Luigi Mangione, the United Healthcare CEO’s killer, had posted an X-ray of his back, showing fixation hardware for a fusion of L5 and S1. It’s obvious that L5 was too forward of S1.
The X-ray appears in lots of places online now. Here’s one:
When I look at that X-ray, L3 looks weird, like it’s thin or partly missing or something. Some of the main body of L3 is dark, as if the density is very low. I’m not at all trained – if you are, what do you see there? Is this a much bigger problem than a fusion can fix?
L3 looks dark because that’s a bubble of bowel gas overlying it.
Beyond that, the image is pretty low resolution, and that makes it difficult to comment on further. He’s obviously had a significant procedure down by L5-S1 and a bit lower. But for accurate assessment of the area, I’d be relying on a CT or MRI of that region more than just plane films.
I’m not a radiologist but I did spend 4 decades reviewing these sorts of films on my patients.
I rely on radiologist reports and specialists’ interpretations, and that said what I see besides the hardware is what looks to me like a severe degree of lumbar lordosis (excessive curve of the lower spine forward). Which from the little I understand is not great in the context of spondylolithesis. @Qadgop_the_Mercotan as someone who has seen many more of these than I have, is that right?
His Cobb angle is about 85 degrees, so that’s a pretty significant lordosis for sure; but I’m nowhere near expert enough to know if or how the surgery lower down might have impacted it. He does have apparent anterolisthesis down by L5-S1. I’ve no idea if the surgery evident on the x-ray was expected to improve that, or just stabilize it, or what.
I do note Mangione’s statement in the link: “Remember that the human body is supposed to exist in a pain-free state". How I wish that were true, but it’s not. Time grinds all things down.
What surprises me a bit is that the back problems started when he was in his early 20s, and while apparently in fairly good shape. (Not excessively obese or anything like that.)
A high school classmate of mine had to have back surgery around age 15. He wasn’t particularly overweight, though maybe a bit “husky” (by 1980 standards); I might guess that my classmate’s surgery was related to some sort of congenital defect, rather than an injury suffered through use.
I graduated high school in 1984 and sometime in elementary school we were screened for scoliosis. One kid I know wore a brace for a while due to that condition.
The advice given to the elderly is that it’s safer to build strength in a controlled environment than letting yourself become so weak that you become at-risk of injury if ever there’s an incident that requires greater movement and strength than you’ve become accustomed to.
But, the most likely path to injury is doing something dumb or ego-driven like overdoing it in the gym. I’d venture to guess that if you were to do 30-60 minutes of warmup and target achieving and maintaining certain minimums of mobility and strength - rather than constantly pushing for gains - use machines to the greatest extent possible, and be quick to stop if something felt janky, then that would probably prevent what you’re talking about.
To be sure, that’s not what people do at the gym (under the age of 60). Nevertheless, you could do it that way.
But, barring traumatic injury and disease, it is a reasonable expectation for a 26 year old.
There are certainly a lot of thing we do in modern society that do not predispose people to good fitness and long term health including many competitive sports, sitting in an upright posture for hours on end, not developing flexibility and joint resilience, focusing on fine print and closely held ‘screens’ (often with the neck craned awkwardly down) for long periods of time, et cetera, but Mangione’s back problems seem to indicate some more chronic condition or prior traumatic injury, and those issues can be difficult to diagnose and problematic to treat, hence why insurance companies have a predisposition to deny claims even when the treating physician acknowledges the reality of the pain and impact upon quality of life. Back injuries and chronic back pain are also showing up at greater rates in much younger adults for reasons that are not entirely clear, which makes an expensive proposition for insurance that may be on the hook paying for treatments and diagnostics for decades if they can’t manufacture a reason to deny the claim.
This is, of course, just a small part of the overall problem with the for-profit health care industry, but it is one that patients will suffer with for long periods often without apparent relief. Corporate leaders for the health care industry can argue that some terminal conditions should not receive ‘heroic’ treatments (and extend that logic to expensive chemotherapy and radiotherapy treatments or other ‘experimental’ treatments even when they have measurable efficacy in quality and duration of life) which, with sufficient stalling tactics is a problem that will ‘resolve itself’ in due course, but with chronic but stable conditions like idiopathic back pain an insured patient may repeatedly contest a rejection of coverage and become frustrated with how obviously unscrupulous and reprobate such denials are.
The story as I understand it is that he had a congenital weakening of the portion of the vertebra that wraps around the spinal cord - spondylolysis. With sports, especially those activities that include hyperextension, gymnastics and wrestling inclusive, that weak bit can break and the body of vertebra can shift forward - spondylolithesis. That can cause muscles to react and press on the nerves coming out or even the cord itself.
In my population usually PT is sufficient and sometimes activities are modified more long term. Surgery is often pushed off for as long as possible as fusing one layer can increase the stress forces above or below. But from my perspective it is easy. To the specialists they go!
According to the CDCs, over a third of us live with back pain. My SIL the nurse lives with it, my brother who was a nurse too, until he lifted an obese patient (his employer fought his claim for ten years, including suborning his coworkers to lie at deposition. His doctor over-prescribed him with opioids during that national crisis, and he nearly died from it). Myself, presented one day with a situation at work that tore away most of the lower back muscles and sick for weeks afterward as their dead tissue worked through my system. A lot of you have similar stories.
Young master Mangione hurt himself surfing in Hawaii. The sector of the national media dedicated to preserving the status quo will make sure you know of this. Bad things only happen to people who deserve it. (Although the media on the opposite pole are applying this same logic to the victim. If the political horseshoe fits, wear it).
It reminds one of the 2004 movie The Clearing. Willem Defoe is a creepy-looking loser who kidnaps and kills golden-boy CEO Robert Redford. Redford had shuttered the plant that left Dafoe unemployed and having to live with his in-laws. His FIL kept him awake with the TV full-blast. So not for the cause of social justice, but rather because an old man won’t buy a hearing aid, Robert Redford has to die.
People will want to know how bad it was. He’s already a sympathetic character to some, back pain made me kill is not going to work against him. His main legal problem is still that little bit about how it’s illegal to kill people even if you think they deserve it.
I had a laminectomy and a titanium cage built around my L5-L4 lower spine vertebrae to shore them up. Seven years after that I had a laminectomy and a titanium cage built around my L4-L3 lower spine vertebrae to shore them up. My spinal x-rays look much like the picture above.
Seven years later, guess what? I have spinal stenosis because of the crumbling of my L3-L2 vertebrae. But for various reasons, a third operation is counter-indicated. Some mornings when I get out of bed I can barely make my way to the bathroom because the pain is so intense.
I will probably be this way for the rest of my life. Although I’ve been through a number of procedures short of another cage, nothing works except for thermohydrotherapy - soaking in a warm bath. That apparently relaxes something so that the pressure is lessened. Not pain-free but tolerable for the sedentary life I lead.
If I thought my surgeon - the head of orthopedics at the local medical school - had bungled my surgeries, my anger at him would be colossal. (He didn’t, to be clear.) If I thought that another surgery could help for another seven years but insurance turned it down, my anger would be volcanic.
So many people are in that last category that the pent-up relief of having someone else express that anger is like a nationwide gust of wind. Murder of CEOs is obviously not a large-scale solution to anything but this national outpouring of “Now do you get it?” would in any sane country lead to systemic change.
Do we live in a sane country? I have many doubts right now. Nevertheless, with both the right and left expressing similar displeasure at the system maybe Congress can pass a half-measure and call it a win.
So far there has been nothing shared that this individual ever had any care coverage denied by UHC … heck we don’t even know if he was covered by UHC. We do know he got his surgery. We do know that he comes from a family that had resources most do not, donations made in the millions, and not only was not asking them for help with medical bills or support but had dropped off from all contact with them sometime after his surgery, reported missing.
I know as little as anyone else but I’ll place my bet on a psychotic break. No particular insurance sin against him.
There was a “Jackass” episode where a guy cracked his tailbone (big surprise, KWIM?) and they showed his x-ray, which not only had his boy parts on full display, but he also wanted to know what those blobs were. “Stool”, replied the nurse. “You mean, you can see my crap on an x-ray?”
I was always tempted to say that whenever I had a customer who wanted to know why they had to take laxatives when their kidneys were being x-rayed, but I would reply, “Intestinal contents show up on an x-ray.”
Otherwise, I can’t comment further.
I’ve seen my cats’ x-rays and it shows up there too.