Globus Medical (GMED) 10-K 21 Feb 19 2018 FY Annual report Financial data

Document and Entity Information

Document and Entity Information - USD ($)	12 Months Ended
	Dec. 31, 2018	Feb. 18, 2019	Jun. 30, 2018
DEI [Abstract]
Entity Registrant Name	GLOBUS MEDICAL INC
Entity Central Index Key	1,237,831
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Document Type	10-K
Document Period End Date	Dec. 31, 2018
Document Fiscal Year Focus	2,018
Document Fiscal Period Focus	FY
Amendment Flag	false
Entity Common Stock, Shares Outstanding		98,653,450
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Well-known Seasoned Issuer	No
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Public Float			$ 3,767,473,308

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
ASSETS
Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents	$ 139,747	$ 118,817
Cash and Cash Equivalents, at Carrying Value	139,647	118,817
Short-term marketable securities	199,937	254,890
Accounts receivable, net of allowances of $4,226 and $3,963, respectively	137,067	116,676
Inventories	131,254	108,409
Prepaid expenses and other current assets	15,387	11,166
Notes, Loans and Financing Receivable, Net, Current	0	1,667
Income taxes receivable	7,289	8,717
Total current assets	630,681	620,342
Property and equipment, net of accumulated depreciation of $216,809 and $191,760, respectively	171,873	143,167
Long-term marketable securities	263,117	56,133
Note receivable	0	28,333
Intangible assets, net	87,323	78,659
Goodwill	123,734	123,890
Other assets	10,364	7,947
Deferred income taxes	13,578	20,031
Total assets	1,300,670	1,078,502
LIABILITIES AND EQUITY
Accounts payable	25,895	25,039
Accrued expenses	59,878	52,594
Income taxes payable	917	3,274
Business acquisition liabilities	6,830	11,411
Deferred Revenue, Current	2,598	755
Total current liabilities	96,118	93,073
Business acquisition liabilities, net of current portion	3,288	4,508
Deferred income taxes	8,114	10,669
Other liabilities	7,634	2,474
Total liabilities	115,154	110,724
Commitments and contingencies (Note 15)
Equity:
Additional paid-in capital	299,869	238,341
Accumulated other comprehensive loss	(7,172)	(6,907)
Retained earnings	892,721	736,247
Total equity	1,185,516	967,778
Total liabilities and equity	1,300,670	1,078,502
Class A Common
Equity:
Common stock	76	73
Class B Common
Equity:
Common stock	$ 22	$ 24

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parentheticals) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Current Assets:
Allowance for doubtful accounts	$ 4,226	$ 3,963
Equity:
Common stock, shares authorized (in shares)	785,000,000
Common stock, shares issued	98,573,354	96,657,881
Common stock, shares outstanding	98,573,354	96,657,881
Accumulated Depreciation, Depletion and Amortization, Property, Plant, and Equipment	$ 216,809	$ 191,760
Class A Common
Equity:
Common stock, par value (in usd per share)	$ 0.001	$ 0.001
Common stock, shares authorized (in shares)	500,000,000	500,000,000
Common stock, shares issued	76,143,257	72,780,325
Common stock, shares outstanding	76,143,257	72,780,325
Class B Common
Equity:
Common stock, par value (in usd per share)	$ 0.001	$ 0.001
Common stock, shares authorized (in shares)	275,000,000	275,000,000
Common stock, shares issued	22,430,097	23,877,556
Common stock, shares outstanding	22,430,097	23,877,556

Consolidated Statements of Inco

Consolidated Statements of Income - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Revenues	$ 712,969	$ 635,977	$ 563,994
Cost of goods sold	159,410	150,453	134,705
Gross profit	553,559	485,524	429,289
Operating expenses:
Research and development	55,496	43,679	44,532
Selling, general and administrative	311,591	267,817	222,156
Provision for litigation	5,878	2,668	3,156
Amortization of intangibles	9,588	7,909	3,478
Acquisition related costs	1,681	1,611	1,826
Total operating expenses	384,234	323,684	275,148
Operating income	169,325	161,840	154,141
Interest income, net	13,278	6,608	3,057
Foreign currency transaction loss	360	909	(482)
Other income	5,642	571	563
Total other income, net	19,280	8,088	3,138
Income before income taxes	188,605	169,928	157,279
Income tax provision	32,131	62,580	52,938
Net income	$ 156,474	$ 107,348	$ 104,341
Earnings per share:
Basic	$ 1.60	$ 1.12	$ 1.09
Diluted	$ 1.54	$ 1.10	$ 1.08
Weighted average shares outstanding:
Basic	97,884	96,243	95,647
Dilutive stock options	3,432	1,644	785
Diluted	101,316	97,887	96,432
Anti-dilutive stock options excluded from weighted average calculation	2,451	2,873	5,481

Consolidated Statements of Comp

Consolidated Statements of Comprehensive Income - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Statement of Comprehensive Income [Abstract]
Net income	$ 156,474	$ 107,348	$ 104,341
Other comprehensive loss:
Unrealized gain/(loss) on marketable securities, net of tax	145	(146)	(48)
Foreign currency translation gain/(loss)	(410)	1,881	(6,636)
Total other comprehensive income/(loss)	(265)	1,735	(6,684)
Comprehensive income	$ 156,209	$ 109,083	$ 97,657

Consolidated Statements of Equi

Consolidated Statements of Equity - USD ($) shares in Thousands, $ in Thousands	Total	Additional Paid-in Capital	Accumulated Other Comprehensive Income	Retained Earnings	Class A CommonCommon Stock	Class B CommonCommon Stock
Balance, Shares at Dec. 31, 2015					71,442	23,878
Total stockholders' equity, beginning of period at Dec. 31, 2015	$ 715,324	$ 192,629	$ (1,958)	$ 524,558	$ 71	$ 24
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock-based compensation	11,652	11,652
Exercise of stock options (shares)					610
Exercise of stock options	5,874	5,873			$ 1
Tax benefit related to nonqualified stock options excercised	1,571	1,571
Comprehensive income	97,657		(6,684)	104,341
Balance, Shares at Dec. 31, 2016					72,052	23,878
Total stockholders' equity, end of period at Dec. 31, 2016	832,078	211,725	(8,642)	628,899	$ 72	$ 24
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock-based compensation	14,882	14,882
Tax benefit related to nonqualified stock options excercised	11,735	11,734
Comprehensive income	109,083		1,735	107,348
Balance, Shares at Dec. 31, 2017					72,780	23,878
Total stockholders' equity, end of period at Dec. 31, 2017	967,778	238,341	(6,907)	736,247	$ 73	$ 24
Conversion of Stock, Shares Issued					1,447	(1,447)
Conversion of Stock, Amount Issued					$ 1	$ (1)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock-based compensation	$ 22,219	22,219
Exercise of stock options (shares)	1,917				1,917
Exercise of stock options	$ 39,311	39,309			$ 2
Comprehensive income	156,209		(265)	156,474
Balance, Shares at Dec. 31, 2018					76,144	22,431
Total stockholders' equity, end of period at Dec. 31, 2018	$ 1,185,516	$ 299,869	$ (7,172)	$ 892,721	$ 76	$ 22

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Cash flows from operating activities:
Net income	$ 156,474,000	$ 107,348,000	$ 104,341,000
Adjustments to reconcile net income to net cash provided by operating activities
Depreciation and amortization	41,630,000	42,067,000	38,771,000
Amortization of premium on marketable securities	1,677,000	2,671,000	4,068,000
Write-down for excess and obsolete inventories	10,475,000	11,519,000	12,836,000
Stock-based compensation expense	21,899,000	14,686,000	11,382,000
Allowance for doubtful accounts	957,000	1,718,000	685,000
Change in fair value of contingent consideration	985,000	1,240,000	2,866,000
Non-cash settlement of accrued expenses	0	0	(4,632,000)
Impairment of intangible assets	0	516,000	3,472,000
Change in deferred income taxes	971,000	8,292,000	(3,810,000)
(Gain)/loss on disposal of assets, net	(3,557,000)	0	0
(Increase)/decrease in:
Accounts receivable	(21,789,000)	(24,955,000)	(4,668,000)
Inventories	(31,382,000)	(5,277,000)	(10,503,000)
Prepaid expenses and other assets	(7,496,000)	(4,774,000)	4,568,000
Increase/(decrease) in:
Accounts payable	(3,008,000)	9,843,000	(23,000)
Accrued expenses and other liabilities	14,728,000	(2,064,000)	(18,164,000)
Income taxes payable/receivable	(921,000)	(3,772,000)	6,634,000
Net cash provided by operating activities	181,643,000	159,058,000	147,823,000
Cash flows from investing activities:
Purchases of marketable securities	(537,942,000)	(392,895,000)	(350,448,000)
Maturities of marketable securities	278,049,000	240,353,000	281,885,000
Sales of marketable securities	106,388,000	122,512,000	52,802,000
Purchases of property and equipment	(59,697,000)	(51,303,000)	(40,909,000)
Issuance of note receivable	30,000,000	0	(30,000,000)
Proceeds from sale of assets	5,000,000	0	0
Acquisition of businesses, net of cash acquired	(14,825,000)	(29,944,000)	(76,068,000)
Net cash used in investing activities	(193,027,000)	(111,277,000)	(162,738,000)
Cash flows from financing activities:
Payment of business acquisition liabilities	(6,739,000)	(10,109,000)	(5,404,000)
Proceeds from exercise of stock options	39,309,000	11,735,000	5,874,000
Net cash provided by financing activities	32,570,000	1,626,000	470,000
Effect of foreign exchange rate on cash	(256,000)	1,979,000	(1,894,000)
Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents, Period Increase (Decrease), Including Exchange Rate Effect	20,930,000	51,386,000	(16,339,000)
Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents, beginning of period	118,817,000	67,431,000	83,770,000
Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents, end of period	139,747,000	118,817,000	67,431,000
Supplemental disclosures of cash flow information:
Interest paid	6,000	3,000	35,000
Income taxes paid	$ 30,552,000	$ 59,111,000	$ 50,087,000

BACKGROUND AND SUMMARY OF SIGNI

BACKGROUND AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES	12 Months Ended
	Dec. 31, 2018
BACKGROUND AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES [Abstract]
Background and Summary of Significant Accounting Policies	BACKGROUND AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (a) The Company Globus Medical, Inc., together with its subsidiaries, is a medical device company that develops and commercializes healthcare solutions in a mission to improve the quality of life of patients with musculoskeletal disorders. We are primarily focused on implants that promote healing in patients with musculoskeletal disorders, including the use of a robotic guidance and navigation system and products to treat patients who have experienced orthopedic traumas. We are an engineering-driven company with a history of rapidly developing and commercializing advanced products and procedures to assist surgeons in effectively treating their patients and address new treatment options. With over 190 products launched, we offer a comprehensive portfolio of innovative and differentiated technologies that address a variety of musculoskeletal pathologies, anatomies, and surgical approaches. We are headquartered in Audubon, Pennsylvania, and market and sell our products through our exclusive sales force in the United States, as well as within North, Central & South America, Europe, Asia, Africa and Australia. The sales force consists of direct sales representatives and distributor sales representatives employed by exclusive independent distributors. The terms the “Company,” “Globus,” “we,” “us” and “our” refer to Globus Medical, Inc. and, where applicable, our consolidated subsidiaries. (b) Basis of Presentation The accompanying consolidated financial statements have been prepared in conformity with U.S. generally accepted accounting principles (“U.S. GAAP”). During the fourth quarter of 2016 , we self-identified and recorded non-cash prior period adjustments primarily related to depreciation and scrap expense for our instruments and cases. This $1.8 million net cumulative adjustment related to the period beginning in 2013 and through 2015 and resulted in a $5.5 million pre-tax increase in depreciation and a $3.7 million pre-tax decrease in scrap and provision for excess and obsolete inventory, both of which are primarily components of our full fiscal year 2016 cost of goods sold on our consolidated statement of income. We performed the analysis required by Staff Accounting Bulletin No. 99, Materiality , and Staff Accounting Bulletin No. 108, Considering the Effects of Prior Year Misstatements When Quantifying Misstatements in Current Year Financial Statements , and determined that the effect of the adjustments was not material to the financial position, results of operations or cash flows of any prior fiscal year from both a quantitative and qualitative perspective and is not material to the full fiscal year 2016 . During the fourth quarter of 2017 , the Company identified and recorded an adjustment to its December 31, 2016 consolidated balance sheet to correct the presentation of $65.8 million of its Variable Rate Demand Notes (“VRDNs”) as short-term marketable securities instead of cash and cash equivalents. Accordingly, the statement of cash flows for the year ended December 31, 2016 has been adjusted to appropriately increase purchases of marketable securities by $63.3 million , resulting in an increase in net cash used in investing activities and a decrease to cash and cash equivalents, end of period of $63.3 million . The statement of cash flows for the year ended December 31, 2015 has been adjusted to appropriately increase purchases of marketable securities by $2.5 million , resulting in an increase in net cash used in investing activities and a decrease to cash and cash equivalents, end of period of $2.5 million . As of December 31, 2016 , this adjustment also resulted in the addition of VRDNs to the table in Note 5, Marketable Securities and an adjustment to appropriately present VRDNs in the table in Note 6, Fair Value Measurements within Municipal bonds instead of cash equivalents. The Company does not own VRDNs as of December 31, 2018 and December 31, 2017 . (c) Principles of Consolidation The accompanying consolidated financial statements include the accounts of Globus and its wholly owned subsidiaries. All intercompany balances and transactions are eliminated in consolidation. (d) Use of Estimates The preparation of the consolidated financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosures of contingent assets and liabilities at the date of the consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. We base our estimates, in part, on historical experience that management believes to be reasonable under the circumstances. Actual results could differ from those estimates. Estimates and assumptions are periodically reviewed and the effects of revisions are reflected in the consolidated financial statements in the period they are determined to be necessary. Significant areas that require management’s estimates include intangible assets, contingent payment liabilities, allowance for doubtful accounts, stock-based compensation, write-down for excess and obsolete inventory, useful lives of assets, the outcome of litigation, recoverability of intangible assets and income taxes. We are subject to risks and uncertainties due to changes in the healthcare environment, regulatory oversight, competition, and legislation that may cause actual results to differ from estimated results. During fourth quarter of 2017, we completed a review of the estimated useful life of our Instruments and Modules and cases. Based on historical useful life information, forecasted product life cycles and demand expectations, the useful life of Instruments and Modules and cases were extended from three to five years. This was accounted for as a change in accounting estimate and was made on a prospective basis effective October 1, 2017. For the three months ended December 31, 2018 , depreciation expense was lower by approximately $1.3 million than it would have been had the useful life of these assets not been extended. The effect of this change on basic and diluted earnings per share for the three months ended December 31, 2018 was $0.01 per share. For the year ended December 31, 2018 , depreciation expense was lower by approximately $5.7 million than it would have been had the useful life of these assets not been extended, with a diluted earnings per share impact of $0.05 per share. (e) Foreign Currency Translation The functional currency of our foreign subsidiaries is generally their local currency. Assets and liabilities of the foreign subsidiaries are translated at the period end currency exchange rate and revenues and expenses are translated at an average currency exchange rate for the period. The resulting foreign currency translation gains and losses are included as a component of accumulated other comprehensive income. Gains and losses arising from intercompany foreign transactions are included in other income, net on the consolidated statement of income. (f) Cash, Cash Equivalents, and Restricted Cash Cash and cash equivalents include cash on hand and all highly liquid investments with a maturity of three months or less when purchased. In December 2014, we set aside cash for the payment of a portion of the DePuy Synthes and Bianco litigations. We classified this cash as restricted, as the amount was placed in escrow to be used for payment of the litigation obligations, should we not be successful with our appeals. On January 13, 2016, we settled our litigation with DePuy Synthes and made a payment of $7.9 million and recovered approximately $8.4 million related to that settlement shortly thereafter. See “Note 15. Commitments and Contingencies” below for more details regarding these litigations. The following table provides a reconciliation of cash, cash equivalents, and restricted cash reported within the statement of financial position that sum to the total of the same such amounts shown in the statement of cash flows: (In thousands) December 31, 2018 December 31, 2017 December 31, 2016 December 31, 2015 Cash and cash equivalents $ 139,647 $ 118,817 $ 66,954 $ 57,651 Restricted cash 100 — 477 26,119 Total cash, cash equivalents, and restricted cash as presented in the consolidated statement of cash flows $ 139,747 $ 118,817 $ 67,431 $ 83,770 (g) Concentrations of Credit Risk Financial instruments, which potentially subject us to concentrations of credit risk, are primarily marketable securities and accounts receivable. Concentrations of credit risk with respect to accounts receivable are limited due to the large number of entities comprising our customer base. We perform ongoing credit evaluations of our customers and generally do not require collateral. There was no customer that accounted for 10% or more of sales for the years ended December 31, 2018 , 2017 , and 2016 , respectively. (h) Marketable Securities Our marketable securities include municipal bonds, corporate debt securities, commercial paper, securities of government, federal agency, and other sovereign obligations, and asset-backed securities, and are classified as available-for-sale as of December 31, 2018 and 2017 . Available-for-sale securities are recorded at fair value in both short-term and long-term marketable securities on our consolidated balance sheets. The change in fair value for available-for-sale securities is recorded, net of taxes, as a component of accumulated other comprehensive income or loss on our consolidated balance sheets. Premiums and discounts are recognized over the life of the related security as an adjustment to yield using the straight-line method. Realized gains or losses from the sale of our marketable securities are determined on a specific identification basis. Realized gains and losses, along with interest income and the amortization/accretion of premiums/discounts are included as a component of other income, net, on our consolidated statements of income. Interest receivable is recorded as a component of prepaid expenses and other current assets on our consolidated balance sheets. We maintain a portfolio of various holdings, types and maturities, though most of the securities in our portfolio could be liquidated at minimal cost at any time. We invest in securities that meet or exceed standards as defined in our investment policy. Our policy also limits the amount of credit exposure to any one issue, issuer or type of security. We review our securities for other-than-temporary impairment at each reporting period. If an unrealized loss for any security is considered to be other-than-temporary, the loss will be recognized in our consolidated statement of income in the period the determination is made. (i) Inventories I nventories are stated at the lower of cost or net realizable value. Cost is determined on a first-in, first-out basis. The majority of our inventories are finished goods and we utilize both in-house manufacturing and third-party suppliers to source our products. We periodically evaluate the carrying value of our inventories in relation to our estimated forecast of product demand, which takes into consideration the estimated life cycle of product releases. When quantities on hand exceed estimated sales forecasts, we record a write-down for such excess inventories. (j) Property and Equipment Property and equipment are recorded at cost less accumulated depreciation. Additions or improvements are capitalized, while repairs and maintenance are expensed as incurred. Depreciation and amortization are provided using the straight-line method over the related useful lives of the assets. When assets are sold or otherwise disposed of, the related property, equipment, and accumulated depreciation amounts are relieved from the accounts, and any gain or loss is recorded in the consolidated statements of income. Purchases of property and equipment included in accounts payable and accrued expenses were $ 10.1 million , $ 6.5 million , and $ 5.2 million during the twelve months ended December 31, 2018 , 2017 , and 2016 , respectively. (k) Goodwill and Intangible Assets Goodwill represents the excess purchase price over the fair values of the identifiable assets acquired less the liabilities assumed. Goodwill is tested for impairment at a minimum on an annual basis. Goodwill is tested for impairment at the reporting unit level by comparing the reporting unit’s carrying amount to the fair value of the reporting unit. The fair values are estimated using an income and discounted cash flow approach. We perform our annual impairment test for goodwill in the fourth quarter of each year. We consider qualitative indicators of the fair value of a reporting unit when it is unlikely that a reporting unit has impaired goodwill. During the years ended December 31, 2018 , 2017 and 2016 , we did not record any impairment charges related to goodwill. Intangible assets consist of purchased in-process research and development (“IPR&D”), developed technology, supplier network, patents, customer relationships and non-compete agreements. Intangible assets with finite useful lives are amortized over the period of estimated benefit using the straight-line method and estimated useful lives ranging from one to seventeen years. Intangible assets are tested for impairment annually or whenever events or circumstances indicate that a carrying amount of an asset (asset group) may not be recoverable. If impairment is indicated, we measure the amount of the impairment loss as the amount by which the carrying amount exceeds the fair value of the asset. Fair value is generally determined using a discounted future cash flow analysis. During 2017 , we recorded an impairment charge of $ 0.5 million related to one of our developed technologies related to one of our systems as a component of selling, general and administrative expense. There were no impairments of finite-lived intangible assets during the years ended December 31, 2018 and 2016 . IPR&D has an indefinite life and is not amortized until completion of the project at which time the IPR&D becomes an amortizable asset. If the related project is not completed in a timely manner, we may have an impairment related to the IPR&D, calculated as the excess of the asset’s carrying value over its fair value. During 2016 , we recorded an impairment charge of $3.5 million related to one of our IPR&D projects as a component of acquisition related costs. There were no impairments of IPR&D during the years ended December 31, 2018 or 2017 . (m) Impairment of Long-Lived Assets We periodically evaluate the recoverability of the carrying amount of long-lived assets, which include property and equipment, as well as whenever events or changes in circumstances indicate that the carrying amount of an asset group may not be fully recoverable. An impairment is assessed when the undiscounted future cash flows from the use and eventual disposition of an asset group are less than its carrying value. If impairment is indicated, we measure the amount of the impairment loss as the amount by which the carrying amount exceeds the fair value of the asset group. Our fair value methodology is based on quoted market prices, if available. If quoted market prices are not available, an estimate of fair value is made based on prices of similar assets or other valuation techniques including present value techniques. During the years ended December 31, 2018 , 2017 and 2016 , we did not record any impairment charges related to long-lived assets. (l) Revenue Recognition Revenue is recognized upon transfer of control of promised products or services to customers in an amount that reflects the consideration we expect to receive in exchange for those products or services. Sales and other taxes we collect concurrent with revenue-producing activities are excluded from revenue. Incidental items that are immaterial in the context of the contract are recognized as expense. For purposes of disclosing disaggregated revenue, we disaggregate our revenue, into two categories, Musculoskeletal Solutions and Enabling Technologies, based on the timing of revenue recognition. Our Musculoskeletal Solutions products consist primarily of the implantable devices, disposables, and unique instruments used in an expansive range of spine, orthopedic trauma and extremity procedures. The majority of our Musculoskeletal Solutions contracts have a single performance obligation and revenue is recognized at a point in time. Our Enabling Technologies products are the advanced hardware and software systems and related technologies that are designed to enhance a surgeon’s capabilities and streamline surgical procedures by making them less invasive, more accurate, and more reproducible to improve patient care. The majority of our Enabling Technologies product contracts typically contain multiple performance obligations, including maintenance and support, and revenue is recognized as we fulfill each performance obligation. For contracts with multiple performance obligations, we allocate the contract’s transaction price to each performance obligation using our best estimate of the standalone selling price of each distinct good or service in the contract. Our policy is to classify shipping and handling costs billed to customers as sales and the related expenses as cost of goods sold. Nature of Products and Services A significant portion of our Musculoskeletal Solutions product revenue is generated from consigned inventory maintained at hospitals or with sales representatives. Revenue from the sale of consigned Musculoskeletal products is recognized when we transfer control, which occurs at the time the product is used or implanted. For all other Musculoskeletal Solutions product transactions, we recognize revenue when we transfer title to the goods, provided there are no remaining performance obligations that will affect the customer’s final acceptance of the sale. We use an observable price to determine the stand-alone selling price for the identified performance obligation. Revenue from the sale of Enabling Technologies products is generally recognized when title transfers to the customer which occurs at the time the product is shipped or delivered. Depending on the terms of the arrangement, we may also defer the recognition of a portion of the consideration received as we have to satisfy a future performance obligation to provide maintenance and support. We use an observable price to determine the stand-alone selling price for each separate performance obligation. Contract Balances Timing of revenue recognition may differ from the timing of invoicing to customers. We record a receivable when revenue is recognized prior to invoicing, or deferred revenue when revenue is recognized subsequent to invoicing. Deferred revenue is comprised mainly of unearned revenue related to the sales of certain Enabling Technologies products, which includes maintenance and support services. Deferred revenue is generally invoiced annually at the beginning of each contract period and recognized ratably over the coverage period. For the three months and year ended December 31, 2018 , there was an immaterial amount of revenue recognized from previously deferred revenue. Disaggregation of Revenue The following table represents total sales by revenue stream: Three Months Ended Twelve Months Ended (In thousands) December 31, December 31, December 31, December 31, Musculoskeletal Solutions products $ 181,638 $ 165,114 $ 666,040 $ 625,057 Enabling Technologies products 14,300 10,920 46,929 10,920 Total sales $ 195,938 $ 176,034 $ 712,969 $ 635,977 (m) Cost of Goods Sold Cost of goods sold consists primarily of costs from our in-house manufacturing, costs of products purchased from third-party suppliers, excess and obsolete inventory charges, depreciation of surgical instruments and cases, royalties, shipping, inspection and related costs incurred in making our products available for sale or use. (n) Research and Development Research and development costs are expensed as incurred. Research and development costs include salaries, employee benefits, supplies, consulting services, clinical services and clinical trial costs, and facilities costs. Costs incurred in obtaining technology licenses and patents are charged immediately to research and development expense if the technology licensed has not reached technological feasibility and has no alternative future use. (o) Other Income In June 2018, we sold assets for $5.0 million , which resulted in a gain on sale of assets of $4.6 million . (p) Stock-Based Compensation The cost for employee and non-employee director awards is measured at the grant date based on the fair value of the award. The fair value of the portion of the award that is ultimately expected to vest is recognized as expense over the requisite service period (generally the vesting period of the equity award). Awards issued to non-employees are recorded at their fair value as determined in accordance with authoritative guidance, and are periodically revalued as the awards vest and are recognized as expense over the requisite service period. The determination of the fair value of stock options is made utilizing the Black-Scholes option-pricing model which is affected by our stock price and a number of assumptions, including expected volatility, expected term, risk-free interest rate and expected dividends. As we became a publicly traded entity in 2012, historic volatility for our common stock is insufficient to estimate expected volatility. As a result, we estimate volatility based on a consistently defined peer group of public companies that we believe collectively provides a reasonable basis for estimating volatility. We intend to continue to use the consistently defined group of publicly traded peer companies to determine volatility in the future until sufficient information regarding volatility of the price of our shares of Class A common stock becomes available or the selected companies are no longer suitable for this purpose. The expected term of the stock options is determined utilizing the simplified method given the limited extent of our historical data. The risk-free interest rate assumption is based on observed interest rates of U.S. Treasury securities appropriate for the expected terms of the stock options. The dividend yield assumption is based on the history and expectation of no dividend payouts. (q) Income Taxes Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax bases. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the year in which such items are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in the period that includes the enactment date. A valuation allowance is established to offset any deferred tax assets if, based upon available evidence, it is more likely than not that some or all of the deferred tax assets will not be realized. Significant judgment is required in determining income tax provisions and in evaluating tax positions. We will establish additional provisions for income taxes when, despite the belief that tax positions are fully supportable, there remain certain positions that do not meet the minimum probability threshold that a tax position is more likely than not to be sustained upon examination by the taxing authority. In the normal course of business, we and our subsidiaries are examined by various federal, state, and foreign tax authorities. We regularly assess the potential outcomes of these examinations and any future examinations for the current or prior years in determining the adequacy of the provision for income taxes. We periodically assess the likelihood and amount of potential adjustments and adjust the income tax provision, the current tax liability, and deferred taxes in the period in which the facts that give rise to a revision become known. (r) Fair Value of Financial Instruments As of December 31, 2018 , the carrying values of cash and cash equivalents, short and long-term investments, accounts receivable, accounts payable and accrued expenses approximate their respective fair values based on their short and long-term nature. We classify our financial assets and liabilities that are measured at fair value into one of the three categories based upon inputs used to determine fair value. See “Note 6. Fair Value Measurements” below for more details regarding inputs and classifications. (s) Advertising Expense We expense advertising costs as they are incurred. Advertising expense was $1.9 million , $1.5 million and $0.9 million , for the years ended December 31, 2018 , 2017 , and 2016 , respectively. (t) Legal Costs We are involved in a number of proceedings, legal actions, and claims. Such matters are subject to many uncertainties, and the outcomes of these matters are not within our control and may not be known for prolonged periods of time. In some actions, the claimants seek damages, as well as other relief, including injunctions prohibiting us from engaging in certain activities, which, if granted, could require significant expenditures and/or result in lost revenues. We record a liability in the consolidated financial statements for these actions when a loss is known or considered probable and the amount can be reasonably estimated. If the reasonable estimate of a known or probable loss is a range, and no amount within the range is a better estimate than any other, the minimum amount of the range is accrued. If a loss is reasonably possible but not known or probable, and can be reasonably estimated, the estimated loss or range of loss is disclosed. In most cases, significant judgment is required to estimate the amount and timing of a loss to be recorded. We expense legal costs related to loss contingencies as incurred. (u) Acquisition Related Costs Acquisition related costs represents the change in fair value of business acquisition related contingent consideration; costs related to integrating recently acquired businesses including but not limited to costs to exit or convert contractual obligations, severance, and information system conversion; and specific costs related to the consummation of the acquisition process such as banker fees, legal fees, and other acquisition related professional fees. (v) Medical Device Excise Tax Effective as of January 1, 2013, the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Affordability Reconciliation Act (collectively “PPACA”) imposed a medical device excise tax (“MDET”) of 2.3% on any entity that manufactures or imports certain medical devices offered for sale in the United States. We have historically accounted for the MDET as a component of our cost of goods sold. The Consolidated Appropriations Act of 2016, which was signed into law in December 2015, included a two-year suspension on the medical device excise tax, effective January 1, 2016. In January 2018, Congress further extended the moratorium on the medical device excise tax through January 1, 2020. (w) Recently Issued Accounting Pronouncements In February 2016, the FASB released ASU 2016-02, Leases (Topic 842) (“ASU 2016-02”). Under ASU 2016-02, a right-of-use asset and lease obligation will be recorded for all leases with terms greater than 12 months, whether operating or financing, while the income statement will reflect lease expense for operating leases and amortization/interest expense for financing leases. ASU 2016-02 is effective for fiscal years beginning after December 15, 2018, with early adoption permitted, and permits modified retrospective method or cumulative-effect adjustment method. We have elected to apply the cumulative-effect adjustment transition method and will record the adjustment to the opening balance of retained earnings in the period of adoption. Adoption of the standard will not have a material impact on our financial position, results of operations, and disclosures. In January 2017, the FASB released ASU 2017-04, Intangibles - Goodwill and Other (Topic 805): Simplifying the Test for Goodwill Impairment (“ASU 2017-04”), which eliminates the Step 2 calculation for the implied fair value of goodwill to measure a goodwill impairment charge. Under the updated standard, an entity will record an impairment charge based on the excess of a reporting unit’s carrying amount over its fair value. ASU 2017-04 does not change the guidance on completing Step 1 of the goodwill impairment test and still allows an entity to perform the optional qualitative goodwill impairment assessment before determining whether to proceed to Step 1. This update is effective for annual and interim goodwill impairment tests in fiscal years beginning after December 15, 2019 with early adoption permitted for any impairment test performed on testing dates after January 1, 2017. We are currently evaluating the timing and impact of the new standard on our financial position, results of operations and disclosures. In February 2018, the FASB released ASU 2018-02, Income Statement - Reporting Comprehensive Income (Topic 220) , Reclassification of Certain Tax Effects from Accumulated Other Comprehensive Income (“ASU 2018-02”). Prior to ASU 2018-02, GAAP required the remeasurement of deferred tax assets and liabilities as a result of a change in tax laws or rates to be presented in net income from continuing operations, even in situations in which the related income tax effects of items in accumulated other comprehensive income were originally recognized in other comprehensive income. As a result, such items, referred to as stranded tax effects, did not reflect the appropriate tax rate. Under ASU 2018-02, entities are permitted, but not required, to reclassify from accumulated other comprehensive income to retained earnings those stranded tax effects resulting from the Tax Act. ASU 2018-02 is effective for all entities for fiscal years beginning after December 15, 2018, and interim periods within those fiscal years. Early adoption is permitted. Adoption of the standard will not have a material impact on our financial position, results of operations and disclosures. In June 2018, the FASB released ASU 2018-07, Compensation—Stock Compensation (Topic 718) , (“ASU 2018-07”), which expanded the scope of Topic 718 to include share-based payment transactions for acquiring goods and services from nonemployees. ASU 2018-07 specifies that Topic 718 applies to all share-based payment transactions in which a grantor acquires goods or services to be used or consumed in a grantor’s own operations by issuing share-based payment awards. This update is effective for public entities for fiscal years beginning after December 15, 2018, and interim periods within those fiscal years. Early adoption is permitted. Adoption of the standard will not have a material impact on our financial position, results of operations, and disclosures. In August 2018, the FASB released ASU 2018-13, Fair Value Measurement (Topic 820), (“ASU 2018-13), which modifies the disclosure requirements on fair value measurements in Topic 820, including the consideration of costs and benefits. This update is effective for public entities for fiscal years beginning after December 15, 2019, and interim periods within those fiscal years. Early adoption is permitted. We are currently evaluating the timing and impact of the new standard on our financial position, results of operations and disclosures. (x) Recently Adopted Accounting Pronouncements In May 2014, the FASB issued Accounting Standards Update 2014-09, Revenue from Contracts with Customers (Topic 606) (“ASU 2014-09”) . ASU 2014-09 amends the guidance in former Topic 605, Revenue Recognition , and most other existing revenue guidance in US GAAP. Under the new standard, an entity will recognize revenue to depict the transfer of goods or services to customers in amounts that reflect the payment to which the entity expects to be entitled in exchange for those goods or services and provide additional disclosures. As amended, the effective date for public entities is annual reporting periods beginning after December 15, 2017 and interim periods therein. We adopted the standard on January 1, 2018, using the modified retrospective method. We implemented internal controls to enable the preparation of financial information u

BUSINESS COMBINATIONS

BUSINESS COMBINATIONS	12 Months Ended
	Dec. 31, 2018
Business Combinations [Abstract]
Business Acquisitions	BUSINESS COMBINATIONS KB Medical On June 13, 2017, we acquired KB Medical SA (“KB Medical”), a Swiss-based robotic developer, to further bolster our development team, intellectual property, and product portfolio (the “KB Medical Acquisition”). We have included the financial results of KB Medical in our consolidated financial statements from the acquisition date, and the results from KB Medical were not material to our consolidated financial statements. We accounted for the KB Medical Acquisition under the purchase method of accounting. Amounts recognized for assets acquired and liabilities assumed are based on our purchase price allocations and on certain management judgments. These allocations are based on an analysis of the estimated fair values of assets acquired and liabilities assumed, including identifiable tangible assets, and estimates of the useful lives of tangible assets. The fair value of the consideration for the KB Medical Acquisition was approximately $31.5 million of cash paid at closing, plus a potential $4.9 million contingent consideration payment based on product development milestones. We recorded $20.2 million of identifiable net assets, based on their estimated fair values, and goodwill of $16.2 million . None of the goodwill is expected to be deductible for tax purposes. As of December 31, 2018 , the maximum aggregate undiscounted amount of contingent consideration potentially payable related to the KB Medical Acquisition is $5.1 million . The table below represents the purchase price allocation for the identifiable tangible and intangible assets and liabilities of KB Medical: (In thousands) Consideration: Cash paid at closing $ 31,501 Purchase price contingent consideration 4,871 Fair value of consideration $ 36,372 Identifiable assets acquired and liabilities assumed: Cash acquired $ 1,557 Prepaid and other current assets 168 Intangible assets, gross 24,500 Other assets 18 Accounts payable and accrued expenses (1,312 ) Deferred tax liabilities (4,727 ) Total identifiable net assets 20,204 Goodwill 16,168 Total allocated purchase price $ 36,372

NOTE RECEIVABLE

NOTE RECEIVABLE	12 Months Ended
	Dec. 31, 2018
Note Receivable [Abstract]
Note Receivable Disclosure	NOTE RECEIVABLE On September 1, 2016, in connection with the Alphatec Acquisition, we entered into a Credit, Security and Guaranty Agreement (the “Credit Agreement”) with Alphatec and Alphatec Spine, Inc. (“Alphatec Spine” and together with Alphatec, the “Alphatec Borrowers”), pursuant to which we made available to the Alphatec Borrowers a senior secured term loan facility in an amount not to exceed $30.0 million . The term loan interest rate for the first two years following the Closing Date was priced at the London Interbank Offered Rate (“ LIBOR ”) plus 8.0% , subject to a 9.5% floor. The term loan interest rate thereafter was LIBOR plus 13.0% . On the Closing Date, we made an initial loan of $25.0 million and the Alphatec Borrowers issued a note for such amount to us. On December 20, 2016, the remaining $5.0 million was drawn by the Alphatec Borrowers and added to the note. On November 7, 2018, the Alphatec Borrowers repaid all of the then outstanding principal and interest under the Credit Agreement in a total amount of $29.3 million .

GOODWILL AND INTANGIBLE ASSETS

GOODWILL AND INTANGIBLE ASSETS	12 Months Ended
	Dec. 31, 2018
Intangible Assets Disclosure [Abstract]
Intangible Assets Disclosure	GOODWILL AND INTANGIBLE ASSETS A summary of intangible assets is presented below: December 31, 2018 (In thousands) Weighted- Gross Accumulated Amortization Intangible In-process research & development — $ 19,813 $ — $ 19,813 Supplier network 10.0 4,000 (1,667 ) $ 2,333 Customer relationships & other intangibles 6.7 42,413 (17,746 ) $ 24,667 Developed technology 8.6 37,547 (3,498 ) $ 34,049 Patents 16.5 7,764 (1,303 ) $ 6,461 Total intangible assets $ 111,537 $ (24,214 ) $ 87,323 On September 5, 2018, we acquired Nemaris, Inc. (“Nemaris”), a privately held company that markets and develops Surgimap ® , a surgical planning software platform (“Nemaris Acquisition”). The assets of the Nemaris Acquisition consist primarily of developed technology. We determined that substantially all the fair value of the gross assets on the date of acquisition is captured in the developed technology and as a result, the Nemaris acquisition was accounted for as an asset purchase. We allocated the consideration paid of $15.2 million on a pro rata basis to the assets acquired on their respective fair values. The useful lives of the developed technology is seven years and will be amortized on a straight-line basis. In addition to the cash paid at closing, there is a potential $10.0 million contingent consideration payment based on product development milestones. December 31, 2017 (In thousands) Weighted- Gross Accumulated Amortization Intangible In-process research & development — $ 20,003 $ — $ 20,003 Supplier network 10.0 4,000 (1,267 ) 2,733 Customer relationships & other intangibles 6.8 41,345 (11,589 ) 29,756 Developed technology 10.0 20,460 (682 ) 19,778 Patents 16.9 7,389 (1,000 ) 6,389 Total intangible assets $ 93,197 $ (14,538 ) $ 78,659 Due to the FDA 510(k) clearance for the Company’s robotic guidance and navigation system in the third quarter of 2017, $20.5 million of IPR&D was transferred to developed technology and began to be amortized over a period of 10 years. During 2016, we recorded an impairment charge of $3.5 million related to one of our IPR&D projects as a component of acquisition related costs. We used a discounted future cash flow analysis to determine the fair value used to determine the impairment charge. A summary of the net carrying value of goodwill is presented below: (In thousands) December 31, 2016 $ 105,926 Additions and adjustments 17,907 Foreign exchange 57 December 31, 2017 123,890 Additions and adjustments — Foreign exchange (156 ) December 31, 2018 $ 123,734 For intangible assets subject to amortization as of December 31, 2018 , the following is the expected future amortization: (In thousands) Annual Amortization Year ending December 31: 2019 $ 11,505 2020 10,871 2021 10,635 2022 10,082 2023 8,514 Thereafter 15,903 Total $ 67,510

MARKETABLE SECURITIES

MARKETABLE SECURITIES	12 Months Ended
	Dec. 31, 2018
Marketable Securities [Abstract]
Investments in Debt and Marketable Equity Securities (and Certain Trading Assets) Disclosure	MARKETABLE SECURITIES The composition of our short-term and long-term marketable securities is as follows: December 31, 2018 (In thousands) Contractual Maturity (in years) Amortized Cost Gross Unrealized Gains Gross Unrealized Losses Fair Value Short-term: Municipal bonds Less than 1 $ 14,923 $ — $ (25 ) $ 14,898 Corporate debt securities Less than 1 118,823 — (185 ) 118,638 Commercial paper Less than 1 50,202 3 (11 ) 50,194 Government, federal agency, and other sovereign obligations Less than 1 4,497 — (1 ) 4,496 Asset-backed securities Less than 1 11,765 — (54 ) 11,711 Total short-term marketable securities $ 200,210 $ 3 $ (276 ) $ 199,937 Long-term: Municipal bonds 1-2 $ 2,676 $ — $ (4 ) $ 2,672 Corporate debt securities 1-3 127,676 196 (295 ) 127,577 Asset backed securities 1-3 128,297 262 (89 ) 128,470 Government, federal agency, and other sovereign obligations 1-3 4,411 — (13 ) 4,398 Total long-term marketable securities $ 263,060 $ 458 $ (401 ) $ 263,117 December 31, 2017 (In thousands) Contractual Maturity (in years) Amortized Cost Gross Unrealized Gains Gross Unrealized Losses Fair Value Short-term: Municipal bonds Less than 1 $ 124,817 $ 1 $ (141 ) $ 124,677 Corporate debt securities Less than 1 64,599 5 (68 ) 64,536 Commercial paper Less than 1 55,768 — (27 ) 55,741 U.S. government and agency securities Less than 1 9,960 — (24 ) 9,936 Total short-term marketable securities $ 255,144 $ 6 $ (260 ) $ 254,890 Long-term: Municipal bonds 1-2 $ 15,285 $ — $ (48 ) $ 15,237 Corporate debt securities 1-2 17,155 3 (39 ) 17,119 Asset backed securities 1-2 23,841 — (64 ) 23,777 Total long-term marketable securities $ 56,281 $ 3 $ (151 ) $ 56,133

FAIR VALUE MEASUREMENTS

FAIR VALUE MEASUREMENTS	12 Months Ended
	Dec. 31, 2018
Fair Value Disclosures [Abstract]
Fair Value Measurements	FAIR VALUE MEASUREMENTS Under the accounting for fair value measurements and disclosures, fair value is defined as the price that would be received for an asset or paid to transfer a liability (an exit price) in the principal or most advantageous market for the asset or the liability in an orderly transaction between market participants on the measurement date. Additionally, a fair value hierarchy was established that prioritizes the inputs to valuation techniques used to measure fair value. The hierarchy gives the highest priority to unadjusted quoted prices in active markets for identical assets and liabilities and the lowest priority to unobservable inputs. The level within the fair value hierarchy is based on the lowest level of any input that is significant to the fair value measurement. Our assets and liabilities measured at fair value on a recurring basis are classified and disclosed in one of the following three categories: Level 1—quoted prices (unadjusted) in active markets for identical assets and liabilities; Level 2—observable inputs other than quoted prices in active markets for identical assets and liabilities; and Level 3—unobservable inputs in which there is little or no market data available, which require the reporting entity to use significant unobservable inputs or valuation techniques. The fair value of our assets and liabilities measured at fair value on a recurring basis was as follows: Balance at (In thousands) December 31, Level 1 Level 2 Level 3 Assets Cash equivalents $ 48,040 $ 259 $ 47,781 $ — Municipal bonds 17,570 — 17,570 — Corporate debt securities 246,215 — 246,215 — Commercial paper 50,194 — 50,194 — Asset-backed securities 140,181 — 140,181 — Government, federal agency, and other sovereign obligations 8,894 — 8,894 — Liabilities Contingent consideration 10,118 — — 10,118 Balance at (In thousands) December 31, Level 1 Level 2 Level 3 Assets Cash equivalents $ 31,549 $ 5,927 $ 25,622 $ — Municipal bonds 139,914 — 139,914 — Corporate debt securities 81,655 — 81,655 — Commercial paper 55,741 — 55,741 — Asset-backed securities 23,777 — 23,777 — U.S. government and agency securities 9,936 — 9,936 — Liabilities Contingent consideration 15,919 — — 15,919 Our marketable securities are classified as Level 2 within the fair value hierarchy, as we measure their fair value using market prices for similar instruments and inputs such as actual trade data, benchmark yields, broker/dealer quotes and other similar data obtained from quoted market prices or independent pricing vendors. Assets and Liabilities That Are Measured at Fair Value on a Nonrecurring Basis The purchase price of business acquisitions is primarily allocated to the tangible and identifiable intangible assets acquired and liabilities assumed based on their estimated fair values on the acquisition dates, with the excess recorded as goodwill. We utilize Level 3 inputs in the determination of the initial fair value. Non-financial assets such as goodwill, intangible assets, and property, plant, and equipment are subsequently measured at fair value when there is an indicator of impairment and recorded at fair value only when an impairment is recognized. We assess the impairment of intangible assets annually or whenever events or changes in circumstances indicate that the carrying amount of an intangible asset may not be recoverable. The fair value of our goodwill and intangible assets is not estimated if there is no change in events or circumstances that indicate the carrying amount of an intangible asset may not be recoverable. Contingent consideration represents our contingent milestone, performance and revenue-sharing payment obligations related to our acquisitions and is measured at fair value, based on significant inputs not observable in the market, which represents a Level 3 measurement within the fair value hierarchy. The valuation of contingent consideration uses assumptions we believe would be made by a market participant. We assess these estimates on an ongoing basis as additional data impacting the assumptions is obtained. The balances of the fair value of contingent consideration are recognized within business acquisition liabilities on our consolidated balance sheets, and the changes in the fair value of contingent consideration are recognized within acquisition related costs in the consolidated statements of income. As part of the KB Medical Acquisition during the second quarter of 2017, we incurred a milestone-based contingent consideration liability . The recurring Level 3 fair value measurements of our contingent consideration liabilities include the following significant unobservable inputs, which have not materially changed since December 31, 2017: Fair Value at (In thousands) December 31, Valuation technique Unobservable input Range Discount rate 8.5% Revenue-based payments $ 5,289 Discounted cash flow Probability of payment 75% - 100% Projected year of payment 2019 - 2029 Discount rate 4.4% Milestone-based payments $ 4,829 Discounted cash flow Probability of payment 100% Projected year of payment 2019 The following table provides a reconciliation of the beginning and ending balances of contingent consideration: Year Ended (In thousands) December 31, December 31, Beginning balance $ 15,919 $ 19,849 Purchase price contingent consideration — 4,871 Contingent payments (6,738 ) (10,109 ) Non-cash settlement of certain contingent consideration — — Changes resulting from foreign currency fluctuations (48 ) 68 Changes in fair value of contingent consideration 985 1,240 Ending balance $ 10,118 $ 15,919

INVENTORIES

INVENTORIES	12 Months Ended
	Dec. 31, 2018
Inventory Disclosure [Abstract]
Inventories	INVENTORIES (In thousands) December 31, 2018 December 31, 2017 Raw materials $ 20,740 $ 19,984 Work in process 13,179 10,012 Finished goods 97,335 78,413 Total $ 131,254 $ 108,409

PROPERTY & EQUIPMENT

PROPERTY & EQUIPMENT	12 Months Ended
	Dec. 31, 2018
Property, Plant and Equipment [Abstract]
Property And Equipment	PROPERTY AND EQUIPMENT (In thousands) Useful Life December 31, 2018 December 31, 2017 Land — $ 8,298 $ 8,314 Buildings and improvements 30 27,267 24,974 Equipment 5-7 84,150 65,035 Instruments* 5 219,451 189,974 Modules and cases* 5 34,183 27,346 Other property and equipment 3-5 15,333 19,284 388,682 334,927 Less: accumulated depreciation (216,809 ) (191,760 ) Total $ 171,873 $ 143,167 ______________ * As of December 31, 2017, we completed a review of the estimated useful life of our Instruments and Modules and cases. Based on historical useful life information, as well as forecasted product life cycles and demand expectations, the useful life of Instruments and Modules and cases was extended from three to five years. For additional information regarding the change in estimate, please see “Note 1. Background and Summary of Significant Accounting Policies; (d) Use of Estimates” above. Instruments are hand-held devices used by surgeons to install implants during surgery. Modules and cases are used to store and transport the instruments and implants. Depreciation expense related to property and equipment was as follows: Year Ended (In thousands) December 31, 2018 December 31, 2017 December 31, 2016 Depreciation $ 32,042 $ 34,158 $ 35,293 Included in the 2016 amount is $5.5 million related to the impact from prior periods and $2.1 million related to the 2016 activity as a result of the prior period adjustment. For additional information regarding the prior period adjustment, please see “Note 1. Background and Summary of Significant Accounting Policies; (b) Basis of Presentation” above.

ACCRUED EXPENSES

ACCRUED EXPENSES	12 Months Ended
	Dec. 31, 2018
Payables and Accruals [Abstract]
Accrued Expenses	ACCRUED EXPENSES (In thousands) December 31, December 31, Compensation and other employee-related costs $ 32,465 $ 29,006 Legal and other settlements and expenses 6,684 1,177 Accrued non-income taxes 3,593 6,325 Royalties 2,500 2,139 Other 14,636 13,947 Total accrued expenses $ 59,878 $ 52,594

DEBT

DEBT	12 Months Ended
	Dec. 31, 2018
Debt Disclosure [Abstract]
Debt	DEBT Line of Credit In May 2011 , we entered into a credit agreement with Wells Fargo Bank related to a revolving credit facility that provides for borrowings up to $50.0 million . In June 2018, we amended the credit agreement to increase the revolving credit facility amount from $50.0 million to $125.0 million . At our request, and with the approval of the bank, the amount of borrowings available under the revolving credit facility can be increased to $150.0 million . The revolving credit facility includes up to a $25.0 million sub-limit for letters of credit. As amended to date, the revolving credit facility expires in May 2019 . Cash advances bear interest at our option either at a fluctuating rate per annum equal to the daily LIBOR in effect for a one -month period plus 0.75% , or a fixed rate for a one - or three -month period equal to LIBOR plus 0.75% . The credit agreement governing the revolving credit facility also subjects us to various restrictive covenants, including the requirement to maintain maximum consolidated leverage. The covenants also include limitations on our ability to repurchase shares, to pay cash dividends or to enter into a sale transaction. As of December 31, 2018 , we were in compliance with all financial covenants under the credit agreement, there were no outstanding borrowings under the revolving credit facility and available borrowings were $125.0 million . We may terminate the credit agreement at any time on ten days’ notice without premium or penalty.

EQUITY

EQUITY	12 Months Ended
	Dec. 31, 2018
Equity [Abstract]
Equity	EQUITY Our amended and restated Certificate of Incorporation provides for a total of 785,000,000 authorized shares of common stock. Of the authorized number of shares of common stock, 500,000,000 shares are designated as Class A common stock (“Class A Common”), 275,000,000 shares are designated as Class B common stock (“Class B Common”) and 10,000,000 shares are designated as Class C common stock (“Class C Common”). The holders of Class A Common are entitled to one vote for each share of Class A Common held. The holders of Class B Common are entitled to 10 votes for each share of Class B Common held. The holders of Class A Common and Class B Common vote together as one class of common stock. The Class C Common is nonvoting. Except for voting rights, the Class A Common, Class B Common and Class C Common have the same rights and privileges. Our issued and outstanding common shares by Class were as follows: (Shares) Class A Common Class B Common Class C Common Total December 31, 2018 76,143,257 22,430,097 — 98,573,354 December 31, 2017 72,780,325 23,877,556 — 96,657,881 The tables below present the changes in each component of accumulated other comprehensive income (loss), including current period other comprehensive loss and reclassifications out of accumulated other comprehensive income (loss): (In thousands) Unrealized loss on marketable securities, net of tax Foreign currency translation adjustments Accumulated other comprehensive loss Accumulated other comprehensive loss, net of tax, at December 31, 2016 $ (167 ) $ (8,475 ) $ (8,642 ) Other comprehensive loss before reclassifications (143 ) 1,881 1,738 Amounts reclassified from accumulated other comprehensive loss, net of tax (3 ) — (3 ) Other comprehensive loss, net of tax (146 ) 1,881 1,735 Accumulated other comprehensive loss, net of tax, at December 31, 2017 (313 ) (6,594 ) (6,907 ) Other comprehensive (loss)/income before reclassifications 160 (410 ) (250 ) Amounts reclassified from accumulated other comprehensive loss, net of tax (15 ) — (15 ) Other comprehensive (loss)/income, net of tax 145 (410 ) (265 ) Accumulated other comprehensive loss, net of tax, at December 31, 2018 (168 ) (7,004 ) (7,172 ) Amounts reclassified from accumulated other comprehensive loss, net of tax, related to unrealized gains/losses on marketable securities were released to other income, net in our consolidated statements of income.

STOCK-BASED COMPENSATION

STOCK-BASED COMPENSATION	12 Months Ended
	Dec. 31, 2018
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Stock-Based Compensation	STOCK-BASED COMPENSATION We have three stock plans: our Amended and Restated 2003 Stock Plan, our 2008 Stock Plan, and our 2012 Equity Incentive Plan (the “2012 Plan”). The 2012 Plan is the only remaining active stock plan. The purpose of these stock plans was, and the 2012 Plan is, to provide incentive to employees, directors, and consultants of Globus. The Plans are administered by the Board of Directors of Globus (the “Board”) or its delegates. The number, type of option, exercise price, and vesting terms are determined by the Board or its delegates in accordance with the terms of the Plans. The options granted expire on a date specified by the Board, but generally not more than ten years from the grant date. Option grants to employees generally vest in varying installments over a four -year period. The 2012 Plan was approved by our Board in March 2012, and by our stockholders in June 2012. Under the 2012 Plan, the aggregate number of shares of Class A Common stock that may be issued subject to options and other awards is equal to the sum of (i) 3,076,923 shares, (ii) any shares available for issuance under the 2008 Plan as of March 13, 2012, (iii) any shares underlying awards outstanding under the 2008 Plan as of March 13, 2012 that, on or after that date, are forfeited, terminated, expired or lapse for any reason, or are settled for cash without delivery of shares and (iv) starting January 1, 2013, an annual increase in the number of shares available under the 2012 Plan equal to up to 3% of the number of shares of our common and preferred stock outstanding at the end of the previous year, as determined by our Board. The number of shares that may be issued or transferred pursuant to incentive stock options under the 2012 Plan is limited to 10,769,230 shares. The shares of Class A Common stock covered by the 2012 Plan include authorized but unissued shares, treasury shares or shares of common stock purchased on the open market. As of December 31, 2018 , pursuant to the 2012 Plan, there were 14,889,882 shares of Class A Common stock reserved and 3,027,462 shares of Class A Common stock available for future grants. The weighted average grant date per share fair values of the options awarded to employees were as follows: Year Ended December 31, December 31, December 31, Weighted average grant date per share fair value $ 14.90 $ 9.12 $ 7.62 The fair value of the options was estimated on the date of the grant using a Black-Scholes option pricing model with the following assumptions: Year Ended December 31, December 31, December 31, Risk-free interest rate 2.30% - 3.09% 1.74% - 2.20% 1.03% - 2.01% Expected term (years) 5.8 - 7.5 5.8 - 6.4 5.8 - 6.5 Expected volatility 23.0% - 28.0% 26.0% - 29.0% 28.0% - 29.0% Expected dividend yield —% —% —% Stock option activity during the year ended December 31, 2018 is summarized as follows: Option Shares (thousands) Weighted average exercise price Weighted average remaining contractual life (years) Aggregate intrinsic value (thousands) Outstanding at January 1, 2018 9,041 $ 23.40 Granted 3,167 47.78 Exercised (1,917 ) 20.48 Forfeited (623 ) 31.42 Outstanding at December 31, 2018 9,668 $ 31.45 7.5 $ 128,067 Exercisable at December 31, 2018 4,308 22.87 6.1 87,972 Expected to vest at December 31, 2018 5,360 $ 38.34 8.6 $ 40,094 We use the Black Scholes pricing model to determine the fair value of our stock options (see “Note 1. Background and Summary of Significant Accounting Policies, (q) Stock-Based Compensation” above). Compensation expense related to stock options granted to employees and non-employees under the Plans and the intrinsic value of stock options exercised was as follows: Year Ended (In thousands) December 31, December 31, December 31, Intrinsic value of stock options exercised $ 59,345 $ 12,217 $ 8,824 Stock-based compensation expense $ 21,899 $ 14,686 $ 11,382 Net stock-based compensation capitalized into inventory 320 196 270 Total stock-based compensation cost $ 22,219 $ 14,882 $ 11,652 As of December 31, 2018 , there was $52.9 million of unrecognized compensation expense related to unvested employee stock options that vest over a weighted average period of three years.

INCOME TAXES

INCOME TAXES	12 Months Ended
	Dec. 31, 2018
Income Tax Disclosure [Abstract]
Income Taxes	INCOME TAXES The components of income before income taxes are as follows: Year ended (In thousands) December 31, 2018 December 31, 2017 December 31, 2016 Domestic $ 180,701 $ 155,051 $ 154,377 Foreign 7,904 14,877 2,902 Total $ 188,605 $ 169,928 $ 157,279 The components of the provision for income taxes are as follows: Year ended (In thousands) December 31, 2018 December 31, 2017 December 31, 2016 Current: Federal $ 23,774 $ 46,728 $ 51,785 State 4,662 5,009 4,533 Foreign 2,724 2,638 748 31,160 54,375 57,066 Deferred: Federal 4,155 10,553 (4,527 ) State (587 ) (1,123 ) 204 Foreign (2,597 ) (1,225 ) 195 971 8,205 (4,128 ) Total $ 32,131 $ 62,580 $ 52,938 A reconciliation of the statutory U.S. federal tax rate to our effective rate is as follows: Year ended December 31, 2018 December 31, 2017 December 31, 2016 Statutory U.S. federal tax rate 21.0 % 35.0 % 35.0 % State income taxes, net of federal benefit 2.3 1.9 2.2 Foreign taxes 1.7 1.0 0.4 Domestic production activities deduction (0.7 ) (2.3 ) (2.7 ) Tax credits (1.6 ) (3.8 ) (1.3 ) Stock compensation windfall (5.2 ) (1.4 ) — Nondeductible expenses (0.6 ) 0.1 0.1 Other 0.1 (0.2 ) — Tax reform impact — 6.5 — Effective tax rate 17.0 % 36.8 % 33.7 % Deferred income taxes reflect the tax effects of temporary differences between the basis of assets and liabilities recognized for financial reporting purposes and tax purposes. Significant components of our deferred income taxes are as follows: (In thousands) December 31, 2018 December 31, 2017 Deferred tax assets: Inventory reserve $ 25,398 $ 23,087 Accruals, reserves, and other currently not deductible 10,377 7,812 Stock-based compensation 10,959 9,109 Net operating loss carryforwards 3,852 1,924 Total deferred tax assets 50,586 41,932 Valuation allowance (2,683 ) (1,821 ) Total deferred tax assets, net of valuation allowance 47,903 40,111 Deferred tax liabilities: Depreciation and amortization (42,439 ) (30,749 ) Total deferred tax liabilities (42,439 ) (30,749 ) Net deferred tax assets $ 5,464 $ 9,362 In assessing the realizability of deferred tax assets, management considers whether it is more likely than not that some portion or all of the deferred tax assets will not be realized. The ultimate realization of deferred tax assets is dependent upon the generation of future taxable income during the periods in which those temporary differences become deductible. Based upon the level of historical taxable income and projections for future taxable income over the periods in which the deferred tax assets are deductible, management believes it is more likely than not that we will realize a portion of the benefits of these deductible differences at December 31, 2018 and 2017 . The Company has established valuation allowances of $2.7 million and $1.8 million at December 31, 2018 and 2017 , respectively, primarily related to the uncertainty of the utilization of certain deferred tax assets and primarily comprised of tax loss carryforwards in various jurisdictions. The increase in the valuation allowance during fiscal year 2018 is primarily driven by current year foreign tax losses that are not expected to be realized. The amount of the deferred tax asset considered realizable, however, could be reduced in the near term if estimates of future taxable income during the carryforward period are reduced. As of December 31, 2018 and 2017 , we have NOL carryforwards of $3.9 million and $1.9 million , respectively, which, if unused, will expire in years 2020 through 2037. A reconciliation of the beginning and ending amount of unrecognized tax benefits is as follows: Year ended (In thousands) December 31, 2018 December 31, 2017 December 31, 2016 Unrecognized tax benefits at the beginning of the year $ 2,601 $ 1,862 $ 1,575 Additions related to current year tax positions — — — Additions related to prior year tax positions 2,176 739 287 Reductions related to prior year tax positions — — — Unrecognized tax benefits at the end of the year $ 4,777 $ 2,601 $ 1,862 The impact of our unrecognized tax benefits to the effective income tax rate is as follows: (In thousands) December 31, 2018 December 31, 2017 December 31, 2016 Portion of total unrecognized tax benefits that, if recognized, would affect the effective income tax rate $ 4,084 $ 2,076 $ 1,542 The Company intends to indefinitely reinvest its foreign earnings abroad to ensure sufficient working capital for further expansion of its existing operations outside the United States, therefore the Company has not recorded income taxes on the undistributed earnings of its foreign subsidiaries. The undistributed earnings of our foreign subsidiaries as of December 31, 2018 are immaterial. In the event we are required to repatriate funds from outside of the United States, such repatriation may be subject to local laws, customs, and tax consequences. Interest and penalties are recorded in the statement of income as provision for income taxes. The total interest and penalties recorded in the statement of income was nominal for the years ended December 31, 2018 , 2017 and 2016 . We do not expect a significant change in our uncertain tax benefits in the next twelve months. We are subject to federal income tax as well as income tax of multiple state and foreign jurisdictions. With few exceptions, we are no longer subject to income tax examination by tax authorities in major jurisdictions for years prior to 2013 as of December 31, 2018 . On December 22, 2017, the Tax Reform Act was enacted. The Tax Reform Act includes a number of changes to existing U.S. tax laws that impact the Company, most notably a reduction of the U.S. corporate income tax rate from 35% to 21%, repeals the deduction for domestic production activities, implements a territorial tax system and imposes a repatriation tax on earnings of foreign subsidiaries, among other things. The Company recognized the income tax effects of the Tax Reform Act in its 2017 financial statements in accordance with Staff Accounting Bulletin No. 118, which provides SEC staff guidance for the application of ASC Topic 740, Income Taxes , in the reporting period in which the Tax Reform Act was signed into law. As such, the Company has recorded a net tax charge of $10.3 million related to the re-measurement of its deferred tax assets as well as a current tax charge of $0.7 million related to the deemed repatriation of its foreign earnings for the three months and year ended December 31, 2017 . December 22, 2018 marked the end of the measurement period for purposes of SAB 118. As such, we have completed our analysis based on legislative updates relating to the Act currently available which resulted in an immaterial change to provisional amounts previously recorded in its December 31, 2017 financial statements.

LEASES

LEASES	12 Months Ended
	Dec. 31, 2018
Leases, Operating [Abstract]
Leases	LEASES The Company leases certain equipment and facilities under operating leases. As of December 31, 2018 , minimum future rental payments under operating leases for each of the next five years are as follows: (In thousands) Year ending December 31: 2019 $ 1,581 2020 863 2021 235 2022 78 2023 37 Total $ 2,794 Rent expense related to all operating leases recognized as a component of selling, general and administrative expenses was as follows: Year ended (In thousands) December 31, 2018 December 31, 2017 December 31, 2016 Rent expense $ 2,950 $ 2,123 $ 1,500

COMMITMENTS AND CONTINGENCIES

COMMITMENTS AND CONTINGENCIES	12 Months Ended
	Dec. 31, 2018
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	COMMITMENTS AND CONTINGENCIES We are involved in a number of proceedings, legal actions, and claims. Such matters are subject to many uncertainties, and the outcomes of these matters are not within our control and may not be known for prolonged periods of time. In some actions, the claimants seek damages, as well as other relief, including injunctions prohibiting us from engaging in certain activities, which, if granted, could require significant expenditures and/or result in lost revenues. We record a liability in the consolidated financial statements for these actions when a loss is known or considered probable and the amount can be reasonably estimated. If the reasonable estimate of a known or probable loss is a range, and no amount within the range is a better estimate than any other, the minimum amount of the range is accrued. If a loss is reasonably possible but not known or probable, and can be reasonably estimated, the estimated loss or range of loss is disclosed. In most cases, significant judgment is required to estimate the amount and timing of a loss to be recorded. While it is not possible to predict the outcome for most of the matters discussed, we believe it is possible that costs associated with them could have a material adverse impact on our consolidated earnings, financial position or cash flows. N-Spine, Synthes and DePuy Synthes Litigation In April 2010, N-Spine, Inc. and Synthes USA Sales, LLC filed suit against us in the U.S. District Court for the District of Delaware for patent infringement. N-Spine, the patent owner, and Synthes USA, a licensee of the subject patent, alleged that we infringed one or more claims of the patent by making, using, offering for sale or selling our TRANSITION ® stabilization system product. This matter was one of the four patent infringement lawsuits concerning spinal implant technologies between Globus Medical, Inc. and DePuy Synthes settled on January 13, 2016 for $7.9 million . In a related matter, on January 8, 2014, DePuy Synthes Products, LLC (“Depuy Synthes”) filed suit against us in the U.S. District Court for the District of Delaware for patent infringement. DePuy Synthes alleged that we infringed one or more claims of the asserted patent by making, using, offering for sale or selling our TRANSITION ® stabilization system product. This matter was one of the four patent infringement lawsuits concerning spinal implant technologies between Globus Medical, Inc. and DePuy Synthes settled on January 13, 2016 for $7.9 million . Synthes USA, LLC, Synthes USA Products, LLC and Synthes USA Sales, LLC Litigation In July 2011, Synthes USA, LLC, Synthes USA Products, LLC and Synthes USA Sales, LLC filed suit against us in the U.S. District Court for the District of Delaware for patent infringement. Synthes USA LLC, the patent owner, Synthes USA Products, LLC, a licensee to manufacture products of the subject patents, and Synthes USA Sales LLC, a licensee to sell products of the subject patents, alleged that we infringed one or more claims of three patents by making, using, offering for sale or selling our COALITION ® , INDEPENDENCE ® and INTERCONTINENTAL ® products. This matter was one of the four patent infringement lawsuits concerning spinal implant technologies between Globus Medical, Inc. and DePuy Synthes settled on January 13, 2016 for $7.9 million . L5 Litigation In December 2009, we filed suit in the Court of Common Pleas of Montgomery County, Pennsylvania against our former exclusive independent distributor L5 Surgical, LLC and its principals, seeking an injunction and declaratory judgment concerning certain restrictive covenants made to L5 by its sales representatives. L5 brought counterclaims against us alleging tortious interference, unfair competition and conspiracy. The injunction phase was resolved in September 2010 and the remaining claims were fully resolved through settlement by the parties on February 6, 2019. Bianco Litigation On March 21, 2012, Sabatino Bianco filed suit against us in the Federal District Court for the Eastern District of Texas claiming that we misappropriated his trade secret and confidential information and improperly utilized it in developing our CALIBER ® product. On October 1, 2013, Bianco amended his complaint to claim that his trade secrets and confidential information were also used improperly in developing our RISE ® and CALIBER ® -L products. On September 13, 2017, we settled this matter with Bianco for $11.5 million in cash, which resulted in the reversal of a previously recorded accrual of $2.5 million and the recording of $9.0 million in other assets that will be amortized through June 30, 2022, as a component of cost of goods sold. Bonutti Skeletal Innovations, LLC Litigation On November 19, 2014, Bonutti Skeletal Innovations, LLC (“Bonutti Skeletal”) filed suit against us in the U.S. District Court for the Eastern District of Pennsylvania for patent infringement. Bonutti Skeletal, a non-practicing entity, alleged that Globus willfully infringed one or more claims of six patents by making, using, offering for sale or selling the CALIBER ® , CALIBER ® -L, COALITION ® , CONTINENTAL ® , FORGE ® , FORTIFY ® , INDEPENDENCE ® , INTERCONTINENTAL ® , MONUMENT ® , NIKO ® , RISE ® , SIGNATURE ® , SUSTAIN ® , and TRANSCONTINENTAL ® products. Globus Medical, Inc. and Bonutti Skeletal settled this matter on June 9, 2016. Flexuspine, Inc. Litigation On March 11, 2015, Flexuspine, Inc. filed suit against us in the U.S. District Court for the Eastern District of Texas for patent infringement. Flexuspine, Inc. alleged that Globus willfully infringed one or more claims of five patents by making, using, offering for sale or selling the CALIBER ® , CALIBER ® -L, and ALTERA ® products. On August 19, 2016, a jury returned a verdict in our favor finding no infringement of the asserted patents. On January 19, 2018 the United States Court of Appeals for the Federal Circuit affirmed the decisions of the lower court. On February 19, 2018, Flexuspine, Inc. filed a petition for panel rehearing in the United States Court of Appeals for the Federal Circuit. On March 7, 2018, the United States Court of Appeals for the Federal Circuit denied Flexuspine Inc.’s petition for panel rehearing. In addition, we are subject to legal proceedings arising in the ordinary course of business.

RETIREMENT BENEFIT PLANS

RETIREMENT BENEFIT PLANS	12 Months Ended
	Dec. 31, 2018
Defined Contribution Plan [Abstract]
Retirement Benefit Plans	RETIREMENT BENEFIT PLANS We sponsor a 401(k) Plan covering all eligible U.S. employees. Under the 401(k) Plan, we make nondiscretionary matching contributions at the rate of 100% of employee’s contributions up to a maximum annual contribution of $6,000 per eligible employee, limited to 3% of the employee’s compensation for the period. Additionally, we contribute to various foreign retirement benefit plans required by local law or coordinated with government sponsored plans which cover many of our international employees. The benefits offered under these plans are reflective of local customs and practices in the countries concerned. Company contributions to these retirement plans were as follows: Year ended (In thousands) December 31, 2018 December 31, 2017 December 31, 2016 401(k) and other retirement plan contributions $ 4,682 $ 3,597 $ 2,772

SEGMENT AND GEOGRAPHIC INFORMAT

SEGMENT AND GEOGRAPHIC INFORMATION	12 Months Ended
	Dec. 31, 2018
Segment Reporting [Abstract]
Segment And Geographic Information	SEGMENT AND GEOGRAPHIC INFORMATION Operating segments are defined as components of an enterprise for which separate financial information is available and evaluated regularly by the chief operating decision maker, or decision-making group, in deciding how to allocate resources and in assessing performance. We globally manage the business within one operating segment. Segment information is consistent with how management reviews the business, makes investing and resource allocation decisions and assesses operating performance. The following table represents total sales by geographic area, based on the location of the customer: Year Ended (In thousands) December 31, December 31, December 31, United States $ 593,878 $ 529,882 $ 500,226 International 119,091 106,095 63,768 Total sales $ 712,969 $ 635,977 $ 563,994

QUARTERLY FINANCIAL DATA (unaud

QUARTERLY FINANCIAL DATA (unaudited)	12 Months Ended
	Dec. 31, 2018
Quarterly Financial Information Disclosure [Abstract]
Quarterly Financial Data (unaudited)	QUARTERLY FINANCIAL DATA (unaudited) (unaudited) (In thousands, except per share amounts) March 31, June 30, September 30, December 31, Sales $ 174,411 $ 173,384 $ 169,236 $ 195,938 Gross profit 136,441 135,747 131,387 149,984 Net income 39,538 44,977 35,208 36,751 Net earnings per common share - basic 0.41 0.46 0.36 0.37 Net earnings per common share - diluted 0.39 0.44 0.35 0.36 (unaudited) (In thousands, except per share amounts) March 31, June 30, September 30, December 31, Sales $ 155,809 $ 152,390 $ 151,744 $ 176,034 Gross profit 120,209 115,191 114,946 135,178 Net income 28,714 28,667 25,591 24,376 Net earnings per common share - basic 0.30 0.30 0.27 0.25 Net earnings per common share - diluted 0.30 0.29 0.26 0.25

VALUATION ACCOUNTS AND QUALIFYI

VALUATION ACCOUNTS AND QUALIFYING ACCOUNTS	12 Months Ended
	Dec. 31, 2018
SEC Schedule, 12-09, Valuation and Qualifying Accounts [Abstract]
Valuation Accounts and Qualifying Accounts	SCHEDULE II. VALUATION ACCOUNTS AND QUALIFYING ACCOUNTS Allowance for doubtful accounts: (In thousands) Beginning of period Charged to expenses Write-offs End of period Year ended December 31, 2016 $ 2,513 $ 865 $ (607 ) $ 2,771 Year ended December 31, 2017 2,771 1,718 (526 ) 3,963 Year ended December 31, 2018 $ 3,963 $ 960 $ (697 ) $ 4,226 Deferred tax valuation allowance: Additions Deductions (In thousands) Beginning of period Charged to expenses Charged to other accounts Other deductions End of period Year ended December 31, 2016 $ 43 $ 42 $ — $ (2 ) (b) $ 83 Year ended December 31, 2017 83 511 1,227 (a) — 1,821 Year ended December 31, 2018 $ 1,821 $ 924 $ — $ (62 ) (b) $ 2,683

BACKGROUND AND SUMMARY OF SIG_2

BACKGROUND AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Policies)	12 Months Ended
	Dec. 31, 2018
BACKGROUND AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES [Abstract]
Basis of Presentation and Significant Accounting Policies [Text Block]	(b) Basis of Presentation The accompanying consolidated financial statements have been prepared in conformity with U.S. generally accepted accounting principles (“U.S. GAAP”). During the fourth quarter of 2016 , we self-identified and recorded non-cash prior period adjustments primarily related to depreciation and scrap expense for our instruments and cases. This $1.8 million net cumulative adjustment related to the period beginning in 2013 and through 2015 and resulted in a $5.5 million pre-tax increase in depreciation and a $3.7 million pre-tax decrease in scrap and provision for excess and obsolete inventory, both of which are primarily components of our full fiscal year 2016 cost of goods sold on our consolidated statement of income. We performed the analysis required by Staff Accounting Bulletin No. 99, Materiality , and Staff Accounting Bulletin No. 108, Considering the Effects of Prior Year Misstatements When Quantifying Misstatements in Current Year Financial Statements , and determined that the effect of the adjustments was not material to the financial position, results of operations or cash flows of any prior fiscal year from both a quantitative and qualitative perspective and is not material to the full fiscal year 2016 . During the fourth quarter of 2017 , the Company identified and recorded an adjustment to its December 31, 2016 consolidated balance sheet to correct the presentation of $65.8 million of its Variable Rate Demand Notes (“VRDNs”) as short-term marketable securities instead of cash and cash equivalents. Accordingly, the statement of cash flows for the year ended December 31, 2016 has been adjusted to appropriately increase purchases of marketable securities by $63.3 million , resulting in an increase in net cash used in investing activities and a decrease to cash and cash equivalents, end of period of $63.3 million . The statement of cash flows for the year ended December 31, 2015 has been adjusted to appropriately increase purchases of marketable securities by $2.5 million , resulting in an increase in net cash used in investing activities and a decrease to cash and cash equivalents, end of period of $2.5 million . As of December 31, 2016 , this adjustment also resulted in the addition of VRDNs to the table in Note 5, Marketable Securities and an adjustment to appropriately present VRDNs in the table in Note 6, Fair Value Measurements within Municipal bonds instead of cash equivalents. The Company does not own VRDNs as of December 31, 2018 and December 31, 2017 .
Principles of Consolidation	Principles of Consolidation The accompanying consolidated financial statements include the accounts of Globus and its wholly owned subsidiaries. All intercompany balances and transactions are eliminated in consolidation.
Use of Estimates	Use of Estimates The preparation of the consolidated financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosures of contingent assets and liabilities at the date of the consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. We base our estimates, in part, on historical experience that management believes to be reasonable under the circumstances. Actual results could differ from those estimates. Estimates and assumptions are periodically reviewed and the effects of revisions are reflected in the consolidated financial statements in the period they are determined to be necessary. Significant areas that require management’s estimates include intangible assets, contingent payment liabilities, allowance for doubtful accounts, stock-based compensation, write-down for excess and obsolete inventory, useful lives of assets, the outcome of litigation, recoverability of intangible assets and income taxes. We are subject to risks and uncertainties due to changes in the healthcare environment, regulatory oversight, competition, and legislation that may cause actual results to differ from estimated results. During fourth quarter of 2017, we completed a review of the estimated useful life of our Instruments and Modules and cases. Based on historical useful life information, forecasted product life cycles and demand expectations, the useful life of Instruments and Modules and cases were extended from three to five years. This was accounted for as a change in accounting estimate and was made on a prospective basis effective October 1, 2017. For the three months ended December 31, 2018 , depreciation expense was lower by approximately $1.3 million than it would have been had the useful life of these assets not been extended. The effect of this change on basic and diluted earnings per share for the three months ended December 31, 2018 was $0.01 per share. For the year ended December 31, 2018 , depreciation expense was lower by approximately $5.7 million than it would have been had the useful life of these assets not been extended, with a diluted earnings per share impact of $0.05 per share.
Foreign Currency Translation	Foreign Currency Translation The functional currency of our foreign subsidiaries is generally their local currency. Assets and liabilities of the foreign subsidiaries are translated at the period end currency exchange rate and revenues and expenses are translated at an average currency exchange rate for the period. The resulting foreign currency translation gains and losses are included as a component of accumulated other comprehensive income. Gains and losses arising from intercompany foreign transactions are included in other income, net on the consolidated statement of income.
Cash and Cash Equivalents	Cash, Cash Equivalents, and Restricted Cash Cash and cash equivalents include cash on hand and all highly liquid investments with a maturity of three months or less when purchased. In December 2014, we set aside cash for the payment of a portion of the DePuy Synthes and Bianco litigations. We classified this cash as restricted, as the amount was placed in escrow to be used for payment of the litigation obligations, should we not be successful with our appeals. On January 13, 2016, we settled our litigation with DePuy Synthes and made a payment of $7.9 million and recovered approximately $8.4 million related to that settlement shortly thereafter. See “Note 15. Commitments and Contingencies” below for more details regarding these litigations. The following table provides a reconciliation of cash, cash equivalents, and restricted cash reported within the statement of financial position that sum to the total of the same such amounts shown in the statement of cash flows: (In thousands) December 31, 2018 December 31, 2017 December 31, 2016 December 31, 2015 Cash and cash equivalents $ 139,647 $ 118,817 $ 66,954 $ 57,651 Restricted cash 100 — 477 26,119 Total cash, cash equivalents, and restricted cash as presented in the consolidated statement of cash flows $ 139,747 $ 118,817 $ 67,431 $ 83,770
Concentrations of Credit Risk	Concentrations of Credit Risk Financial instruments, which potentially subject us to concentrations of credit risk, are primarily marketable securities and accounts receivable. Concentrations of credit risk with respect to accounts receivable are limited due to the large number of entities comprising our customer base. We perform ongoing credit evaluations of our customers and generally do not require collateral. There was no customer that accounted for 10% or more of sales for the years ended December 31, 2018 , 2017 , and 2016 , respectively.
Marketable Securities, Policy [Policy Text Block]	Marketable Securities Our marketable securities include municipal bonds, corporate debt securities, commercial paper, securities of government, federal agency, and other sovereign obligations, and asset-backed securities, and are classified as available-for-sale as of December 31, 2018 and 2017 . Available-for-sale securities are recorded at fair value in both short-term and long-term marketable securities on our consolidated balance sheets. The change in fair value for available-for-sale securities is recorded, net of taxes, as a component of accumulated other comprehensive income or loss on our consolidated balance sheets. Premiums and discounts are recognized over the life of the related security as an adjustment to yield using the straight-line method. Realized gains or losses from the sale of our marketable securities are determined on a specific identification basis. Realized gains and losses, along with interest income and the amortization/accretion of premiums/discounts are included as a component of other income, net, on our consolidated statements of income. Interest receivable is recorded as a component of prepaid expenses and other current assets on our consolidated balance sheets. We maintain a portfolio of various holdings, types and maturities, though most of the securities in our portfolio could be liquidated at minimal cost at any time. We invest in securities that meet or exceed standards as defined in our investment policy. Our policy also limits the amount of credit exposure to any one issue, issuer or type of security. We review our securities for other-than-temporary impairment at each reporting period. If an unrealized loss for any security is considered to be other-than-temporary, the loss will be recognized in our consolidated statement of income in the period the determination is made.
Inventories	Inventories I nventories are stated at the lower of cost or net realizable value. Cost is determined on a first-in, first-out basis. The majority of our inventories are finished goods and we utilize both in-house manufacturing and third-party suppliers to source our products. We periodically evaluate the carrying value of our inventories in relation to our estimated forecast of product demand, which takes into consideration the estimated life cycle of product releases. When quantities on hand exceed estimated sales forecasts, we record a write-down for such excess inventories.
Property and Equipment	Property and Equipment Property and equipment are recorded at cost less accumulated depreciation. Additions or improvements are capitalized, while repairs and maintenance are expensed as incurred. Depreciation and amortization are provided using the straight-line method over the related useful lives of the assets. When assets are sold or otherwise disposed of, the related property, equipment, and accumulated depreciation amounts are relieved from the accounts, and any gain or loss is recorded in the consolidated statements of income. Purchases of property and equipment included in accounts payable and accrued expenses were $ 10.1 million , $ 6.5 million , and $ 5.2 million during the twelve months ended December 31, 2018 , 2017 , and 2016 , respectively.
Goodwill and Intangible Assets	Goodwill and Intangible Assets Goodwill represents the excess purchase price over the fair values of the identifiable assets acquired less the liabilities assumed. Goodwill is tested for impairment at a minimum on an annual basis. Goodwill is tested for impairment at the reporting unit level by comparing the reporting unit’s carrying amount to the fair value of the reporting unit. The fair values are estimated using an income and discounted cash flow approach. We perform our annual impairment test for goodwill in the fourth quarter of each year. We consider qualitative indicators of the fair value of a reporting unit when it is unlikely that a reporting unit has impaired goodwill. During the years ended December 31, 2018 , 2017 and 2016 , we did not record any impairment charges related to goodwill. Intangible assets consist of purchased in-process research and development (“IPR&D”), developed technology, supplier network, patents, customer relationships and non-compete agreements. Intangible assets with finite useful lives are amortized over the period of estimated benefit using the straight-line method and estimated useful lives ranging from one to seventeen years. Intangible assets are tested for impairment annually or whenever events or circumstances indicate that a carrying amount of an asset (asset group) may not be recoverable. If impairment is indicated, we measure the amount of the impairment loss as the amount by which the carrying amount exceeds the fair value of the asset. Fair value is generally determined using a discounted future cash flow analysis. During 2017 , we recorded an impairment charge of $ 0.5 million related to one of our developed technologies related to one of our systems as a component of selling, general and administrative expense. There were no impairments of finite-lived intangible assets during the years ended December 31, 2018 and 2016 . IPR&D has an indefinite life and is not amortized until completion of the project at which time the IPR&D becomes an amortizable asset. If the related project is not completed in a timely manner, we may have an impairment related to the IPR&D, calculated as the excess of the asset’s carrying value over its fair value. During 2016 , we recorded an impairment charge of $3.5 million related to one of our IPR&D projects as a component of acquisition related costs. There were no impairments of IPR&D during the years ended December 31, 2018 or 2017 .
Impairment of Long-Lived Assets	Impairment of Long-Lived Assets We periodically evaluate the recoverability of the carrying amount of long-lived assets, which include property and equipment, as well as whenever events or changes in circumstances indicate that the carrying amount of an asset group may not be fully recoverable. An impairment is assessed when the undiscounted future cash flows from the use and eventual disposition of an asset group are less than its carrying value. If impairment is indicated, we measure the amount of the impairment loss as the amount by which the carrying amount exceeds the fair value of the asset group. Our fair value methodology is based on quoted market prices, if available. If quoted market prices are not available, an estimate of fair value is made based on prices of similar assets or other valuation techniques including present value techniques. During the years ended December 31, 2018 , 2017 and 2016 , we did not record any impairment charges related to long-lived assets.
Revenue Recognition	Revenue Recognition Revenue is recognized upon transfer of control of promised products or services to customers in an amount that reflects the consideration we expect to receive in exchange for those products or services. Sales and other taxes we collect concurrent with revenue-producing activities are excluded from revenue. Incidental items that are immaterial in the context of the contract are recognized as expense. For purposes of disclosing disaggregated revenue, we disaggregate our revenue, into two categories, Musculoskeletal Solutions and Enabling Technologies, based on the timing of revenue recognition. Our Musculoskeletal Solutions products consist primarily of the implantable devices, disposables, and unique instruments used in an expansive range of spine, orthopedic trauma and extremity procedures. The majority of our Musculoskeletal Solutions contracts have a single performance obligation and revenue is recognized at a point in time. Our Enabling Technologies products are the advanced hardware and software systems and related technologies that are designed to enhance a surgeon’s capabilities and streamline surgical procedures by making them less invasive, more accurate, and more reproducible to improve patient care. The majority of our Enabling Technologies product contracts typically contain multiple performance obligations, including maintenance and support, and revenue is recognized as we fulfill each performance obligation. For contracts with multiple performance obligations, we allocate the contract’s transaction price to each performance obligation using our best estimate of the standalone selling price of each distinct good or service in the contract. Our policy is to classify shipping and handling costs billed to customers as sales and the related expenses as cost of goods sold. Nature of Products and Services A significant portion of our Musculoskeletal Solutions product revenue is generated from consigned inventory maintained at hospitals or with sales representatives. Revenue from the sale of consigned Musculoskeletal products is recognized when we transfer control, which occurs at the time the product is used or implanted. For all other Musculoskeletal Solutions product transactions, we recognize revenue when we transfer title to the goods, provided there are no remaining performance obligations that will affect the customer’s final acceptance of the sale. We use an observable price to determine the stand-alone selling price for the identified performance obligation. Revenue from the sale of Enabling Technologies products is generally recognized when title transfers to the customer which occurs at the time the product is shipped or delivered. Depending on the terms of the arrangement, we may also defer the recognition of a portion of the consideration received as we have to satisfy a future performance obligation to provide maintenance and support. We use an observable price to determine the stand-alone selling price for each separate performance obligation. Contract Balances Timing of revenue recognition may differ from the timing of invoicing to customers. We record a receivable when revenue is recognized prior to invoicing, or deferred revenue when revenue is recognized subsequent to invoicing. Deferred revenue is comprised mainly of unearned revenue related to the sales of certain Enabling Technologies products, which includes maintenance and support services. Deferred revenue is generally invoiced annually at the beginning of each contract period and recognized ratably over the coverage period. For the three months and year ended December 31, 2018 , there was an immaterial amount of revenue recognized from previously deferred revenue.
Cost of Sales, Policy [Policy Text Block]	Cost of Goods Sold Cost of goods sold consists primarily of costs from our in-house manufacturing, costs of products purchased from third-party suppliers, excess and obsolete inventory charges, depreciation of surgical instruments and cases, royalties, shipping, inspection and related costs incurred in making our products available for sale or use.
Research and Development Expense, Policy [Policy Text Block]	Research and Development Research and development costs are expensed as incurred. Research and development costs include salaries, employee benefits, supplies, consulting services, clinical services and clinical trial costs, and facilities costs. Costs incurred in obtaining technology licenses and patents are charged immediately to research and development expense if the technology licensed has not reached technological feasibility and has no alternative future use.
Other Income(Expense)	Other Income In June 2018, we sold assets for $5.0 million , which resulted in a gain on sale of assets of $4.6 million .
Stock-Based Compensation	Stock-Based Compensation The cost for employee and non-employee director awards is measured at the grant date based on the fair value of the award. The fair value of the portion of the award that is ultimately expected to vest is recognized as expense over the requisite service period (generally the vesting period of the equity award). Awards issued to non-employees are recorded at their fair value as determined in accordance with authoritative guidance, and are periodically revalued as the awards vest and are recognized as expense over the requisite service period. The determination of the fair value of stock options is made utilizing the Black-Scholes option-pricing model which is affected by our stock price and a number of assumptions, including expected volatility, expected term, risk-free interest rate and expected dividends. As we became a publicly traded entity in 2012, historic volatility for our common stock is insufficient to estimate expected volatility. As a result, we estimate volatility based on a consistently defined peer group of public companies that we believe collectively provides a reasonable basis for estimating volatility. We intend to continue to use the consistently defined group of publicly traded peer companies to determine volatility in the future until sufficient information regarding volatility of the price of our shares of Class A common stock becomes available or the selected companies are no longer suitable for this purpose. The expected term of the stock options is determined utilizing the simplified method given the limited extent of our historical data. The risk-free interest rate assumption is based on observed interest rates of U.S. Treasury securities appropriate for the expected terms of the stock options. The dividend yield assumption is based on the history and expectation of no dividend payouts.
Income Taxes	Income Taxes Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax bases. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the year in which such items are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in the period that includes the enactment date. A valuation allowance is established to offset any deferred tax assets if, based upon available evidence, it is more likely than not that some or all of the deferred tax assets will not be realized. Significant judgment is required in determining income tax provisions and in evaluating tax positions. We will establish additional provisions for income taxes when, despite the belief that tax positions are fully supportable, there remain certain positions that do not meet the minimum probability threshold that a tax position is more likely than not to be sustained upon examination by the taxing authority. In the normal course of business, we and our subsidiaries are examined by various federal, state, and foreign tax authorities. We regularly assess the potential outcomes of these examinations and any future examinations for the current or prior years in determining the adequacy of the provision for income taxes. We periodically assess the likelihood and amount of potential adjustments and adjust the income tax provision, the current tax liability, and deferred taxes in the period in which the facts that give rise to a revision become known.
Fair Value of Financial Instruments	Fair Value of Financial Instruments As of December 31, 2018 , the carrying values of cash and cash equivalents, short and long-term investments, accounts receivable, accounts payable and accrued expenses approximate their respective fair values based on their short and long-term nature. We classify our financial assets and liabilities that are measured at fair value into one of the three categories based upon inputs used to determine fair value. See “Note 6. Fair Value Measurements” below for more details regarding inputs and classifications.
Advertising Expense	Advertising Expense We expense advertising costs as they are incurred.
Legal costs	Legal Costs We are involved in a number of proceedings, legal actions, and claims. Such matters are subject to many uncertainties, and the outcomes of these matters are not within our control and may not be known for prolonged periods of time. In some actions, the claimants seek damages, as well as other relief, including injunctions prohibiting us from engaging in certain activities, which, if granted, could require significant expenditures and/or result in lost revenues. We record a liability in the consolidated financial statements for these actions when a loss is known or considered probable and the amount can be reasonably estimated. If the reasonable estimate of a known or probable loss is a range, and no amount within the range is a better estimate than any other, the minimum amount of the range is accrued. If a loss is reasonably possible but not known or probable, and can be reasonably estimated, the estimated loss or range of loss is disclosed. In most cases, significant judgment is required to estimate the amount and timing of a loss to be recorded. We expense legal costs related to loss contingencies as incurred.
Acquisition Related Costs	Acquisition Related Costs Acquisition related costs represents the change in fair value of business acquisition related contingent consideration; costs related to integrating recently acquired businesses including but not limited to costs to exit or convert contractual obligations, severance, and information system conversion; and specific costs related to the consummation of the acquisition process such as banker fees, legal fees, and other acquisition related professional fees.
Medical Device Excise Tax	Medical Device Excise Tax Effective as of January 1, 2013, the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Affordability Reconciliation Act (collectively “PPACA”) imposed a medical device excise tax (“MDET”) of 2.3% on any entity that manufactures or imports certain medical devices offered for sale in the United States. We have historically accounted for the MDET as a component of our cost of goods sold. The Consolidated Appropriations Act of 2016, which was signed into law in December 2015, included a two-year suspension on the medical device excise tax, effective January 1, 2016. In January 2018, Congress further extended the moratorium on the medical device excise tax through January 1, 2020.
Recently Issued Accounting Pronouncements	Recently Issued Accounting Pronouncements In February 2016, the FASB released ASU 2016-02, Leases (Topic 842) (“ASU 2016-02”). Under ASU 2016-02, a right-of-use asset and lease obligation will be recorded for all leases with terms greater than 12 months, whether operating or financing, while the income statement will reflect lease expense for operating leases and amortization/interest expense for financing leases. ASU 2016-02 is effective for fiscal years beginning after December 15, 2018, with early adoption permitted, and permits modified retrospective method or cumulative-effect adjustment method. We have elected to apply the cumulative-effect adjustment transition method and will record the adjustment to the opening balance of retained earnings in the period of adoption. Adoption of the standard will not have a material impact on our financial position, results of operations, and disclosures. In January 2017, the FASB released ASU 2017-04, Intangibles - Goodwill and Other (Topic 805): Simplifying the Test for Goodwill Impairment (“ASU 2017-04”), which eliminates the Step 2 calculation for the implied fair value of goodwill to measure a goodwill impairment charge. Under the updated standard, an entity will record an impairment charge based on the excess of a reporting unit’s carrying amount over its fair value. ASU 2017-04 does not change the guidance on completing Step 1 of the goodwill impairment test and still allows an entity to perform the optional qualitative goodwill impairment assessment before determining whether to proceed to Step 1. This update is effective for annual and interim goodwill impairment tests in fiscal years beginning after December 15, 2019 with early adoption permitted for any impairment test performed on testing dates after January 1, 2017. We are currently evaluating the timing and impact of the new standard on our financial position, results of operations and disclosures. In February 2018, the FASB released ASU 2018-02, Income Statement - Reporting Comprehensive Income (Topic 220) , Reclassification of Certain Tax Effects from Accumulated Other Comprehensive Income (“ASU 2018-02”). Prior to ASU 2018-02, GAAP required the remeasurement of deferred tax assets and liabilities as a result of a change in tax laws or rates to be presented in net income from continuing operations, even in situations in which the related income tax effects of items in accumulated other comprehensive income were originally recognized in other comprehensive income. As a result, such items, referred to as stranded tax effects, did not reflect the appropriate tax rate. Under ASU 2018-02, entities are permitted, but not required, to reclassify from accumulated other comprehensive income to retained earnings those stranded tax effects resulting from the Tax Act. ASU 2018-02 is effective for all entities for fiscal years beginning after December 15, 2018, and interim periods within those fiscal years. Early adoption is permitted. Adoption of the standard will not have a material impact on our financial position, results of operations and disclosures. In June 2018, the FASB released ASU 2018-07, Compensation—Stock Compensation (Topic 718) , (“ASU 2018-07”), which expanded the scope of Topic 718 to include share-based payment transactions for acquiring goods and services from nonemployees. ASU 2018-07 specifies that Topic 718 applies to all share-based payment transactions in which a grantor acquires goods or services to be used or consumed in a grantor’s own operations by issuing share-based payment awards. This update is effective for public entities for fiscal years beginning after December 15, 2018, and interim periods within those fiscal years. Early adoption is permitted. Adoption of the standard will not have a material impact on our financial position, results of operations, and disclosures. In August 2018, the FASB released ASU 2018-13, Fair Value Measurement (Topic 820), (“ASU 2018-13), which modifies the disclosure requirements on fair value measurements in Topic 820, including the consideration of costs and benefits. This update is effective for public entities for fiscal years beginning after December 15, 2019, and interim periods within those fiscal years. Early adoption is permitted. We are currently evaluating the timing and impact of the new standard on our financial position, results of operations and disclosures. (x) Recently Adopted Accounting Pronouncements In May 2014, the FASB issued Accounting Standards Update 2014-09, Revenue from Contracts with Customers (Topic 606) (“ASU 2014-09”) . ASU 2014-09 amends the guidance in former Topic 605, Revenue Recognition , and most other existing revenue guidance in US GAAP. Under the new standard, an entity will recognize revenue to depict the transfer of goods or services to customers in amounts that reflect the payment to which the entity expects to be entitled in exchange for those goods or services and provide additional disclosures. As amended, the effective date for public entities is annual reporting periods beginning after December 15, 2017 and interim periods therein. We adopted the standard on January 1, 2018, using the modified retrospective method. We implemented internal controls to enable the preparation of financial information upon adoption. The adoption of this standard does not have a material impact on our financial position and results of operations. See “Note 1. Background and Summary of Significant Accounting Policies; (l) Revenue Recognition ” above for more detail regarding our disclosures. In October 2016, the FASB released ASU 2016-16, Income Taxes (Topic 740): Intra-Entity Transfers of Assets Other Than Inventory (“ASU 2016-16”). ASU 2016-16 removes the current exception in US GAAP prohibiting entities from recognizing current and deferred income tax expenses or benefits related to transfer of assets, other than inventory, within the consolidated entity. The current exception to defer the recognition of any tax impact on the transfer of inventory within the consolidated entity until it is sold to a third party remains unaffected. This update is effective for public entities for annual reporting periods beginning after December 15, 2017. We adopted ASU 2016-16 on January 1, 2018. This standard does not have a material impact on our financial position, results of operations, and disclosures. In November 2016, the FASB released ASU 2016-18, Statement of Cash Flows (Topic 230): Restricted Cash (“ASU 2016-18”), which requires that amounts generally described as restricted cash and restricted cash equivalents be included with cash and cash equivalents when reconciling the total beginning and ending amounts for the periods shown on the statement of cash flows. Transfers between cash and cash equivalents and restricted cash and restricted cash equivalents will no longer be presented in the statement of cash flows. The amendments in this update should be applied using a retrospective transition method to each period presented. This update is effective for annual periods beginning after December 15, 2017, and interim periods within those fiscal years; early adoption is permitted, including adoption in an interim period. We adopted ASU 2016-18 on January 1, 2018. This standard does not have a material impact on our financial position, results of operations, and disclosures. In January 2017, the FASB released ASU 2017-01, Business Combinations (Topic 805): Clarifying the Definition of a Business (“ASU 2017-01”), which clarifies the definition of a business with the objective of adding guidance to assist entities with evaluating whether transactions should be accounted for as acquisitions or disposals of assets or businesses. The amendments in this ASU should be applied prospectively and are effective for fiscal years beginning after December 15, 2017, including interim periods within those fiscal years, with early application permitted. No disclosures are required at transition. We adopted ASU 2017-01 on January 1, 2018. This standard does not have a material impact on our financial position, results of operations, and disclosures. In May 2017, the FASB released ASU 2017-09, Compensation - Stock Compensation (Topic 718): Scope of Modification Accounting (“ASU 2017-09”), which clarifies the changes to terms or conditions of a share based payment award that requires application of modification accounting under Topic 718. A change to an award should be accounted for as a modification unless the fair value of the modified award is the same as the original award, the vesting conditions do not change, and the classification as an equity or liability instrument does not change. This update is effective for annual reporting periods, and interim periods within those annual periods, beginning after December 15, 2017. Early application is permitted and prospective application is required for awards modified on or after the adoption date. We adopted ASU 2017-09 on January 1, 2018. This standard does not have a material impact on our financial position, results of operations, and disclosures.

BACKGROUND AND SUMMARY OF SIG_3

BACKGROUND AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES Disaggregation of Revenue (Tables)	12 Months Ended
	Dec. 31, 2018
Revenue Recognition and Deferred Revenue [Abstract]
Schedule Of Reconciliation Of Cash And Cash Equivalents Restricted Cash And Cash Equivalents [Table Text Block]	The following table provides a reconciliation of cash, cash equivalents, and restricted cash reported within the statement of financial position that sum to the total of the same such amounts shown in the statement of cash flows: (In thousands) December 31, 2018 December 31, 2017 December 31, 2016 December 31, 2015 Cash and cash equivalents $ 139,647 $ 118,817 $ 66,954 $ 57,651 Restricted cash 100 — 477 26,119 Total cash, cash equivalents, and restricted cash as presented in the consolidated statement of cash flows $ 139,747 $ 118,817 $ 67,431 $ 83,770
Disaggregation of Revenue [Table Text Block]	Disaggregation of Revenue The following table represents total sales by revenue stream: Three Months Ended Twelve Months Ended (In thousands) December 31, December 31, December 31, December 31, Musculoskeletal Solutions products $ 181,638 $ 165,114 $ 666,040 $ 625,057 Enabling Technologies products 14,300 10,920 46,929 10,920 Total sales $ 195,938 $ 176,034 $ 712,969 $ 635,977

BUSINESS COMBINATIONS (Tables)

BUSINESS COMBINATIONS (Tables)	12 Months Ended
	Dec. 31, 2018
Acquisition 2017 [Member]
Business Acquisition
Schedule of Assets Acquired and Liabilities Assumed	The table below represents the purchase price allocation for the identifiable tangible and intangible assets and liabilities of KB Medical: (In thousands) Consideration: Cash paid at closing $ 31,501 Purchase price contingent consideration 4,871 Fair value of consideration $ 36,372 Identifiable assets acquired and liabilities assumed: Cash acquired $ 1,557 Prepaid and other current assets 168 Intangible assets, gross 24,500 Other assets 18 Accounts payable and accrued expenses (1,312 ) Deferred tax liabilities (4,727 ) Total identifiable net assets 20,204 Goodwill 16,168 Total allocated purchase price $ 36,372

GOODWILL AND INTANGIBLE ASSETS

GOODWILL AND INTANGIBLE ASSETS (Tables)	12 Months Ended
	Dec. 31, 2018
Goodwill [Line Items]
Schedule of Goodwill [Table Text Block]	A summary of the net carrying value of goodwill is presented below: (In thousands) December 31, 2016 $ 105,926 Additions and adjustments 17,907 Foreign exchange 57 December 31, 2017 123,890 Additions and adjustments — Foreign exchange (156 ) December 31, 2018 $ 123,734
Intangible Assets Acquired as Part of Business Combination	A summary of intangible assets is presented below: December 31, 2018 (In thousands) Weighted- Gross Accumulated Amortization Intangible In-process research & development — $ 19,813 $ — $ 19,813 Supplier network 10.0 4,000 (1,667 ) $ 2,333 Customer relationships & other intangibles 6.7 42,413 (17,746 ) $ 24,667 Developed technology 8.6 37,547 (3,498 ) $ 34,049 Patents 16.5 7,764 (1,303 ) $ 6,461 Total intangible assets $ 111,537 $ (24,214 ) $ 87,323 On September 5, 2018, we acquired Nemaris, Inc. (“Nemaris”), a privately held company that markets and develops Surgimap ® , a surgical planning software platform (“Nemaris Acquisition”). The assets of the Nemaris Acquisition consist primarily of developed technology. We determined that substantially all the fair value of the gross assets on the date of acquisition is captured in the developed technology and as a result, the Nemaris acquisition was accounted for as an asset purchase. We allocated the consideration paid of $15.2 million on a pro rata basis to the assets acquired on their respective fair values. The useful lives of the developed technology is seven years and will be amortized on a straight-line basis. In addition to the cash paid at closing, there is a potential $10.0 million contingent consideration payment based on product development milestones. December 31, 2017 (In thousands) Weighted- Gross Accumulated Amortization Intangible In-process research & development — $ 20,003 $ — $ 20,003 Supplier network 10.0 4,000 (1,267 ) 2,733 Customer relationships & other intangibles 6.8 41,345 (11,589 ) 29,756 Developed technology 10.0 20,460 (682 ) 19,778 Patents 16.9 7,389 (1,000 ) 6,389 Total intangible assets $ 93,197 $ (14,538 ) $ 78,659
Schedule of Finite-Lived Intangible Assets, Future Amortization Expense	For intangible assets subject to amortization as of December 31, 2018 , the following is the expected future amortization: (In thousands) Annual Amortization Year ending December 31: 2019 $ 11,505 2020 10,871 2021 10,635 2022 10,082 2023 8,514 Thereafter 15,903 Total $ 67,510

MARKETABLE SECURITIES (Tables)

MARKETABLE SECURITIES (Tables)	12 Months Ended
	Dec. 31, 2018
Marketable Securities [Abstract]
Marketable Securities	The composition of our short-term and long-term marketable securities is as follows: December 31, 2018 (In thousands) Contractual Maturity (in years) Amortized Cost Gross Unrealized Gains Gross Unrealized Losses Fair Value Short-term: Municipal bonds Less than 1 $ 14,923 $ — $ (25 ) $ 14,898 Corporate debt securities Less than 1 118,823 — (185 ) 118,638 Commercial paper Less than 1 50,202 3 (11 ) 50,194 Government, federal agency, and other sovereign obligations Less than 1 4,497 — (1 ) 4,496 Asset-backed securities Less than 1 11,765 — (54 ) 11,711 Total short-term marketable securities $ 200,210 $ 3 $ (276 ) $ 199,937 Long-term: Municipal bonds 1-2 $ 2,676 $ — $ (4 ) $ 2,672 Corporate debt securities 1-3 127,676 196 (295 ) 127,577 Asset backed securities 1-3 128,297 262 (89 ) 128,470 Government, federal agency, and other sovereign obligations 1-3 4,411 — (13 ) 4,398 Total long-term marketable securities $ 263,060 $ 458 $ (401 ) $ 263,117 December 31, 2017 (In thousands) Contractual Maturity (in years) Amortized Cost Gross Unrealized Gains Gross Unrealized Losses Fair Value Short-term: Municipal bonds Less than 1 $ 124,817 $ 1 $ (141 ) $ 124,677 Corporate debt securities Less than 1 64,599 5 (68 ) 64,536 Commercial paper Less than 1 55,768 — (27 ) 55,741 U.S. government and agency securities Less than 1 9,960 — (24 ) 9,936 Total short-term marketable securities $ 255,144 $ 6 $ (260 ) $ 254,890 Long-term: Municipal bonds 1-2 $ 15,285 $ — $ (48 ) $ 15,237 Corporate debt securities 1-2 17,155 3 (39 ) 17,119 Asset backed securities 1-2 23,841 — (64 ) 23,777 Total long-term marketable securities $ 56,281 $ 3 $ (151 ) $ 56,133

FAIR VALUE MEASUREMENTS (Tables

FAIR VALUE MEASUREMENTS (Tables)	12 Months Ended
	Dec. 31, 2018
Fair Value Disclosures [Abstract]
Fair Value, Assets Measured on Recurring Basis	The fair value of our assets and liabilities measured at fair value on a recurring basis was as follows: Balance at (In thousands) December 31, Level 1 Level 2 Level 3 Assets Cash equivalents $ 48,040 $ 259 $ 47,781 $ — Municipal bonds 17,570 — 17,570 — Corporate debt securities 246,215 — 246,215 — Commercial paper 50,194 — 50,194 — Asset-backed securities 140,181 — 140,181 — Government, federal agency, and other sovereign obligations 8,894 — 8,894 — Liabilities Contingent consideration 10,118 — — 10,118 Balance at (In thousands) December 31, Level 1 Level 2 Level 3 Assets Cash equivalents $ 31,549 $ 5,927 $ 25,622 $ — Municipal bonds 139,914 — 139,914 — Corporate debt securities 81,655 — 81,655 — Commercial paper 55,741 — 55,741 — Asset-backed securities 23,777 — 23,777 — U.S. government and agency securities 9,936 — 9,936 — Liabilities Contingent consideration 15,919 — — 15,919
Fair Value Measurement Inputs and Valuation Techniques [Table Text Block]	The recurring Level 3 fair value measurements of our contingent consideration liabilities include the following significant unobservable inputs, which have not materially changed since December 31, 2017: Fair Value at (In thousands) December 31, Valuation technique Unobservable input Range Discount rate 8.5% Revenue-based payments $ 5,289 Discounted cash flow Probability of payment 75% - 100% Projected year of payment 2019 - 2029 Discount rate 4.4% Milestone-based payments $ 4,829 Discounted cash flow Probability of payment 100% Projected year of payment 2019
Rollforward of contingent consideration	The following table provides a reconciliation of the beginning and ending balances of contingent consideration: Year Ended (In thousands) December 31, December 31, Beginning balance $ 15,919 $ 19,849 Purchase price contingent consideration — 4,871 Contingent payments (6,738 ) (10,109 ) Non-cash settlement of certain contingent consideration — — Changes resulting from foreign currency fluctuations (48 ) 68 Changes in fair value of contingent consideration 985 1,240 Ending balance $ 10,118 $ 15,919

INVENTORIES (Tables)

INVENTORIES (Tables)	12 Months Ended
	Dec. 31, 2018
Inventory Disclosure [Abstract]
Schedule of Inventory	(In thousands) December 31, 2018 December 31, 2017 Raw materials $ 20,740 $ 19,984 Work in process 13,179 10,012 Finished goods 97,335 78,413 Total $ 131,254 $ 108,409

PROPERTY & EQUIPMENT (Tables)

PROPERTY & EQUIPMENT (Tables)	12 Months Ended
	Dec. 31, 2018
Property, Plant and Equipment [Abstract]
Property And Equipment	(In thousands) Useful Life December 31, 2018 December 31, 2017 Land — $ 8,298 $ 8,314 Buildings and improvements 30 27,267 24,974 Equipment 5-7 84,150 65,035 Instruments* 5 219,451 189,974 Modules and cases* 5 34,183 27,346 Other property and equipment 3-5 15,333 19,284 388,682 334,927 Less: accumulated depreciation (216,809 ) (191,760 ) Total $ 171,873 $ 143,167
Schedule Of Depreciation Of Property And Equipment	Depreciation expense related to property and equipment was as follows: Year Ended (In thousands) December 31, 2018 December 31, 2017 December 31, 2016 Depreciation $ 32,042 $ 34,158 $ 35,293 Included in the 2016 amount is $5.5 million related to the impact from prior periods and $2.1 million related to the 2016 activity as a result of the prior period adjustment. For additional information regarding the prior period adjustment, please see “Note 1. Background and Summary of Significant Accounting Policies; (b) Basis of Presentation” above.

ACCRUED EXPENSES (Tables)

ACCRUED EXPENSES (Tables)	12 Months Ended
	Dec. 31, 2018
Payables and Accruals [Abstract]
Accrued Expenses	(In thousands) December 31, December 31, Compensation and other employee-related costs $ 32,465 $ 29,006 Legal and other settlements and expenses 6,684 1,177 Accrued non-income taxes 3,593 6,325 Royalties 2,500 2,139 Other 14,636 13,947 Total accrued expenses $ 59,878 $ 52,594

EQUITY (Tables)

EQUITY (Tables)	12 Months Ended
	Dec. 31, 2018
Equity [Abstract]
Schedule of Issued and Outstanding Shares by Class	Our issued and outstanding common shares by Class were as follows: (Shares) Class A Common Class B Common Class C Common Total December 31, 2018 76,143,257 22,430,097 — 98,573,354 December 31, 2017 72,780,325 23,877,556 — 96,657,881
Schedule of Accumulated Other Comprehensive Income/(Loss), Net of Tax	The tables below present the changes in each component of accumulated other comprehensive income (loss), including current period other comprehensive loss and reclassifications out of accumulated other comprehensive income (loss): (In thousands) Unrealized loss on marketable securities, net of tax Foreign currency translation adjustments Accumulated other comprehensive loss Accumulated other comprehensive loss, net of tax, at December 31, 2016 $ (167 ) $ (8,475 ) $ (8,642 ) Other comprehensive loss before reclassifications (143 ) 1,881 1,738 Amounts reclassified from accumulated other comprehensive loss, net of tax (3 ) — (3 ) Other comprehensive loss, net of tax (146 ) 1,881 1,735 Accumulated other comprehensive loss, net of tax, at December 31, 2017 (313 ) (6,594 ) (6,907 ) Other comprehensive (loss)/income before reclassifications 160 (410 ) (250 ) Amounts reclassified from accumulated other comprehensive loss, net of tax (15 ) — (15 ) Other comprehensive (loss)/income, net of tax 145 (410 ) (265 ) Accumulated other comprehensive loss, net of tax, at December 31, 2018 (168 ) (7,004 ) (7,172 )

STOCK-BASED COMPENSATION (Table

STOCK-BASED COMPENSATION (Tables)	12 Months Ended
	Dec. 31, 2018
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Grants in Period, Weighted Average Grant Date Fair Value	The weighted average grant date per share fair values of the options awarded to employees were as follows: Year Ended December 31, December 31, December 31, Weighted average grant date per share fair value $ 14.90 $ 9.12 $ 7.62
Fair Value of Options, Assumptions Schedule	The fair value of the options was estimated on the date of the grant using a Black-Scholes option pricing model with the following assumptions: Year Ended December 31, December 31, December 31, Risk-free interest rate 2.30% - 3.09% 1.74% - 2.20% 1.03% - 2.01% Expected term (years) 5.8 - 7.5 5.8 - 6.4 5.8 - 6.5 Expected volatility 23.0% - 28.0% 26.0% - 29.0% 28.0% - 29.0% Expected dividend yield —% —% —%
Summary of Stock Option Activity	Stock option activity during the year ended December 31, 2018 is summarized as follows: Option Shares (thousands) Weighted average exercise price Weighted average remaining contractual life (years) Aggregate intrinsic value (thousands) Outstanding at January 1, 2018 9,041 $ 23.40 Granted 3,167 47.78 Exercised (1,917 ) 20.48 Forfeited (623 ) 31.42 Outstanding at December 31, 2018 9,668 $ 31.45 7.5 $ 128,067 Exercisable at December 31, 2018 4,308 22.87 6.1 87,972 Expected to vest at December 31, 2018 5,360 $ 38.34 8.6 $ 40,094
Stock Option Compensation Expense and Intrinsic Value Schedule	Compensation expense related to stock options granted to employees and non-employees under the Plans and the intrinsic value of stock options exercised was as follows: Year Ended (In thousands) December 31, December 31, December 31, Intrinsic value of stock options exercised $ 59,345 $ 12,217 $ 8,824 Stock-based compensation expense $ 21,899 $ 14,686 $ 11,382 Net stock-based compensation capitalized into inventory 320 196 270 Total stock-based compensation cost $ 22,219 $ 14,882 $ 11,652

INCOME TAXES (Tables)

INCOME TAXES (Tables)	12 Months Ended
	Dec. 31, 2018
Income Tax Disclosure [Abstract]
Schedule of Income before Income Tax, Domestic and Foreign	The components of income before income taxes are as follows: Year ended (In thousands) December 31, 2018 December 31, 2017 December 31, 2016 Domestic $ 180,701 $ 155,051 $ 154,377 Foreign 7,904 14,877 2,902 Total $ 188,605 $ 169,928 $ 157,279
Schedule of Components Provision/(Benefit) for Income Taxes	The components of the provision for income taxes are as follows: Year ended (In thousands) December 31, 2018 December 31, 2017 December 31, 2016 Current: Federal $ 23,774 $ 46,728 $ 51,785 State 4,662 5,009 4,533 Foreign 2,724 2,638 748 31,160 54,375 57,066 Deferred: Federal 4,155 10,553 (4,527 ) State (587 ) (1,123 ) 204 Foreign (2,597 ) (1,225 ) 195 971 8,205 (4,128 ) Total $ 32,131 $ 62,580 $ 52,938
U.S. Federal Tax Rate To Effective Rate Reconciliation	A reconciliation of the statutory U.S. federal tax rate to our effective rate is as follows: Year ended December 31, 2018 December 31, 2017 December 31, 2016 Statutory U.S. federal tax rate 21.0 % 35.0 % 35.0 % State income taxes, net of federal benefit 2.3 1.9 2.2 Foreign taxes 1.7 1.0 0.4 Domestic production activities deduction (0.7 ) (2.3 ) (2.7 ) Tax credits (1.6 ) (3.8 ) (1.3 ) Stock compensation windfall (5.2 ) (1.4 ) — Nondeductible expenses (0.6 ) 0.1 0.1 Other 0.1 (0.2 ) — Tax reform impact — 6.5 — Effective tax rate 17.0 % 36.8 % 33.7 %
Schedule of Components of Deferred Income Taxes	Significant components of our deferred income taxes are as follows: (In thousands) December 31, 2018 December 31, 2017 Deferred tax assets: Inventory reserve $ 25,398 $ 23,087 Accruals, reserves, and other currently not deductible 10,377 7,812 Stock-based compensation 10,959 9,109 Net operating loss carryforwards 3,852 1,924 Total deferred tax assets 50,586 41,932 Valuation allowance (2,683 ) (1,821 ) Total deferred tax assets, net of valuation allowance 47,903 40,111 Deferred tax liabilities: Depreciation and amortization (42,439 ) (30,749 ) Total deferred tax liabilities (42,439 ) (30,749 ) Net deferred tax assets $ 5,464 $ 9,362
Reconciliation of Beginning and Ending Amount of Unrecognized Tax Benefits	A reconciliation of the beginning and ending amount of unrecognized tax benefits is as follows: Year ended (In thousands) December 31, 2018 December 31, 2017 December 31, 2016 Unrecognized tax benefits at the beginning of the year $ 2,601 $ 1,862 $ 1,575 Additions related to current year tax positions — — — Additions related to prior year tax positions 2,176 739 287 Reductions related to prior year tax positions — — — Unrecognized tax benefits at the end of the year $ 4,777 $ 2,601 $ 1,862
Impact of Unrecognized Tax Benefits to Effective Income Tax Rate	The impact of our unrecognized tax benefits to the effective income tax rate is as follows: (In thousands) December 31, 2018 December 31, 2017 December 31, 2016 Portion of total unrecognized tax benefits that, if recognized, would affect the effective income tax rate $ 4,084 $ 2,076 $ 1,542

LEASES (Tables)

LEASES (Tables)	12 Months Ended
	Dec. 31, 2018
Leases, Operating [Abstract]
Schedule of Minimum Future Rental Payments Under Operating Leases	As of December 31, 2018 , minimum future rental payments under operating leases for each of the next five years are as follows: (In thousands) Year ending December 31: 2019 $ 1,581 2020 863 2021 235 2022 78 2023 37 Total $ 2,794
Schedule of Rent Expense for Operating Leases	Rent expense related to all operating leases recognized as a component of selling, general and administrative expenses was as follows: Year ended (In thousands) December 31, 2018 December 31, 2017 December 31, 2016 Rent expense $ 2,950 $ 2,123 $ 1,500

RETIREMENT BENEFIT PLANS (Table

RETIREMENT BENEFIT PLANS (Tables)	12 Months Ended
	Dec. 31, 2018
Defined Contribution Plan [Abstract]
Company Contributions To Retirement Benefit Plans	Company contributions to these retirement plans were as follows: Year ended (In thousands) December 31, 2018 December 31, 2017 December 31, 2016 401(k) and other retirement plan contributions $ 4,682 $ 3,597 $ 2,772

SEGMENT AND GEOGRAPHIC INFORM_2

SEGMENT AND GEOGRAPHIC INFORMATION (Tables)	12 Months Ended
	Dec. 31, 2018
Segment Reporting [Abstract]
Schedule of Revenue from External Customers By Geographical Area International and Domestic	The following table represents total sales by geographic area, based on the location of the customer: Year Ended (In thousands) December 31, December 31, December 31, United States $ 593,878 $ 529,882 $ 500,226 International 119,091 106,095 63,768 Total sales $ 712,969 $ 635,977 $ 563,994

QUARTERLY FINANCIAL DATA (una_2

QUARTERLY FINANCIAL DATA (unaudited) (Tables)	12 Months Ended
	Dec. 31, 2018
Quarterly Financial Information Disclosure [Abstract]
Schedule of Quarterly Financial Information	(unaudited) (In thousands, except per share amounts) March 31, June 30, September 30, December 31, Sales $ 174,411 $ 173,384 $ 169,236 $ 195,938 Gross profit 136,441 135,747 131,387 149,984 Net income 39,538 44,977 35,208 36,751 Net earnings per common share - basic 0.41 0.46 0.36 0.37 Net earnings per common share - diluted 0.39 0.44 0.35 0.36 (unaudited) (In thousands, except per share amounts) March 31, June 30, September 30, December 31, Sales $ 155,809 $ 152,390 $ 151,744 $ 176,034 Gross profit 120,209 115,191 114,946 135,178 Net income 28,714 28,667 25,591 24,376 Net earnings per common share - basic 0.30 0.30 0.27 0.25 Net earnings per common share - diluted 0.30 0.29 0.26 0.25

VALUATION ACCOUNTS AND QUALIF_2

VALUATION ACCOUNTS AND QUALIFYING ACCOUNTS (Tables)	12 Months Ended
	Dec. 31, 2018
Valuation and Qualifying Accounts Disclosure
Summary of Valuation Allowances	Allowance for doubtful accounts: (In thousands) Beginning of period Charged to expenses Write-offs End of period Year ended December 31, 2016 $ 2,513 $ 865 $ (607 ) $ 2,771 Year ended December 31, 2017 2,771 1,718 (526 ) 3,963 Year ended December 31, 2018 $ 3,963 $ 960 $ (697 ) $ 4,226 Deferred tax valuation allowance: Additions Deductions (In thousands) Beginning of period Charged to expenses Charged to other accounts Other deductions End of period Year ended December 31, 2016 $ 43 $ 42 $ — $ (2 ) (b) $ 83 Year ended December 31, 2017 83 511 1,227 (a) — 1,821 Year ended December 31, 2018 $ 1,821 $ 924 $ — $ (62 ) (b) $ 2,683

BACKGROUND AND SUMMARY OF SIG_4

BACKGROUND AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Details)	Jun. 21, 2018USD ($)	Dec. 31, 2018USD ($)	Sep. 30, 2018USD ($)	Jun. 30, 2018USD ($)	Mar. 31, 2018USD ($)	Dec. 31, 2017USD ($)	Sep. 30, 2017USD ($)	Jun. 30, 2017USD ($)	Mar. 31, 2017USD ($)	Sep. 30, 2018USD ($)	Sep. 30, 2017USD ($)	Dec. 31, 2018USD ($)	Dec. 31, 2017USD ($)	Dec. 31, 2016USD ($)products	Dec. 31, 2015USD ($)
Summary of Significant Accounting Policies
Concentration Risk, Percentage												10.00%
Revenues		$ 195,938,000	$ 169,236,000	$ 173,384,000	$ 174,411,000	$ 176,034,000	$ 151,744,000	$ 152,390,000	$ 155,809,000			$ 712,969,000	$ 635,977,000	$ 563,994,000
Cash and Cash Equivalents, at Carrying Value		139,647,000				118,817,000						139,647,000	118,817,000	66,954,000	$ 57,651,000
Proceeds from Sale of Other Assets	$ 5,000,000
Capital Expenditures Incurred but Not yet Paid												10,100,000	6,500,000	5,200,000
Cost of goods sold												159,410,000	150,453,000	134,705,000
Increase in Depreciation												(32,042,000)	(34,158,000)	(35,293,000)
Payments to Acquire Investments												537,942,000	392,895,000	350,448,000
Advertising expense												1,900,000	1,500,000	900,000
Restricted cash		100,000				0						$ 100,000	0	477,000	26,119,000
Medical Device Excise Tax Percentage												2.30%
Impairment of intangible assets												$ 0	516,000	3,472,000
Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents		$ 139,747,000				118,817,000						$ 139,747,000	118,817,000	67,431,000	83,770,000
Gain (Loss) on Disposition of Other Assets	$ 4,600,000
Minimum
Summary of Significant Accounting Policies
Number of Products Launched Since Inception		190										190
Estimated useful life of finite-lived intangible assets												1 year
Maximum
Summary of Significant Accounting Policies
Estimated useful life of finite-lived intangible assets												17 years
Synthes related Litigations
Summary of Significant Accounting Policies
Payments for Legal Settlements														7,900,000
Decrease in Restricted Cash														$ 8,400,000
In-process Research and Development | Maximum
Summary of Significant Accounting Policies
Number of Projects | products														1
Acquisition-related costs
Summary of Significant Accounting Policies
Impairment of intangible assets														$ 3,500,000
General and Administrative Expense [Member] | Customer Relationships [Member]
Summary of Significant Accounting Policies
Impairment of intangible assets													500,000
Adjustments for New Accounting Pronouncement [Member]
Summary of Significant Accounting Policies
Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents		$ 139,747,000				$ 118,817,000						$ 139,747,000	118,817,000	67,431,000	83,770,000
Restatement Adjustment
Summary of Significant Accounting Policies
Earnings Per Share Policy, Basic		0.01										0.047
Restatement Adjustment | Cost of Goods, Total
Summary of Significant Accounting Policies
Cost of goods sold													1,800,000
Increase in Depreciation		$ (1,300,000)										$ (5,700,000)	5,500,000
Decrease in Scrap													$ 3,700,000
Restatement Adjustment | Available-for-sale Securities [Member]
Summary of Significant Accounting Policies
Marketable Securities														65,800,000	$ 2,500,000
Payments to Acquire Investments														$ 63,300,000
Spine [Member]
Summary of Significant Accounting Policies
Revenues			181,638,000				165,114,000			$ 666,040,000	$ 625,057,000
Emerging Technology [Member]
Summary of Significant Accounting Policies
Revenues			$ 14,300,000				$ 10,920,000			$ 46,929,000	$ 10,920,000

BUSINESS COMBINATIONS (Textuals

BUSINESS COMBINATIONS (Textuals) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Jun. 13, 2017	Dec. 31, 2016
Business Acquisition
Business Combination, Contingent Consideration, Liability	$ 10,118	$ 15,919		$ 19,849
Goodwill	123,734	$ 123,890
Acquisition 2017 [Member]
Business Acquisition
Business Combination, Consideration Transferred	36,372
Business Combination, Contingent Consideration, Liability	5,100		$ 4,900
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Net	20,204		20,200
Payments to Acquire Businesses, Gross	31,501
Goodwill	16,168		$ 16,200
Business Acquisition, Goodwill, Expected Tax Deductible Amount	$ 0

BUSINESS COMBINATIONS (Assets A

BUSINESS COMBINATIONS (Assets Acquired and Liabilities) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Jun. 13, 2017
Business Acquisition
Deferred Tax Assets, Net	$ 5,464	$ 9,362
Goodwill	123,734	$ 123,890
Acquisition 2017 [Member]
Business Acquisition
Payments to Acquire Businesses, Gross	31,501
Business Combination, Consideration Transferred	36,372
Net working capital adjustment due	4,871
Cash acquired	1,557
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Current Assets, Prepaid Expense and Other Assets	168
Accounts payable and accrued expenses	(1,312)
Deferred tax liability, net	(4,727)
Identifiable intangible assets:	24,500
Other assets	18
Total identifiable net assets	20,204		$ 20,200
Goodwill	16,168		$ 16,200
Total allocated purchase price	$ 36,372

NOTE RECEIVABLE (Details)

NOTE RECEIVABLE (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 20, 2016	Sep. 01, 2016
Note Receivable
Note receivable, gross, noncurrent	$ 0	$ 28,333
Proceeds from Collection of Notes Receivable	29,300
Maximum
Note Receivable
Note receivable, gross, noncurrent	$ 30,000
Minimum
Note Receivable
Note receivable, basis spread on variable rate	9.50%
Initial Draw
Note Receivable
Note receivable, gross, noncurrent				$ 25,000
Final Draw
Note Receivable
Note receivable, gross, noncurrent			$ 5,000
First Two Years
Note Receivable
Note receivable, basis spread on variable rate	8.00%
Last Three Years
Note Receivable
Note receivable, basis spread on variable rate	13.00%

GOODWILL AND INTANGIBLE ASSET_2

GOODWILL AND INTANGIBLE ASSETS (Details)	12 Months Ended
	Dec. 31, 2018USD ($)	Dec. 31, 2017USD ($)	Dec. 31, 2016USD ($)products	Sep. 05, 2018USD ($)
Acquired Intangible Assets
Indefinite-lived intangible assets	$ 19,813,000
Intangible Assets, Gross Carrying Amount	111,537,000	$ 93,197,000
Accumulated Amortization	(24,214,000)	(14,538,000)
Intangible assets, net	87,323,000	78,659,000
Finite-lived intangible assets, net	67,510,000
Impairment of intangible assets	0	516,000	$ 3,472,000
Business Combination, Contingent Consideration, Liability	$ 10,118,000	15,919,000	19,849,000
Maximum
Acquired Intangible Assets
Weighted average amortization period	17 years
Acquisition-related costs
Acquired Intangible Assets
Impairment of intangible assets			$ 3,500,000
In-process Research and Development
Acquired Intangible Assets
Accumulated Amortization	$ 0	$ 0
Supplier Network
Acquired Intangible Assets
Weighted average amortization period	10 years	10 years
Gross carrying amount	$ 4,000,000	$ 4,000,000
Accumulated Amortization	(1,667,000)	(1,267,000)
Finite-lived intangible assets, net	$ 2,333,000	$ 2,733,000
Customer Relationships [Member]
Acquired Intangible Assets
Weighted average amortization period	6 years 8 months 18 days	6 years 9 months 18 days
Gross carrying amount	$ 42,413,000	$ 41,345,000
Accumulated Amortization	(17,746,000)	(11,589,000)
Finite-lived intangible assets, net	$ 24,667,000	$ 29,756,000
Developed Technology Rights [Member]
Acquired Intangible Assets
Weighted average amortization period	8 years 7 months	10 years
Gross carrying amount	$ 37,547,000	$ 20,460,000
Accumulated Amortization	(3,498,000)	(682,000)
Finite-lived intangible assets, net	$ 34,049,000	$ 19,778,000
Patents
Acquired Intangible Assets
Weighted average amortization period	16 years 6 months 1 day	16 years 10 months 24 days
Gross carrying amount	$ 7,764,000	$ 7,389,000
Accumulated Amortization	(1,303,000)	(1,000,000)
Finite-lived intangible assets, net	6,461,000	6,389,000
In-process Research and Development
Acquired Intangible Assets
Indefinite-lived intangible assets	19,813,000	$ 20,003,000
In-process Research and Development | Maximum
Acquired Intangible Assets
Number of Projects | products			1
Acquisition 2018 [Member]
Acquired Intangible Assets
Payments to Acquire Businesses, Gross	$ 15,200,000
Business Combination, Contingent Consideration, Liability				$ 10,000,000

GOODWILL AND INTANGIBLE ASSET_3

GOODWILL AND INTANGIBLE ASSETS Expected Future Amortization of Acquired Intangible Assets (Details) $ in Thousands	Dec. 31, 2018USD ($)
Finite-Lived Intangible Assets, Amortization Expense, Maturity Schedule [Abstract]
Year ending December 31, 2019	$ 11,505
Year ending December 31, 2020	10,871
Year ending December 31, 2021	10,635
Year ending December 30, 2022	10,082
Year ending December 31, 2023	8,514
Thereafter	15,903
Finite-lived intangible assets, net	$ 67,510

GOODWILL AND INTANGIBLE ASSET_4

GOODWILL AND INTANGIBLE ASSETS Rollforward of Goodwill (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Goodwill [Line Items]
Goodwill, Gross	$ 123,734	$ 123,890	$ 105,926
Goodwill, Acquired During Period	0	17,907
Goodwill, Foreign Currency Translation Gain (Loss)	$ (156)	$ 57

MARKETABLE SECURITIES (Details)

MARKETABLE SECURITIES (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Short-term Marketable Securities
Schedule of Marketable Securities
Amortized Cost	$ 200,210	$ 255,144
Available-for-sale Securities, Accumulated Gross Unrealized Gain, before Tax	3	6
Available-for-sale Securities, Accumulated Gross Unrealized Loss, before Tax	(276)	(260)
Fair Value	199,937	254,890
Short-term Marketable Securities | Municipal Bonds
Schedule of Marketable Securities
Amortized Cost	14,923	124,817
Available-for-sale Securities, Accumulated Gross Unrealized Gain, before Tax	0	1
Available-for-sale Securities, Accumulated Gross Unrealized Loss, before Tax	(25)	(141)
Fair Value	$ 14,898	$ 124,677
Short-term Marketable Securities | Municipal Bonds | Maximum
Schedule of Marketable Securities
Available For Sale Securities Contractual Maturity	1 year	1 year
Short-term Marketable Securities | Corporate Debt Securities
Schedule of Marketable Securities
Amortized Cost	$ 118,823	$ 64,599
Available-for-sale Securities, Accumulated Gross Unrealized Gain, before Tax	0	5
Available-for-sale Securities, Accumulated Gross Unrealized Loss, before Tax	(185)	(68)
Fair Value	$ 118,638	$ 64,536
Short-term Marketable Securities | Corporate Debt Securities | Maximum
Schedule of Marketable Securities
Available For Sale Securities Contractual Maturity	1 year	1 year
Short-term Marketable Securities | Commercial Paper
Schedule of Marketable Securities
Amortized Cost	$ 50,202	$ 55,768
Available-for-sale Securities, Accumulated Gross Unrealized Gain, before Tax	3	0
Available-for-sale Securities, Accumulated Gross Unrealized Loss, before Tax	(11)	(27)
Fair Value	$ 50,194	$ 55,741
Short-term Marketable Securities | Commercial Paper | Maximum
Schedule of Marketable Securities
Available For Sale Securities Contractual Maturity	1 year	1 year
Short-term Marketable Securities | Asset-backed Securities
Schedule of Marketable Securities
Amortized Cost	$ 11,765
Available-for-sale Securities, Accumulated Gross Unrealized Gain, before Tax	0
Available-for-sale Securities, Accumulated Gross Unrealized Loss, before Tax	(54)
Fair Value	11,711
Short-term Marketable Securities | Asset-backed Securities | Maximum
Schedule of Marketable Securities
Available For Sale Securities Contractual Maturity		1 year
Short-term Marketable Securities | Securities of U.S. government-sponsored agencies
Schedule of Marketable Securities
Amortized Cost	4,497	$ 9,960
Available-for-sale Securities, Accumulated Gross Unrealized Gain, before Tax	0	0
Available-for-sale Securities, Accumulated Gross Unrealized Loss, before Tax	(1)	(24)
Fair Value	4,496	$ 9,936
Short-term Marketable Securities | Securities of U.S. government-sponsored agencies | Maximum
Schedule of Marketable Securities
Available For Sale Securities Contractual Maturity		1 year
Long-term Marketable Securities
Schedule of Marketable Securities
Amortized Cost	263,060	$ 56,281
Available-for-sale Securities, Accumulated Gross Unrealized Gain, before Tax	458	3
Available-for-sale Securities, Accumulated Gross Unrealized Loss, before Tax	(401)	(151)
Fair Value	263,117	56,133
Long-term Marketable Securities | Municipal Bonds
Schedule of Marketable Securities
Amortized Cost	2,676	15,285
Available-for-sale Securities, Accumulated Gross Unrealized Gain, before Tax	0	0
Available-for-sale Securities, Accumulated Gross Unrealized Loss, before Tax	(4)	(48)
Fair Value	$ 2,672	$ 15,237
Long-term Marketable Securities | Municipal Bonds | Minimum
Schedule of Marketable Securities
Available For Sale Securities Contractual Maturity	1 year	1 year
Long-term Marketable Securities | Municipal Bonds | Maximum
Schedule of Marketable Securities
Available For Sale Securities Contractual Maturity	2 years	2 years
Long-term Marketable Securities | Corporate Debt Securities
Schedule of Marketable Securities
Amortized Cost	$ 127,676	$ 17,155
Available-for-sale Securities, Accumulated Gross Unrealized Gain, before Tax	196	3
Available-for-sale Securities, Accumulated Gross Unrealized Loss, before Tax	(295)	(39)
Fair Value	$ 127,577	$ 17,119
Long-term Marketable Securities | Corporate Debt Securities | Minimum
Schedule of Marketable Securities
Available For Sale Securities Contractual Maturity	1 year	1 year
Long-term Marketable Securities | Corporate Debt Securities | Maximum
Schedule of Marketable Securities
Available For Sale Securities Contractual Maturity	2 years	2 years
Long-term Marketable Securities | Asset-backed Securities
Schedule of Marketable Securities
Amortized Cost	$ 128,297	$ 23,841
Available-for-sale Securities, Accumulated Gross Unrealized Gain, before Tax	262	0
Available-for-sale Securities, Accumulated Gross Unrealized Loss, before Tax	(89)	(64)
Fair Value	$ 128,470	$ 23,777
Long-term Marketable Securities | Asset-backed Securities | Minimum
Schedule of Marketable Securities
Available For Sale Securities Contractual Maturity		1 year
Long-term Marketable Securities | Asset-backed Securities | Maximum
Schedule of Marketable Securities
Available For Sale Securities Contractual Maturity		2 years
Long-term Marketable Securities | Securities of U.S. government-sponsored agencies | Minimum
Schedule of Marketable Securities
Available For Sale Securities Contractual Maturity	1 year
Long-term Marketable Securities | Securities of U.S. government-sponsored agencies | Maximum
Schedule of Marketable Securities
Available For Sale Securities Contractual Maturity	2 years

FAIR VALUE MEASUREMENTS (Detail

FAIR VALUE MEASUREMENTS (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Fair Value, Assets and Liabilities Measured on Recurring Basis
Fair Value Measurement Inputs and Valuation Techniques [Table Text Block]	The recurring Level 3 fair value measurements of our contingent consideration liabilities include the following significant unobservable inputs, which have not materially changed since December 31, 2017: Fair Value at (In thousands) December 31, Valuation technique Unobservable input Range Discount rate 8.5% Revenue-based payments $ 5,289 Discounted cash flow Probability of payment 75% - 100% Projected year of payment 2019 - 2029 Discount rate 4.4% Milestone-based payments $ 4,829 Discounted cash flow Probability of payment 100% Projected year of payment 2019
Contingent consideration currency translation loss/(gain)	$ (48)	$ 68
Contingent Consideration Payment [Roll Forward]
Contingent consideration, beginning balance	15,919	19,849
Purchase price contingent consideration	0	4,871
Business Acquisition, Contingent Consideration, Milestone Payment	(6,738)	(10,109)
Changes in fair value of contingent consideration	985	1,240
Contingent consideration, ending balance	10,118	15,919
NonCashSettlementOfContingentConsideration	0	0
Fair Value, Measurements, Recurring
Fair Value, Assets and Liabilities Measured on Recurring Basis
Cash equivalents	48,040	31,549
Contingent Consideration Payment [Roll Forward]
Contingent consideration, beginning balance	15,919
Contingent consideration, ending balance	10,118	15,919
Fair Value, Measurements, Recurring | Municipal Bonds
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale	17,570	139,914
Fair Value, Measurements, Recurring | Corporate Debt Securities
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale	246,215	81,655
Fair Value, Measurements, Recurring | Commercial Paper
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale	50,194	55,741
Fair Value, Measurements, Recurring | Asset-backed Securities
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale	140,181	23,777
Fair Value, Measurements, Recurring | Securities of U.S. government-sponsored agencies
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale	8,894	9,936
Fair Value, Measurements, Recurring | Level 1
Fair Value, Assets and Liabilities Measured on Recurring Basis
Cash equivalents	259	5,927
Contingent Consideration Payment [Roll Forward]
Contingent consideration, beginning balance	0
Contingent consideration, ending balance	0	0
Fair Value, Measurements, Recurring | Level 1 | Municipal Bonds
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale	0	0
Fair Value, Measurements, Recurring | Level 1 | Corporate Debt Securities
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale	0	0
Fair Value, Measurements, Recurring | Level 1 | Commercial Paper
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale	0	0
Fair Value, Measurements, Recurring | Level 1 | Asset-backed Securities
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale	0	0
Fair Value, Measurements, Recurring | Level 1 | Securities of U.S. government-sponsored agencies
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale	0	0
Fair Value, Measurements, Recurring | Level 2
Fair Value, Assets and Liabilities Measured on Recurring Basis
Cash equivalents	47,781	25,622
Contingent Consideration Payment [Roll Forward]
Contingent consideration, beginning balance	0
Contingent consideration, ending balance	0	0
Fair Value, Measurements, Recurring | Level 2 | Municipal Bonds
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale	17,570	139,914
Fair Value, Measurements, Recurring | Level 2 | Corporate Debt Securities
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale	246,215	81,655
Fair Value, Measurements, Recurring | Level 2 | Commercial Paper
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale	50,194	55,741
Fair Value, Measurements, Recurring | Level 2 | Asset-backed Securities
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale	140,181	23,777
Fair Value, Measurements, Recurring | Level 2 | Securities of U.S. government-sponsored agencies
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale	8,894	9,936
Fair Value, Measurements, Recurring | Level 3
Fair Value, Assets and Liabilities Measured on Recurring Basis
Cash equivalents	0	0
Contingent Consideration Payment [Roll Forward]
Contingent consideration, beginning balance	15,919
Contingent consideration, ending balance	10,118	15,919
Fair Value, Measurements, Recurring | Level 3 | Municipal Bonds
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale	0	0
Fair Value, Measurements, Recurring | Level 3 | Corporate Debt Securities
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale	0	0
Fair Value, Measurements, Recurring | Level 3 | Commercial Paper
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale	0	0
Fair Value, Measurements, Recurring | Level 3 | Asset-backed Securities
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale	0	0
Fair Value, Measurements, Recurring | Level 3 | Securities of U.S. government-sponsored agencies
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale	0	$ 0
Revenue-based payments | Fair Value, Measurements, Recurring | Level 3
Contingent Consideration Payment [Roll Forward]
Contingent consideration, ending balance	$ 5,289
Revenue-based payments | Fair Value, Measurements, Recurring | Minimum | Level 3
Fair Value, Assets and Liabilities Measured on Recurring Basis
Probability of Payment	75.00%
Revenue-based payments | Fair Value, Measurements, Recurring | Maximum | Level 3
Fair Value, Assets and Liabilities Measured on Recurring Basis
Probability of Payment	100.00%
Milestone-based payments | Fair Value, Measurements, Recurring | Level 3
Contingent Consideration Payment [Roll Forward]
Contingent consideration, ending balance	$ 4,829
Milestone-based payments | Fair Value, Measurements, Recurring | Minimum | Level 3
Fair Value, Assets and Liabilities Measured on Recurring Basis
Probability of Payment	100.00%
Measurement Input, Discount Rate [Member] | Revenue-based payments | Fair Value, Measurements, Recurring | Maximum | Level 3
Fair Value, Assets and Liabilities Measured on Recurring Basis
Fair Value Measurement Inputs and Valuation Techniques [Table Text Block]	0.085
Measurement Input, Discount Rate [Member] | Milestone-based payments | Fair Value, Measurements, Recurring | Minimum | Level 3
Fair Value, Assets and Liabilities Measured on Recurring Basis
Fair Value Measurement Inputs and Valuation Techniques [Table Text Block]	0.044
Property, Plant and Equipment, Other Types [Member] | Minimum
Fair Value, Assets and Liabilities Measured on Recurring Basis
Property, Plant and Equipment, Useful Life	3 years
Property, Plant and Equipment, Other Types [Member] | Maximum
Fair Value, Assets and Liabilities Measured on Recurring Basis
Property, Plant and Equipment, Useful Life	5 years
Equipment [Member] | Minimum
Fair Value, Assets and Liabilities Measured on Recurring Basis
Property, Plant and Equipment, Useful Life	5 years
Equipment [Member] | Maximum
Fair Value, Assets and Liabilities Measured on Recurring Basis
Property, Plant and Equipment, Useful Life	7 years

INVENTORIES (Details)

INVENTORIES (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Inventory Disclosure [Abstract]
Raw materials	$ 20,740	$ 19,984
Work in process	13,179	10,012
Finished goods	97,335	78,413
Total	$ 131,254	$ 108,409

PROPERTY & EQUIPMENT (Details)

PROPERTY & EQUIPMENT (Details) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Property and Equipment
Depreciation		$ 32,042	$ 34,158	$ 35,293
Property and equipment, gross	$ 388,682	388,682	334,927
Less: accumulated depreciation	(216,809)	(216,809)	(191,760)
Total	171,873	171,873	143,167
Land
Property and Equipment
Property and equipment, gross	8,298	$ 8,298	8,314
Building and improvements
Property and Equipment
Property, Plant and Equipment, Useful Life		30 years
Property and equipment, gross	27,267	$ 27,267	24,974
Equipment [Member]
Property and Equipment
Property and equipment, gross	84,150	$ 84,150	65,035
Equipment [Member] | Minimum
Property and Equipment
Property, Plant and Equipment, Useful Life		5 years
Equipment [Member] | Maximum
Property and Equipment
Property, Plant and Equipment, Useful Life		7 years
Instruments
Property and Equipment
Property, Plant and Equipment, Useful Life		3 years
Property and equipment, gross	219,451	$ 219,451	189,974
Modules and cases
Property and Equipment
Property, Plant and Equipment, Useful Life		3 years
Property and equipment, gross	34,183	$ 34,183	27,346
Property, Plant and Equipment, Other Types [Member]
Property and Equipment
Property and equipment, gross	15,333	$ 15,333	19,284
Property, Plant and Equipment, Other Types [Member] | Minimum
Property and Equipment
Property, Plant and Equipment, Useful Life		3 years
Property, Plant and Equipment, Other Types [Member] | Maximum
Property and Equipment
Property, Plant and Equipment, Useful Life		5 years
Restatement Adjustment | Cost of Goods, Total
Property and Equipment
Depreciation	$ 1,300	$ 5,700	(5,500)
Current Year Impact | Restatement Adjustment | Cost of Goods, Total
Property and Equipment
Depreciation			$ 2,100

ACCRUED EXPENSES (Details)

ACCRUED EXPENSES (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Payables and Accruals [Abstract]
Compensation and other employee-related costs	$ 32,465	$ 29,006
Legal and other settlements and expenses	6,684	1,177
Accrual for Taxes Other than Income Taxes	3,593	6,325
Royalties	2,500	2,139
Other	14,636	13,947
Total accrued expenses	$ 59,878	$ 52,594

DEBT (Details)

DEBT (Details) - Revolving Credit Facility - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2018	May 31, 2011
Debt Instruments
Credit facility, current borrowing capacity	$ 125	$ 50
Credit facility, maximum borrowing capacity	150
Line of Credit Facility, Fair Value of Amount Outstanding	$ 0
Revolving credit facility, minimum termination notice period	10 days
Fluctuating Rate Per Annum
Debt Instruments
Credit facility, basis spread on variable rate	0.75%
Credit facility, variable rate	LIBOR
Credit facility, period of variable rate	1 month
Fixed Rate
Debt Instruments
Credit facility, basis spread on variable rate	0.75%
Credit facility, variable rate	LIBOR
Fixed Rate | Minimum
Debt Instruments
Credit facility, period of variable rate	1 month
Fixed Rate | Maximum
Debt Instruments
Credit facility, period of variable rate	3 months
Letter of Credit
Debt Instruments
Credit facility, maximum borrowing capacity	$ 25

EQUITY (Textuals) (Details)

EQUITY (Textuals) (Details) - shares	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017
Class of Stock
Common stock, shares outstanding	98,573,354	96,657,881
Common stock, shares authorized (in shares)	785,000,000
Class A Common
Class of Stock
Common stock, shares outstanding	76,143,257	72,780,325
Common stock, shares authorized (in shares)	500,000,000	500,000,000
Common stock, votes per share	1
Class B Common
Class of Stock
Common stock, shares outstanding	22,430,097	23,877,556
Common stock, shares authorized (in shares)	275,000,000	275,000,000
Common stock, votes per share	10
Class C Common
Class of Stock
Common stock, shares authorized (in shares)	10,000,000

EQUITY (Schedule of Issued and

EQUITY (Schedule of Issued and Outstanding Shares) (Details) - shares	Dec. 31, 2018	Dec. 31, 2017
Class of Stock
Common stock, shares outstanding	98,573,354	96,657,881
Common stock, shares issued	98,573,354	96,657,881
Class A Common
Class of Stock
Common stock, shares outstanding	76,143,257	72,780,325
Common stock, shares issued	76,143,257	72,780,325
Class B Common
Class of Stock
Common stock, shares outstanding	22,430,097	23,877,556
Common stock, shares issued	22,430,097	23,877,556
Common Class C [Member]
Class of Stock
Common stock, shares issued	0	0

EQUITY Accumulated Other Compre

EQUITY Accumulated Other Comprehensive Income (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Accumulated other comprehensive income/(loss), net of tax	$ (7,172)	$ (6,907)	$ (8,642)
Other comprehensive income/(loss) before reclassifications	(250)	1,738
Amounts reclassified from accumulated other comprehensive income, net of tax	(15)	(3)
Other comprehensive income/(loss), net of tax	(265)	1,735	(6,684)
Foreign Currency Translation Adjustment
Accumulated other comprehensive income/(loss), net of tax	(7,004)	(6,594)	(8,475)
Other comprehensive income/(loss) before reclassifications	(410)	1,881
Amounts reclassified from accumulated other comprehensive income, net of tax	0	0
Other comprehensive income/(loss), net of tax	(410)	1,881
Unrealized Gain/(Loss) on Marketable Securities, Net of Tax
Accumulated other comprehensive income/(loss), net of tax	(168)	(313)	$ (167)
Other comprehensive income/(loss) before reclassifications	160	(143)
Amounts reclassified from accumulated other comprehensive income, net of tax	(15)	(3)
Other comprehensive income/(loss), net of tax	$ 145	$ (146)

STOCK-BASED COMPENSATION (Textu

STOCK-BASED COMPENSATION (Textuals) (Details) $ in Millions	12 Months Ended
	Dec. 31, 2018USD ($)shares
Share-based Compensation Arrangement by Share-based Payment Award
Share-based Compensation, Number of Stock Plans	3
Stock Options
Share-based Compensation Arrangement by Share-based Payment Award
Maximum contractual term	10 years
Unrecognized compensation expense, unvested stock options | $	$ 52.9
Weighted average period of recognition, unvested stock options	3 years
Stock Options | Minimum
Share-based Compensation Arrangement by Share-based Payment Award
Award vesting period (in years)	4 years
2012 Equity Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award
Base number of shares that may be issuable under stock plan	3,076,923
2012 Equity Incentive Plan | Maximum
Share-based Compensation Arrangement by Share-based Payment Award
Number of shares available for grant	10,769,230
Annual percentage limit for incremental shares that may be issued	3.00%
2012 Equity Incentive Plan | Class A Common
Share-based Compensation Arrangement by Share-based Payment Award
Shares reserved under the 2012 Equity Incentive Plan	14,889,882
Number of shares available for grant	3,027,462

STOCK-BASED COMPENSATION (Grant

STOCK-BASED COMPENSATION (Grant Date Fair Values of Options Awarded to Employees) (Details) - $ / shares	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Weighted average grant date per share fair value	$ 14.90	$ 9.12	$ 7.62

STOCK-BASED COMPENSATION (Fair

STOCK-BASED COMPENSATION (Fair Value of Options, Assumptions) (Details)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Risk-free interest rate, minimum	2.30%	1.74%	1.03%
Risk-free interest rate, maximum	3.09%	2.20%	2.01%
Expected volatility, minimum	23.00%	26.00%	28.00%
Expected volatility, maximum	28.00%	29.00%	29.00%
Expected dividend yield	0.00%	0.00%	0.00%
Minimum
Expected term	5 years 9 months 18 days	5 years 9 months 18 days	5 years 9 months 18 days
Maximum
Expected term	7 years 6 months	6 years 4 months 24 days	6 years 6 months

STOCK-BASED COMPENSATION (Stock

STOCK-BASED COMPENSATION (Stock Option Activity) (Details) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2018USD ($)$ / sharesshares
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding [Roll Forward]
Number of shares outstanding beginning balance | shares	9,041
Number of shares granted | shares	3,167
Number of shares exercised | shares	(1,917)
Number of shares outstanding ending balance | shares	9,668
Number of shares exercisable | shares	4,308
Number of shares expected to vest | shares	5,360
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding, Weighted Average Exercise Price [Roll Forward]
Weighted average exercise price per share outstanding beginning balance | $ / shares	$ 23.40
Weighted average exercise price per share granted | $ / shares	47.78
Weighted average exercise price per share exercised | $ / shares	$ 20.48
Share-based Compensation Arrangement by Share-based Payment Award, Options, Forfeitures in Period | shares	623
Weighted average exercise price per share forfeited | $ / shares	$ 31.42
Weighted average exercise price per share outstanding ending balance | $ / shares	31.45
Weighted average exercise price per share exercisable | $ / shares	22.87
Weighted average exercise price per share expected to vest | $ / shares	$ 38.34
Weighted average remaining contractual life outstanding	7 years 5 months 24 days
Weighted average remaining contractual life exercisable	6 years 1 month 15 days
Weighted average remaining contractual life expected to vest	8 years 7 months 15 days
Aggregate intrinsic value outstanding | $	$ 128,067
Aggregate intrinsic value exercisable | $	87,972
Aggregate intrinsic value expected to vest | $	$ 40,094

STOCK-BASED COMPENSATION (Compe

STOCK-BASED COMPENSATION (Compensation Expense Related to Stock Options and Their Intrinsic Values) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Intrinsic value of stock options exercised	$ 59,345	$ 12,217	$ 8,824
Stock-based compensation expense	21,899	14,686	11,382
Net stock-based compensation capitalized into inventory	320	196	270
Total stock-based compensation cost	$ 22,219	$ 14,882	$ 11,652

INCOME TAXES (Components of Inc

INCOME TAXES (Components of Income (Loss) Before Income Taxes) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Income Tax Disclosure [Abstract]
Income before taxes, domestic	$ 180,701	$ 155,051	$ 154,377
Income before taxes, foreign	7,904	14,877	2,902
Income before income taxes	$ 188,605	$ 169,928	$ 157,279

INCOME TAXES (Components of Pro

INCOME TAXES (Components of Provision for Income Taxes) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Current Income Tax Expense
Current income tax provision, federal	$ 23,774	$ 46,728	$ 51,785
Current income tax provision, state	4,662	5,009	4,533
Current income tax provision, foreign	2,724	2,638	748
Current income tax provision	31,160	54,375	57,066
Deferred Income Tax Expense/(Benefit)
Deferred income tax provision/(benefit), federal	4,155	10,553	(4,527)
Deferred income tax (benefit), state	(587)	(1,123)	204
Deferred income tax benefit, foreign	(2,597)	(1,225)	195
Deferred income tax provision/(benefit)	971	8,205	(4,128)
Income tax provision, total	$ 32,131	$ 62,580	$ 52,938

INCOME TAXES (Reconciliation of

INCOME TAXES (Reconciliation of Statutory U.S. Federal Tax Rate to Effective Rate) (Details)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Income Tax Disclosure [Abstract]
Statutory U.S. federal tax rate	21.00%	35.00%	35.00%
State income taxes, net of federal benefit	2.30%	1.90%	2.20%
Effective Income Tax Rate Reconciliation, Tax Credit, Foreign, Percent	1.70%	1.00%	0.40%
Domestic production activities deduction	(0.70%)	(2.30%)	(2.70%)
Tax credits	(1.60%)	(3.80%)	(1.30%)
Effective Income Tax Rate Reconciliation,Other Reconciling Items, Percent	(5.20%)	(1.40%)	(0.00%)
Nondeductible expenses	(0.60%)	0.10%	0.10%
Other	0.10%	(0.20%)	(0.00%)
Effective Income Tax Rate Reconciliation, Change in Enacted Tax Rate, Percent	0.00%	6.50%	0.00%
Effective tax rate	17.00%	36.80%	33.70%

INCOME TAXES (Components of Def

INCOME TAXES (Components of Deferred Income Taxes) (Details) - USD ($) $ in Thousands	Dec. 31, 2018	Dec. 31, 2017
Income Tax Disclosure [Abstract]
Deferred income taxes	$ 13,578	$ 20,031
Components of Deferred Tax Assets [Abstract]
Inventory reserve	25,398	23,087
Accruals, reserves, and other currently not deductible	10,377	7,812
Stock-based compensation	10,959	9,109
Foreign net operating loss carryforwards	3,852	1,924
Total deferred tax assets	50,586	41,932
Valuation allowance	(2,683)	(1,821)
Total deferred tax assets, net of valuation allowance	47,903	40,111
Components of Deferred Tax Liabilities [Abstract]
Depreciation and amortization	(42,439)	(30,749)
Total deferred tax liabilities	(42,439)	(30,749)
Net deferred tax assets	$ 5,464	$ 9,362

INCOME TAXES (Reconciliation _2

INCOME TAXES (Reconciliation of Beginning and Ending Amounts of Unrecognized Tax Benefits) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns [Roll Forward]
Unrecognized tax benefits at the beginning of the year	$ 2,601	$ 1,862	$ 1,575
Additions related to current year tax positions	0	0	0
Additions related to prior year tax positions	2,176	739	287
Reductions related to prior year tax positions	0	0	0
Unrecognized tax benefit at the end of the year	4,777	2,601	1,862
Portion of total unrecognized tax benefits that, if recognized, that would affect the effective income tax rate	$ 4,084	$ 2,076	$ 1,542

INCOME TAXES (Narrative) (Detai

INCOME TAXES (Narrative) (Details) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Income Tax Examination
Long term deferred tax asset	$ 13,578	$ 13,578	$ 20,031
Income Tax Expense (Benefit)		32,131	$ 62,580	$ 52,938
Latest Tax Year [Member]
Income Tax Examination
Long term deferred tax asset	10,300	$ 10,300
Income Tax Expense (Benefit)	$ 700

LEASES (Minimum Future Rental P

LEASES (Minimum Future Rental Payments Under Operating Leases) (Details) $ in Thousands	Dec. 31, 2018USD ($)
Leases, Operating [Abstract]
Year ending December 31, 2019	$ 1,581
Year ending December 31, 2020	863
Year ending December 31, 2021	235
Year ending December 31, 2022	78
Year ending December 31, 2023	37
Total	$ 2,794

LEASES (Rent Expense Related to

LEASES (Rent Expense Related to Operating Leases) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Leases, Operating [Abstract]
Rent expense	$ 2,950	$ 2,123	$ 1,500

COMMITMENTS AND CONTINGENCIES (

COMMITMENTS AND CONTINGENCIES (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2018USD ($)	Dec. 31, 2017USD ($)	Dec. 31, 2016USD ($)	Mar. 11, 2015claim	Nov. 19, 2014claim	Jul. 31, 2011claim	Apr. 30, 2010claim
Loss Contingencies
Provision for litigation | $	$ 5,878	$ 2,668	$ 3,156
Accrued Liabilities and Other Liabilities | $	2,500
prepaid royalty | $	$ 9,000
Synthes related Litigations
Loss Contingencies
Patent claims (number of claims)						3
Loss Contingency, Claims Settled, Number	4
Payments for Legal Settlements | $			$ 7,900
Synthes related Litigations | Minimum
Loss Contingencies
Patent claims (number of claims)							1
Bianco [Member]
Loss Contingencies
Payments for Legal Settlements | $	$ 11,500
Bonutti Skeletal Innovations LLCLitigation [Member]
Loss Contingencies
Patent claims (number of claims)					6
Bonutti Skeletal Innovations LLCLitigation [Member] | Minimum
Loss Contingencies
Patent claims (number of claims)					1
Flexuspine Inc. Litigation [Member]
Loss Contingencies
Patent claims (number of claims)				5
Flexuspine Inc. Litigation [Member] | Minimum
Loss Contingencies
Patent claims (number of claims)				1

RETIREMENT BENEFIT PLANS (Detai

RETIREMENT BENEFIT PLANS (Details) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Defined Contribution Plan [Abstract]
Nondiscretionary employee contribution match rate	100.00%
Maximum annual contribution match, per employee	$ 6,000
Maximum annual contribution match, percent per employee	3.00%
401(k) and other retirement plan contributions	$ 4,682,000	$ 3,597,000	$ 2,772,000

SEGMENT AND GEOGRAPHIC INFORM_3

SEGMENT AND GEOGRAPHIC INFORMATION (Geographic Location) (Details) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2018USD ($)	Sep. 30, 2018USD ($)	Jun. 30, 2018USD ($)	Mar. 31, 2018USD ($)	Dec. 31, 2017USD ($)	Sep. 30, 2017USD ($)	Jun. 30, 2017USD ($)	Mar. 31, 2017USD ($)	Dec. 31, 2018USD ($)segments	Dec. 31, 2017USD ($)	Dec. 31, 2016USD ($)
Revenues from External Customers
Number of reportable segments | segments									1
Revenues	$ 195,938	$ 169,236	$ 173,384	$ 174,411	$ 176,034	$ 151,744	$ 152,390	$ 155,809	$ 712,969	$ 635,977	$ 563,994
United States
Revenues from External Customers
Revenues									593,878	529,882	500,226
International
Revenues from External Customers
Revenues									$ 119,091	$ 106,095	$ 63,768

SEGMENT AND GEOGRAPHIC INFORM_4

SEGMENT AND GEOGRAPHIC INFORMATION (Products) (Details) $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2018USD ($)	Sep. 30, 2018USD ($)	Jun. 30, 2018USD ($)	Mar. 31, 2018USD ($)	Dec. 31, 2017USD ($)	Sep. 30, 2017USD ($)	Jun. 30, 2017USD ($)	Mar. 31, 2017USD ($)	Dec. 31, 2018USD ($)segments	Dec. 31, 2017USD ($)	Dec. 31, 2016USD ($)
Revenue from External Customer
Revenues | $	$ 195,938	$ 169,236	$ 173,384	$ 174,411	$ 176,034	$ 151,744	$ 152,390	$ 155,809	$ 712,969	$ 635,977	$ 563,994
Textuals [Abstract]
Number of reportable segments | segments									1

QUARTERLY FINANCIAL DATA (una_3

QUARTERLY FINANCIAL DATA (unaudited) (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended								12 Months Ended
	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2017	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Quarterly Financial Information Disclosure [Abstract]
Revenues	$ 195,938	$ 169,236	$ 173,384	$ 174,411	$ 176,034	$ 151,744	$ 152,390	$ 155,809	$ 712,969	$ 635,977	$ 563,994
Net income	$ 36,751	$ 35,208	$ 44,977	$ 39,538	$ 24,376	$ 25,591	$ 28,667	$ 28,714	$ 156,474	$ 107,348	$ 104,341
Net earnings per common share - basic	$ 0.37	$ 0.36	$ 0.46	$ 0.41	$ 0.25	$ 0.27	$ 0.30	$ 0.30	$ 1.60	$ 1.12	$ 1.09
Net earnings per common share - dilutive	$ 0.36	$ 0.35	$ 0.44	$ 0.39	$ 0.25	$ 0.26	$ 0.29	$ 0.30	$ 1.54	$ 1.10	$ 1.08
Cost of Goods Sold (Deprecated 2018-01-31)									$ 159,410	$ 150,453	$ 134,705
Gross Profit	$ 149,984	$ 131,387	$ 135,747	$ 136,441	$ 135,178	$ 114,946	$ 115,191	$ 120,209	$ 553,559	$ 485,524	$ 429,289

VALUATION ACCOUNTS AND QUALIF_3

VALUATION ACCOUNTS AND QUALIFYING ACCOUNTS (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Allowance for doubtful accounts
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Beginning of period	$ 3,963	$ 2,771	$ 2,513
Additions	960	1,718	865
Write-offs	(697)	(526)	(607)
End of period	4,226	3,963	2,771
Deferred tax valuation allowance
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Beginning of period	1,821	83	43
Additions	924	511	42
SEC Schedule, 12-09, Valuation Allowances and Reserves, Additions, Charge to Other Account	0	1,227	0
Write-offs	(62)	0	(2)
End of period	$ 2,683	$ 1,821	$ 83