Affected are primarily children and young adults. Your visual difference to the bone cyst: Your cavity is filled with blood. In contrast to the solitary bone cyst, it is often expressed by pain and a rapidly increasing protrusion. Most importantly, consult a specialist if you have symptoms that negatively affect your well-being, or if you feel pain or swelling in the area of ​​the bones. In other words, every bone change must be evaluated by a specialist.

Frequency of recurrence - who can be affected by a bone cyst and when

The solitary bone cysts occur most frequently in the age of 4 to 10 year olds. From 55 to 65 percent, they are found in the humerus, 25 to 30 percent in the femur. Spinal bone cysts are rare. People with multiple bone cysts are mostly male and women are less affected. Of an aneurysmal bone cyst, which is less common overall, are primarily affected people between 10 and 20 years old. The aneurysmal bone cysts account for about 6% of bone lesions. Mostly they are found on the spine and in long bones.

When looking for the causes you will have some questions

That is, in principle, the exact causes of bone cysts formation are unknown. Possible causes include injuries to the bone, blood clots, (disorders of the blood circulation that, as a result, activate substances that destroy the bone), inflammation or developmental disorders. Interestingly, people with osteoarthritis, rheumatoid arthritis and chronic gout are also often affected.

Symptoms - warning signals are pain after minimal injuries

Simple bone cysts have usually no symptoms at all. They will be diagnosed because of reduced bone strength, breakage, or bone fracture after an accident. Of course it can also cause swelling - the signals should be perceived after a minimal accident. When cysts become noticeable through pain, they are predominantly difficult to define, drawing pain, which occur with stimuli such as cold or heat. Larger cysts cause permanent pain. Aneurysmal bone cysts in the spine can lead to dysfunction and seldom fractures. In particular, patients complain of pain in the femur (femur), tibia (tibia) and in the dorsal parts of the spine in aneurysmal bone cysts. These are the 'favorite places' for aneurysmal bone cysts.

An accurate diagnosis for yourself or your child? The path leads to the specialist

Whenever you see a bone change in yourself or your child, there is only one way: go to the specialist! He will conduct the so-called anamnesis interview in which he will explain the symptoms but this conversation alone is not enough for a diagnosis. Therefore, he will order imaging examinations - primarily a radiograph in two planes, possibly a magnetic resonance imaging (MRI).
 
What is important to recognize: Is it a juvenile or an aneurysmal bone cyst? Is it a benign or a malignant neoplasm? If the images show an aneurysmal bone cyst, the doctor will certainly consider a scan necessary because it might be a tumor. Aneurysmal bone cyst can become very aggressive and dangerous. Ultimately safe diagnostics decide on the therapy.

There are cysts that are only observed

The simple (juvenile) bone cyst and the aneurysmal bone cyst are treated differently. Treatment with the simple bone cyst is not always necessary if secondary damage to the cyst can be largely ruled out. It is enough to watch them. If cysts are less than 5 centimeter long or wide, they usually disappear. With the completion of the growth phase, bone cysts are no longer recognizable. If they need to be treated, there are usually two ways to prevent fractures at this point. The bone cyst gets a cortisone stimulus that is injected to help it heal. Furthermore, the bone cyst can be scraped off with a spoon-like instrument (curettage) and the cavity filled with a bone substance. In some cases, screws are inserted into the bone in order to stabilize the bone.

The aneurysmal bone cyst should always be surgically removed. Because it is well supplied with blood, it can otherwise continue to grow, cause pain, use up the bone substance and damage it permanently. The filling of the cavity is done with bone cement (kyphoplasty) or bone grafts. If these cysts lead to instability of the spine, then stabilization measures would be considered.

Prognosis - be careful of dangerous sports

Prognosis is generally good if the appropriate therapeutic measures were taken by a specialist because after the therapy the bone is strong as it was before the formation of the cyst. At the same time, it is sensible the patient should pay attention and be careful of dangerous sports and/or activities that can cause new fractures.

Dr. med. Munther Sabarini

Author
Dr. med. Munther Sabarini
Specialist in Neurosurgery

Hans-Heinrich Reichelt

Co-author
Hans-Heinrich Reichelt
Chief Editor of Medizin für Menschen

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Since the year 2001, the Avicenna Clinic is based in Berlin. Our doctors have at least 25 years of international experience in their respective fields (neurosurgery, spinal surgery, anesthesia, and orthopedics).

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