In-orthosis correction is typically looked upon as how much correction to the Cobb angle is achieved, but the practitioner must also look at overall spinal balance in relation to the central sacral line to determine the direction and application of forces. For instance, a decreased Cobb angle with a marked asymmetrical balance in relation to trunk shift and decompensation is unacceptable. As evidenced in Figure 1, both spinal balance and Cobb angle have been greatly improved. If there was good Cobb angle correction but poor spinal balance in the coronal plane, then the correction would be unacceptable. It is important to also pay particular attention to the sagittal plane when decreasing Cobb angle in-orthosis to prevent increasing hypokyphosis. A marked decrease in sagittal kyphosis should not be sacrificed for in-orthosis Cobb measurements.
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