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The presence and absence of lymphatic vessels in the adult human intervertebral disc: relation to disc pathology

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Abstract

Objective

Although the normal adult human intervertebral disc is considered to be avascular, vascularised cellular fibrous tissue can be found in pathological conditions involving the disc such as disc herniation. Whether lymphatics vessels form a component of this reparative tissue is not known as the presence or absence of lymphatics in herniated and normal disc tissue is not known. We examined spinal tissues and discectomy specimens for the presence of lymphatics.

Methods

The examination used immunohistochemistry to identify the specific lymphatic endothelial cell markers, podoplanin and LYVE1.

Results

Lymphatic vessels were not found in the nucleus pulposus or annulus fibrosus of intact, non-herniated lumbar and thoracic discs but were present in the surrounding ligaments. Ingrowth of fibrous tissue was seen in 73% of herniated disc specimens of which 36% contained LYVE1+/podoplanin + lymphatic vessels. Lymphatic vessels were not seen in the sacrum and coccyx or biopsies of four sacrococcygeal chordomas, but they were noted in surrounding extra-osseous fat and fibrous tissue at the edge of the infiltrating tumour.

Conclusion

Our findings indicate that lymphatic vessels are not present in the normal adult intervertebral disc but that, when there is extrusion of disc material into surrounding soft tissue, there is ingrowth of reparative fibrous tissue containing lymphatic vessels. Our findings also indicate that chordoma, a tumour of notochordal origin, spreads to regional lymph nodes via lymphatics in para-spinal soft tissues.

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Acknowledgements

The authors wish to thank C. Lowe for typing the manuscript and J. Fairbank, J. W. McDonald and G. Bowden for supplying specimens to carry out this project. This study was supported by the EU as part of EuroBoNet and the NIHR Biomedical Research Unit, Oxford.

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Authors and Affiliations

  1. Nuffield Department of Orthopaedic, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, OX3 7LD, England

    Karolina Kliskey, Kelly Williams, J. Yu, Jill Urban & Nick Athanasou

  2. Human Immunology Unit, Weatherall Institute of Molecular Medicine, Oxford, OX3 9D6, UK

    David Jackson

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  1. Karolina Kliskey
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  2. Kelly Williams
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  3. J. Yu
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Correspondence to Nick Athanasou.

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Kliskey, K., Williams, K., Yu, J. et al. The presence and absence of lymphatic vessels in the adult human intervertebral disc: relation to disc pathology. Skeletal Radiol 38, 1169–1173 (2009). https://doi.org/10.1007/s00256-009-0770-2

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  • DOI: https://doi.org/10.1007/s00256-009-0770-2

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