Inverted Napoleon hat sign

Case contributed by David Fortunato Juan-Sierra
Diagnosis certain

Presentation

Low back pain.

Patient Data

Age: 40 years
Gender: Male
x-ray

The AP view shows the inverted Napoleon hat sign, indicative of bilateral L5 pars defects and high grade anterolisthesis.

In the lateral view pars interarticularis defect and spondyloptosis are noted.

Case Discussion

Spondyloptosis is the most advanced stage of anterolisthesis and represents a displacement greater than 100%.

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