Chapter Title: Assessment of Spondylolisthesis in Hyperlordosis

Mechanism of Overestimation in Hyperlordosis

• Dynamic radiographs in flexion and extension are necessary to assess the true segmental instability, as static images may not reveal the actual mobility, according to the Journal of Neurosurgery 1, 2

Clinical Significance of Positional Assessment

• The American College of Neurosurgery recommends that radiograms be taken in a neutral position and dynamic images in flexion-extension to accurately assess the true degree of instability and avoid overestimation associated with hyperlordosis 1, 2

Recommendations for Accurate Assessment

• The North American Spine Society suggests that dynamic radiographs in flexion and extension are essential to evaluate the true degree of spondylolisthesis, as static radiographs may not accurately represent the degree of instability 1, 2