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Suspect's motive remains unclear

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Social media, interviews suggest Mangione had back pain

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Mangione spent time in Thailand in the spring, traveling

companion says

By Amina Niasse and Julie Steenhuysen

NEW YORK, Dec 10 (Reuters) - A potential history of back

pain emerged on Tuesday as a point of interest in the

UnitedHealthcare CEO murder case, based on accounts from two

people who knew the suspect and details from his social media

profiles.

Luigi Mangione is in custody in Pennsylvania and faces

multiple charges there as well as murder charges in New York.

While the gunman's motive remains unclear, police have said

Brian Thompson, the head of one of the nation's largest health

insurers, was deliberately targeted.

The case has drawn intense interest online, where sleuths

have looked for answers as to how a 26-year-old from a prominent

family who had attended an Ivy League college ended up an

accused murderer.

Social media commentators said clues about back pain could

explain both personal distress and difficulties obtaining

insurance coverage for treatment.

Reuters could not determine whether Mangione had been

diagnosed with a back condition or whether he sought, or

received, treatment including surgery.

On social media, Mangione left a trail of clues, including a

picture of an x-ray of a spinal surgery on his X profile and a

review on Goodreads of a book called "Crooked: Outwitting the

Back Pain Industry and Getting on the Road to Recovery."

In a 14-page handwritten document that Sky News identified

as having been uploaded to his Google Drive account in 2021 and

which has not been independently verified by Reuters, Mangione

said he had a back injury known as an L5-S1 isthmic

spondylolisthesis, in which one of the bones in the spine slips

forward and presses on the vertebra below it.

Dr. Wellington Hsu, professor of orthopedic surgery at

Northwestern University Feinberg School of Medicine, said about

6% of the population has this condition and most people don't

even know it because it typically does not cause pain.

About 20% of people with this condition have symptoms, and

of those, another 20% may need surgery.

Paul Piek, a 21-year-old software testing professional from

Flensburg, Germany, met Mangione in March while watching a muay

thai boxing fight in Ao Nang, Thailand.

The two and another friend of Piek's met up again in Krabi,

Thailand on April 8 and roadtripped through Khao Sok and

Bangkok, where they shared a hotel room for four nights and

visited temples.

"He told us he did (muy thai) before his injury," said Piek.

Piek said Mangione told him he was interested in hiking when

they met, with no further mention of his back injury. "It didn't

seem like a problem," though he did opt out of one guided hike

for an easier walk, saying he was ill.

Mangione said he was "between jobs" while in Thailand," said

Piek, who described Mangione as a spontaneous travel companion,

who enjoyed partying.

After traveling for another month alone, Mangione indicated

in June that he was returning to the U.S., Piek said. In July,

Piek stopped hearing from him.

BACK SURGERY

Mangione had left his previous employer, Truecar ( TRUE ), a

car buying platform with offices in California, in 2023, the

company said.

A colleague he worked with there told Reuters he took leave

during the middle of 2023 for about two months, a move the

colleague's manager told him was due to back-related issues.

He also told the manager of Surfbreak, a co-living residence

in Hawaii, that he had a back problem, and in August of 2023

sent him pictures of a back surgery, according to the New York

Times.

Mangione's notes mention that his condition involved a

stress fracture in the pars bone that connects the vertebrae to

the spinal column.

Dr. Richard Nachwalter, a Morristown, N.J. orthopedic spine

surgeon, said frequently a bone connecting the vertebra cracks

from sports in adolescence, fails to heal and changes the

mechanics of the spine, causing the vertebrae to slip forward

over time.

"As it slides forward, the disc degenerates, and either you

get back pain, and if it slides and pulls on a nerve, you'll get

leg pain," he said of spondylolisthesis.

Mangione's profile on X includes an x-ray of a person who

has had an L5-S1 spinal operation in which two vertebra are

surgically fused together. The surgery has an overall success

rate of 80%, according to the National Institutes of Health.

In general, a spinal fusion surgery in a young person

"should be a very predictable operation," Nachwalter said.

"You should be able to live your regular life, go back and

play sports, play golf," he said.