Inverted Napoleon hat sign

What is the inverted Napoleon hat sign?

This is a finding seen on a frontal radiograph of the lumbar spine or pelvis that is associated with spondylolisthesis of L5 upon S1. The anterior-inferior vertebral margin and transverse processes of the severely anteriorly displaced L5 vertebra when superimposed upon S1 have the appearance of Napoleon’s hat turned upside down


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