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 the CEO of United Healthcare, Brian Thompson, appears to suffer from a back condition called spondylolisthesis, which can cause severe pain, his social media accounts suggest. Mangione had reportedly lived with chronic pain before undergoing back surgery in 2023, Business Insider reported. An image on his X banner appears to show an X-ray of his back after surgery, and several neurosurgeons and spine specialists agree that it looks like the operation was done to correct a condition known as spondylolisthesis.

Here’s what 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 was apparently aggravated 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 having experienced pain and numbness in his back, limbs and groin for a year and a half. A later post from the same account described the injury as “completely devastating.”

Mangione apparently wrote in another post that he spent 1.5 years undergoing “conservative” treatment for his back pain until he posted in 2023 about having back surgery, adding that he needed “zero pain meds” within a week of the operation. But, in May of that year, he reposted 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 of the spine slip out of place, Dr. Uzma Samadani, a Minnesota neurologist specializing in spine surgery, tells Yahoo Life. Because the vertebrae usually sit neatly on top of each other, when one slips out of place, it can compress both the disc that provides a cushion between the bones and the bundle of nerves that run through them, causing acute pain, chronic pain or both, Samadani says.

How does it happen?

Spondylolisthesis affects between 4% and 8% of the U.S. population, and the most common form, degenerative spondylolisthesis, can be due to the wear and tear of normal aging, according to the Cleveland Clinic. It’s far less common among young people like Mangione, but when young people do 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 get investigated 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 hurt a lot,” Samadani adds. “It is an excruciating pain, and it doesn’t go away with conservative management. Medications aren’t going to help, injections aren’t going to 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 has only slipped slightly out of place, the pain may be manageable without surgery, the Cleveland Clinic suggests. But a higher “grade” — or degree of slippage — case of spondylolisthesis can cause much more severe pain and warrant aggressive treatment. R.J. Martin, a friend of Mangione’s who lived with him in Hawaii, told the New York Times that Mangione’s “lower vertebrae were almost like a half-inch off, and I think it pinched a nerve. Sometimes he’d be doing well and other times not.”

Darnall says that chronic pain can be deeply 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 impacts daily acts, school work, daily self-care. Those people are more likely to really struggle with mood, with one’s ability to get restorative sleep to manage the distress and anxiety that can naturally occur with pain.”

Delays in treatment are not uncommon

Mangione never mentioned being covered by or angry with United Healthcare specifically in any social media, according to multiple reports. But Samadani, who treats patients with spondylolisthesis, notes that many insurers 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 sort of like a torture, a mandatory torture imposed by the insurance company,” Samadani says.

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