Uccess of bmp in the anterior column has motivated further research into using bmp in the posterior column. Two forms of bmp are available for use in the posterior spine. Bmp-7 (op-1, stryker) is approved by the food and drug administration (fda) for use in single- or multilevel lumbar fusion in hosts who present a challenge to achieving solid arthrodesis (revision for demonstrated nonunion, multiple medical comorbidities, smoker, for example). lowest price viagra 20mg 7 bmp-2 is currently not fda approved for use in the posterior spine. Initial data for both of these substances as autograft replacements are encouraging. The higher bmp doses (and thus higher cost) required in the posterior spine make bmp use less attractive. Bone marrow aspirate applied to either a collagen sponge or morselized bone graft has demonstrated promising results in the posterior column. I prefer to use bmp with a structural cage (peek or allograft) in the anterior column and use local bone with icbg posterolaterally for thoracolumbar fusions. Allograft is usually an excellent autograft graft substitute for posterior thoracolumbar fusions in ais. For multilevel thoracolumbar fusions in the adult patient, i prefer to supplement the posterior fusion with bmp and allograft. Figure 36-1. Bone graft substitutes. Femoral ring allograft (fra) used for anterior lumbar interbody fusion (alif) in conjunction with an instrumented posterior spinal fusion to generate an anteroposterior spinal fusion (apsf) or 360-degree fusion. buy viagra The benefit of fra is that it provides structural interbody support (unlike morselized autograft) and will act as a scaffold for a biological product (autograft, demineralized bone matrix, bone morphogenetic protein, etc) to promote interbody fusion.   references 1.   samartzis d, shen fh, matthews dk, yoon st, goldberg ej, an hs. Comparison of allograft to autograft in multilevel anterior cervical discectomy and fusion with rigid plate fixation. Spine. 2003;3:451-459. viagra pill wikipedia 2. viagra pill wikipedia   samartzis d, shen fh, goldberg ej, an hs. Is autograft the gold standard in achieving radiographic fusion in one-level anterior cervical discectomy and fusion with rigid anterior plate fixation? viagra cost Spine. 2005;30:1756-1761. 3. generic viagra online pharmacy   smucker jd, rhee jm, singh k, yoon st, heller jg. Increased swelling complications associated with off-label usage of rhbmp-2 in the anterior cervical spine. Spine. viagra online 2006;31:2813-2819. 4. superlara 100 viagra   shields lb, raque gh, glassman sd, et al. Adverse effects associated with high-dose recombinant human bone morphogenetic protein-2 use in anterior cervical spine fusion. Spine. viagra without prescription 2006;31:542-547. 5.   betz rr, petrizzo am, kerner pj, falatyn sp, clements dh, huss gk. woman in viagra commercials Allograft versus no graft with a posterior multisegmented hook system for the treatment of idiopathic scoliosis. Spine. 2006;31:121-127. 6.   burkus jk, gornet mf, dickman ca, zdeblick ta. Anterior lumbar interbody fusion using rhbmp-2 with tapered interbody cages. viagra online without prescription viagra pill wikipedia