What a difference a fraction of an inch can make.
The fact that one of the 33 bones in his spine was displaced by less than half an inch apparently affected Luigi Mangione's quality of life so much that his lower legs felt as if they were on fire. At other times, the 26-year-old charged with murdering the UnitedHealthcare CEO vacillated between pain and numbness in his lower back and genital area.
Social media posts believed to have been written by Mangione suggested he had been diagnosed spondylolisthesis, a back disease that occurred in childhood and led to impairment after an accident during a surfing lesson in 2022.
“My back and hips were locked after the accident,” wrote a Reddit user whose biographical details match Mangione's. The user whose account was deleted also complained that “intermittent numbness has become constant.”
“I’m terrified of the repercussions,” the user wrote. according to CNN.
Mangione is accused of fatally shooting Brian Thompson outside a midtown Manhattan hotel last week and evading capture for five days. The Ivy League graduate said his lawyer intended to plead not guilty to the murder charge.
Back pain isn't the only health issue plaguing Mangione — the Reddit account included posts about brain fog and Lyme disease — but the spondylolisthesis appeared to be the most stressful.
There are many reasons why a part of the spine can become out of alignment.
spondylolisthesis (pronounced spawn-duh-low-lis-THEE-sus) can begin before birth if the spine does not develop properly in the uterus. Or it can occur suddenly when an accident or injury occurs one of the vertebrae out of position.
A fracture in the part of the bone that connects the vertebrae can become so large that part of the spine can no longer be held in place. A bone-weakening disease like osteoporosis or even one Spinal tumor can also disrupt the alignment of the vertebrae.
Most commonly, spondylolisthesis is a result of aging. The older we get, the thinner the discs that separate the vertebrae become. If the bones aren't held firmly in place, it's easier to end up where they don't belong.
Any part of the spine can be affected by spondylolisthesis, but it most commonly occurs in the lower back. (The Reddit user, believed to be Mangione, stated that his misaligned bone was at the bottom of his lumbar spine, just above the pelvis.)
Wherever it occurs, the misalignment of a spinal bone can affect the nerves surrounding the spine. Back pain is a typical symptom, but the pain can spread to the legs and feet if one of the causes is Sciatic nerves is involved. The discomfort can also manifest itself in a tingling tingling sensation.
In Mangione's case, symptoms appear to have particularly increased while surfing in Hawaii in 2022. The Reddit user said he “experienced sciatica for the first time” while on the water. according to Business InsiderHowever, it is not clear whether the painful condition caused his accident or was a result of it.
Things got worse a few weeks later when he “slipped on a piece of paper,” he said. “For a week my right glute was locked and my right leg was out of commission. Couldn’t bear any weight on it.”
He also felt an “almost constant burning/twitching sensation in both ankles/calves.”
Pain is not the only symptom of spondylolisthesis. If part of the spine is out of place, patients may experience back stiffness, be unable to stand for more than a few minutes, or have difficulty walking.
These problems can worsen if left untreated. Other possible complications include urinary or intestinal incontinence, says the Cleveland Clinic.
Initial treatment usually includes rest to take pressure off the spine and pain medications such as Advil, Motrin, Aleve, or Tylenol to relieve pain and reduce inflammation. If over-the-counter medications aren't enough, doctors may prescribe corticosteroid medications or a cortisone injection.
Once the rest period has passed, targeted exercises can strengthen the muscles in the abdominal and lower back areas, providing better support for the spine. Braces or a brace may also be necessary, especially if the problem was caused by a fracture that needs to heal.
The only way to actually put the bone back in place is surgery. This may be necessary if serious problems persist.
The goal of surgery depends on the cause of the patient's spondylolisthesis. accordingly the American Academy of Orthopedic Surgeons.
If a broken bone is to blame, surgeons can support it by fusing it to another vertebra using screws and rods. Mangione underwent spinal fusion surgery in 2023 after living with pain for a year and a half.
He shared a picture of a post-surgical X-ray with one of his former roommates from his time in Hawaii. The image “looked hideous, with just huge screws in his spine,” former roommate RJ Martin told CNN.
On Reddit, the user, believed to be Mangione, reported that the operation was successful. “Within 7 days of the fusion, I took no pain medications,” he wrote. according to ABC News.
If a rupture is not the problem, but a misaligned disc is compressing adjacent nerves, surgeons may perform a laminectomy. This procedure involves removing parts of the bone and surrounding ligaments to make more room for the nerves.
Sometimes surgical patients receive both treatments, the academy says.
Although Mangione seemed happy with the results of his surgery, he wasn't happy that it took so long to get it. The Reddit user said he feared he would be “subject to chronic pain and a desk job for the rest of my life.”
He advised other Reddit users to exaggerate their symptoms – like pretending they are could not lift the forefoot or intentionally urinating in their clothes – to get surgery sooner.