It is a retrospective cohort analysis of patients treated at the same time. The researchers wanted to determine if routine functional radiographs of lumbar spondylolisthesis captured enough flexion-extension. In the case of lumbar spondylolisthesis, standing flexion-extension radiographs were the most typically utilized to assess spinal instability. However, the results can vary because these functional radiographs are sometimes dependent on the patient’s effort and cooperation. A total of 92 patients with L4-5 degenerative lumbar spondylolisthesis were included in the investigation. The researchers compared flexion-extension radiographs taken with and without the patient being led by the hand (LH). On functional radiographs taken in both tests, sagittal translation (ST), segmental angulation (SA), posterior opening (PO), and lumbar lordosis (LL) were quantified. The ST, SA, PO, detection rate of instability, and, LL in LH were comparable to NLH. Furthermore, the relationship between ST, lumbar angulation, and LL was investigated. In LH, the relative value of ST was 9.5%±4.3%, while in NLH, it was 5.6%±3.3%, a significant difference (P<0.001). In addition, SA and PO were substantially higher in LH than in NLH. Instability was detected 71.7% of the time in LH and 30.4% in NLH (P<0.001). On flexion, the LH measured 17.6°±13.5°, and the NLH measured 28.2°±12.2°, which differed considerably (P<0.001). However, there was no discernible change in LL on extension between LH and NLH. The differences in ST, SA, PO, and LL on flexion had a moderate association. Flexion with help from a physical therapist effectively detected aberrant lumbar mobility. Physical aid, such as placing a table in front of a patient, could lead to a comparative evaluation of segmental instability, taking radiation exposure into account.