Nuvasive (NUVA) 10-Q 2 Aug 23 2023 Q2 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	6 Months Ended
	Jun. 30, 2023	Jul. 31, 2023
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Jun. 30, 2023
Document Transition Report	false
Entity File Number	000-50744
Entity Registrant Name	NUVASIVE, INC
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	33-0768598
Entity Address, Address Line One	12101 Airport Way
Entity Address, City or Town	Broomfield
Entity Address, State or Province	CO
Entity Address, Postal Zip Code	80021
City Area Code	(800)
Local Phone Number	455-1476
Title of 12(b) Security	Common Stock, par value $0.001 per share
Trading Symbol	NUVA
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		52,449,167
Entity Central Index Key	0001142596
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	Q2
Amendment Flag	false

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Current assets:
Cash and cash equivalents	$ 80,718	$ 248,663
Accounts receivable, net of allowances of $21,413 and $19,601, respectively	267,105	249,373
Inventory, net	350,805	338,601
Prepaid income taxes	8,566	7,118
Prepaid expenses and other current assets	21,060	21,457
Total current assets	728,254	865,212
Property and equipment, net	360,433	346,510
Intangible assets, net	169,848	184,289
Goodwill	638,428	639,663
Operating lease right-of-use assets	92,160	95,112
Deferred tax assets	75,825	68,273
Restricted cash and investments	1,494	1,494
Other assets	23,108	23,952
Total assets	2,089,550	2,224,505
Current liabilities:
Accounts payable and accrued liabilities	118,809	120,333
Contingent consideration liabilities	35,158	66,975
Accrued payroll and related expenses	49,867	58,448
Operating lease liabilities	10,785	10,019
Income tax liabilities	17,958	12,217
Short-term borrowings	350,000	0
Senior convertible notes	0	448,056
Total current liabilities	582,577	716,048
Long-term senior convertible notes	445,540	444,202
Deferred and other tax liabilities	15,980	13,088
Operating lease liabilities	99,823	103,806
Contingent consideration liabilities	35,951	63,640
Other long-term liabilities	17,136	14,831
Commitments and contingencies
Stockholders’ equity:
Preferred stock, $0.001 par value; 5,000 shares authorized, none outstanding	0	0
Common stock, $0.001 par value; 150,000 shares authorized at June 30, 2023 and December 31, 2022; 59,324 shares issued and 52,449 outstanding at June 30, 2023; 58,939 shares issued and 52,134 outstanding at December 31, 2022	63	63
Additional paid-in capital	1,487,698	1,469,411
Accumulated other comprehensive loss	(1,256)	(3,249)
Retained earnings	92,466	86,115
Treasury stock at cost; 6,875 shares and 6,805 shares at June 30, 2023 and December 31, 2022, respectively	(686,428)	(683,450)
Total equity	892,543	868,890
Total liabilities and equity	$ 2,089,550	$ 2,224,505

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Accounts receivable, allowances	$ 21,413	$ 19,601
Preferred stock, par value (in dollars per share)	$ 0.001	$ 0.001
Preferred stock, shares authorized (in shares)	5,000,000	5,000,000
Preferred stock, shares outstanding (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.001	$ 0.001
Common stock, shares authorized (in shares)	150,000,000	150,000,000
Common stock, shares issued (in shares)	59,324,000	58,939,000
Common stock, shares outstanding (in shares)	52,449,000	52,134,000
Treasury stock at cost, shares (in shares)	6,875,000	6,805,000

Consolidated Statements of Oper

Consolidated Statements of Operations - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Net sales:
Net sales	$ 317,786	$ 310,451	$ 625,497	$ 601,213
Cost of sales (excluding below amortization of intangible assets):
Cost of sales	89,475	85,758	175,845	164,855
Gross profit	228,311	224,693	449,652	436,358
Operating expenses:
Selling, general and administrative	163,859	160,696	340,051	320,977
Research and development	28,654	25,913	53,227	49,271
Amortization of intangible assets	8,021	12,637	16,817	25,669
Business transition costs	9,812	(7,624)	14,426	(4,564)
Total operating expenses	210,346	191,622	424,521	391,353
Interest and other expense, net:
Interest income	1,355	262	3,183	305
Interest expense	(6,008)	(4,352)	(10,386)	(8,731)
Other expense, net	(826)	(29,681)	(5,262)	(13,437)
Total interest and other expense, net	(5,479)	(33,771)	(12,465)	(21,863)
Income (loss) before income taxes	12,486	(700)	12,666	23,142
Income tax expense	(5,122)	(193)	(6,315)	(4,834)
Consolidated net income (loss)	$ 7,364	$ (893)	$ 6,351	$ 18,308
Net income (loss) per share:
Basic (in dollars per share)	$ 0.14	$ (0.02)	$ 0.12	$ 0.35
Diluted (in dollars per share)	$ 0.14	$ (0.02)	$ 0.12	$ 0.35
Weighted average shares outstanding:
Basic (in shares)	52,418	52,022	52,331	51,926
Diluted (in shares)	52,907	52,022	52,843	57,299
Product [Member]
Net sales:
Net sales	$ 288,889	$ 280,419	$ 568,259	$ 546,392
Cost of sales (excluding below amortization of intangible assets):
Cost of sales	66,344	65,267	131,221	122,450
Service [Member]
Net sales:
Net sales	28,897	30,032	57,238	54,821
Cost of sales (excluding below amortization of intangible assets):
Cost of sales	$ 23,131	$ 20,491	$ 44,624	$ 42,405

Consolidated Statements of Comp

Consolidated Statements of Comprehensive Income (Loss) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Statement of Comprehensive Income [Abstract]
Consolidated net income	$ 7,364	$ (893)	$ 6,351	$ 18,308
Other comprehensive income:
Translation adjustments, net of tax	136	4,531	1,993	582
Other comprehensive income	136	4,531	1,993	582
Total consolidated comprehensive income	$ 7,500	$ 3,638	$ 8,344	$ 18,890

Consolidated Statements of Equi

Consolidated Statements of Equity - USD ($) shares in Thousands, $ in Thousands	Total	Common Stock	Additional Paid-in Capital	Accumulated Other Comprehensive Loss	Retained Earnings	Treasury Stock
Beginning Balance (in shares) at Dec. 31, 2021		58,469
Beginning Balance at Dec. 31, 2021	$ 795,207	$ 63	$ 1,434,976	$ (7,792)	$ 45,708	$ (677,748)
Beginning Balance (in shares) at Dec. 31, 2021						(6,700)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock under employee and director equity option and purchase plans (in shares)		278				98
Issuance of common stock under employee and director equity option and purchase plans	(5,345)					$ (5,345)
Stock-based compensation expense	6,807		6,807
Consolidated net income	19,201				19,201
Other comprehensive income (loss)	(3,949)			(3,949)
Ending Balance (in shares) at Mar. 31, 2022		58,747
Ending Balance at Mar. 31, 2022	811,921	$ 63	1,441,783	(11,741)	64,909	$ (683,093)
Ending Balance (in shares) at Mar. 31, 2022						(6,798)
Beginning Balance (in shares) at Dec. 31, 2021		58,469
Beginning Balance at Dec. 31, 2021	795,207	$ 63	1,434,976	(7,792)	45,708	$ (677,748)
Beginning Balance (in shares) at Dec. 31, 2021						(6,700)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Consolidated net income	18,308
Other comprehensive income (loss)	582
Ending Balance (in shares) at Jun. 30, 2022		58,863
Ending Balance at Jun. 30, 2022	826,569	$ 63	1,453,013	(7,210)	64,016	$ (683,313)
Ending Balance (in shares) at Jun. 30, 2022						(6,802)
Beginning Balance (in shares) at Mar. 31, 2022		58,747
Beginning Balance at Mar. 31, 2022	811,921	$ 63	$ 1,441,783	(11,741)	64,909	$ (683,093)
Beginning Balance (in shares) at Mar. 31, 2022						(6,798)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock under employee and director equity option and purchase plans (in shares)		116	3,716			4
Issuance of common stock under employee and director equity option and purchase plans	3,496					$ (220)
Stock-based compensation expense	7,514		$ 7,514
Consolidated net income	(893)				(893)
Other comprehensive income (loss)	4,531			4,531
Ending Balance (in shares) at Jun. 30, 2022		58,863
Ending Balance at Jun. 30, 2022	$ 826,569	$ 63	1,453,013	(7,210)	64,016	$ (683,313)
Ending Balance (in shares) at Jun. 30, 2022						(6,802)
Beginning Balance (in shares) at Dec. 31, 2022	58,939	58,939
Beginning Balance at Dec. 31, 2022	$ 868,890	$ 63	1,469,411	(3,249)	86,115	$ (683,450)
Beginning Balance (in shares) at Dec. 31, 2022	(6,805)					(6,805)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock under employee and director equity option and purchase plans (in shares)		284				69
Issuance of common stock under employee and director equity option and purchase plans	$ (2,961)					$ (2,961)
Stock-based compensation expense	6,907		6,907
Consolidated net income	(1,013)				(1,013)
Other comprehensive income (loss)	1,857			1,857
Ending Balance (in shares) at Mar. 31, 2023		59,223
Ending Balance at Mar. 31, 2023	$ 873,680	$ 63	1,476,318	(1,392)	85,102	$ (686,411)
Ending Balance (in shares) at Mar. 31, 2023						(6,874)
Beginning Balance (in shares) at Dec. 31, 2022	58,939	58,939
Beginning Balance at Dec. 31, 2022	$ 868,890	$ 63	1,469,411	(3,249)	86,115	$ (683,450)
Beginning Balance (in shares) at Dec. 31, 2022	(6,805)					(6,805)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Consolidated net income	$ 6,351
Other comprehensive income (loss)	$ 1,993
Ending Balance (in shares) at Jun. 30, 2023	59,324	59,324
Ending Balance at Jun. 30, 2023	$ 892,543	$ 63	1,487,698	(1,256)	92,466	$ (686,428)
Ending Balance (in shares) at Jun. 30, 2023	(6,875)					(6,875)
Beginning Balance (in shares) at Mar. 31, 2023		59,223
Beginning Balance at Mar. 31, 2023	$ 873,680	$ 63	1,476,318	(1,392)	85,102	$ (686,411)
Beginning Balance (in shares) at Mar. 31, 2023						(6,874)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock under employee and director equity option and purchase plans (in shares)		101				1
Issuance of common stock under employee and director equity option and purchase plans	3,415		3,432			$ (17)
Stock-based compensation expense	7,948		7,948
Consolidated net income	7,364				7,364
Other comprehensive income (loss)	$ 136			136
Ending Balance (in shares) at Jun. 30, 2023	59,324	59,324
Ending Balance at Jun. 30, 2023	$ 892,543	$ 63	$ 1,487,698	$ (1,256)	$ 92,466	$ (686,428)
Ending Balance (in shares) at Jun. 30, 2023	(6,875)					(6,875)

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022
Operating activities:
Consolidated net income	$ 6,351	$ 18,308
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	66,385	73,285
Deferred income taxes	(5,008)	(5,304)
Amortization of non-cash interest	3,588	3,932
Stock-based compensation	14,855	14,321
Changes in fair value of contingent consideration	(3,910)	(8,836)
Net loss on strategic investments	298	232
Net loss from foreign currency adjustments	4,962	13,574
Reserves on current assets	4,294	(1,461)
Other non-cash adjustments	2,876	8,231
Changes in operating assets and liabilities, net of effects from acquisitions:
Accounts receivable	(19,715)	(22,596)
Inventory	(12,407)	(14,632)
Prepaid expenses and other current assets	(479)	(111)
Payment of contingent consideration	(25,462)	(1,198)
Accounts payable and accrued liabilities	6,072	(4,859)
Accrued payroll and related expenses	(8,493)	(5,207)
Income taxes	4,280	413
Net cash provided by operating activities	38,487	68,092
Investing activities:
Purchases of property and equipment	(69,160)	(68,745)
Acquisitions and investments	(3,082)	(5,250)
Purchases of intangible assets	(3,000)	0
Other investing activities	0	(698)
Net cash used in investing activities	(75,242)	(74,693)
Financing activities:
Repayment of senior convertible notes	(450,000)	0
Proceeds from borrowings under revolving senior credit facility	350,000	0
Payment of contingent consideration	(31,671)	(6,839)
Proceeds from the issuance of common stock	3,432	3,716
Purchases of treasury stock	(2,978)	(5,565)
Other financing activities	(486)	(982)
Net cash used in financing activities	(131,703)	(9,670)
Effect of exchange rate changes on cash	513	(3,835)
Decrease in cash, cash equivalents and restricted cash	(167,945)	(20,106)
Cash, cash equivalents and restricted cash at beginning of period	250,157	247,585
Cash, cash equivalents and restricted cash at end of period	82,212	227,479
Reconciliation of cash, cash equivalents and restricted cash
Cash and cash equivalents	80,718	225,985
Restricted cash	1,494	1,494
Total cash, cash equivalents and restricted cash shown in the unaudited Consolidated Statements of Cash Flows	$ 82,212	$ 227,479

Description of Business and Bas

Description of Business and Basis of Presentation	6 Months Ended
	Jun. 30, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Description of Business and Basis of Presentation	Description of Business and Basis of Presentation Description of Business NuVasive, Inc., or the Company, or NuVasive, was incorporated in Delaware on July 21, 1997, and began commercializing its products in 2001. Since its incorporation in 1997, the Company has grown from a small developer of specialty spinal implants into a global medical technology company delivering procedurally integrated solutions for spine surgery. Underlying the Company’s procedurally integrated solutions for spine surgery are technologies designed to enable better clinical, financial, and operational outcomes, including: • its surgical access instruments, including its integrated split-blade retractor system, designed to enable less-invasive surgical techniques by minimizing soft tissue disruption during spine surgery; • its Advanced Materials Science portfolio of specialized spinal implants, designed to advance spinal fusion by enhancing the osseointegration and biomechanical properties of implant materials, including porous titanium and porous polyetheretherketone; • its fixation systems, designed to facilitate the preservation and restoration of patient alignment, while addressing a vast array of spinal pathologies from an open or less-invasive approach across all spinal procedures; • its cervical total disc replacement, or cTDR, technology, which complements the Company’s portfolio of products and services for cervical spinal fusion surgery and is designed to offer surgeons capabilities across key performance functions—anatomic, physiologic motion, and radiologic design; • its neuromonitoring systems, which use proprietary software-driven nerve detection and avoidance technology, and the Company's intraoperative neuromonitoring, or IONM, services and support; and • its Pulse platform, a software ecosystem that integrates multiple hardware technologies into a single, condensed footprint in the operating room, including: radiation reduction, imaging enhancement, rod bending, navigation, IONM, and spinal alignment tools. In addition, the Company also designs and sells expandable growing rod implant systems for the treatment of early-onset scoliosis that can be non-invasively lengthened following implantation with precise, incremental adjustments via an external remote controller using magnetic technology called MAGnetic External Control, or MAGEC. This technology is also the basis for the Company’s Precice line of products which is designed to support complex orthopedic reconstruction, such as trauma and limb length discrepancy. Precice is an intramedullary device that, once implanted, utilizes the MAGEC technology to non-invasively lengthen the femur and tibia. Proposed Merger with Globus Medical On February 8, 2023, the Company entered into an Agreement and Plan of Merger, or the Merger Agreement, with Globus Medical, Inc., or Globus Medical, and Zebra Merger Sub, Inc., a wholly owned subsidiary of Globus Medical, or Merger Sub. The Merger Agreement provides, among other things, that subject to the satisfaction or waiver of the conditions set forth therein, Merger Sub will merge with and into NuVasive, referred to as the Merger, with NuVasive surviving the merger as a wholly owned subsidiary of Globus Medical. Under the Merger Agreement, at the effective time of the Merger, or the Effective Time, each share of common stock of the Company issued and outstanding immediately prior to the Effective Time (other than certain excluded shares as described in the Merger Agreement) will be cancelled and converted into the right to receive 0.75 fully paid and non-assessable shares of Class A common stock of Globus Medical, and cash in lieu of fractional shares. On April 27, 2023, the Company and Globus Medical announced that the stockholders of each company had approved all proposals related to the Merger at each company’s respective special meeting of stockholders. Completion of the Merger is subject to the satisfaction of the remaining customary closing conditions, including the expiration or termination of the waiting period under the Hart-Scott-Rodino Antitrust Improvements Act of 1976, as amended. Impact of COVID-19 and Global Macroeconomic Conditions on the Company's Business The COVID-19 pandemic significantly impacted the Company’s business and results of operations during the years 2020 through 2022 and may continue to negatively impact the Company’s business, results of operations, financial condition and cash flows. Additionally, the COVID-19 pandemic and general macroeconomic conditions have led to disruptions in the global supply chain. The Company has experienced challenges associated with material and component availability for certain product lines, longer shipping and delivery times for raw materials and components, constrained logistics capacity related to the movement of products, availability of skilled labor and increased costs of raw materials, components, labor, and freight and courier services. Net sales and profitability from our foreign operations have also been negatively affected by the unfavorable foreign currency exchange impact of the strengthened U.S. dollar against a number of currencies. Basis of Presentation and Principles of Consolidation The accompanying unaudited Consolidated Financial Statements include the accounts of the Company and its majority-owned or controlled subsidiaries, collectively referred to as either NuVasive or the Company. The Company translates the financial statements of its foreign subsidiaries using end-of-period exchange rates for assets and liabilities and average exchange rates during each reporting period for results of operations. When there is a portion of equity in an acquired subsidiary not attributable, directly or indirectly, to the respective parent entity, the Company records the fair value of the non-controlling interest at the acquisition date and classifies the amounts attributable to the non-controlling interest separately in equity in the Company's Consolidated Financial Statements. Any subsequent changes in a parent's ownership interest while the parent retains its controlling financial interest in its subsidiary are accounted for as equity transactions. All significant intercompany balances and transactions have been eliminated in consolidation. The accompanying unaudited Consolidated Financial Statements have been prepared pursuant to the rules and regulations of the SEC. Pursuant to these rules and regulations, the Company has condensed or omitted certain information and footnote disclosures it normally includes in its annual Consolidated Financial Statements prepared in accordance with generally accepted accounting principles in the United States, or U.S. GAAP. Operating results for the three and six months ended June 30, 2023 are not necessarily indicative of the results that may be expected for any other interim period or for the full year. These unaudited Consolidated Financial Statements should be read in conjunction with the audited Consolidated Financial Statements and notes thereto for the year ended December 31, 2022 included in the Company’s Annual Report on Form 10-K filed with the SEC. In the opinion of management, the unaudited Consolidated Financial Statements and notes thereto include all adjustments that are of a normal and recurring nature that are necessary for the fair presentation of the Company’s financial position and of the results of operations and cash flows for the periods presented. Use of Estimates To prepare financial statements in conformity with U.S. GAAP, management must make estimates and assumptions that affect the amounts reported in the financial statements and accompanying notes. These estimates and assumptions involve judgments with respect to numerous factors that are difficult to predict. As a result, actual amounts could be materially different from these estimates. Recent Accounting Pronouncements Not Yet Adopted In June 2022, the Financial Accounting Standards Board, or FASB, issued Accounting Standards Update, or ASU, No. 2022-03, Fair Value Measurement (Topic 820), Fair Value Measurement of Equity Securities Subject to Contractual Sale Restrictions, which clarifies that a contractual restriction on the sale of an equity security is not considered part of the unit of account of the equity security and, therefore, is not considered in measuring fair value. The ASU introduces new disclosure requirements to provide investors with information about contractual restrictions, including the nature and remaining duration of such restrictions. This update is effective for fiscal years beginning after December 15, 2023, and interim periods within those fiscal years, with early adoption permitted. The amendments should be applied prospectively with any adjustments from the adoption of the amendments recognized in earnings and disclosed on the date of adoption. The Company is currently evaluating the impact the standard will have on its Consolidated Financial Statements. Recently Adopted Accounting Standards In October 2021, the FASB issued ASU No. 2021-08, Business Combinations (Topic 805), Accounting for Contract Assets and Contract Liabilities from Contracts with Customers, which requires an entity (acquirer) to recognize and measure contract assets and liabilities acquired in a business combination in accordance with Accounting Standards Codification Topic 606, Revenue from Contracts with Customers, or ASC 606. This update is effective for fiscal years beginning after December 15, 2022, and interim periods within those fiscal years, with early adoption permitted. The amendments should be applied prospectively to business combinations occurring on or after the effective date of the amendments. The Company adopted ASU 2021-08 as of January 1, 2023. The adoption did not have a material impact on the Company’s Consolidated Financial Statements. Revenue Recognition In accordance with ASC 606, the Company recognizes revenue upon the transfer of goods or services to a customer at an amount that reflects the expected consideration to be received in exchange for those goods or services. The principles in ASC 606 are applied using the following five steps: (i) identify the contract with a customer; (ii) identify the performance obligation(s) in the contract; (iii) determine the transaction price; (iv) allocate the transaction price to the performance obligation(s) in the contract; and (v) recognize revenue when (or as) the Company satisfies its performance obligation(s). Specifically, revenue from the sale of implants, fixation products and disposables is generally recognized at an amount that reflects the expected consideration upon notice that the Company’s products have been used in a surgical procedure or upon shipment to a third-party customer assuming control of the products. Revenue from IONM services is recognized in the period the service is performed for the amount of consideration expected to be received. Revenue from the sale of surgical instrument sets is generally recognized upon receipt of a purchase order and the subsequent shipment to a customer who assumes control. In certain cases, the Company does offer the ability for customers to lease surgical instrumentation primarily on a non-sales type basis. Revenue from the sale or lease of capital equipment is recognized when the Company transfers control to the customer, which is generally at the point when acceptance occurs that indicates customer acknowledgment of delivery or installation, depending on the terms of the arrangement. Selling and leasing of surgical instrument sets and capital equipment represents an immaterial amount of the Company’s total net sales in all periods presented. Revenue associated with products holding rights of return or trade-in are recognized when the Company concludes there is not a risk of significant revenue reversal in future periods for the expected consideration in the transaction. Costs incurred by the Company associated with sales contracts with customers are deferred over the performance obligation period and recognized in the same period as the related revenue, with the exception of contracts that complete within one year or less, in which case the associated costs are expensed as incurred. Accounts Receivable and Related Valuation Accounts Accounts receivable in the accompanying unaudited Consolidated Balance Sheets are presented net of allowances for credit losses. The Company maintains an allowance for credit losses resulting from the inability of its customers, including hospitals, ambulatory surgery centers, and distributors, to make required payments. The allowance for credit losses is calculated quarterly, and is estimated on a region-by-region basis considering a number of factors including age of account balances, collection history, historical account write-offs, third party credit reports, identified trends, current economic conditions, and supportable forecasted economic expectations. The allowance is adjusted on a specific identification basis for certain accounts as well as pooling of accounts with similar characteristics. An increase in the provision for credit losses may be required when the financial condition of the Company’s customers or its collection experience deteriorates. An increase to the allowance for credit losses results in a corresponding charge to selling, general and administrative expenses. The Company has a diverse customer base and no single customer represented greater than ten percent of net sales or accounts receivable. Historically, the Company’s reserves have been adequate to cover credit losses. The Company's exposure to credit losses may increase if its customers are adversely affected by changes in healthcare laws, coverage and reimbursement, macroeconomic pressures or uncertainty associated with local or global economic recessions, disruption associated with the current COVID-19 pandemic, or other customer-specific factors. It is possible that there could be a significant adverse impact from potential adjustments to the carrying amount of trade receivables as customers’ cash flows are impacted by their response to the COVID-19 pandemic and the deferral of elective surgical procedures and other macroeconomic challenges. The following table summarizes the changes in the allowance for credit losses: (in thousands) June 30, 2023 December 31, 2022 Allowance for credit losses at January 1 $ 11,404 $ 10,928 Current-period provision for expected losses 1,913 748 Write-offs charged against the allowance (137) (196) Recoveries of amounts previously written off 26 31 Changes resulting from foreign currency fluctuations 65 (107) Allowance for credit losses at end of period $ 13,271 $ 11,404 Inventory, net Net inventory as of June 30, 2023 consisted of $338.3 million of finished goods, $3.8 million of work in progress and $8.7 million of raw materials. Net inventory as of December 31, 2022 consisted of $326.1 million of finished goods, $5.8 million of work in progress and $6.7 million of raw materials. Finished goods primarily consists of specialized implants, fixation products and disposables and are stated at the lower of cost or net realizable value determined by utilizing a standard cost method, which includes capitalized variances, which approximates the weighted average cost. Work in progress and raw materials represent the underlying material, and labor for work in progress, that ultimately yield finished goods upon completion and are recorded at the lower of cost or net realizable value. The Company reviews the components of its inventory on a periodic basis for excess and obsolescence and adjusts inventory to its net realizable value as necessary. The Company records an inventory reserve for estimated excess and obsolete inventory based upon historical turnover and assumptions about future demand for its products and market conditions, such as product life cycles and timing of the introduction and development of new or enhanced products. The Company’s allograft products have shelf lives ranging from two years to five years and are subject to demand fluctuations based on the availability and demand for alternative products. The Company’s inventory, which consists primarily of disposables, specialized implants and fixation products, is at risk of obsolescence following the introduction and development of new or enhanced products. One of the Company’s strategic objectives is to continue to rapidly develop and commercialize new products and product enhancements which increases the risk that products will become obsolete prior to the end of their anticipated useful life. The Company’s estimates and assumptions for excess and obsolete inventory are reviewed and updated on a quarterly basis. The estimates the Company uses for demand are also used for near-term capacity planning and inventory purchasing and are consistent with its net sales forecasts. Increases in the reserve for excess and obsolete inventory result in a corresponding charge to cost of sales. Derivative Financial Instruments The Company recognizes all derivative instruments as assets or liabilities in its unaudited Consolidated Balance Sheets and measures these instruments at fair value by revaluing these assets and liabilities at the end of each reporting period. Gains and losses are recorded as a component of other expense, net in the unaudited Consolidated Statements of Operations. Other Comprehensive Income (Loss) Other comprehensive income (loss) is defined as the change in equity during a period from transactions and other events and circumstances from non-owner sources. Other comprehensive income (loss) includes net of tax, unrealized gains or losses on the Company’s marketable debt securities and foreign currency translation adjustments. The accumulated other comprehensive income (loss) was $(1.3) million and $(3.2) million as of June 30, 2023 and December 31, 2022, respectively. Product Shipment Costs Product shipment costs, included in selling, general and administrative expense in the accompanying unaudited Consolidated Statements of Operations, were $8.9 million and $17.6 million for the three and six months ended June 30, 2023, respectively, and $10.0 million and $18.1 million for the three and six months ended June 30, 2022, respectively. The majority of the Company’s shipping costs are associated with providing instrument sets to hospitals for use in individual surgical procedures. Amounts billed to customers for shipping and handling of products are reflected in net sales and are not material for any period presented. Business Transition Costs The Company incurs certain costs related to acquisition, integration and business transition activities, which include severance, relocation, consulting, leasehold exit costs, costs related to the proposed merger with Globus Medical, third-party acquisition costs and contingent consideration fair value adjustments and other costs directly associated with such activities. Contingent consideration is accrued based on the fair value of the expected payment, and such accruals are subject to increase or decrease based on the assessment of the likelihood that the contingent milestones will be achieved resulting in payment. If an accrual for contingent consideration decreases based upon the assessment during a particular period, it results in a reduction of costs during such period, which the Company records as a benefit. During the three months ended June 30, 2023, the Company recorded $9.8 million of costs related to acquisition, integration and business transition activities, which includes $8.9 million related to costs associated with the proposed merger with Globus Medical and $0.9 million related to fair value adjustments on contingent consideration liabilities associated with the Company’s 2022, 2021, 2017, and 2016 acquisitions. During the six months ended June 30, 2023, the Company recorded $14.4 million of costs related to acquisition, integration and business transition activities, which includes $16.3 million related to costs associated with the proposed merger with Globus Medical, offset by a benefit of $(3.9) million related to fair value adjustments on contingent consideration liabilities associated with the Company’s 2022, 2021, 2018, 2017 and 2016 acquisitions. During the three months ended June 30, 2022, the Company recorded a benefit of $(7.6) million related to acquisition, integration and business transition activities, which included $(8.9) million in fair value adjustments on contingent consideration liabilities associated with the Company’s 2021, 2017 and 2016 acquisitions. During the six months ended June 30, 2022, the Company recorded a benefit of $(4.6) million related to acquisition, integration and business transition activities, which included $(8.8) million in fair value adjustments on contingent consideration liabilities associated with the Company’s 2021, 2017 and 2016 acquisitions.

Net Income (Loss) Per Share

Net Income (Loss) Per Share	6 Months Ended
	Jun. 30, 2023
Earnings Per Share [Abstract]
Net Income (Loss) Per Share	Net Income (Loss) Per Share The following table sets forth the computation of basic and diluted consolidated net income (loss) per share: Three Months Ended June 30, Six Months Ended June 30, (in thousands, except per share data) 2023 2022 2023 2022 Numerator: Net income (loss) for basic $ 7,364 $ (893) $ 6,351 $ 18,308 Dilutive potential net income (loss): Interest and debt issuance costs on the 0.375% Senior Convertible Notes due 2025, net of tax — — — 1,642 Net income (loss) for diluted $ 7,364 $ (893) $ 6,351 $ 19,950 Denominator for basic and diluted net income (loss) per share: Weighted average common shares outstanding for basic 52,418 52,022 52,331 51,926 Dilutive potential common stock outstanding: Employee stock purchase plan (ESPP) — — 4 1 Restricted stock units (RSUs) and performance restricted stock units (PRSUs) 489 — 508 548 0.375% Senior Convertible Notes due 2025 — — — 4,824 Weighted average common shares outstanding for diluted 52,907 52,022 52,843 57,299 Basic net income (loss) per share $ 0.14 $ (0.02) $ 0.12 $ 0.35 Diluted net income (loss) per share $ 0.14 $ (0.02) $ 0.12 $ 0.35 In accordance with ASU No. 2020-06, Debt with Conversion and Other Options (Subtopic 470-20), or ASU 2020-06, the Company applies the if-converted method in computing the effect of the Company's senior convertible notes on diluted net income per share. For periods in which the Company reports net income, the numerator of the diluted per share computation is adjusted for interest expense and amortization of debt issuance costs, net of tax, and the denominator is adjusted for the weighted average number of shares into which each of the Company’s senior convertible notes could be converted. The effect is only included in the calculation of diluted net income per share for those senior convertible notes which reduce net income per share. The following weighted average outstanding common stock equivalents were not included in the calculation of net income (loss) per diluted share because their effects were anti-dilutive: Three Months Ended June 30, Six Months Ended June 30, ( in thousands ) 2023 2022 2023 2022 ESPP, RSUs and PRSUs 53 46 69 143 Warrants 10,169 10,169 10,169 10,169 Senior convertible notes 4,824 10,169 4,824 5,345 Total 15,046 20,384 15,062 15,657

Financial Instruments and Fair

Financial Instruments and Fair Value Measurements	6 Months Ended
	Jun. 30, 2023
Fair Value Disclosures [Abstract]
Financial Instruments and Fair Value Measurements	Financial Instruments and Fair Value Measurements Foreign Currency and Derivative Financial Instruments The Company translates the financial statements of its foreign subsidiaries using end-of-period exchange rates for assets and liabilities, and average exchange rates during each reporting period for results of operations. Some of the Company’s reporting entities conduct a portion of their business in currencies other than the entity’s functional currency. These transactions give rise to receivables and payables that are denominated in currencies other than the entity’s functional currency. The value of these receivables and payables is subject to changes in currency exchange rates from the point at which the transactions are originated until the settlement in cash. Both realized and unrealized gains and losses in the value of these receivables and payables are included in the determination of net income or loss. Net currency exchange (losses) gains, which include gains and losses from derivative instruments, were $(0.2) million and $(5.0) million for the three and six months ended June 30, 2023, respectively, and $(29.6) million and $13.6 million for the three and six months ended June 30, 2022, respectively, and are included in other expense, net in the unaudited Consolidated Statements of Operations. To manage foreign currency exposure risks, the Company uses derivatives for activities in entities that have short-term intercompany receivables and payables denominated in a currency other than the entity’s functional currency. The fair value is based on a quoted market price (Level 1). As of June 30, 2023 and December 31, 2022, a notional principal amount of $16.0 million and $15.0 million, respectively, was outstanding to hedge currency risk relative to the Company’s foreign currency-denominated receivables and payables. Derivative instrument net gains on the Company’s forward exchange contracts were $1.0 million and $1.1 million for the three and six months ended June 30, 2023, respectively, and $1.7 million and $2.5 million for the three and six months ended June 30, 2022, respectively, and are included in other expense, net in the unaudited Consolidated Statements of Operations. The fair value of the forward contract exchange derivative instrument asset (liability) was $(0.1) million and $(0.2) million as of June 30, 2023 and December 31, 2022, respectively. The derivative instruments are recorded in other current assets or other current liabilities in the unaudited Consolidated Balance Sheets commensurate with the nature of the instrument at period end. Fair Value Measurements The Company measures certain assets and liabilities in accordance with authoritative guidance, which requires fair value measurements be classified and disclosed in one of the following three categories: Level 1: Quoted prices (unadjusted) in active markets that are accessible at the measurement date for assets or liabilities. Level 2: Observable prices that are based on inputs not quoted on active markets, but corroborated by market data. Level 3: Unobservable inputs are used when little or no market data is available. Assets and liabilities are classified based on the lowest level of input that is significant to the fair value measurements. The Company reviews the fair value hierarchy classification on a quarterly basis. Changes in the ability to observe valuation inputs may result in a reclassification of levels for certain assets or liabilities within the fair value hierarchy. The Company did not have any transfers of assets and liabilities between the levels of the fair value measurement hierarchy during the periods presented. The fair values of the Company’s assets and liabilities, including cash equivalents, marketable debt and equity securities, restricted investments, derivatives, and contingent consideration are measured at fair value on a recurring basis. The fair value of the securities classified as cash equivalents and marketable equity securities are based on quoted market prices in active markets (Level 1). As of June 30, 2023, the Company held investments in securities classified as cash equivalents and marketable equity securities. Unrealized gains (losses) for marketable equity securities was $(0.6) million and $(0.3) million for the three and six months ended June 30, 2023, respectively, and included in other expense, net in the unaudited Consolidated Statement of Operations. Unrealized gains (losses) for marketable equity securities was $(0.2) million for both the three and six months ended June 30, 2022 and included in other expense, net in the unaudited Consolidated Statement of Operations. As of December 31, 2022, the Company held investments in securities classified as cash equivalents and marketable equity securities. During the periods presented, the Company did not hold any such investments that were in a significant unrealized loss position and no impairment charges were recorded on such investments. Realized and unrealized gains and losses and interest income related to marketable debt securities were immaterial during all periods presented. The Company’s assets that are measured at fair value were based on the following fair value categories: (in thousands) Total Quoted Price in Active Market (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) June 30, 2023: Cash equivalents: Money market funds $ 26,495 $ 26,495 $ — $ — Other assets: Marketable equity securities 3,185 3,185 — — Total cash equivalents and other assets $ 29,680 $ 29,680 $ — $ — December 31, 2022: Cash equivalents: Money market funds $ 176,344 $ 176,344 $ — $ — Other assets: Marketable equity securities 3,483 3,483 — — Total cash equivalents and other assets $ 179,827 $ 179,827 $ — $ — The carrying amounts of certain financial instruments such as cash and cash equivalents, accounts receivable, prepaid expenses, other current assets, accounts payable, accrued expenses, and other current liabilities as of June 30, 2023 and December 31, 2022 approximate their related fair values due to the short-term maturities of these instruments. The fair value of certain financial instruments was measured and classified within Level 1 of the fair value hierarchy based on quoted prices. Fair Value of Senior Convertible Notes On June 1, 2023, the Company’s Senior Convertible Notes due 2023 were repaid in full at their scheduled maturity. The fair value, based on a quoted market price (Level 1), of the Company’s outstanding $450.0 million principal amount of Senior Convertible Notes due 2023 at December 31, 2022 was approximately $441.6 million. The fair value, based on a quoted market price (Level 1), of the Company’s outstanding $450.0 million principal amount of Senior Convertible Notes due 2025 at June 30, 2023 and December 31, 2022 was approximately $411.3 million and $394.9 million, respectively. See Note 5, Indebtedness, in the Notes to unaudited Consolidated Financial Statements included in this Quarterly Report for further discussion on the carrying value of the Company’s outstanding senior convertible notes. Contingent Consideration Liabilities The fair value of contingent consideration liabilities assumed in business combinations is recorded as part of the purchase price consideration of the acquisition, and is determined using a discounted cash flow The recurring Level 3 fair value measurements of contingent consideration liabilities associated with commercial sales milestones include the following significant unobservable inputs as of June 30, 2023: 2023 Valuation Techniques Discounted cash flow, probability, Monte Carlo Discount Rate Range 6.1% - 7.8% Weighted Average Discount Rate 6.5% Expected Years 2023 - 2028 Contingent consideration liabilities at June 30, 2023 and December 31, 2022 were $71.1 million and $130.6 million, respectively, and were recorded in the unaudited Consolidated Balance Sheets commensurate with the respective payment terms. The following table sets forth the changes in the estimated fair value of the Company's contingent consideration liabilities measured on a recurring basis using significant unobservable inputs (Level 3): Six Months Ended June 30, ( in thousands ) 2023 2022 Beginning balance at January 1 $ 130,615 $ 147,810 Contingent consideration liability recorded upon acquisition 1,541 — Change in fair value measurement (3,910) (8,836) Contingent consideration paid or settled (57,133) (8,037) Changes resulting from foreign currency fluctuations (4) 4 Balance at end of period $ 71,109 $ 130,941 During the first quarter of 2021, the Company recorded $103.4 million in contingent consideration liabilities as part of the Simplify Medical acquisition, of which $42.8 million and $60.6 million relate to the regulatory approval and net sales milestones, respectively. In the second quarter of 2021, the Simplify Cervical Disc received approval from the Food and Drug Administration, or FDA, for two-level cervical total disc replacement which resulted in the payment of $45.8 million for the achievement of the regulatory milestone. As a result of the milestone achievement, the Company recorded a $3.0 million increase in the fair value of the contingent consideration liability, which has been recorded within business transition costs in the Company’s Consolidated Statements of Operations in the year ended December 31, 2021. Additional milestone payments, which are uncapped and contingent upon net sales from products incorporating the Simplify Medical cervical disc technology, are payable in the calendar years 2023, 2024 and 2025. The first net sales milestone payment in the amount of $56.5 million was paid in March 2023. For the six months ended June 30, 2023 and year ended December 31, 2022, the Company decreased the contingent consideration liability by $4.9 million, and $12.2 million, respectively, as a result of updates to the Company's forecasted net sales assumptions and significant unobservable inputs. The remaining contingent consideration liabilities for the Simplify Medical acquisition totaled $34.9 million and $96.3 million as of June 30, 2023 and December 31, 2022, respectively. Changes in fair value measurement of the contingent consideration liabilities are recorded in the unaudited Consolidated Statements of Operations within the business transition costs line item. Non-financial assets and liabilities measured on a nonrecurring basis Certain non-financial assets and liabilities are measured at fair value, usually with Level 3 inputs including the discounted cash flow method or cost method, on a nonrecurring basis in accordance with authoritative guidance. These include items such as non-financial assets and liabilities initially measured at fair value in a business combination and non-financial long-lived assets measured at fair value for an impairment assessment. In general, non-financial assets, including goodwill, intangible assets and property and equipment, are measured at fair value when there is an indication of impairment and are recorded at fair value only when any impairment is recognized. The carrying values of the Company’s financing lease obligations approximated their estimated fair value as of June 30, 2023 and December 31, 2022.

Goodwill and Intangible Assets

Goodwill and Intangible Assets	6 Months Ended
	Jun. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill and Intangible Assets	Goodwill and Intangible Assets Goodwill and intangible assets consisted of the following: (in thousands, except years) Weighted- Gross Accumulated Intangible June 30, 2023: Intangible assets subject to amortization: Developed technology 11 $ 366,333 $ (248,725) $ 117,608 Patents 10 56,291 (38,487) 17,804 Manufacturing know-how and trade secrets 12 21,380 (21,380) — Trade name and trademarks 9 24,889 (22,405) 2,484 Customer relationships 9 157,893 (128,441) 29,452 Total intangible assets subject to amortization 10 $ 626,786 $ (459,438) $ 167,348 In-process research and development $ 2,500 $ — $ 2,500 Total intangible assets, net $ 629,286 $ (459,438) $ 169,848 (in thousands, except years) Weighted- Average Amortization Period (in years) Gross Amount Accumulated Amortization Intangible Assets, net December 31, 2022: Intangible assets subject to amortization: Developed technology 11 $ 366,521 $ (241,119) $ 125,402 Patents 10 56,719 (37,420) 19,299 Manufacturing know-how and trade secrets 12 21,364 (21,364) — Trade name and trademarks 9 24,967 (22,124) 2,843 Customer relationships 9 156,681 (122,436) 34,245 Total intangible assets subject to amortization 10 $ 626,252 $ (444,463) $ 181,789 In-process research and development $ 2,500 $ — $ 2,500 Total intangible assets, net $ 628,752 $ (444,463) $ 184,289 The changes to goodwill are comprised of the following: ( in thousands ) December 31, 2022 Gross goodwill $ 647,963 Accumulated impairment loss (8,300) 639,663 Changes to gross goodwill Changes resulting from foreign currency fluctuations (1,235) June 30, 2023 Gross goodwill 646,728 Accumulated impairment loss (8,300) $ 638,428 Total expense related to the amortization of intangible assets, which is recorded in both cost of sales and operating expenses in the unaudited Consolidated Statements of Operations depending on the functional nature of the intangible asset, was $8.0 million and $16.8 million for the three and six months ended June 30, 2023, respectively, and $13.4 million and $27.3 million for the three and six months ended June 30, 2022, respectively. Total future amortization expense related to intangible assets subject to amortization at June 30, 2023 is set forth in the table below: (in thousands) Remaining 2023 $ 12,741 2024 21,550 2025 20,621 2026 15,491 2027 12,733 Thereafter through 2038 84,212 Total future amortization expense $ 167,348

Indebtedness

Indebtedness	6 Months Ended
	Jun. 30, 2023
Debt Disclosure [Abstract]
Indebtedness	Indebtedness The carrying values of the Company’s Senior Convertible Notes are as follows: (in thousands) June 30, 2023 December 31, 2022 1.00% Senior Convertible Notes due 2023: Principal amount $ — $ 450,000 Unamortized debt issuance costs — (1,944) — 448,056 0.375% Senior Convertible Notes due 2025: Principal amount 450,000 450,000 Unamortized debt issuance costs (4,460) (5,798) 445,540 444,202 Total Senior Convertible Notes $ 445,540 $ 892,258 Less: Current portion of Senior Convertible Notes $ — $ (448,056) Long-term Senior Convertible Notes $ 445,540 $ 444,202 Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Interest expense: Contractual coupon interest $ 1,172 $ 1,547 $ 2,719 $ 3,094 Amortization of debt issuance costs 1,449 1,816 3,282 3,626 Total interest expense recognized on Senior Convertible Notes $ 2,621 $ 3,363 $ 6,001 $ 6,720 Effective interest rates: Senior Convertible Notes due 2023 (1)(2) 2.0 % 2.0 % 2.0 % 2.0 % Senior Convertible Notes due 2025 (1) 1.0 % 1.0 % 1.0 % 1.0 % (1) Interest on Senior Convertible Notes due 2023 and 2025 began accruing upon issuance and is payable semi-annually. (2) Senior Convertible Notes due 2023 were repaid in full at their scheduled maturity on June 1, 2023. 1.00% Senior Convertible Notes due 2023 In June 2020, the Company issued $450.0 million principal amount of unsecured Senior Convertible Notes with a stated interest rate of 1.00% and a maturity date of June 1, 2023, or the 2023 Notes. On June 1, 2023 the Company repaid in full the 2023 Notes at their scheduled maturity as further discussed below. The net proceeds from the offering of the 2023 Notes, after deducting initial purchasers’ discounts and costs directly related to the offering, were approximately $436.7 million. The 2023 Notes were initially required to be settled in cash as the Company did not have sufficient reserved shares. On September 10, 2020, the Company held a Special Meeting of Stockholders and received stockholder approval to amend the Company’s Restated Certificate of Incorporation to increase the number of shares of its common stock authorized for issuance from 120,000,000 shares to 150,000,000 shares. As a result of the increase in the number of shares of the Company’s common stock authorized for issuance, as of September 10, 2020 and as of December 31, 2020, 2021 and 2022, respectively, the Company had sufficient reserved shares. The 2023 Notes permitted the Company to settle conversions of the 2023 Notes in cash, stock, or a combination thereof, solely at the Company’s discretion, and the Company elected to settle all conversions in cash. The initial conversion rate of the 2023 Notes was 11.8778 shares per $1,000 principal amount, which was equivalent to a conversion price of approximately $84.19 per share, subject to adjustments. The Company also entered into transactions for a convertible notes hedge and warrants concurrently with the issuance of the 2023 Notes. At the time of issuance, the cash conversion feature of the 2023 Notes required bifurcation from the 2023 Notes and was initially accounted for as a derivative liability (the "Embedded Conversion Derivative"), which was included in long-term liabilities in the Company’s unaudited Consolidated Balance Sheets. The fair value of the 2023 Notes Embedded Conversion Derivative was $57.2 million, and was recorded as the original debt discount for purposes of accounting for the debt component of the 2023 Notes. On September 10, 2020, as a result of the increase in the number of shares of the Company’s common stock authorized for issuance, the Company had sufficient reserved shares to settle conversions of the 2023 Notes in cash, stock, or a combination thereof, and in accordance with authoritative literature, the Embedded Conversion Derivative was marked to fair value and reclassified to stockholders’ equity, which resulted in recognizing $37.3 million in additional paid-in-capital during 2020. The original issue discount was recognized as interest expense using the effective interest method. As of January 1, 2021, the Company early adopted ASU 2020-06, which removed the requirement of separating the embedded conversion feature classified within stockholders’ equity from the 2023 Notes. Accordingly, the Company reclassified the unamortized debt discount from its additional paid-in capital to its senior convertible notes within long-term liabilities in the unaudited Consolidated Balance Sheets. The impact of the adoption of ASU 2020-06 as of January 1, 2021 resulted in an increase in senior convertible notes and retained earnings of $46.8 million and $7.9 million, respectively, and a decrease in deferred tax liabilities and additional paid-in capital by $11.2 million and $43.5 million, respectively. Prior to February 1, 2023, holders could have converted their 2023 Notes only under the following conditions: (a) during any calendar quarter commencing after the calendar quarter ending on September 30, 2020 (and only during such calendar quarter), if the last reported sale price of the Company’s common stock for at least 20 trading days (whether or not consecutive) during a period of 30 consecutive trading days ending on, and including, the last trading day of the immediately preceding calendar quarter is greater than or equal to 130% of the conversion price on each applicable trading day; (b) during the five business day period after any five consecutive trading day period, or the measurement period, in which the trading price of the 2023 Notes per $1,000 principal amount of notes for each trading day of the measurement period was less than 98% of the product of the last reported sale price of the Company’s common stock and the conversion rate on such trading day; or (c) upon the occurrence of specified corporate events, as defined in the 2023 Notes. On or after February 1, 2023, until the close of business on the second scheduled trading day immediately preceding June 1, 2023, holders could have converted their 2023 Notes at any time, regardless of the foregoing conditions. The Company could not have redeemed the 2023 Notes prior to the maturity date and no principal payments were due on the 2023 Notes prior to maturity. Other than restrictions relating to certain fundamental changes and consolidations, mergers or asset sales and customary anti-dilution adjustments, the 2023 Notes did not contain any financial covenants and did not restrict the Company from conducting significant restructurings, paying dividends or issuing or repurchasing any of its other securities. 2023 Hedge In connection with the sale of the 2023 Notes, the Company entered into privately negotiated call option transactions with certain dealers, which included affiliates of certain of the initial purchasers of the 2023 Notes and other financial institutions, or the 2023 Counterparties, entitling the Company to purchase up to 5,345,010 shares of the Company’s common stock at an initial stock price of $84.19 per share, each of which was subject to adjustment. The 2023 Hedge was initially required to be settled in cash as the Company did not have sufficient reserved shares with respect to the 2023 Notes. As a result, the 2023 Hedge was accounted for as a derivative asset, which was included in long-term assets in the Company’s unaudited Consolidated Balance Sheets. The cost of the 2023 Hedge was $69.5 million. On September 10, 2020, as a result of the increase in the number of shares of the Company’s common stock authorized for issuance, the Company had sufficient reserved shares to settle the 2023 Notes, which therefore allowed for the 2023 Hedge to be settled in cash, stock, or a combination thereof. In accordance with authoritative literature, the Convertible Note Hedge Derivative was marked to fair value and reclassified to stockholders’ equity, which resulted in recognizing a reduction of $37.3 million in additional paid-in-capital during 2020. The 2023 Hedge expired on the second scheduled trading day immediately preceding June 1, 2023 and was put in place to reduce the potential equity dilution upon conversion of the 2023 Notes if the daily volume-weighted average price per share of the Company’s common stock exceeded the strike price of the 2023 Hedge. Prior to its expiration, an assumed exercise of the 2023 Hedge by the Company was considered anti-dilutive since the effect of the inclusion would always be anti-dilutive with respect to the calculation of diluted earnings per share. 2023 Warrants In connection with the sale of the 2023 Notes, the Company sold warrants to the 2023 Counterparties, or the 2023 Warrants, to acquire up to 5,345,010 shares of the Company’s common stock. The 2023 Warrants initially limited the amount of shares the Company was required to reserve for issuance under the 2023 Warrants to an aggregate of 3,093,500 shares of the Company’s common stock, subject to adjustment upon the Company having a sufficient amount of authorized and unissued shares which are not reserved for other transactions. As a result of the Company receiving stockholder approval to increase the number of shares of the Company’s common stock authorized for issuance on September 10, 2020, the Company subsequently entered into amendment agreements with each of the 2023 Counterparties to increase the number of authorized shares of the Company’s common stock required to be reserved under the 2023 Warrants to the aggregate amount of 6,948,512 shares. The 2023 Warrants will expire on various dates from September 2023 through November 2023 and may be settled in net shares or cash, subject to certain conditions. It is the Company’s current intent and policy to settle all conversions in shares of the Company’s common stock. The Company received $46.8 million in cash proceeds from the sale of the 2023 Warrants, which was recorded in additional paid-in-capital. The 2023 Warrants could have a dilutive effect on the Company’s earnings per share to the extent that the price of the Company's common stock during a given measurement period exceeds the strike price of the 2023 Warrants, which is $104.84 per share. The Company uses the treasury share method for assumed conversion of its 2023 Warrants to compute the weighted average common shares outstanding for diluted earnings per share. Repayment of the 2023 Notes On June 1, 2023, the 2023 Notes reached maturity and the Company repaid in full the 2023 Notes. The Company applied $452.3 million in cash to repay the outstanding principal of the 2023 Notes and accrued and unpaid interest thereon at maturity. The Company funded the repayment of the outstanding principal amount of the 2023 Notes and accrued interest thereon using proceeds from borrowings under its senior credit facility and available cash on hand. 0.375% Senior Convertible Notes due 2025 In March 2020, the Company issued $450.0 million principal amount of unsecured Senior Convertible Notes with a stated interest rate of 0.375% and a maturity date of March 15, 2025, or the 2025 Notes. The net proceeds from the offering of the 2025 Notes, after deducting initial purchasers’ discounts and costs directly related to the offering, were approximately $437.0 million. The 2025 Notes may be settled in cash, stock, or a combination thereof, solely at the Company’s discretion. It is the Company's current intent and policy to settle all conversions through combination settlement, which involves satisfying the principal amount outstanding with cash and any note conversion value over the principal amount in shares of the Company’s common stock. The initial conversion rate of the 2025 Notes is 10.7198 shares per $1,000 principal amount, which is equivalent to a conversion price of approximately $93.29 per share, subject to adjustments. In addition, following certain corporate events that occur prior to the maturity date or if the Company issues a notice of redemption, the Company will increase the conversion rate for a holder who elects to convert its 2025 Notes in connection with such a corporate event or in connection with such redemption in certain circumstances. The Company also entered into transactions for a convertible notes hedge, or the 2025 Hedge, and warrants, or the 2025 Warrants, concurrently with the issuance of the 2025 Notes. At the time of issuance and in accordance with Accounting Standards Codification Topic 470, the embedded conversion feature of the 2025 Notes required bifurcation from the notes and was initially accounted for as an equity instrument classified to stockholders’ equity, which resulted in recognizing $78.3 million in additional paid-in-capital during 2020. As of January 1, 2021, the Company early adopted ASU 2020-06, which removed the requirement of separating the embedded conversion feature classified within stockholders’ equity from the 2025 Notes. Accordingly, the Company reclassified the unamortized debt discount and corresponding debt issuance costs from its additional paid-in capital to its senior convertible notes within long-term liabilities in the unaudited Consolidated Balance Sheets. The impact of the adoption of ASU 2020-06 as of January 1, 2021 resulted in an increase in senior convertible notes and retained earnings of $64.7 million and $8.8 million, respectively, and a decrease in deferred tax liabilities and additional paid-in capital by $15.9 million and $57.6 million, respectively. Prior to September 15, 2024, holders may convert their 2025 Notes only under the following conditions: (a) during any calendar quarter commencing after the calendar quarter ending on June 30, 2020 (and only during such calendar quarter), if the last reported sale price of the Company’s common stock for at least 20 trading days (whether or not consecutive) during a period of 30 consecutive trading days ending on, and including, the last trading day of the immediately preceding calendar quarter is greater than or equal to 130% of the conversion price on each applicable trading day; (b) during the five business day period after any five consecutive trading day period, or the measurement period, in which the trading price of the 2025 Notes per $1,000 principal amount of notes for each trading day of the measurement period was less than 98% of the product of the last reported sale price of the Company’s common stock and the conversion rate on such trading day; (c) if the Company calls any or all of the 2025 Notes for redemption, at any time prior to the close of business on the second scheduled trading day preceding the redemption date; or (d) upon the occurrence of specified corporate events, as defined in the 2025 Notes. On or after September 15, 2024, until the close of business on the second scheduled trading day immediately preceding March 15, 2025, holders may convert their 2025 Notes at any time, regardless of the foregoing conditions. The Company may not redeem the 2025 Notes prior to March 20, 2023. The Company may redeem the 2025 Notes, at its option, in whole or in part, on or after March 20, 2023 until the close of business on the business day immediately preceding September 15, 2024, if the last reported sale price of the Company’s common stock has been at least 130% of the conversion price then in effect for at least 20 trading days during any 30 consecutive trading day period ending on, and including, the trading day immediately preceding the date on which the Company delivers written notice of a redemption. The redemption price will be equal to 100% of the principal amount of such 2025 Notes to be redeemed plus accrued and unpaid interest to, but excluding, the redemption date. No principal payments are due on the 2025 Notes prior to maturity. Other than restrictions relating to certain fundamental changes and consolidations, mergers or asset sales and customary anti-dilution adjustments, the 2025 Notes do not contain any financial covenants and do not restrict the Company from conducting significant restructurings, paying dividends or issuing or repurchasing any of its other securities. 2025 Hedge In connection with the sale of the 2025 Notes, the Company entered into privately negotiated call option transactions with certain dealers, which included affiliates of certain of the initial purchasers of the 2025 Notes and other financial institutions, or the 2025 Counterparties, entitling the Company to purchase up to 4,823,910 shares of the Company’s common stock at an initial stock price of $93.29 per share, each of which is subject to adjustment. The cost of the 2025 Hedge was $78.3 million and accounted for as an equity instrument by recognizing $78.3 million in additional paid-in-capital during 2020. The 2025 Hedge will expire on the second scheduled trading day immediately preceding March 15, 2025. The 2025 Hedge is expected to reduce the potential equity dilution upon conversion of the 2025 Notes if the daily volume-weighted average price per share of the Company’s common stock exceeds the strike price of the 2025 Hedge. An assumed exercise of the 2025 Hedge by the Company is considered anti-dilutive since the effect of the inclusion would always be anti-dilutive with respect to the calculation of diluted earnings per share. 2025 Warrants The Company sold warrants to the 2025 Counterparties to acquire up to 4,823,910 shares of the Company’s common stock. The 2025 Warrants will expire on various dates from June 2025 through October 2025 and may be settled in net shares or cash, subject to certain conditions. It is the Company’s current intent and policy to settle all conversions in shares of the Company’s common stock. The Company received $47.1 million in cash proceeds from the sale of the 2025 Warrants, which was recorded in additional paid-in-capital. The 2025 Warrants could have a dilutive effect on the Company’s earnings per share to the extent that the price of the Company's common stock during a given measurement period exceeds the strike price of the 2025 Warrants, which is $127.84 per share. The Company uses the treasury share method for assumed conversion of its 2025 Warrants to compute the weighted average common shares outstanding for diluted earnings per share. Revolving Senior Credit Facility In February 2020, the Company entered into a Second Amended and Restated Credit Agreement, or the 2020 Credit Agreement, for a revolving senior credit facility, or the 2020 Facility, which replaced the previous Amended and Restated Credit Agreement the Company had entered into in April 2017. The 2020 Credit Agreement was amended in May 2020 to, among other things, provide additional flexibility in determining the financial covenant leverage ratios for the second and third fiscal quarters of 2020 and to adjust certain margin and benchmark rates used to determine interest under the 2020 Facility. The 2020 Credit Agreement was further amended in May 2023 to replace the LIBOR-based rates with a SOFR-based rate (including a customary spread adjustment) and other rates for “Alternate Currencies” including, Australian dollars (BBSY), British pound sterling (SONIA), Euros (EURIBOR) and Japanese yen (TIBOR) and adjusts certain other provisions to reflect current documentation standards and other agreed modifications. The 2020 Credit Agreement provides for secured revolving loans, multicurrency loan options and letters of credit in an aggregate amount of up to $550.0 million. The 2020 Credit Agreement also contains an expansion feature, which allows the Company to increase the aggregate principal amount of the 2020 Facility provided the Company remains in compliance with the underlying financial covenants on a pro forma basis, including but not limited to, compliance with the consolidated interest coverage ratio and certain consolidated leverage ratios. The 2020 Facility matures in February 2025 (subject to an earlier springing maturity date), and includes a sublimit of $50.0 million for standby letters of credit, a sublimit of $250.0 million for multicurrency borrowings, and a sublimit of $5.0 million for swingline loans. All assets of the Company and its material domestic subsidiaries continue to be pledged as collateral under the 2020 Facility (subject to customary exceptions) pursuant to the terms set forth in the Second Amended and Restated Security and Pledge Agreement executed in favor of the administrative agent by the Company. Each of the Company’s material domestic subsidiaries guarantee the 2020 Facility. In connection with the 2020 Facility, the Company incurred issuance costs which will be amortized over the term of the 2020 Facility. As of June 30, 2023, the Company had $350.0 million in aggregate principal amount of revolving loans outstanding under the 2020 Facility. The Company did not carry any outstanding revolving loans under the 2020 Facility as of December 31, 2022. Any borrowings under the 2020 Facility are intended to be used by the Company to provide financing for working capital and other general corporate purposes, including potential mergers and acquisitions and to refinance indebtedness. Borrowings under the 2020 Facility bear interest, at the Company’s option, at a rate equal to an applicable margin plus: (a) the applicable Eurocurrency Rate (as defined in the 2020 Credit Agreement), or (b) a base rate determined by reference to the highest of (1) the federal funds effective rate plus 0.50%, (2) the Bank of America prime rate, and (3) the Eurocurrency Rate plus 1.00%. The margin for the 2020 Facility ranges, based on the Company’s consolidated total net leverage ratio, from 0.50% to 1.25% in the case of base rate loans and from 1.50% to 2.25% in the case of Eurocurrency Rate loans. The 2020 Facility includes an unused line fee ranging, based on the Company’s consolidated total net leverage ratio, from 0.35% to 0.50% per annum on the revolving commitment. The 2020 Credit Agreement contains affirmative, negative, permitted acquisition and financial covenants, and events of default customary for financings of this type. The financial covenants require the Company to maintain a consolidated interest coverage ratio and certain consolidated leverage ratios, which are measured on a quarterly basis. The 2020 Facility grants the lenders preferred first priority liens and security interests in capital stock, intercompany debt and all of the present and future property and assets of the Company and each guarantor. The Company is currently in compliance with the 2020 Credit Agreement covenants.

Business Combinations

Business Combinations	6 Months Ended
	Jun. 30, 2023
Business Combination and Asset Acquisition [Abstract]
Business Combinations	Business Combinations The Company recognizes the assets acquired, liabilities assumed, and any non-controlling interest at fair value at the date of acquisition. Certain acquisitions contain contingent consideration arrangements that require the Company to assess the acquisition date fair value of the contingent consideration liabilities. Such liabilities are recorded as part of the purchase price allocation of the acquisition, with subsequent fair value adjustments to the contingent consideration recorded in the unaudited Consolidated Statements of Operations. See Note 3, Financial Instruments and Fair Value Measurements, in the Notes to unaudited Consolidated Financial Statements included in this Quarterly Report for further discussion on contingent consideration liabilities. Variable Interest Entities The Company provides IONM services through various subsidiaries, which conduct business as NuVasive Clinical Services. In providing IONM services to surgeons and healthcare facilities across the U.S., the Company maintains contractual relationships with several physician practices, or PCs. In accordance with authoritative guidance, the Company has determined that the PCs are variable interest entities and therefore, the accompanying unaudited Consolidated Financial Statements include the accounts of the PCs from the date of acquisition. During the periods presented, the results of the PCs were immaterial to the Company’s financial statements. The creditors of the PCs have claims only to the assets of the PCs, which are not material, and the assets of the PCs are not available to the Company.

Stockholders' Equity

Stockholders' Equity	6 Months Ended
	Jun. 30, 2023
Stockholders' Equity Note [Abstract]
Stockholders' Equity	Stockholders’ EquityThe Company is authorized to repurchase up to $100 million of its common stock through December 31, 2023. Under this program, the Company is authorized to repurchase its shares in open market purchases, privately negotiated purchases or other transactions. The Company did not repurchase any common stock during the six months ended June 30, 2023.

Stock-Based Compensation

Stock-Based Compensation	6 Months Ended
	Jun. 30, 2023
Share-Based Payment Arrangement [Abstract]
Stock-Based Compensation	Stock-Based Compensation The compensation cost that has been included in the unaudited Consolidated Statements of Operations for the Company’s stock-based compensation plans was as follows: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Selling, general and administrative expense $ 3,886 $ 5,171 $ 10,247 $ 11,612 Research and development expense 4,048 2,288 4,557 2,617 Cost of sales 15 55 51 92 Stock-based compensation expense before taxes 7,949 7,514 14,855 14,321 Related income tax benefit (734) (1,331) (1,373) (2,536) Stock-based compensation expense, net of taxes $ 7,215 $ 6,183 $ 13,482 $ 11,785 As of June 30, 2023, there was $59.9 million of unrecognized compensation expense for restricted stock units, or RSUs, and performance-based restricted stock units, or PRSUs, to be recognized over a weighted average period of 2.2 years. Restricted Stock Units and Performance-Based Restricted Stock Units The Company issued approximately 7,000 and 291,000 shares of common stock, before net share settlement, upon vesting of RSUs and PRSUs during the three and six months ended June 30, 2023, respectively, and issued approximately 329,000 shares of common stock, before net share settlement, upon vesting of RSUs and PRSUs during the year ended December 31, 2022. Employee Stock Purchase Plan The weighted average assumptions used to estimate the fair value of stock purchase rights under the employee stock purchase plan, or ESPP, are as follows: Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 ESPP Volatility 42 % 44 % 42 % 34 % Expected term (years) 0.5 0.5 0.5 0.5 Risk free interest rate 4.6 % 1.2 % 4.6 % 0.5 % Expected dividend yield — % — % — % — % Under the terms of the ESPP, employees can elect to have up to 15% of their annual compensation, up to a maximum of $21,250 per year, withheld to purchase shares of Company common stock for a purchase price equal to 85% of the lower of the fair market value per share (at closing) of Company common stock on (i) the commencement date of the six-month offering period, or (ii) the respective purchase date.

Income Taxes

Income Taxes	6 Months Ended
	Jun. 30, 2023
Income Tax Disclosure [Abstract]
Income Taxes	Income TaxesIncome taxes are determined using an estimated annual effective tax rate applied against income, and then adjusted for the tax impacts of certain significant and discrete items. For the six months ended June 30, 2023, the Company treated the tax impact of the following as discrete events for which the tax effect was recognized separately from the application of the annual effective tax rate: tax expense related to shortfalls on stock-based compensation and tax reserves. The Company’s effective tax rate recorded for the six months ended June 30, 2023 was 50%, primarily due to the size of discrete items of tax expense related to shortfalls on stock-based compensation and tax reserves relative to year-to-date pretax income. In accordance with the disclosure requirements as described in Accounting Standards Codification 740, Income Taxes, the Company has classified unrecognized tax benefits as non-current income tax liabilities, or a reduction in deferred tax assets, unless expected to be paid within one year. The Company’s continuing practice is to recognize interest and/or penalties related to income tax matters in income tax expense. During the six months ended June 30, 2023, there was an increase in gross unrecognized tax benefits of approximately $3.6 million, primarily related to research and development credits and the valuation of intangible assets. The Company believes it is reasonably possible that approximately $1.4 million of its remaining unrecognized tax positions may be recognized within the next twelve months primarily attributable to a settlement with the Dutch tax authority related to tax positions involving the valuation of intercompany transactions. The Company is subject to routine compliance reviews on various tax matters around the world in the ordinary course of business. Currently, the only active audits are with the U.S. Internal Revenue Service for the 2014 – 2016 tax years, Illinois State for the 2020 tax year, the Netherlands for the 2019 tax year, and Italy for the 2017 tax year. California income tax returns are subject to examination in all years due to prior year net operating losses and research and development credits. Income tax returns of other major state and foreign jurisdictions remain subject to examination from 2018 and 2017 forward, respectively.

Business Segment, Product, and

Business Segment, Product, and Geographic Information	6 Months Ended
	Jun. 30, 2023
Segment Reporting [Abstract]
Business Segment, Product and Geographic Information	Business Segment, Product and Geographic Information The Company operates in one segment based upon the Company’s organizational structure, the way in which the operations and investments are managed and evaluated by the chief operating decision maker, or the CODM, as well as the lack of availability of discrete financial information at a lower level. The Company’s CODM reviews net sales at the product line offering level, and manufacturing, operating income and expenses, and net income at the Company wide level to allocate resources and assess the Company’s overall performance. The Company shares common, centralized support functions, including finance, human resources, legal, information technology, and corporate marketing, all of which report directly to the CODM. Accordingly, decision-making regarding the Company’s overall operating performance and allocation of Company resources is assessed on a consolidated basis. The Company has disclosed the net sales for each of its product line offerings to provide the reader of the financial statements transparency into the operations of the Company. The Company reports under two distinct product lines; spinal hardware and surgical support. The Company’s spinal hardware product line offerings include implants and fixation products. The Company’s surgical support product offerings include IONM services and disposables, biologics, and capital equipment, all of which are used to aid spinal surgery. Net sales by product line was as follows: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Spinal hardware $ 244,462 $ 232,679 $ 478,762 $ 453,475 Surgical support 73,324 77,772 146,735 147,738 Total net sales $ 317,786 $ 310,451 $ 625,497 $ 601,213 Net sales and property and equipment, net, by geographic area were as follows: Net Sales Property and Equipment, Net Three Months Ended Six Months Ended June 30, December 31, (in thousands) 2023 2022 2023 2022 United States $ 240,581 $ 238,339 $ 477,995 $ 459,168 $ 304,212 $ 295,914 International (excludes Puerto Rico) 77,205 72,112 147,502 142,045 56,221 50,596 Total $ 317,786 $ 310,451 $ 625,497 $ 601,213 $ 360,433 $ 346,510

Commitments

Commitments	6 Months Ended
	Jun. 30, 2023
Commitments and Contingencies Disclosure [Abstract]
Commitments	Commitments Leases At the inception of a contractual arrangement, the Company determines whether the contract contains a lease by assessing whether there is an identified asset and whether the contract conveys the right to control the use of the identified asset in exchange for consideration over a period of time. If both criteria are met, the Company records the associated lease liability and corresponding right-of-use asset upon commencement of the lease using a discount rate based on a credit-adjusted secured borrowing rate commensurate with the term of the lease. The Company records lease liabilities within current liabilities or long-term liabilities based upon the length of time associated with the lease payments. The Company records its operating lease right-of-use assets as long-term assets. Right-of-use assets for financing leases are recorded within property and equipment, net The Company leases office and storage facilities and equipment under various operating and financing lease agreements. The initial terms of these leases range from 1 to 17 years and generally provide for periodic rent increases, and renewal and termination options. The Company’s lease agreements do not contain any material variable lease payments, residual value guarantees or material restrictive covenants. Certain leases require the Company to pay taxes, insurance, and maintenance. Payments for the transfer of goods or services such as common area maintenance and utilities represent non-lease components. The Company elected the package of practical expedients and therefore does not separate non-lease components from lease components. The table below summarizes the Company’s right-of-use assets and lease liabilities as of June 30, 2023 and December 31, 2022: (in thousands, except years and rates) June 30, 2023 December 31, 2022 Assets Operating $ 92,160 $ 95,112 Financing 1,697 1,893 Total leased assets $ 93,857 $ 97,005 Liabilities Current: Operating $ 10,785 $ 10,019 Financing 812 1,084 Long-term: Operating 99,823 103,806 Financing 890 872 Total lease liabilities $ 112,310 $ 115,781 Supplemental non-cash information: Weighted-average remaining lease term (years) - operating leases 10.4 10.9 Weighted-average remaining lease term (years) - finance leases 2.7 2.6 Weighted-average discount rate - operating leases 5.3 % 5.3 % Weighted-average discount rate - finance leases 4.1 % 3.7 % The table below summarizes the Company’s lease costs, cash payments, and operating lease liabilities arising from obtaining right-of-use assets under its operating and financing lease obligations: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Lease expense: Operating lease expense $ 4,156 $ 4,049 $ 8,346 $ 8,156 Finance lease expense: Depreciation of right-of-use assets 209 437 467 834 Interest expense on lease liabilities 21 24 42 54 Total lease expense $ 4,386 $ 4,510 $ 8,855 $ 9,044 Consolidated Statements of Cash Flows information: Operating cash flows used for operating leases $ 4,251 $ 4,139 $ 8,545 $ 8,292 Operating cash flows used for financing leases 21 24 42 54 Financing cash flows used for financing leases 217 461 487 982 Total cash paid for amounts included in the measurement of lease liabilities $ 4,489 $ 4,624 $ 9,074 $ 9,328 Supplemental non-cash information: Operating lease liabilities arising from obtaining right-of-use assets $ 1,699 $ 909 $ 2,496 $ 1,408 The Company’s future minimum annual lease payments under operating and financing leases at June 30, 2023 are as follows: (in thousands) Financing Operating Remaining 2023 $ 504 $ 8,316 2024 668 15,542 2025 352 13,308 2026 287 12,728 2027 — 11,968 Thereafter — 85,152 Total minimum lease payments $ 1,811 $ 147,014 Less: amount representing interest (109) (36,406) Present value of obligations under leases 1,702 110,608 Less: current portion (812) (10,785) Long-term lease obligations $ 890 $ 99,823 Executive Severance Plans The Company has employment contracts with key executives and maintains severance plans that provide for the payment of severance and other benefits if such executives are terminated for reasons other than cause, as defined in those agreements and plans. Certain agreements call for payments that are based on historical compensation, and accordingly, the amount of the contractual commitment will change over time commensurate with the executive’s applicable earnings. At June 30, 2023, future commitments for such key executives were approximately $14.2 million. In certain circumstances, the agreements call for the acceleration of equity vesting. Those figures are not reflected in the above information.

Contingencies

Contingencies	6 Months Ended
	Jun. 30, 2023
Contingencies [Abstract]
Contingencies	Contingencies The Company is subject to potential liabilities under government regulations and various claims and legal actions that are pending or may be asserted from time-to-time. These matters arise in the ordinary course and conduct of the Company’s business and include, for example, commercial, intellectual property, environmental, securities and employment matters. The Company intends to continue to defend itself vigorously in such matters and when warranted, take legal action against others. Furthermore, the Company regularly assesses contingencies to determine the degree of probability and range of possible loss for potential accrual in its financial statements. An estimated loss contingency is accrued in the Company’s financial statements if it is probable that a liability has been incurred and the amount of the loss can be reasonably estimated. Based on the Company’s assessment, it has adequately accrued an amount for contingent liabilities currently in existence. The Company does not accrue amounts for liabilities that it does not believe are probable. Litigation is inherently unpredictable, and unfavorable resolutions could occur. As a result, assessing contingencies is highly subjective and requires judgment about future events. The amount of ultimate loss may exceed the Company’s current accruals, and it is possible that its cash flows or results of operations could be materially affected in any particular period by the unfavorable resolution of one or more of these contingencies.

Pay vs Performance Disclosure

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended				6 Months Ended
	Jun. 30, 2023	Mar. 31, 2023	Jun. 30, 2022	Mar. 31, 2022	Jun. 30, 2023	Jun. 30, 2022
Pay vs Performance Disclosure
Net income (loss) for basic	$ 7,364	$ (1,013)	$ (893)	$ 19,201	$ 6,351	$ 18,308

Insider Trading Arrangements

Insider Trading Arrangements	3 Months Ended
	Jun. 30, 2023
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false

Description of Business and B_2

Description of Business and Basis of Presentation (Policies)	6 Months Ended
	Jun. 30, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Description of Business	Description of Business NuVasive, Inc., or the Company, or NuVasive, was incorporated in Delaware on July 21, 1997, and began commercializing its products in 2001. Since its incorporation in 1997, the Company has grown from a small developer of specialty spinal implants into a global medical technology company delivering procedurally integrated solutions for spine surgery. Underlying the Company’s procedurally integrated solutions for spine surgery are technologies designed to enable better clinical, financial, and operational outcomes, including: • its surgical access instruments, including its integrated split-blade retractor system, designed to enable less-invasive surgical techniques by minimizing soft tissue disruption during spine surgery; • its Advanced Materials Science portfolio of specialized spinal implants, designed to advance spinal fusion by enhancing the osseointegration and biomechanical properties of implant materials, including porous titanium and porous polyetheretherketone; • its fixation systems, designed to facilitate the preservation and restoration of patient alignment, while addressing a vast array of spinal pathologies from an open or less-invasive approach across all spinal procedures; • its cervical total disc replacement, or cTDR, technology, which complements the Company’s portfolio of products and services for cervical spinal fusion surgery and is designed to offer surgeons capabilities across key performance functions—anatomic, physiologic motion, and radiologic design; • its neuromonitoring systems, which use proprietary software-driven nerve detection and avoidance technology, and the Company's intraoperative neuromonitoring, or IONM, services and support; and • its Pulse platform, a software ecosystem that integrates multiple hardware technologies into a single, condensed footprint in the operating room, including: radiation reduction, imaging enhancement, rod bending, navigation, IONM, and spinal alignment tools. In addition, the Company also designs and sells expandable growing rod implant systems for the treatment of early-onset scoliosis that can be non-invasively lengthened following implantation with precise, incremental adjustments via an external remote controller using magnetic technology called MAGnetic External Control, or MAGEC. This technology is also the basis for the Company’s Precice line of products which is designed to support complex orthopedic reconstruction, such as trauma and limb length discrepancy. Precice is an intramedullary device that, once implanted, utilizes the MAGEC technology to non-invasively lengthen the femur and tibia. Proposed Merger with Globus Medical On February 8, 2023, the Company entered into an Agreement and Plan of Merger, or the Merger Agreement, with Globus Medical, Inc., or Globus Medical, and Zebra Merger Sub, Inc., a wholly owned subsidiary of Globus Medical, or Merger Sub. The Merger Agreement provides, among other things, that subject to the satisfaction or waiver of the conditions set forth therein, Merger Sub will merge with and into NuVasive, referred to as the Merger, with NuVasive surviving the merger as a wholly owned subsidiary of Globus Medical. Under the Merger Agreement, at the effective time of the Merger, or the Effective Time, each share of common stock of the Company issued and outstanding immediately prior to the Effective Time (other than certain excluded shares as described in the Merger Agreement) will be cancelled and converted into the right to receive 0.75 fully paid and non-assessable shares of Class A common stock of Globus Medical, and cash in lieu of fractional shares. On April 27, 2023, the Company and Globus Medical announced that the stockholders of each company had approved all proposals related to the Merger at each company’s respective special meeting of stockholders. Completion of the Merger is subject to the satisfaction of the remaining customary closing conditions, including the expiration or termination of the waiting period under the Hart-Scott-Rodino Antitrust Improvements Act of 1976, as amended. Impact of COVID-19 and Global Macroeconomic Conditions on the Company's Business The COVID-19 pandemic significantly impacted the Company’s business and results of operations during the years 2020 through 2022 and may continue to negatively impact the Company’s business, results of operations, financial condition and cash flows. Additionally, the COVID-19 pandemic and general macroeconomic conditions have led to disruptions in the global supply chain. The Company has experienced challenges associated with material and component availability for certain product lines, longer shipping and delivery times for raw materials and components, constrained logistics capacity related to the movement of products, availability of skilled labor and increased costs of raw materials, components, labor, and freight and courier services. Net sales and profitability from our foreign operations have also been negatively affected by the unfavorable foreign currency exchange impact of the strengthened U.S. dollar against a number of currencies.
Basis of Presentation and Principles of Consolidation	Basis of Presentation and Principles of Consolidation The accompanying unaudited Consolidated Financial Statements include the accounts of the Company and its majority-owned or controlled subsidiaries, collectively referred to as either NuVasive or the Company. The Company translates the financial statements of its foreign subsidiaries using end-of-period exchange rates for assets and liabilities and average exchange rates during each reporting period for results of operations. When there is a portion of equity in an acquired subsidiary not attributable, directly or indirectly, to the respective parent entity, the Company records the fair value of the non-controlling interest at the acquisition date and classifies the amounts attributable to the non-controlling interest separately in equity in the Company's Consolidated Financial Statements. Any subsequent changes in a parent's ownership interest while the parent retains its controlling financial interest in its subsidiary are accounted for as equity transactions. All significant intercompany balances and transactions have been eliminated in consolidation. The accompanying unaudited Consolidated Financial Statements have been prepared pursuant to the rules and regulations of the SEC. Pursuant to these rules and regulations, the Company has condensed or omitted certain information and footnote disclosures it normally includes in its annual Consolidated Financial Statements prepared in accordance with generally accepted accounting principles in the United States, or U.S. GAAP. Operating results for the three and six months ended June 30, 2023 are not necessarily indicative of the results that may be expected for any other interim period or for the full year. These unaudited Consolidated Financial Statements should be read in conjunction with the audited Consolidated Financial Statements and notes thereto for the year ended December 31, 2022 included in the Company’s Annual Report on Form 10-K filed with the SEC. In the opinion of management, the unaudited Consolidated Financial Statements and notes thereto include all adjustments that are of a normal and recurring nature that are necessary for the fair presentation of the Company’s financial position and of the results of operations and cash flows for the periods presented.
Use of Estimates	Use of Estimates To prepare financial statements in conformity with U.S. GAAP, management must make estimates and assumptions that affect the amounts reported in the financial statements and accompanying notes. These estimates and assumptions involve judgments with respect to numerous factors that are difficult to predict. As a result, actual amounts could be materially different from these estimates.
Recent Accounting Pronouncements Not Yet Adopted and Recently Adopted Accounting Standards	Recent Accounting Pronouncements Not Yet Adopted In June 2022, the Financial Accounting Standards Board, or FASB, issued Accounting Standards Update, or ASU, No. 2022-03, Fair Value Measurement (Topic 820), Fair Value Measurement of Equity Securities Subject to Contractual Sale Restrictions, which clarifies that a contractual restriction on the sale of an equity security is not considered part of the unit of account of the equity security and, therefore, is not considered in measuring fair value. The ASU introduces new disclosure requirements to provide investors with information about contractual restrictions, including the nature and remaining duration of such restrictions. This update is effective for fiscal years beginning after December 15, 2023, and interim periods within those fiscal years, with early adoption permitted. The amendments should be applied prospectively with any adjustments from the adoption of the amendments recognized in earnings and disclosed on the date of adoption. The Company is currently evaluating the impact the standard will have on its Consolidated Financial Statements. Recently Adopted Accounting Standards In October 2021, the FASB issued ASU No. 2021-08, Business Combinations (Topic 805), Accounting for Contract Assets and Contract Liabilities from Contracts with Customers, which requires an entity (acquirer) to recognize and measure contract assets and liabilities acquired in a business combination in accordance with Accounting Standards Codification Topic 606, Revenue from Contracts with Customers, or ASC 606. This update is effective for fiscal years beginning after December 15, 2022, and interim periods within those fiscal years, with early adoption permitted. The amendments should be applied prospectively to business combinations occurring on or after the effective date of the amendments. The Company adopted ASU 2021-08 as of January 1, 2023. The adoption did not have a material impact on the Company’s Consolidated Financial Statements.
Revenue Recognition	Revenue Recognition In accordance with ASC 606, the Company recognizes revenue upon the transfer of goods or services to a customer at an amount that reflects the expected consideration to be received in exchange for those goods or services. The principles in ASC 606 are applied using the following five steps: (i) identify the contract with a customer; (ii) identify the performance obligation(s) in the contract; (iii) determine the transaction price; (iv) allocate the transaction price to the performance obligation(s) in the contract; and (v) recognize revenue when (or as) the Company satisfies its performance obligation(s). Specifically, revenue from the sale of implants, fixation products and disposables is generally recognized at an amount that reflects the expected consideration upon notice that the Company’s products have been used in a surgical procedure or upon shipment to a third-party customer assuming control of the products. Revenue from IONM services is recognized in the period the service is performed for the amount of consideration expected to be received. Revenue from the sale of surgical instrument sets is generally recognized upon receipt of a purchase order and the subsequent shipment to a customer who assumes control. In certain cases, the Company does offer the ability for customers to lease surgical instrumentation primarily on a non-sales type basis. Revenue from the sale or lease of capital equipment is recognized when the Company transfers control to the customer, which is generally at the point when acceptance occurs that indicates customer acknowledgment of delivery or installation, depending on the terms of the arrangement. Selling and leasing of surgical instrument sets and capital equipment represents an immaterial amount of the Company’s total net sales in all periods presented. Revenue associated with products holding rights of return or trade-in are recognized when the Company concludes there is not a risk of significant revenue reversal in future periods for the expected consideration in the transaction. Costs incurred by the Company associated with sales contracts with customers are deferred over the performance obligation period and recognized in the same period as the related revenue, with the exception of contracts that complete within one year or less, in which case the associated costs are expensed as incurred.
Accounts Receivable and Related Valuation Accounts	Accounts Receivable and Related Valuation Accounts Accounts receivable in the accompanying unaudited Consolidated Balance Sheets are presented net of allowances for credit losses. The Company maintains an allowance for credit losses resulting from the inability of its customers, including hospitals, ambulatory surgery centers, and distributors, to make required payments. The allowance for credit losses is calculated quarterly, and is estimated on a region-by-region basis considering a number of factors including age of account balances, collection history, historical account write-offs, third party credit reports, identified trends, current economic conditions, and supportable forecasted economic expectations. The allowance is adjusted on a specific identification basis for certain accounts as well as pooling of accounts with similar characteristics. An increase in the provision for credit losses may be required when the financial condition of the Company’s customers or its collection experience deteriorates. An increase to the allowance for credit losses results in a corresponding charge to selling, general and administrative expenses. The Company has a diverse customer base and no single customer represented greater than ten percent of net sales or accounts receivable. Historically, the Company’s reserves have been adequate to cover credit losses. The Company's exposure to credit losses may increase if its customers are adversely affected by changes in healthcare laws, coverage and reimbursement, macroeconomic pressures or uncertainty associated with local or global economic recessions, disruption associated with the current COVID-19 pandemic, or other customer-specific factors. It is possible that there could be a significant adverse impact from potential adjustments to the carrying amount of trade receivables as customers’ cash flows are impacted by their response to the COVID-19 pandemic and the deferral of elective surgical procedures and other macroeconomic challenges.
Inventory, net	Inventory, net Net inventory as of June 30, 2023 consisted of $338.3 million of finished goods, $3.8 million of work in progress and $8.7 million of raw materials. Net inventory as of December 31, 2022 consisted of $326.1 million of finished goods, $5.8 million of work in progress and $6.7 million of raw materials. Finished goods primarily consists of specialized implants, fixation products and disposables and are stated at the lower of cost or net realizable value determined by utilizing a standard cost method, which includes capitalized variances, which approximates the weighted average cost. Work in progress and raw materials represent the underlying material, and labor for work in progress, that ultimately yield finished goods upon completion and are recorded at the lower of cost or net realizable value. The Company reviews the components of its inventory on a periodic basis for excess and obsolescence and adjusts inventory to its net realizable value as necessary.
Derivative Financial Instruments	Derivative Financial Instruments The Company recognizes all derivative instruments as assets or liabilities in its unaudited Consolidated Balance Sheets and measures these instruments at fair value by revaluing these assets and liabilities at the end of each reporting period. Gains and losses are recorded as a component of other expense, net in the unaudited Consolidated Statements of Operations.
Other Comprehensive Income (Loss)	Other Comprehensive Income (Loss) Other comprehensive income (loss) is defined as the change in equity during a period from transactions and other events and circumstances from non-owner sources. Other comprehensive income (loss) includes net of tax, unrealized gains or losses on the Company’s marketable debt securities and foreign currency translation adjustments. The accumulated other comprehensive income (loss) was $(1.3) million and $(3.2) million as of June 30, 2023 and December 31, 2022, respectively.
Product Shipment Costs	Product Shipment Costs Product shipment costs, included in selling, general and administrative expense in the accompanying unaudited Consolidated Statements of Operations, were $8.9 million and $17.6 million for the three and six months ended June 30, 2023, respectively, and $10.0 million and $18.1 million for the three and six months ended June 30, 2022, respectively. The majority of the Company’s shipping costs are associated with providing instrument sets to hospitals for use in individual surgical procedures. Amounts billed to customers for shipping and handling of products are reflected in net sales and are not material for any period presented.
Business Transition Costs	Business Transition CostsThe Company incurs certain costs related to acquisition, integration and business transition activities, which include severance, relocation, consulting, leasehold exit costs, costs related to the proposed merger with Globus Medical, third-party acquisition costs and contingent consideration fair value adjustments and other costs directly associated with such activities. Contingent consideration is accrued based on the fair value of the expected payment, and such accruals are subject to increase or decrease based on the assessment of the likelihood that the contingent milestones will be achieved resulting in payment. If an accrual for contingent consideration decreases based upon the assessment during a particular period, it results in a reduction of costs during such period, which the Company records as a benefit.

Description of Business and B_3

Description of Business and Basis of Presentation (Tables)	6 Months Ended
	Jun. 30, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Summary of Changes in Allowance for Credit Losses	The following table summarizes the changes in the allowance for credit losses: (in thousands) June 30, 2023 December 31, 2022 Allowance for credit losses at January 1 $ 11,404 $ 10,928 Current-period provision for expected losses 1,913 748 Write-offs charged against the allowance (137) (196) Recoveries of amounts previously written off 26 31 Changes resulting from foreign currency fluctuations 65 (107) Allowance for credit losses at end of period $ 13,271 $ 11,404

Net Income (Loss) Per Share (Ta

Net Income (Loss) Per Share (Tables)	6 Months Ended
	Jun. 30, 2023
Earnings Per Share [Abstract]
Computation of Basic and Diluted Consolidated Net (Loss) Income Per Share	The following table sets forth the computation of basic and diluted consolidated net income (loss) per share: Three Months Ended June 30, Six Months Ended June 30, (in thousands, except per share data) 2023 2022 2023 2022 Numerator: Net income (loss) for basic $ 7,364 $ (893) $ 6,351 $ 18,308 Dilutive potential net income (loss): Interest and debt issuance costs on the 0.375% Senior Convertible Notes due 2025, net of tax — — — 1,642 Net income (loss) for diluted $ 7,364 $ (893) $ 6,351 $ 19,950 Denominator for basic and diluted net income (loss) per share: Weighted average common shares outstanding for basic 52,418 52,022 52,331 51,926 Dilutive potential common stock outstanding: Employee stock purchase plan (ESPP) — — 4 1 Restricted stock units (RSUs) and performance restricted stock units (PRSUs) 489 — 508 548 0.375% Senior Convertible Notes due 2025 — — — 4,824 Weighted average common shares outstanding for diluted 52,907 52,022 52,843 57,299 Basic net income (loss) per share $ 0.14 $ (0.02) $ 0.12 $ 0.35 Diluted net income (loss) per share $ 0.14 $ (0.02) $ 0.12 $ 0.35
Anti-dilutive Common Stock Equivalents Not Included in Calculation of Net (Loss) Income Per Diluted Share	The following weighted average outstanding common stock equivalents were not included in the calculation of net income (loss) per diluted share because their effects were anti-dilutive: Three Months Ended June 30, Six Months Ended June 30, ( in thousands ) 2023 2022 2023 2022 ESPP, RSUs and PRSUs 53 46 69 143 Warrants 10,169 10,169 10,169 10,169 Senior convertible notes 4,824 10,169 4,824 5,345 Total 15,046 20,384 15,062 15,657

Financial Instruments and Fai_2

Financial Instruments and Fair Value Measurements (Tables)	6 Months Ended
	Jun. 30, 2023
Fair Value Disclosures [Abstract]
Schedule of Fair Value of Assets and Liabilities Measured on Recurring Basis	The Company’s assets that are measured at fair value were based on the following fair value categories: (in thousands) Total Quoted Price in Active Market (Level 1) Significant Other Observable Inputs (Level 2) Significant Unobservable Inputs (Level 3) June 30, 2023: Cash equivalents: Money market funds $ 26,495 $ 26,495 $ — $ — Other assets: Marketable equity securities 3,185 3,185 — — Total cash equivalents and other assets $ 29,680 $ 29,680 $ — $ — December 31, 2022: Cash equivalents: Money market funds $ 176,344 $ 176,344 $ — $ — Other assets: Marketable equity securities 3,483 3,483 — — Total cash equivalents and other assets $ 179,827 $ 179,827 $ — $ —
Schedule of Inputs and Valuation Techniques Used in Recurring Level 3 Fair Value Measurements	The recurring Level 3 fair value measurements of contingent consideration liabilities associated with commercial sales milestones include the following significant unobservable inputs as of June 30, 2023: 2023 Valuation Techniques Discounted cash flow, probability, Monte Carlo Discount Rate Range 6.1% - 7.8% Weighted Average Discount Rate 6.5% Expected Years 2023 - 2028
Schedule of Fair Value of Liabilities Measured on Recurring Basis Using Unobservable Inputs	The following table sets forth the changes in the estimated fair value of the Company's contingent consideration liabilities measured on a recurring basis using significant unobservable inputs (Level 3): Six Months Ended June 30, ( in thousands ) 2023 2022 Beginning balance at January 1 $ 130,615 $ 147,810 Contingent consideration liability recorded upon acquisition 1,541 — Change in fair value measurement (3,910) (8,836) Contingent consideration paid or settled (57,133) (8,037) Changes resulting from foreign currency fluctuations (4) 4 Balance at end of period $ 71,109 $ 130,941

Goodwill and Intangible Assets

Goodwill and Intangible Assets (Tables)	6 Months Ended
	Jun. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Goodwill and Intangible Assets	Goodwill and intangible assets consisted of the following: (in thousands, except years) Weighted- Gross Accumulated Intangible June 30, 2023: Intangible assets subject to amortization: Developed technology 11 $ 366,333 $ (248,725) $ 117,608 Patents 10 56,291 (38,487) 17,804 Manufacturing know-how and trade secrets 12 21,380 (21,380) — Trade name and trademarks 9 24,889 (22,405) 2,484 Customer relationships 9 157,893 (128,441) 29,452 Total intangible assets subject to amortization 10 $ 626,786 $ (459,438) $ 167,348 In-process research and development $ 2,500 $ — $ 2,500 Total intangible assets, net $ 629,286 $ (459,438) $ 169,848 (in thousands, except years) Weighted- Average Amortization Period (in years) Gross Amount Accumulated Amortization Intangible Assets, net December 31, 2022: Intangible assets subject to amortization: Developed technology 11 $ 366,521 $ (241,119) $ 125,402 Patents 10 56,719 (37,420) 19,299 Manufacturing know-how and trade secrets 12 21,364 (21,364) — Trade name and trademarks 9 24,967 (22,124) 2,843 Customer relationships 9 156,681 (122,436) 34,245 Total intangible assets subject to amortization 10 $ 626,252 $ (444,463) $ 181,789 In-process research and development $ 2,500 $ — $ 2,500 Total intangible assets, net $ 628,752 $ (444,463) $ 184,289
Schedule of Changes to Goodwill	The changes to goodwill are comprised of the following: ( in thousands ) December 31, 2022 Gross goodwill $ 647,963 Accumulated impairment loss (8,300) 639,663 Changes to gross goodwill Changes resulting from foreign currency fluctuations (1,235) June 30, 2023 Gross goodwill 646,728 Accumulated impairment loss (8,300) $ 638,428
Future Amortization Expense Related to Intangible Assets	Total future amortization expense related to intangible assets subject to amortization at June 30, 2023 is set forth in the table below: (in thousands) Remaining 2023 $ 12,741 2024 21,550 2025 20,621 2026 15,491 2027 12,733 Thereafter through 2038 84,212 Total future amortization expense $ 167,348

Indebtedness (Tables)

Indebtedness (Tables)	6 Months Ended
	Jun. 30, 2023
Debt Disclosure [Abstract]
Schedule of Senior Convertible Notes	The carrying values of the Company’s Senior Convertible Notes are as follows: (in thousands) June 30, 2023 December 31, 2022 1.00% Senior Convertible Notes due 2023: Principal amount $ — $ 450,000 Unamortized debt issuance costs — (1,944) — 448,056 0.375% Senior Convertible Notes due 2025: Principal amount 450,000 450,000 Unamortized debt issuance costs (4,460) (5,798) 445,540 444,202 Total Senior Convertible Notes $ 445,540 $ 892,258 Less: Current portion of Senior Convertible Notes $ — $ (448,056) Long-term Senior Convertible Notes $ 445,540 $ 444,202 Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Interest expense: Contractual coupon interest $ 1,172 $ 1,547 $ 2,719 $ 3,094 Amortization of debt issuance costs 1,449 1,816 3,282 3,626 Total interest expense recognized on Senior Convertible Notes $ 2,621 $ 3,363 $ 6,001 $ 6,720 Effective interest rates: Senior Convertible Notes due 2023 (1)(2) 2.0 % 2.0 % 2.0 % 2.0 % Senior Convertible Notes due 2025 (1) 1.0 % 1.0 % 1.0 % 1.0 % (1) Interest on Senior Convertible Notes due 2023 and 2025 began accruing upon issuance and is payable semi-annually. (2) Senior Convertible Notes due 2023 were repaid in full at their scheduled maturity on June 1, 2023.

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	6 Months Ended
	Jun. 30, 2023
Share-Based Payment Arrangement [Abstract]
Compensation Cost Included in Unaudited Consolidated Statement of Operations for All Stock-based Compensation Arrangements	The compensation cost that has been included in the unaudited Consolidated Statements of Operations for the Company’s stock-based compensation plans was as follows: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Selling, general and administrative expense $ 3,886 $ 5,171 $ 10,247 $ 11,612 Research and development expense 4,048 2,288 4,557 2,617 Cost of sales 15 55 51 92 Stock-based compensation expense before taxes 7,949 7,514 14,855 14,321 Related income tax benefit (734) (1,331) (1,373) (2,536) Stock-based compensation expense, net of taxes $ 7,215 $ 6,183 $ 13,482 $ 11,785
Weighted Average Assumptions Used to Estimate Fair Value of Stock Purchase Rights under ESPP	The weighted average assumptions used to estimate the fair value of stock purchase rights under the employee stock purchase plan, or ESPP, are as follows: Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 ESPP Volatility 42 % 44 % 42 % 34 % Expected term (years) 0.5 0.5 0.5 0.5 Risk free interest rate 4.6 % 1.2 % 4.6 % 0.5 % Expected dividend yield — % — % — % — %

Business Segment, Product and G

Business Segment, Product and Geographic Information (Tables)	6 Months Ended
	Jun. 30, 2023
Segment Reporting [Abstract]
Schedule of Net Sales by Product Line	Net sales by product line was as follows: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Spinal hardware $ 244,462 $ 232,679 $ 478,762 $ 453,475 Surgical support 73,324 77,772 146,735 147,738 Total net sales $ 317,786 $ 310,451 $ 625,497 $ 601,213
Schedule of Net Sales and Net Property and Equipment by Geographical Area	Net sales and property and equipment, net, by geographic area were as follows: Net Sales Property and Equipment, Net Three Months Ended Six Months Ended June 30, December 31, (in thousands) 2023 2022 2023 2022 United States $ 240,581 $ 238,339 $ 477,995 $ 459,168 $ 304,212 $ 295,914 International (excludes Puerto Rico) 77,205 72,112 147,502 142,045 56,221 50,596 Total $ 317,786 $ 310,451 $ 625,497 $ 601,213 $ 360,433 $ 346,510

Commitments (Tables)

Commitments (Tables)	6 Months Ended
	Jun. 30, 2023
Commitments and Contingencies Disclosure [Abstract]
Right-of-use Assets and Lease Liabilities	The table below summarizes the Company’s right-of-use assets and lease liabilities as of June 30, 2023 and December 31, 2022: (in thousands, except years and rates) June 30, 2023 December 31, 2022 Assets Operating $ 92,160 $ 95,112 Financing 1,697 1,893 Total leased assets $ 93,857 $ 97,005 Liabilities Current: Operating $ 10,785 $ 10,019 Financing 812 1,084 Long-term: Operating 99,823 103,806 Financing 890 872 Total lease liabilities $ 112,310 $ 115,781 Supplemental non-cash information: Weighted-average remaining lease term (years) - operating leases 10.4 10.9 Weighted-average remaining lease term (years) - finance leases 2.7 2.6 Weighted-average discount rate - operating leases 5.3 % 5.3 % Weighted-average discount rate - finance leases 4.1 % 3.7 %
Lease Costs, Cash Payments and Operating Lease Liabilities Arising From Obtaining Right-of-use Assets under Operating and Financing Lease Obligations	The table below summarizes the Company’s lease costs, cash payments, and operating lease liabilities arising from obtaining right-of-use assets under its operating and financing lease obligations: Three Months Ended June 30, Six Months Ended June 30, (in thousands) 2023 2022 2023 2022 Lease expense: Operating lease expense $ 4,156 $ 4,049 $ 8,346 $ 8,156 Finance lease expense: Depreciation of right-of-use assets 209 437 467 834 Interest expense on lease liabilities 21 24 42 54 Total lease expense $ 4,386 $ 4,510 $ 8,855 $ 9,044 Consolidated Statements of Cash Flows information: Operating cash flows used for operating leases $ 4,251 $ 4,139 $ 8,545 $ 8,292 Operating cash flows used for financing leases 21 24 42 54 Financing cash flows used for financing leases 217 461 487 982 Total cash paid for amounts included in the measurement of lease liabilities $ 4,489 $ 4,624 $ 9,074 $ 9,328 Supplemental non-cash information: Operating lease liabilities arising from obtaining right-of-use assets $ 1,699 $ 909 $ 2,496 $ 1,408
Future Minimum Annual Lease Payments under Operating and Financing Leases	The Company’s future minimum annual lease payments under operating and financing leases at June 30, 2023 are as follows: (in thousands) Financing Operating Remaining 2023 $ 504 $ 8,316 2024 668 15,542 2025 352 13,308 2026 287 12,728 2027 — 11,968 Thereafter — 85,152 Total minimum lease payments $ 1,811 $ 147,014 Less: amount representing interest (109) (36,406) Present value of obligations under leases 1,702 110,608 Less: current portion (812) (10,785) Long-term lease obligations $ 890 $ 99,823

Description of Business and B_4

Description of Business and Basis of Presentation (Details Textual) - USD ($) $ in Thousands		3 Months Ended		6 Months Ended
	Feb. 08, 2023	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022	Dec. 31, 2022
Schedule Of Description Of Business And Basis Of Presentation [Line Items]
Inventory, finished goods		$ 338,300		$ 338,300		$ 326,100
Inventory, work in progress		3,800		3,800		5,800
Inventory, raw materials		8,700		8,700		6,700
Cumulative translation adjustments included in accumulated other comprehensive income (loss)		(1,300)		(1,300)		$ (3,200)
Product shipment costs		89,475	$ 85,758	175,845	$ 164,855
Costs (benefit) related to acquisition, integration and business transition activities		9,812	(7,624)	14,426	(4,564)
2021, 2017 and 2016 Acquisitions [Member]
Schedule Of Description Of Business And Basis Of Presentation [Line Items]
Costs (benefit) related to acquisition, integration and business transition activities		900	(8,900)	(3,900)	(8,800)
Globus Medical
Schedule Of Description Of Business And Basis Of Presentation [Line Items]
Acquisition costs		8,900		$ 16,300
Globus Medical | Common Class A
Schedule Of Description Of Business And Basis Of Presentation [Line Items]
Number of shares received for every one common stock shares held at effective time (in shares)	0.75
Allograft Products [Member] | Minimum [Member]
Schedule Of Description Of Business And Basis Of Presentation [Line Items]
Inventory, shelf life				2 years
Allograft Products [Member] | Maximum [Member]
Schedule Of Description Of Business And Basis Of Presentation [Line Items]
Inventory, shelf life				5 years
Product Shipment Costs [Member]
Schedule Of Description Of Business And Basis Of Presentation [Line Items]
Product shipment costs		$ 8,900	$ 10,000	$ 17,600	$ 18,100

Description of Business and B_5

Description of Business and Basis of Presentation - Summary of Changes in Allowance for Credit Losses (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Allowance for credit losses at January 1	$ 11,404	$ 10,928
Current-period provision for expected losses	1,913	748
Write-offs charged against the allowance	(137)	(196)
Recoveries of amounts previously written off	26	31
Changes resulting from foreign currency fluctuations	65	$ (107)
Allowance for credit losses at end of period	$ 13,271

Net Income (Loss) Per Share - C

Net Income (Loss) Per Share - Computation of Basic and Diluted Consolidated Net (Loss) Income Per Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended				6 Months Ended
	Jun. 30, 2023	Mar. 31, 2023	Jun. 30, 2022	Mar. 31, 2022	Jun. 30, 2023	Jun. 30, 2022	Dec. 31, 2022	Mar. 31, 2020
Numerator:
Net income (loss) for basic	$ 7,364	$ (1,013)	$ (893)	$ 19,201	$ 6,351	$ 18,308
Dilutive potential net income (loss):
Net income (loss) for diluted	$ 7,364		$ (893)		$ 6,351	$ 19,950
Denominator for basic and diluted net income (loss) per share:
Weighted average common shares outstanding for basic (in shares)	52,418		52,022		52,331	51,926
Dilutive potential common stock outstanding:
Weighted average common shares outstanding for diluted (in shares)	52,907		52,022		52,843	57,299
Basic net (loss) income per share (in dollars per share)	$ 0.14		$ (0.02)		$ 0.12	$ 0.35
Diluted net (loss) income per share (in dollars per share)	$ 0.14		$ (0.02)		$ 0.12	$ 0.35
Employee stock purchase plan (ESPP) [Member]
Dilutive potential common stock outstanding:
Incremental common shares from share-based payments (in shares)	0		0		4	1
Restricted Stock Units (RSUs) and Performance Restricted Stock Units (PRSUs) [Member]
Dilutive potential common stock outstanding:
Incremental common shares from share-based payments (in shares)	489		0		508	548
0.375% Senior Convertible Notes due 2025 [Member]
Earning Per Share [Line Items]
Interest rate on convertible notes	0.375%				0.375%		0.375%	0.375%
Dilutive potential net income (loss):
Interest and debt issuance costs on the 0.375% Senior Convertible Notes due 2025, net of tax	$ 0		$ 0		$ 0	$ 1,642
Dilutive potential common stock outstanding:
Incremental common shares from senior convertible notes (in shares)	0		0		0	4,824

Net Income (Loss) Per Share - A

Net Income (Loss) Per Share - Anti-dilutive Common Stock Equivalents Not Included in Calculation of Net (Loss) Income Per Diluted Share (Details) - shares shares in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Anti-dilutive securities excluded from computation of earnings per share (in shares)	15,046	20,384	15,062	15,657
ESPP, RSUs and PRSUs [Member]
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Anti-dilutive securities excluded from computation of earnings per share (in shares)	53	46	69	143
Warrants [Member]
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Anti-dilutive securities excluded from computation of earnings per share (in shares)	10,169	10,169	10,169	10,169
Senior Convertible Notes [Member]
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Anti-dilutive securities excluded from computation of earnings per share (in shares)	4,824	10,169	4,824	5,345

Financial Instruments and Fai_3

Financial Instruments and Fair Value Measurements (Details Textual) - USD ($)	1 Months Ended	3 Months Ended				6 Months Ended		12 Months Ended
	Mar. 31, 2023	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2021	Mar. 31, 2021	Jun. 30, 2023	Jun. 30, 2022	Dec. 31, 2022	Dec. 31, 2021	Jun. 30, 2020	Mar. 31, 2020
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Net currency exchange (losses) gains from derivatives instruments		$ (200,000)	$ (29,600,000)			$ (5,000,000)	$ 13,600,000
Unrealized (losses) gains for marketable equity securities		(600,000)	(200,000)			(300,000)	(200,000)
Contingent consideration liabilities		35,158,000				35,158,000		$ 66,975,000
Increase in fair value of contingent consideration liability						(3,910,000)	(8,836,000)
1.00% Senior Convertible Notes due 2023 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Principal amount		0				0		450,000,000		$ 450,000,000
0.375% Senior Convertible Notes due 2025 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Principal amount		450,000,000				450,000,000		450,000,000			$ 450,000,000
Contingent Consideration Liabilities [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Contingent consideration liabilities		71,100,000				71,100,000		130,600,000
Contingent consideration liability recorded upon acquisition						1,541,000	0
Increase (decrease) in contingent consideration liabilities related to the net sales milestone						(4,900,000)		(12,200,000)
Contingent Consideration Liabilities [Member] | Simplify Medical Acquisition [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Contingent consideration liability recorded upon acquisition					$ 103,400,000
Contingent consideration liabilities regulatory milestone					42,800,000
Increase (decrease) in contingent consideration liabilities related to the net sales milestone					$ 60,600,000
Regulatory milestone, payment	$ 56,500,000			$ 45,800,000
Increase in fair value of contingent consideration liability									$ 3,000,000
Contingent consideration liabilities		34,900,000				34,900,000		96,300,000
Quoted Price in Active Market (Level 1) [Member] | 1.00% Senior Convertible Notes due 2023 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Principal amount								450,000,000
Quoted Price in Active Market (Level 1) [Member] | 0.375% Senior Convertible Notes due 2025 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Principal amount		450,000,000				450,000,000		450,000,000
Quoted Price in Active Market (Level 1) [Member] | Convertible Notes due 2023 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Convertible debt fair value								441,600,000
Quoted Price in Active Market (Level 1) [Member] | Convertible Notes due 2025 [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Convertible debt fair value		411,300,000				411,300,000		394,900,000
Foreign Exchange Forward [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Notional principal amount		16,000,000				16,000,000		15,000,000
Derivative instrument net gains		1,000,000	$ 1,700,000			1,100,000	$ 2,500,000
Fair value of derivative instrument asset (liability)		$ (100,000)				$ (100,000)		$ (200,000)

Financial Instruments and Fai_4

Financial Instruments and Fair Value Measurements - Schedule of Fair Value of Assets and Liabilities Measured on Recurring Basis (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Other assets:
Marketable equity securities	$ 3,185	$ 3,483
Total cash equivalents and other assets	29,680	179,827
Money Market Funds [Member]
Cash equivalents:
Money market funds	26,495	176,344
Quoted Price in Active Market (Level 1) [Member]
Other assets:
Marketable equity securities	3,185	3,483
Total cash equivalents and other assets	29,680	179,827
Quoted Price in Active Market (Level 1) [Member] | Money Market Funds [Member]
Cash equivalents:
Money market funds	26,495	176,344
Significant Other Observable Inputs (Level 2) [Member]
Other assets:
Marketable equity securities	0	0
Total cash equivalents and other assets	0	0
Significant Other Observable Inputs (Level 2) [Member] | Money Market Funds [Member]
Cash equivalents:
Money market funds	0	0
Significant Unobservable Inputs (Level 3) [Member]
Other assets:
Marketable equity securities	0	0
Total cash equivalents and other assets	0	0
Significant Unobservable Inputs (Level 3) [Member] | Money Market Funds [Member]
Cash equivalents:
Money market funds	$ 0	$ 0

Financial Instruments and Fai_5

Financial Instruments and Fair Value Measurements - Schedule Inputs and Valuation Techniques Used in Recurring Level 3 Fair Value Measurements (Details) - Significant Unobservable Inputs (Level 3) [Member] - Commercial Sale Milestone [Member] - Fair Value, Recurring [Member]	6 Months Ended
	Jun. 30, 2023
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Business Combination, Contingent Consideration, Liability, Valuation Technique [Extensible List]	Valuation Technique, Discounted Cash Flow [Member]
Discount Rate [Member] | Minimum [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Weighted average measurement input	0.061
Discount Rate [Member] | Maximum [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Weighted average measurement input	0.078
Discount Rate [Member] | Weighted Average [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Weighted average measurement input	0.065
Expected Years [Member] | Minimum [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Expected Years	2023
Expected Years [Member] | Maximum [Member]
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Expected Years	2028

Financial Instruments and Fai_6

Financial Instruments and Fair Value Measurements - Schedule of Fair Value of Liabilities Measured on Recurring Basis Using Unobservable Inputs (Details) - Contingent Consideration Liabilities [Member] - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance at January 1	$ 130,615	$ 147,810
Change in fair value measurement	(3,910)	(8,836)
Contingent consideration paid or settled	(57,133)	(8,037)
Changes resulting from foreign currency fluctuations	(4)	4
Balance at end of period	$ 71,109	$ 130,941

Goodwill and Intangible Asset_2

Goodwill and Intangible Assets - Goodwill and Intangible Assets (Details) - USD ($) $ in Thousands	6 Months Ended	12 Months Ended
	Jun. 30, 2023	Dec. 31, 2022
Intangible assets subject to amortization:
Weighted- Average Amortization Period (in years)	10 years	10 years
Gross Amount	$ 626,786	$ 626,252
Accumulated Amortization	(459,438)	(444,463)
Total intangible assets subject to amortization	167,348	181,789
Intangible assets, gross (excluding goodwill)	629,286	628,752
Total intangible assets, net	169,848	184,289
In Process Research and Development
Intangible assets subject to amortization:
In-process research and development	$ 2,500	$ 2,500
Developed Technology [Member]
Intangible assets subject to amortization:
Weighted- Average Amortization Period (in years)	11 years	11 years
Gross Amount	$ 366,333	$ 366,521
Accumulated Amortization	(248,725)	(241,119)
Total intangible assets subject to amortization	$ 117,608	$ 125,402
Patents [Member]
Intangible assets subject to amortization:
Weighted- Average Amortization Period (in years)	10 years	10 years
Gross Amount	$ 56,291	$ 56,719
Accumulated Amortization	(38,487)	(37,420)
Total intangible assets subject to amortization	$ 17,804	$ 19,299
Manufacturing know-how and trade secrets [Member]
Intangible assets subject to amortization:
Weighted- Average Amortization Period (in years)	12 years	12 years
Gross Amount	$ 21,380	$ 21,364
Accumulated Amortization	(21,380)	(21,364)
Total intangible assets subject to amortization	$ 0	$ 0
Trade name and trademarks [Member]
Intangible assets subject to amortization:
Weighted- Average Amortization Period (in years)	9 years	9 years
Gross Amount	$ 24,889	$ 24,967
Accumulated Amortization	(22,405)	(22,124)
Total intangible assets subject to amortization	$ 2,484	$ 2,843
Customer relationships [Member]
Intangible assets subject to amortization:
Weighted- Average Amortization Period (in years)	9 years	9 years
Gross Amount	$ 157,893	$ 156,681
Accumulated Amortization	(128,441)	(122,436)
Total intangible assets subject to amortization	$ 29,452	$ 34,245

Goodwill and Intangible Asset_3

Goodwill and Intangible Assets - Schedule of Changes to Goodwill (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2023	Dec. 31, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
Gross goodwill	$ 646,728	$ 647,963
Accumulated impairment loss	(8,300)	(8,300)
Goodwill	638,428	$ 639,663
Changes to gross goodwill
Changes resulting from foreign currency fluctuations	$ (1,235)

Goodwill and Intangible Asset_4

Goodwill and Intangible Assets (Details Textual) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization expense related to intangible assets	$ 8	$ 13.4	$ 16.8	$ 27.3

Goodwill and Intangible Asset_5

Goodwill and Intangible Assets - Future Amortization Expense Related to Intangible Assets (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Future amortization expense related to intangible assets
Remaining 2023	$ 12,741
2024	21,550
2025	20,621
2026	15,491
2027	12,733
Thereafter through 2038	84,212
Total intangible assets subject to amortization	$ 167,348	$ 181,789

Indebtedness - Carrying Value o

Indebtedness - Carrying Value of Senior Convertible Notes (Details) - USD ($)	Jun. 30, 2023	Dec. 31, 2022	Jun. 30, 2020	Mar. 31, 2020
Debt Instrument [Line Items]
Total Senior Convertible Notes	$ 445,540,000	$ 892,258,000
Less: Current portion of Senior Convertible Notes	0	(448,056,000)
Long-term senior convertible notes	$ 445,540,000	$ 444,202,000
1.00% Senior Convertible Notes due 2023 [Member]
Debt Instrument [Line Items]
Interest rate on convertible notes	1%	1%	1%
Principal amount	$ 0	$ 450,000,000	$ 450,000,000
Unamortized debt issuance costs	0	(1,944,000)
Total Senior Convertible Notes	$ 0	$ 448,056,000
0.375% Senior Convertible Notes due 2025 [Member]
Debt Instrument [Line Items]
Interest rate on convertible notes	0.375%	0.375%		0.375%
Principal amount	$ 450,000,000	$ 450,000,000		$ 450,000,000
Unamortized debt issuance costs	(4,460,000)	(5,798,000)
Total Senior Convertible Notes	$ 445,540,000	$ 444,202,000

Indebtedness - Interest and Eff

Indebtedness - Interest and Effective Interest Rates (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Interest expense:
Interest Expense, Debt, Total	$ 6,008	$ 4,352	$ 10,386	$ 8,731
Senior Convertible Notes [Member]
Interest expense:
Interest Expense, Debt, Excluding Amortization	1,172	1,547	2,719	3,094
Amortization of Debt Issuance Costs	1,449	1,816	3,282	3,626
Interest Expense, Debt, Total	$ 2,621	$ 3,363	$ 6,001	$ 6,720
Senior Convertible Notes due 2023 [Member] | Senior Convertible Notes [Member]
Effective interest rates:
Effective interest rates	2%	2%	2%	2%
Senior Convertible Notes due 2025 [Member] | Senior Convertible Notes [Member]
Effective interest rates:
Effective interest rates	1%	1%	1%	1%

Indebtedness (Details Textual)

Indebtedness (Details Textual)		1 Months Ended			12 Months Ended
	Jun. 01, 2023 USD ($)	Jun. 30, 2020 USD ($) d $ / shares shares	Mar. 31, 2020 USD ($) d $ / shares shares	Feb. 29, 2020 USD ($)	Dec. 31, 2020 USD ($)	Jun. 30, 2023 USD ($) shares	Dec. 31, 2022 USD ($) shares	Jan. 01, 2021 USD ($)	Sep. 10, 2020 shares	Sep. 09, 2020 shares
Debt Instrument [Line Items]
Common stock, shares authorized (in shares) | shares						150,000,000	150,000,000		150,000,000	120,000,000
Retained earnings						$ 92,466,000	$ 86,115,000
Deferred and other tax liabilities						15,980,000	13,088,000
Revolving Senior Credit Facility [Member]
Debt Instrument [Line Items]
Credit facility, maximum borrowing capacity				$ 550,000,000
Loan outstanding						$ 350,000,000	$ 0
Revolving Senior Credit Facility [Member] | Federal Funds Effective Rate [Member]
Debt Instrument [Line Items]
Interest rate margin				0.50%
Revolving Senior Credit Facility [Member] | Eurocurrency Rate [Member]
Debt Instrument [Line Items]
Interest rate margin				1%
Multicurrency Borrowings [Member]
Debt Instrument [Line Items]
Credit facility, maximum borrowing capacity				$ 250,000,000
Standby Letters of Credit [Member]
Debt Instrument [Line Items]
Credit facility, maximum borrowing capacity				50,000,000
Swing Line Loans [Member]
Debt Instrument [Line Items]
Credit facility, maximum borrowing capacity				$ 5,000,000
2023 Warrants [Member]
Debt Instrument [Line Items]
Cash proceeds from the sale of warrants		$ 46,800,000
Warrant strike price (in dollars per share) | $ / shares		$ 104.84
2025 Warrants [Member]
Debt Instrument [Line Items]
Cash proceeds from the sale of warrants			$ 47,100,000
Warrant strike price (in dollars per share) | $ / shares			$ 127.84
2023 Hedge [Member]
Debt Instrument [Line Items]
Amount reclassified to stockholders' equity					$ 37,300,000
Common stock to be purchased (in shares) | shares		5,345,010
Stock price (in dollars per share) | $ / shares		$ 84.19
Cost of hedge transaction		$ 69,500,000
2025 Hedge [Member]
Debt Instrument [Line Items]
Common stock to be purchased (in shares) | shares			4,823,910
Stock price (in dollars per share) | $ / shares			$ 93.29
Cost of hedge transaction			$ 78,300,000
Minimum [Member] | Revolving Senior Credit Facility [Member]
Debt Instrument [Line Items]
Unused line fee				0.35%
Minimum [Member] | Revolving Senior Credit Facility [Member] | Eurocurrency Rate [Member]
Debt Instrument [Line Items]
Interest rate margin				1.50%
Minimum [Member] | Revolving Senior Credit Facility [Member] | Base Rate [Member]
Debt Instrument [Line Items]
Interest rate margin				0.50%
Maximum [Member] | Revolving Senior Credit Facility [Member]
Debt Instrument [Line Items]
Unused line fee				0.50%
Maximum [Member] | Revolving Senior Credit Facility [Member] | Eurocurrency Rate [Member]
Debt Instrument [Line Items]
Interest rate margin				2.25%
Maximum [Member] | Revolving Senior Credit Facility [Member] | Base Rate [Member]
Debt Instrument [Line Items]
Interest rate margin				1.25%
Additional Paid-in Capital | 2025 Hedge [Member]
Debt Instrument [Line Items]
Cost of hedge transaction			$ 78,300,000
Common Stock | 2023 Warrants [Member]
Debt Instrument [Line Items]
Preferred or common stock into which the warrants is converted (in shares) | shares		3,093,500
Common Stock | 2023 Warrants [Member] | 2023 Counterparties [Member]
Debt Instrument [Line Items]
Preferred or common stock into which the warrants is converted (in shares) | shares									6,948,512
Common Stock | Maximum [Member] | 2023 Warrants [Member]
Debt Instrument [Line Items]
Preferred or common stock into which the warrants is converted (in shares) | shares		5,345,010
Common Stock | Maximum [Member] | 2025 Warrants [Member]
Debt Instrument [Line Items]
Preferred or common stock into which the warrants is converted (in shares) | shares			4,823,910
1.00% Senior Convertible Notes due 2023 [Member]
Debt Instrument [Line Items]
Interest rate on convertible notes		1%				1%	1%
Principal amount		$ 450,000,000				$ 0	$ 450,000,000
Proceeds from issuance of convertible debt, net of issuance costs		436,700,000
Fair value of embedded conversion derivative		$ 57,200,000
Initial conversion rate adjustment, shares		11.8778
Principal amount of debt considered for conversion rate		$ 1,000
Initial conversion price of convertible notes (in dollars per share) | $ / shares		$ 84.19
Repayments of convertible debt	$ 452,300,000
1.00% Senior Convertible Notes due 2023 [Member] | Conversion Option Two [Member]
Debt Instrument [Line Items]
Principal amount of debt considered for conversion rate		$ 1,000
Consecutive trading days considered for debt conversion | d		5
1.00% Senior Convertible Notes due 2023 [Member] | Minimum [Member]
Debt Instrument [Line Items]
Percentage of conversion price		130%
1.00% Senior Convertible Notes due 2023 [Member] | Minimum [Member] | Conversion Option One [Member]
Debt Instrument [Line Items]
Consecutive trading days considered for debt conversion | d		20
1.00% Senior Convertible Notes due 2023 [Member] | Maximum [Member]
Debt Instrument [Line Items]
Percentage of conversion price		98%
1.00% Senior Convertible Notes due 2023 [Member] | Maximum [Member] | Conversion Option One [Member]
Debt Instrument [Line Items]
Consecutive trading days considered for debt conversion | d		30
1.00% Senior Convertible Notes due 2023 [Member] | Cumulative Effect, Period of Adoption, Adjustment [Member] | ASU 2020-06 [Member]
Debt Instrument [Line Items]
Convertible debt liabilities								$ 46,800,000
Retained earnings								7,900,000
Deferred and other tax liabilities								(11,200,000)
Additional paid-in capital								(43,500,000)
1.00% Senior Convertible Notes due 2023 [Member] | Additional Paid-in Capital
Debt Instrument [Line Items]
Amount reclassified to stockholders' equity					37,300,000
0.375% Senior Convertible Notes due 2025 [Member]
Debt Instrument [Line Items]
Interest rate on convertible notes			0.375%			0.375%	0.375%
Principal amount			$ 450,000,000			$ 450,000,000	$ 450,000,000
Proceeds from issuance of convertible debt, net of issuance costs			$ 437,000,000
Debt redemption price percentage			100%
Initial conversion rate adjustment, shares			10.7198
Principal amount of debt considered for conversion rate			$ 1,000
Initial conversion price of convertible notes (in dollars per share) | $ / shares			$ 93.29
Percentage of conversion price			130%
0.375% Senior Convertible Notes due 2025 [Member] | Conversion Option Two [Member]
Debt Instrument [Line Items]
Principal amount of debt considered for conversion rate			$ 1,000
Consecutive trading days considered for debt conversion | d			5
0.375% Senior Convertible Notes due 2025 [Member] | Minimum [Member]
Debt Instrument [Line Items]
Consecutive trading days considered for debt conversion | d			20
Percentage of conversion price			130%
0.375% Senior Convertible Notes due 2025 [Member] | Minimum [Member] | Conversion Option One [Member]
Debt Instrument [Line Items]
Consecutive trading days considered for debt conversion | d			20
0.375% Senior Convertible Notes due 2025 [Member] | Maximum [Member]
Debt Instrument [Line Items]
Consecutive trading days considered for debt conversion | d			30
Percentage of conversion price			98%
0.375% Senior Convertible Notes due 2025 [Member] | Maximum [Member] | Conversion Option One [Member]
Debt Instrument [Line Items]
Consecutive trading days considered for debt conversion | d			30
0.375% Senior Convertible Notes due 2025 [Member] | Cumulative Effect, Period of Adoption, Adjustment [Member] | ASU 2020-06 [Member]
Debt Instrument [Line Items]
Convertible debt liabilities								64,700,000
Retained earnings								8,800,000
Deferred and other tax liabilities								(15,900,000)
Additional paid-in capital								$ (57,600,000)
0.375% Senior Convertible Notes due 2025 [Member] | Additional Paid-in Capital
Debt Instrument [Line Items]
Amount reclassified to stockholders' equity					$ 78,300,000

Stockholders' Equity (Details)

Stockholders' Equity (Details)	6 Months Ended
	Jun. 30, 2023 USD ($)
Common Stock
Equity Class Of Treasury Stock [Line Items]
Share repurchase program, authorized amount	$ 100,000,000
Treasury Stock
Equity Class Of Treasury Stock [Line Items]
Shares repurchased during period, value	$ 0

Stock-Based Compensation - Comp

Stock-Based Compensation - Compensation Cost Included in Unaudited Consolidated Statement of Operations for All Stock-based Compensation Arrangements (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Stock-based compensation expense before taxes	$ 7,949	$ 7,514	$ 14,855	$ 14,321
Related income tax benefit	(734)	(1,331)	(1,373)	(2,536)
Stock-based compensation expense, net of taxes	7,215	6,183	13,482	11,785
Selling, General And Administrative Expense [Member]
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Stock-based compensation expense before taxes	3,886	5,171	10,247	11,612
Research and Development Expense [Member]
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Stock-based compensation expense before taxes	4,048	2,288	4,557	2,617
Cost of Sales [Member]
Employee Service Share Based Compensation Allocation Of Recognized Period Costs [Line Items]
Stock-based compensation expense before taxes	$ 15	$ 55	$ 51	$ 92

Stock-Based Compensation (Detai

Stock-Based Compensation (Details Textual) - USD ($)	3 Months Ended	6 Months Ended	12 Months Ended
	Jun. 30, 2023	Jun. 30, 2023	Dec. 31, 2022
ESPP [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Maximum percentage of annual compensation	15%	15%
Maximum amount withheld to purchase shares of the company		$ 21,250
Percentage of issuance price of stock under the stock issuance program		85%
ESPP offering period		6 months
Restricted Stock Units (RSUs) and Performance-Based Restricted Stock Units (PRSUs) [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Unamortized cost related to share-based compensation	$ 59,900,000	$ 59,900,000
Weighted average period for recognition of unamortized cost		2 years 2 months 12 days
Restricted Stock Units (RSUs) [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares of common stock issued upon vesting (in shares)	7,000	291,000
Performance Based Restricted Stock Units (PRSUs) [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares of common stock issued upon vesting (in shares)			329,000

Stock-Based Compensation - Weig

Stock-Based Compensation - Weighted Average Assumptions Used to Estimate Fair Value of Stock Purchase Rights under ESPP (Details) - ESPP [Member]	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Weighted average assumptions used to estimate fair value of stock options granted and stock purchase rights under ESPP
Volatility	42%	44%	42%	34%
Expected term (years)	6 months	6 months	6 months	6 months
Risk free interest rate	4.60%	1.20%	4.60%	0.50%
Expected dividend yield	0%	0%	0%	0%

Income Taxes (Details)

Income Taxes (Details) - USD ($) $ in Millions	3 Months Ended	6 Months Ended
	Mar. 31, 2023	Jun. 30, 2023
Income Tax Disclosure [Abstract]
Effective income tax rate		50%
Increase in gross unrecognized tax benefits related to research and development	$ 3.6
Remaining unrecognized tax positions that may be recognized in the next twelve months		$ 1.4

Business Segment, Product and_2

Business Segment, Product and Geographic Information (Details Textual)	6 Months Ended
	Jun. 30, 2023 segment productLine
Segment Reporting [Abstract]
Number of operating segments | segment	1
Number of product lines | productLine	2

Business Segment, Product and_3

Business Segment, Product and Geographic Information - Schedule of Net Sales by Product Line (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Entity Wide Information Revenue From External Customer [Line Items]
Net sales	$ 317,786	$ 310,451	$ 625,497	$ 601,213
Spinal Hardware [Member]
Entity Wide Information Revenue From External Customer [Line Items]
Net sales	244,462	232,679	478,762	453,475
Surgical Support [Member]
Entity Wide Information Revenue From External Customer [Line Items]
Net sales	$ 73,324	$ 77,772	$ 146,735	$ 147,738

Business Segment, Product and_4

Business Segment, Product and Geographic Information - Schedule of Net Sales and Net Property and Equipment by Geographical Area (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022	Dec. 31, 2022
Revenues and Net Property and Equipment by Geographical Areas [Line Items]
Net Sales	$ 317,786	$ 310,451	$ 625,497	$ 601,213
Property and equipment, net	360,433		360,433		$ 346,510
United States
Revenues and Net Property and Equipment by Geographical Areas [Line Items]
Net Sales	240,581	238,339	477,995	459,168
Property and equipment, net	304,212		304,212		295,914
International (excludes Puerto Rico) [Member]
Revenues and Net Property and Equipment by Geographical Areas [Line Items]
Net Sales	77,205	$ 72,112	147,502	$ 142,045
Property and equipment, net	$ 56,221		$ 56,221		$ 50,596

Commitments (Details Textual)

Commitments (Details Textual) - USD ($) $ in Millions	Jun. 30, 2023	Dec. 31, 2022
Commitments And Contingencies Disclosure [Line Items]
Finance Lease, Right-of-Use Asset, Statement of Financial Position [Extensible Enumeration]	Property and equipment, net	Property and equipment, net
Restricted cash for security deposit	$ 1.5	$ 1.5
Executive Severance Plans [Member]
Commitments And Contingencies Disclosure [Line Items]
Other commitments	$ 14.2
Minimum [Member]
Commitments And Contingencies Disclosure [Line Items]
Initial terms of lease	1 year
Maximum [Member]
Commitments And Contingencies Disclosure [Line Items]
Initial terms of lease	17 years

Commitments - Right-of-use Asse

Commitments - Right-of-use Assets and Lease Liabilities (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Assets
Operating	$ 92,160	$ 95,112
Financing	1,697	1,893
Total leased assets	93,857	97,005
Current:
Operating	10,785	10,019
Financing	812	1,084
Long-term:
Operating	99,823	103,806
Financing	890	872
Total lease liabilities	$ 112,310	$ 115,781
Supplemental non-cash information:
Weighted-average remaining lease term (years) - operating leases	10 years 4 months 24 days	10 years 10 months 24 days
Weighted-average remaining lease term (years) - finance leases	2 years 8 months 12 days	2 years 7 months 6 days
Weighted-average discount rate - operating leases	5.30%	5.30%
Weighted-average discount rate - finance leases	4.10%	3.70%

Commitments - Lease Costs, Cash

Commitments - Lease Costs, Cash Payments and Operating Lease Liabilities Arising From Obtaining Right-of-use Assets under Operating and Financing Lease Obligations (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022	Jun. 30, 2023	Jun. 30, 2022
Lease expense:
Operating lease expense	$ 4,156	$ 4,049	$ 8,346	$ 8,156
Finance lease expense:
Depreciation of right-of-use assets	209	437	467	834
Interest expense on lease liabilities	21	24	42	54
Total lease expense	4,386	4,510	8,855	9,044
Consolidated Statements of Cash Flows information:
Operating cash flows used for operating leases	4,251	4,139	8,545	8,292
Operating cash flows used for financing leases	21	24	42	54
Financing cash flows used for financing leases	217	461	487	982
Total cash paid for amounts included in the measurement of lease liabilities	4,489	4,624	9,074	9,328
Supplemental non-cash information:
Operating lease liabilities arising from obtaining right-of-use assets	$ 1,699	$ 909	$ 2,496	$ 1,408

Commitments - Future Minimum An

Commitments - Future Minimum Annual Lease Payments under Operating and Financing Leases (Details) - USD ($) $ in Thousands	Jun. 30, 2023	Dec. 31, 2022
Financing Leases
Remaining 2023	$ 504
2024	668
2025	352
2026	287
2027	0
Thereafter	0
Total minimum lease payments	1,811
Less: amount representing interest	(109)
Present value of obligations under leases	1,702
Less: current portion	(812)	$ (1,084)
Long-term lease obligations	890	872
Operating Leases
Remaining 2023	8,316
2024	15,542
2025	13,308
2026	12,728
2027	11,968
Thereafter	85,152
Total minimum lease payments	147,014
Less: amount representing interest	(36,406)
Present value of obligations under leases	110,608
Less: current portion	(10,785)	(10,019)
Long-term lease obligations	$ 99,823	$ 103,806