Luigi Mangione suffered from spondylolisthesis, a back condition. Experts say it can cause ‘massive’ pain.

Luigi Mangione, the 26-year-old who has been arrested and charged in connection with the killing of United Healthcare CEO Brian Thompson, appears to be suffering from a spinal condition called spondylolisthesiswhich can cause severe pain, his social media accounts suggest. Mangione had reportedly been living with chronic pain before undergoing back surgery in 2023, Business Insider reported. A photo on his X-banner appears to show an X-ray of his back after surgery, and several neurosurgeons and spine specialists agree that it appears the surgery was performed to correct a condition known as spondylolisthesis.

Here’s what you need to know about Mangione’s apparent injury, surgery and pain.

What we know about Mangione’s back injury

Aside from the X-ray on his apparent X account, Mangione shared in a handwritten note that he suffered from spondylolisthesis, according to Business Insider. The condition apparently worsened after Mangione went surfing in Hawaii, where he began living in 2022. A post from a Reddit account that appears to belong to Mangione, in a group dedicated to the condition, described experiencing pain and numbness in the back, limbs and groin for a year and a half. A later post from the same account described the damage as “utterly devastating.”

Mangione apparently wrote in another post that he spent 1.5 years undergoing “conservative” treatment for his back pain until he wrote about back surgery in 2023, adding that he needed “zero pain medication” within one week after surgery. But in May of that year, he posted an X post referring to most doctors as “basically worthless” (the post has since been deleted), Business Insider reported.

What is spondylolisthesis?

The condition occurs when one or more vertebrae in the spine slip out of place, Dr. Uzma Samadania neurologist from Minnesota specializing in spine surgery, tells Yahoo Life. Because the vertebrae normally sit neatly on top of each other, when one slips out of place, it can compress both the disc that forms a cushion between the bones and the nerve bundle that runs through them, causing acute pain, chronic pain, or both. , says Samadani.

How does it happen?

Spondylolisthesis affects between 4% and 8% of the American population, and the most common form, degenerative spondylolisthesis, can result from the wear and tear of normal aging, according to Cleveland Clinic. It’s far less common among young people like Mangione, but when young people develop spondylolisthesis, it often occurs after a back fracture due to athletic activities or traumatic accidents like a hard fall.

How painful is spondylolisthesis?

Back pain in general is a known cause of chronic pain. Both Samadani and Stanford University pain management specialist Dr. Beth Darnall say that spondylolisthesis is a common source of back pain. “It’s a common enough problem that people who have back pain should be examined to find out if they have it,” says Samadani.

And it can be quite painful. “If the nerves are pinched … putting weight on your spine can be very painful,” adds Samadani. “It’s excruciating pain and it doesn’t go away with conservative management. Medicines won’t help, injections won’t help.” (According to the Cleveland Clinic, most cases of spondylolisthesis can be effectively managed with rest, pain medication, steroid injections, and physical therapy, but more severe cases may require surgery.)

The severity of the condition also matters. If a vertebra is only slightly out of place, the pain may be manageable without surgery, suggests the Cleveland Clinic. But a higher “grade”—or degree of slippage—case of spondylolisthesis can cause much more severe pain and warrant aggressive treatment. RJ Martin, a friend of Mangione’s who stayed with him in Hawaii, said so New York Times that Mangione’s “lower vertebrae were almost like half an inch off and I think it pinched a nerve. Sometimes he was fine and other times he wasn’t.”

Darnall says chronic pain can be profoundly disruptive to a person’s life and stability. “About 10% of people have what we call high-impact chronic pain,” she says. “This is chronic pain that really affects daily activities, schoolwork, daily self-care. These people are more likely to really struggle with mood, with one’s ability to get restorative sleep to deal with the distress and anxiety that can naturally arise with pain.”

Delays in treatment are not uncommon

Mangione never mentioned being covered by or angry at United Healthcare specifically on social media, according to multiple reports. But Samadani, who treats patients with spondylolisthesis, notes that many insurance companies require patients to undergo six to 12 weeks of physical therapy before the companies will agree to cover surgery or even imaging to diagnose the condition. And for someone with severe spondylolisthesis, physical therapy can be “excruciating” and won’t necessarily help, she adds. “It’s kind of like a torture, a mandatory torture imposed by the insurance company,” says Samadani.

And that is if they are treated at all. Samadani says she has seen several young patients who were initially turned away by doctors who did not believe they could have chronic back pain. “In the case of this particular child, my guess is that he was in massive pain,” she says.