Information for Referring Physicians
PAMO (Paraspinal Muscle Optimization) is a hospital-based medical procedure developed by Professor Semih Keskil for selected adolescents with idiopathic scoliosis.
The procedure was developed following nearly a decade of clinical observation, imaging analysis, anatomical investigation, and protocol development, built upon more than forty years of experience in pediatric neurosurgery, neuroanatomy, and spinal disorders.
This page provides an overview of patient selection, evaluation, procedural planning, and follow-up considerations for physicians interested in referring patients for assessment.
A hospital-based, image-guided procedure.
PAMO is intended for carefully selected adolescents with idiopathic scoliosis. The procedure is performed under image guidance in a hospital environment and focuses on selected paraspinal muscular structures identified through clinical and radiological evaluation.
PAMO is currently performed exclusively by Professor Semih Keskil in Ankara, Türkiye.
Patient Selection
Appropriate patient selection is a fundamental component of the PAMO protocol. Patients typically considered for assessment include:
- Adolescents with idiopathic scoliosis
- Patients between 10 and 20 years of age
- Cobb angles generally between 20° and 50°
- Ongoing skeletal growth
Eligibility is determined individually following comprehensive clinical evaluation and advanced imaging studies.
Patients Generally Not Considered
- Adult scoliosis
- Congenital scoliosis
- Neuromuscular scoliosis
- Patients with completed skeletal maturation and established degenerative spinal changes
Final determination is based on individual clinical assessment.
For preliminary remote review.
Referring physicians may submit available imaging studies and reports, including:
- Full-spine standing scoliosis radiographs
- MRI studies
- CT studies
- EOS imaging when available
Additional test results are also welcome.
Remote review does not establish procedural eligibility.
Patients considered potentially suitable following preliminary review are invited to Ankara for comprehensive evaluation. Assessment may include:
- Clinical examination
- Skeletal maturity assessment
- Review of progression history
- Full-spine imaging studies
- Dynamic imaging
- Biomechanical evaluation
Not all patients referred for evaluation will ultimately be considered candidates for PAMO. Patient selection remains a critical component of the protocol.
A visual representation of PAMO's clinical effect.
The image on the left shows the spine before the PAMO procedure, while the image on the right shows the same patient only five days after the procedure.
The colored arrows represent the direction and magnitude of vertebral rotation at each spinal level when viewed from above.
When the two images are compared, the post-procedural rotational vectors demonstrate a more organized distribution, appear more closely clustered, and show a more balanced alignment around the spinal midline.
This analysis provides a visual representation of changes observed in the three-dimensional rotational organization of the spine.
Procedural Planning
For patients considered appropriate candidates, procedural planning is individualized according to:
- Curve characteristics
- Skeletal maturity
- Clinical findings
- Imaging results
- Functional assessment
Every case is reviewed personally by Professor Semih Keskil prior to proceeding.
Follow-Up
Patients are followed through a structured clinical review process. Follow-up may include:
- Radiological assessment
- Clinical evaluation
- Remote follow-up consultations
- Consideration of additional procedural courses when appropriate
All follow-up recommendations are individualized according to patient-specific findings.
Supporting continuity of care.
When requested by patients and families, communication with referring physicians may be facilitated regarding evaluation findings, procedural planning, and follow-up recommendations. The objective is to support informed clinical decision-making and continuity of care.
Submit a Case for Preliminary Review
Physicians who wish to discuss a potential candidate are invited to contact the PAMO Med International Patient Unit. Our team will provide guidance regarding the preliminary review process, required documentation, and subsequent evaluation steps.