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Luigi Mangione, the person charged with murdering United Healthcare CEO Brian Thompson, reportedly had spinal surgery for chronic back pain caused by spondylolisthesis.

Spondylolisthesis occurs when a vertebra slips forward out of place onto the vertebra below, explained Jessica Stark, MD, spine surgeon at UTHealth Houston. This slippage, a sequela of arthritis, happens most often in the lumbar spine and can put pressure on the nerves around the spine.

"Really arthritic backs can have varying degrees of spondylolisthesis throughout the spine, just because the joints have become overgrown and slipped at different spots," Stark told 名媛直播.

Pain levels depend on the degree of slip and how the spondylolisthesis came to be. When patients come in with the condition, Stark begins by assessing the grade of severity and how much the condition is affecting the patient's life. Many report having back and leg pain or numbness.

"I always tell patients that pain is kind of a warning sign from the nerve compression, but that numbness and weakness is actual nerve damage," Stark said. "When we get to weakness is really when we start to worry, because that's when that nerve is getting pretty severely damaged and sometimes, especially with certain nerves, once they get so much pressure on them, you get so weak that the nerve actually can't heal itself anymore."

She noted that people can develop spondylolisthesis for various reasons.

Degenerative spondylolisthesis, the most common form, occurs from wear and tear of the bones rubbing against each other over time. Most of the time this presents at age 50 or older. Some people, like those who do manual labor or play impact sports, have more wear and tear on their bodies from these high impact activities and are more likely to get arthritis or herniated discs earlier as well as develop spondylolisthesis. Women and African Americans are also more likely to develop degenerative spondylolisthesis, according to the American Academy of Orthopaedic Surgeons.

Those born with congenital pars defects or fractures -- abnormalities in the part of the bone in the back of the spine that keeps the joints in place -- may have their bones slip at an earlier age, perhaps even in their teen years. Traumatic fractures to the pars, stemming most often from vehicle crashes or falls, can also lead to spondylolisthesis.

"Acute injuries, like traumas, obviously get more injury to their nerve because it happens all of a sudden, and their nerves haven't been stretched for a long time so they don't have that kind of protective nerve root healing that's slowly going on," Stark explained.

Treatment often begins with core-strengthening physical therapy to reduce pressure on the spine, long acting anti-inflammatories like celecoxib (Celebrex) or meloxicam, and potentially muscle relaxers or nerve pain medication like gabapentin (Neurontin). For some, this level of intervention is sufficient.

But if the condition doesn't improve or worsens in 6 weeks, the next step is injections given every few months. Stark said this typically involves a lumbar epidural steroid injection that has anti-inflammatory effects with lidocaine for short-term numbing pain relief. Like other similar injections, the lumbar epidural steroid injection works best the first time and becomes less efficacious with each injection.

Surgically stabilizing the spine with four screws and two rods is the last resort and definitive treatment. Stark said most surgeons also clean out the disc and put in "some type of interbody, meaning cage, into the disc space to allow for anterior fusion as well, because it's a lot of stress on those screws, on the rods, and that can fail over time." This gives the intervention a better chance of holding, she explained.

After the vertebrae are stabilized, the spine's first point of movement is a level higher, which slightly increases the risk of arthritis on that level. About 20 years after surgery, some people need a second one on the level above the first.

The silver lining to a difficult condition, Stark said, is that some of the most effective treatments are relatively new.

"I can fix this through a small incision that's less than an inch," she said. "I think that's nice that we can do that -- and that wasn't an option 10 years ago."

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