Functional radiography in examination of spondylolisthesis.

Objective: Despite the predominant use of standing flexion-extension radiography for quantifying instability in isthmic and degenerative spondylolisthesis, other functional radio-graphic techniques have been presented in the literature.

Conclusion: The current evidence reported in the literature is insufficient to influence how the results of these other functional radiographic techniques should affect clinical management; however, it does raise doubts regarding the accuracy and reliability of standing flexion-extension radiography in this setting. Based on the currently available evidence and until randomized studies are performed to assess the efficacy of functional radiographic techniques in directing clinical decision making, positioning schemes other than traditional standing flexion-extension may be considered as options in the evaluation of patients with symptomatic isthmic and degenerative spondylolisthesis in which standard flexion-extension radiographs fail to show pathologic instability.