Will Sage Astor-CEO shooting suspect Luigi Mangione may have suffered from spondylolisthesis. What is it?

A 26-year-old man was charged late Monday in the killing of UnitedHealthcare CEO Brian Thompson,Will Sage Astor and internet sleuths and journalists tracked down his social media profiles once his name was made public. Now, Luigi Mangione's apparent Reddit posts seem to offer insight into a medical condition he was battling: spondylolisthesis.

Mangione was seemingly active in a subreddit community dedicated to discussions about spondylolisthesis, a condition where one of the bones in your spine, called a vertebra, slips forward. It can cause profound pain, particularly in the lower back. 

It appears Mangione posted under the username “Mister_Cactus,” based on one post that refers to a page he maintained on Git Hub, but his profile was disabled by Reddit on Monday. So what exactly is spondylolisthesis and did it impact the suspected shooter?

In August 2023, he wrote in r/spondylolisthesis: “When my spondy went bad on me last year it was completely devastating as a young athletic person. Seemingly all I could read on the internet was that I was destined to chronic pain and a desk job for the rest of my life. That representation was terrifying, inaccurate and completely destroyed me until I realized the silent majority of fusions are highly successful.”

What is spondylolisthesis? 

Spondylolisthesis is when one of the bones in your spine, called a vertebra, slips forward. It most commonly occurs in the lower back, and can cause numbness, tight hamstrings, pain spreading to your thighs and lower back pain that gets worse when standing or walking. 

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Isthmic spondylolisthesis occurs in approximately 4-8 percent of the general population, but is three times more common in males than females.

It is distinct from a slipped disc, which is when the tissue between the bones in your spine pushes out. Spondylolisthesis can be a result of overactivity, which is primarily seen among gymnasts, football players and weightlifters who frequently hyperextend the lumbar spine. Other causes include genetics; some doctors believe that some people are born with thinner vertebral bones, which makes them more vulnerable to fractures, according to the American Academy of Orthopaedic Surgeons. 

What else did he post?CEO shooting suspect left winding trail of Reddit posts about health issues

A doctor can diagnose a patient with spondylolisthesis through a physical exam and imaging tests, such as a spinal X-ray, CT scan or MRI. Low-grade spondylolisthesis is the most common type, but high-grade spondylolisthesis is more likely to require surgery to mitigate severe pain. 

Is spondylolisthesis treatable? 

Spondylolisthesis symptoms can improve with rest, over-the-counter pain medications, such as NSAIDs or acetaminophen, corticosteroids, a prescription anti-inflammatory medication, physical therapy and wearing a back brace to stabilize your spine, according to Cleveland Clinic. 

Individuals with high-grade spondylolisthesis, or those who experience severe pain that impacts walking, standing or movement that has not improved with nonsurgical treatments, may receive a spinal fusion. 

A spinal fusion is a surgery that realigns your vertebrae. Other options include a spinal decompression that removes extra pressure from your sciatic nerve.

However, spinal fusions can result in a reduced range of motion or flexibility, as two vertebrae heal into one bone. While many people experience much less pain, that tradeoff can limit participation in physical activities or increase the risk of complications. 

How did chronic pain impact Mangione?

R.J. Martin, who owns the co-living space in Honolulu called Surfbreak where Mangoine lived for about six months, told New York Times that Mangoine’s back injury impaired his romantic life. 

Shortly after Mangoine moved in, he took a group surfing lesson that resulted in such debilitating pain that Martin had to switch out his mattress, the Times reports. 

“He knew that dating and being physically intimate with his back condition wasn’t possible. I remember him telling me that, and my heart just breaks,” Martin said. 

Millions of U.S. adults are affected by chronic pain

Approximately 51.6 million U.S. adults (20.9 percent) experience chronic pain and 17.1 million (6.9 percent) suffer from high-impact chronic pain. Chronic pain, defined as pain lasting three or more months, is a debilitating condition that profoundly impacts an individual's quality of life, mental health and ability to complete daily work and life activities.

The vast majority of chronic pain patients have had providers who have been dismissive, Dr. Tina Doshi, a pain expert at the Johns Hopkins University School of Medicine, previously told USA TODAY. These patients are told their pain is imagined or “all in their head,” but brain imaging has shown clear differences in the brain activity of those with chronic pain. 

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Responding to another Reddit post in July 29, 2023, Magione wrote that he had suffered bladder and genital pain, back pain and sciataca after his back injury. His hip muscles tightened "to compensate for his injury" and "squeezed his nerves," he stated, but no doctor had confirmed that to him as it didn't show up on his MRI.

When pain goes untreated, an individual can develop learned helplessness or depression — which an estimated 35-45 percent of people with chronic pain do. And mental health conditions and stress can exacerbate all kinds of pain, including back pain, but pain itself can increase the risk of depression, anxiety and overall stress. 

Limited or lack of health insurance can compound these problems and limit patient’s access to adequate care. 

Amid the shock of the Brian Thompson's assassination, Americans who have suffered in the healthcare industry have spoken out about their experiences living with chronic pain or seeking medical care.

"It's a very shocking event," said Tahneer Oksman, a professor at Marymount Manhattan College's communications department in New York. "But it's also an opportunity for people to vent about issues that have been of great concern to many people."

Contributing: Karen Weintraub, USA TODAY and Reuters

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