Justification from literature

PROJECTION FOR SPONDYLOLISTHESIS

Lateral Hyperextension lumbar spine 

Vertebral body alignment and height are best assessed on well-positioned lateral radiographs. Spondylolisthesis involves the anterior or posterior displacement of one vertebra over another, which is best visualized on a lateral view. This perspective shows any forward or backward slippage, often graded by the extent of the displacement. It allows to see changes in disc height, which can help evaluate degenerative changes that may contribute to spondylolisthesis. It’s easier to see defects or fractures in the pars interarticularis, which is critical since defects in this region are a common cause of spondylolisthesis (especially isthmic spondylolisthesis).