Back Pain and Murder
Luigi Mangione, the man accused of fatally shooting healthcare insurance CEO Brian Thompson in New York on 4 December 2024, apparently suffered from chronic low back pain. And according to news reports, this was due to a condition that he was probably born with, called spondylolisthesis; it was treated in 2023 with a spinal fixation operation.
Spondylolisthesis means that one vertebra, commonly the lowest lumbar vertebra (L5), is out of alignment with the bone below, the top part of the sacrum (S1). As a result, one may suffer displacement of the disc between L5 and S1, and the ligaments about this joint may become strained. Both these situations can result in pain felt in the lower back. A displaced disc (‘slipped disc’) between L5 and SI may impinge on one or more of the roots of the sciatic nerve, causing pain down the leg (sciatica) and possibly weakness of one or more muscles supplied by the nerve, with numbness of the overlying skin.
Effective treatment of this condition, as with all medical problems, depends of accurate diagnosis. If a patient has a lower lumbar disc displacement, it may be helped by manipulation of the lower back or by using local anaesthetic and steroid injections around the affected nerve root. But what about the stretched ligaments? These can be strengthened by sclerosant injections. Over the course of my career as a general practitioner I have given such injections scores of times, usually with good results. They don’t cure everyone, of course, but if these conservative measures fail, they in no way prejudice spinal surgery in the relatively few patients who may need it as a last resort.
What usually happens in chronic (long lasting) low back pain, however, is that most doctors, being ignorant of how to examine and diagnose such patients, after waiting a few weeks, and in the meantime in effect doing nothing, arrange an X-ray or scan. Then they may assume that what they see on the image is the cause of the patient’s pain.
The X-ray shown above appeared in news reports of the alleged murder, and apparently it is of Mr Mangione’s post-operative state. However, what is glaringly obvious is that the bones have been fixed by means of a metal plate, but in the wrong position. You can see the two top screws passing from right to left in the L5 vertebra, and below these, two more screws into the first two parts of the sacrum (S1 and S2). The vertebrae should have been properly aligned first and then fixed in the correct anatomical position. Furthermore, the lower two screws are too long: the bottom one has passed right through S2 and the one above it, in S1, is on the point of penetrating through the bone.
No wonder Mr Mangione was, and doubtless still is, in a lot of pain. This is not, of course, an excuse for him allegedly committing murder. But one cannot help wondering, if he had had successful treatment and was pain-free, whether the alleged crime would not have happened.
Text © Gabriel Symonds