Edit: Here’s a link to what is most likely the real manifesto: https://www.kenklippenstein.com/p/luigis-manifesto
Ken Klippenstein is a very reliable journalist and this version of the manifesto contains the snippets that have been released by law enforcement. Also, considering the thing was hand-written, that very long version involving his mom is dubious. (And there’s not any good evidence that his mom is in anything besides decent/good health)
I’ve read that spinal surgeries are especially iffy, with roughly 1/3rd chances of improving/stagnating/worsening. It’s a shame that his pain only resulted in one dead health insurance demon when there are so many to choose from. Thousands just walking around as the most prolific serial killers in history. Put me on the jury.