Globus Medical (GMED) 10-Q 2 May 19 2019 Q1 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	3 Months Ended
	Mar. 31, 2019	May 02, 2019
Document Information
Entity Registrant Name	GLOBUS MEDICAL INC
Entity Central Index Key	0001237831
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Document Type	10-Q
Document Period End Date	Mar. 31, 2019
Document Fiscal Year Focus	2019
Document Fiscal Period Focus	Q1
Amendment Flag	false
Entity Common Stock, Shares Outstanding		98,990,287
Entity Small Business	false
Entity Emerging Growth Company	false

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
ASSETS
Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents	$ 129,976	$ 139,747
Debt Securities, Available-for-sale, Current	190,688	199,937
Accounts receivable, net of allowances of $4,235 and $4,226, respectively	139,616	137,067
Inventories	143,380	131,254
Prepaid expenses and other current assets	12,915	15,387
Income taxes receivable	993	7,289
Total current assets	617,568	630,681
Property and equipment, net of accumulated depreciation of $223,662 and $216,809, respectively	184,288	171,873
Intangible assets, net	84,269	87,323
Goodwill	123,680	123,734
Other assets	12,962	10,364
Deferred income taxes	12,350	13,578
Total assets	1,335,919	1,300,670
LIABILITIES AND EQUITY
Accounts payable	25,031	25,895
Accrued expenses	48,605	59,878
Income taxes payable	1,068	917
Business acquisition liabilities	2,000	6,830
Deferred Revenue, Current	2,788	2,598
Total current liabilities	79,492	96,118
Business acquisition liabilities, net of current portion	3,289	3,288
Deferred income taxes	7,938	8,114
Other liabilities	7,986	7,634
Total liabilities	98,705	115,154
Commitments and contingencies (Note 13)
Equity:
Additional paid-in capital	316,665	299,869
Accumulated other comprehensive loss	(5,480)	(7,172)
Retained earnings	925,930	892,721
Total equity	1,237,214	1,185,516
Total liabilities and equity	1,335,919	1,300,670
Debt Securities, Available-for-sale, Noncurrent	300,802	263,117
Class A Common
Equity:
Common stock	77	76
Class B Common
Equity:
Common stock	$ 22	$ 22

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parentheticals) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Current Assets:
Allowance for doubtful accounts	$ 4,235	$ 4,226
Property, Plant and Equipment, Net
Accumulated depreciation	$ 223,662	$ 216,809
Equity:
Common stock, shares authorized	785,000,000
Common stock, shares issued	98,982,386	98,573,354
Common stock, shares outstanding	98,982,386	98,573,354
Class A Common
Equity:
Common stock, par value	$ 0.001	$ 0.001
Common stock, shares authorized	500,000,000	500,000,000
Common stock, shares issued	76,552,289	76,143,257
Common stock, shares outstanding	76,552,289	76,143,257
Class B Common
Equity:
Common stock, par value	$ 0.001	$ 0.001
Common stock, shares authorized	275,000,000	275,000,000
Common stock, shares issued	22,430,097	22,430,097
Common stock, shares outstanding	22,430,097	22,430,097

Condensed Consolidated Statemen

Condensed Consolidated Statements of Income - USD ($) shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Income Statement [Abstract]
Revenues	$ 182,947	$ 174,411
Cost of Goods and Services Sold	41,838	37,970
Gross profit	141,109	136,441
Operating expenses:
Research and development	14,324	12,689
Selling, general and administrative	85,784	75,694
Amortization of intangibles	3,343	2,187
Acquisition related costs	579	238
Total operating expenses	104,030	90,808
Operating Income	37,079	45,633
Other income, net
Interest income, net	4,159	2,291
Foreign currency transaction gain/(loss)	189	(5)
Other income	224	158
Total other income, net	4,572	2,444
Income before income taxes	41,651	48,077
Income tax provision	8,441	8,539
Net Income	$ 33,210	$ 39,538
Earnings per share:
Basic	$ 0.34	$ 0.41
Diluted	$ 0.33	$ 0.39
Weighted average shares outstanding:
Basic	98,727	96,840
Dilutive stock options	2,640	3,656
Diluted	101,367	100,496
Anti-dilutive stock options excluded from weighted average calculation	4,687	1,917

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Comprehensive Income - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Statement of Comprehensive Income [Abstract]
Net income	$ 33,210	$ 39,538
Other comprehensive income/(loss):
Unrealized gain on marketable securities, net of tax	1,799	(236)
Foreign currency translation gain/(loss)	(107)	4,371
Total other comprehensive income/(loss)	1,692	4,135
Comprehensive Income	$ 34,902	$ 43,673

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Statement of Cash Flows [Abstract]
Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents	$ 129,976	$ 119,836
Cash flows from operating activities:
Net income	33,210	39,538
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	12,254	9,476
Amortization of premium (discount) on marketable securities	(396)	785
Write-down for excess and obsolete inventories	2,167	2,483
Stock-based compensation expense	6,448	6,053
Allowance for doubtful accounts	33	217
Change in fair value of contingent consideration	579	234
Change in deferred income taxes	1,059	(124)
Gain (Loss) on Disposition of Assets	94	0
(Increase)/decrease in:
Accounts receivable	(2,533)	(5,080)
Inventories	(13,844)	(1,206)
Prepaid expenses and other assets	848	(1,234)
Increase/(decrease) in:
Accounts payable	2,827	728
Accrued expenses and other liabilities	(9,984)	(7,072)
Income taxes payable/receivable	6,441	7,497
Net cash provided by operating activities	39,203	52,295
Cash flows from investing activities:
Purchases of marketable securities	(127,911)	(118,403)
Maturities of marketable securities	90,454	73,330
Proceeds from Sale of Available-for-sale Securities	11,773	1,333
Purchases of property and equipment	(28,155)	(12,374)
Cash flows from financing activities:
Payment of business acquisition liabilities	(5,350)	(5,440)
Proceeds from exercise of stock options	10,255	9,307
Net cash provided by financing activities	4,905	3,867
Effect of foreign exchange rate on cash	(40)	971
Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents, Period Increase (Decrease), Including Exchange Rate Effect	(9,771)	1,019
Cash and cash equivalents, beginning of period	139,647	118,817
Net cash used in investing activities	(53,839)	(56,114)
Cash and cash equivalents, end of period	129,976	119,836
Supplemental disclosures of cash flow information:
Interest paid	2	0
Income taxes paid	$ 1,450	$ 1,197

BACKGROUND AND SUMMARY OF SIGNI

BACKGROUND AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES	3 Months Ended
	Mar. 31, 2019
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 whose mission is 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 on the market, 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 interim unaudited condensed consolidated financial statements have been prepared in conformity with U.S. generally accepted accounting principles (“U.S. GAAP”) for interim financial statements and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, certain information and footnote disclosures normally included in complete financial statements prepared in accordance with U.S. GAAP have been condensed or omitted pursuant to the rules and regulations of the Securities and Exchange Commission (“SEC”). As such, the information included in this Quarterly Report on Form 10-Q should be read in conjunction with the consolidated financial statements and accompanying footnotes included in our Annual Report on Form 10-K for the year ended December 31, 2018 . In the opinion of management, the statements include all adjustments necessary, which are of a normal and recurring nature, for the fair presentation of our financial position and of the results for the three month periods presented. The results of operations for any interim period are not indicative of results for the full year. (c) Principles of Consolidation The accompanying unaudited condensed 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 condensed 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 condensed 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 condensed consolidated financial statements in the period they are determined to be necessary. Significant areas that require management’s estimates include intangible assets, business acquisition 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. (e) Cash, Cash Equivalents, and Restricted Cash 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) March 31, 2019 December 31, 2018 March 31, 2018 December 31, 2017 Cash and cash equivalents $ 129,976 $ 139,647 $ 119,836 $ 118,817 Restricted cash — 100 — — Total cash, cash equivalents, and restricted cash as presented in the condensed consolidated statement of cash flows $ 129,976 $ 139,747 $ 119,836 $ 118,817 (f) 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 March 31, 2019 . Available-for-sale securities are recorded at fair value in both short-term and long-term marketable securities on our condensed 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 condensed 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 /(expense), on our condensed consolidated statements of income. Interest receivable is recorded as a component of prepaid expenses and other current assets on our condensed 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 condensed consolidated statement of income in the period the determination is made. (g) Inventories Inventories 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. (h) Property and Equipment Purchases of property and equipment included in accounts payable and accrued expenses were $3.6 million and $7.7 million during the three months ended March 31, 2019 and March 31, 2018 , respectively. (i) 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 control 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 ended March 31, 2019 , 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 (In thousands) March 31, March 31, Musculoskeletal Solutions products $ 175,758 $ 161,689 Enabling Technologies products 7,189 12,722 Total sales $ 182,947 $ 174,411 (j) Recently Issued Accounting Pronouncements 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 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. (k) 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; (i) 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. 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 adopted the standard on January 1, 2019, using the cumulative-effect adjustment transition method. As part of the adoption, we elected the package of practical expedients permitted under the transition guidance within the new standard, which among other things, allowed carry forward of historical lease classifications. The adoption of this standard does not have a material impact on our financial position and results of operations. See “Note 13. Leases” for more detail regarding our 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. We adopted ASU 2018-02 on January 1, 2019. Adoption of the standard did 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. We adopted ASU 2018-07 on January 1, 2019. Adoption of the standard did not have a material impact on our financial position, results of operations, and disclosures.

NOTE RECEIVABLE

NOTE RECEIVABLE	3 Months Ended
	Mar. 31, 2019
Note Receivable [Abstract]
Note Receivable Disclosure	NOTE RECEIVABLE On September 1, 2016 (the “Closing Date”), in connection with the acquisition of the international operations and distribution channel of Alphatec Holdings, Inc. (“Alphatec”), 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 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 million and the Alphatec Borrowers issued a note for such amount to us. On December 20, 2016, the remaining $5 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	3 Months Ended
	Mar. 31, 2019
Intangible Assets Disclosure [Abstract]
Intangible Assets Disclosure	GOODWILL AND INTANGIBLE ASSETS A summary of intangible assets is presented below: March 31, 2019 (In thousands) Weighted Gross Accumulated Amortization Intangible Supplier network 10.0 4,000 (1,767 ) 2,233 Customer relationships & other intangibles 6.7 42,530 (19,389 ) 23,141 Developed technology 8.6 57,272 (5,050 ) 52,222 Patents 16.3 8,061 (1,388 ) 6,673 Total intangible assets $ 111,863 $ (27,594 ) $ 84,269 Due to the FDA 510(k) clearance for AQRate, a robotic guidance and navigation system, in the first quarter of 2019, $19.8 million of IPR&D was transferred to Developed technology and began to be amortized over a period of 8.5 years. 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 acquired in 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. A summary of the net carrying value of goodwill is presented below: (In thousands) December 31, 2017 $ 123,890 Additions and adjustments — Foreign exchange (156 ) December 31, 2018 123,734 Additions and adjustments — Foreign exchange (54 ) March 31, 2019 $ 123,680

MARKETABLE SECURITIES

MARKETABLE SECURITIES	3 Months Ended
	Mar. 31, 2019
Marketable Securities [Abstract]
Marketable Securities	MARKETABLE SECURITIES The composition of our short-term and long-term marketable securities is as follows: March 31, 2019 (In thousands) Contractual Maturity (in years) Amortized Cost Gross Unrealized Gains Gross Unrealized Losses Fair Value Short-term: Municipal bonds Less than 1 $ 14,834 $ 1 $ (3 ) $ 14,832 Corporate debt securities Less than 1 106,850 116 (13 ) 106,953 Commercial paper Less than 1 47,506 12 (9 ) 47,509 Government, federal agency, and other sovereign obligations Less than 1 9,862 10 — 9,872 Asset-backed securities Less than 1 11,541 — (19 ) 11,522 Total short-term marketable securities $ 190,593 $ 139 $ (44 ) $ 190,688 Long-term: Municipal bonds 1-2 $ 13,866 $ 50 $ (1 ) $ 13,915 Corporate debt securities 1-3 128,615 1,145 (25 ) 129,735 Asset-backed securities 1-3 151,855 870 (17 ) 152,708 Government, federal agency, and other sovereign obligations 1-2 4,422 22 — 4,444 Total long-term marketable securities $ 298,758 $ 2,087 $ (43 ) $ 300,802 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

FAIR VALUE MEASUREMENTS

FAIR VALUE MEASUREMENTS	3 Months Ended
	Mar. 31, 2019
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) March 31, Level 1 Level 2 Level 3 Assets Cash equivalents $ 26,569 $ 9,598 $ 16,971 $ — Municipal bonds 28,747 — 28,747 — Corporate debt securities 236,688 — 236,688 — Commercial paper 47,509 — 47,509 — Asset-backed securities 164,230 — 164,230 — Government, federal agency, and other sovereign obligations 14,316 — 14,316 — Liabilities Business acquisition liabilities 5,289 — — 5,289 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 Business acquisition liabilities 10,118 — — 10,118 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 condensed consolidated balance sheets, and the changes in the fair value of contingent consideration are recognized within acquisition related costs in the condensed consolidated statements of income. The recurring Level 3 fair value measurements of our business acquisition liabilities include the following significant unobservable inputs, which have not materially changed since December 31, 2018 : Fair Value at (In thousands) March 31, Valuation technique Unobservable input Range Discount rate 8.5% Revenue-based payments $ 5,289 Discounted cash flow Probability of payment 75.0% - 100.0% Projected year of payment 2019 - 2029 The following table provides a reconciliation of the beginning and ending balances of business acquisition liabilities: Three Months Ended (In thousands) March 31, March 31, Beginning balance $ 10,118 $ 15,919 Changes resulting from foreign currency fluctuations (58 ) 141 Contingent payments (5,350 ) (5,440 ) Changes in fair value of business acquisition liabilities 579 234 Ending balance $ 5,289 $ 10,854

INVENTORIES

INVENTORIES	3 Months Ended
	Mar. 31, 2019
Inventory Disclosure [Abstract]
Inventories	INVENTORIES (In thousands) March 31, December 31, 2018 Raw materials $ 27,157 $ 20,740 Work in process 11,216 13,179 Finished goods 105,007 97,335 Total inventories $ 143,380 $ 131,254

ACCRUED EXPENSES

ACCRUED EXPENSES	3 Months Ended
	Mar. 31, 2019
Payables and Accruals [Abstract]
Accrued Expenses	ACCRUED EXPENSES (In thousands) March 31, December 31, Compensation and other employee-related costs $ 26,107 $ 32,465 Legal and other settlements and expenses 1,643 6,684 Accrued non-income taxes 4,425 3,593 Royalties 2,417 2,500 Other 14,013 14,636 Total accrued expenses $ 48,605 $ 59,878

DEBT

DEBT	3 Months Ended
	Mar. 31, 2019
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 March 31, 2019 , 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	3 Months Ended
	Mar. 31, 2019
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”). Our issued and outstanding common shares by Class were as follows: (Shares) Class A Common Class B Common Class C Common Total March 31, 2019 76,552,289 22,430,097 — 98,982,386 December 31, 2018 76,143,257 22,430,097 — 98,573,354 The following table summarizes changes in total equity: Three Months Ended Three Months Ended (In thousands) March 31, March 31, Total equity, beginning of period $ 1,185,516 $ 967,778 Net income 33,210 39,538 Stock-based compensation cost 6,541 6,110 Exercise of stock options 10,255 9,307 Other comprehensive income 1,692 4,135 Total equity, end of period $ 1,237,214 $ 1,026,868 The tables below present the changes in each component of accumulated other comprehensive income/(loss), including current period other comprehensive income/(loss) and reclassifications out of accumulated other comprehensive income/(loss): (In thousands) Three Months 2018 Unrealized gain/(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, 2018 $ (168 ) $ (7,004 ) $ (7,172 ) Other comprehensive (loss)/income before reclassifications 2,353 (107 ) 2,246 Amounts reclassified from accumulated other comprehensive income, net of tax (554 ) — (554 ) Other comprehensive (loss)/income, net of tax 1,799 (107 ) 1,692 Accumulated other comprehensive loss, net of tax, at March 31, 2019 $ 1,631 $ (7,111 ) $ (5,480 ) (In thousands) Three Months 2017 Unrealized gain/(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, 2017 $ (313 ) $ (6,594 ) $ (6,907 ) Other comprehensive income before reclassifications (237 ) 4,371 4,134 Amounts reclassified from accumulated other comprehensive income, net of tax 1 — 1 Other comprehensive income, net of tax (236 ) 4,371 4,135 Accumulated other comprehensive loss, net of tax, at March 31, 2018 $ (549 ) $ (2,223 ) $ (2,772 )

STOCK-BASED COMPENSATION

STOCK-BASED COMPENSATION	3 Months Ended
	Mar. 31, 2019
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 issuable under the 2012 Plan include authorized but unissued shares, treasury shares or shares of common stock purchased on the open market. As of March 31, 2019 , pursuant to the 2012 Plan, there were 14,889,882 shares of Class A Common stock reserved and 1,535,915 shares of Class A Common stock available for future grants. The weighted average grant date fair value per share of the options awarded to employees were as follows: Three Months Ended March 31, March 31, Weighted average grant date fair value per share $ 13.78 $ 13.74 Stock option activity during the three months ended March 31, 2019 is summarized as follows: Option Shares (thousands) Weighted average exercise price Weighted average remaining contractual life (years) Aggregate intrinsic value (thousands) Outstanding at December 31, 2018 9,668 $ 31.45 Granted 1,802 45.66 Exercised (407 ) 25.60 Forfeited (311 ) 38.62 Outstanding at March 31, 2019 10,752 $ 33.84 7.7 $ 170,472 Exercisable at March 31, 2019 4,599 $ 24.78 6.2 $ 113,287 Expected to vest at March 31, 2019 6,153 $ 40.61 8.8 $ 57,185 The intrinsic value of stock options exercised and the compensation cost related to stock options granted to employees and non-employees under our stock plans was as follows: Three Months Ended (In thousands) March 31, March 31, Intrinsic value of stock options exercised $ 8,424 $ 14,848 Stock-based compensation expense $ 6,448 $ 6,053 Net stock-based compensation capitalized into inventory 93 57 Total stock-based compensation cost $ 6,541 $ 6,110 As of March 31, 2019 , there was $68.9 million of unrecognized compensation expense related to unvested employee stock options that are expected to vest over a weighted average period of three years.

INCOME TAXES

INCOME TAXES	3 Months Ended
	Mar. 31, 2019
Income Tax Disclosure [Abstract]
Income Taxes	INCOME TAXES In computing our income tax provision, we make certain estimates and management judgments, such as estimated annual taxable income or loss, annual effective tax rate, the nature and timing of permanent and temporary differences between taxable income for financial reporting and tax reporting, and the recoverability of deferred tax assets. Our estimates and assumptions may change as new events occur, additional information is obtained, or as the tax environment changes. Should facts and circumstances change during a quarter causing a material change to the estimated effective income tax rate, a cumulative adjustment is recorded. The following table provides a summary of our effective tax rate: Three Months Ended March 31, March 31, Effective income tax rate 20.3 % 17.8 % The period over period change in the effective income tax rate for the three months ended March 31, 2019 is primarily driven by the reduction of benefits related to the exercise of stock based compensation (ASU 2016-09).

COMMITMENTS AND CONTINGENCIES

COMMITMENTS AND CONTINGENCIES	3 Months Ended
	Mar. 31, 2019
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 condensed 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. 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. 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.

LEASES Leases

LEASES Leases	3 Months Ended
	Mar. 31, 2019
Leases [Abstract]
Lessee, Operating Leases [Text Block]	LEASES The Company leases certain equipment, vehicles, and facilities under operating leases. Our leases have initial lease terms ranging from one year to fourteen years. Certain leases contain options to extend terms beyond the lease termination date. In these leases, we use judgment to determine whether it is reasonably possible that we will extend the lease beyond the initial term and for how long. Leases that have terms of less than 12 months are treated as short-term and are not recognized as right of use assets or lease liabilities. As most leases do not provide an implicit rate, we use an incremental borrowing rate based on the information available at commencement date in determining the present value of future payments. As of March 31, 2019, the company’s short term lease commitments and sublease income are immaterial. The Company classifies right-of-use assets as Other assets, short-term lease liabilities as Accrued expenses, and long-term lease liabilities as Other liabilities on the Consolidated Balance Sheet. Lease expense is recognized, on a straight-line basis over the term of the lease, as a component of operating income on the Consolidated Statement of Income. Amounts reported in the Consolidated Balance Sheet as of the quarter ended March 31, 2019 were as follows: (In thousands, except weighted average lease term and discount rate) Operating leases: Right of use assets $ 1,944 Lease liability - short term 1,141 Lease liability - long term 803 Total operating lease liability $ 1,944 Lease expense as of March 31, 2019 $ 719 Weighted-average remaining lease term - operating leases (in years) 2 Weighted-average discount rate 2.9 % Future minimum lease payments under non-cancellable leases as of the quarter ended March 31, 2019 are as follows: (In thousands) Operating Leases 2019 (excluding the three months ended March 31, 2019) $ 924 2020 775 2021 210 2022 74 2023 36 Thereafter — Total undiscounted leases payments $ 2,019 Less : imputed interest 75 Total lease liabilities $ 1,944

SEGMENT AND GEOGRAPHIC INFORMAT

SEGMENT AND GEOGRAPHIC INFORMATION	3 Months Ended
	Mar. 31, 2019
Segment Reporting [Abstract]
Segment And Geographic Information	SEGMENT AND GEOGRAPHIC INFORMATION Operating segments are defined as components of an enterprise for which separate discrete 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: Three Months Ended (In thousands) March 31, March 31, United States $ 147,536 $ 145,618 International 35,411 28,793 Total sales $ 182,947 $ 174,411

BACKGROUND AND SUMMARY OF SIG_2

BACKGROUND AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Policies)	3 Months Ended
	Mar. 31, 2019
BACKGROUND AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES [Abstract]
Principles of Consolidation	Principles of Consolidation The accompanying unaudited condensed 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 condensed 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 condensed 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 condensed consolidated financial statements in the period they are determined to be necessary. Significant areas that require management’s estimates include intangible assets, business acquisition 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.
Cash and Cash Equivalents, Restricted Cash and Cash Equivalents, Policy [Policy Text Block]	Cash, Cash Equivalents, and Restricted Cash 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) March 31, 2019 December 31, 2018 March 31, 2018 December 31, 2017 Cash and cash equivalents $ 129,976 $ 139,647 $ 119,836 $ 118,817 Restricted cash — 100 — — Total cash, cash equivalents, and restricted cash as presented in the condensed consolidated statement of cash flows $ 129,976 $ 139,747 $ 119,836 $ 118,817
Marketable Securities	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 March 31, 2019 . Available-for-sale securities are recorded at fair value in both short-term and long-term marketable securities on our condensed 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 condensed 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 /(expense), on our condensed consolidated statements of income. Interest receivable is recorded as a component of prepaid expenses and other current assets on our condensed 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 condensed consolidated statement of income in the period the determination is made.
Inventories	Inventories Inventories 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, Plant and Equipment, Policy [Policy Text Block]	Property and Equipment Purchases of property and equipment included in accounts payable and accrued expenses were $3.6 million and $7.7 million during the three months ended March 31, 2019 and March 31, 2018 , respectively.
Revenue from Contract with Customer [Text Block]	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 control 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 ended March 31, 2019 , there was an immaterial amount of revenue recognized from previously deferred revenue.
Recently Issued Accounting Pronouncements	Recently Issued Accounting Pronouncements 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 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. (k) 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; (i) 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. 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 adopted the standard on January 1, 2019, using the cumulative-effect adjustment transition method. As part of the adoption, we elected the package of practical expedients permitted under the transition guidance within the new standard, which among other things, allowed carry forward of historical lease classifications. The adoption of this standard does not have a material impact on our financial position and results of operations. See “Note 13. Leases” for more detail regarding our 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. We adopted ASU 2018-02 on January 1, 2019. Adoption of the standard did 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. We adopted ASU 2018-07 on January 1, 2019. Adoption of the standard did 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 (Tables)	3 Months Ended
	Mar. 31, 2019
BACKGROUND AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES [Abstract]
Disaggregation of Revenue [Table Text Block]	Disaggregation of Revenue The following table represents total sales by revenue stream: Three Months Ended (In thousands) March 31, March 31, Musculoskeletal Solutions products $ 175,758 $ 161,689 Enabling Technologies products 7,189 12,722 Total sales $ 182,947 $ 174,411
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) March 31, 2019 December 31, 2018 March 31, 2018 December 31, 2017 Cash and cash equivalents $ 129,976 $ 139,647 $ 119,836 $ 118,817 Restricted cash — 100 — — Total cash, cash equivalents, and restricted cash as presented in the condensed consolidated statement of cash flows $ 129,976 $ 139,747 $ 119,836 $ 118,817

GOODWILL AND INTANGIBLE ASSETS

GOODWILL AND INTANGIBLE ASSETS (Tables)	3 Months Ended
	Mar. 31, 2019
Intangible Assets Disclosure [Abstract]
Intangible Assets Acquired as Part of Business Combination	A summary of intangible assets is presented below: March 31, 2019 (In thousands) Weighted Gross Accumulated Amortization Intangible Supplier network 10.0 4,000 (1,767 ) 2,233 Customer relationships & other intangibles 6.7 42,530 (19,389 ) 23,141 Developed technology 8.6 57,272 (5,050 ) 52,222 Patents 16.3 8,061 (1,388 ) 6,673 Total intangible assets $ 111,863 $ (27,594 ) $ 84,269 Due to the FDA 510(k) clearance for AQRate, a robotic guidance and navigation system, in the first quarter of 2019, $19.8 million of IPR&D was transferred to Developed technology and began to be amortized over a period of 8.5 years. 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

GOODWILL AND INTANGIBLE ASSET_2

GOODWILL AND INTANGIBLE ASSETS Schedule of Goodwill (Tables)	3 Months Ended
	Mar. 31, 2019
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, 2017 $ 123,890 Additions and adjustments — Foreign exchange (156 ) December 31, 2018 123,734 Additions and adjustments — Foreign exchange (54 ) March 31, 2019 $ 123,680

MARKETABLE SECURITIES (Tables)

MARKETABLE SECURITIES (Tables)	3 Months Ended
	Mar. 31, 2019
Marketable Securities [Abstract]
Marketable Securities	The composition of our short-term and long-term marketable securities is as follows: March 31, 2019 (In thousands) Contractual Maturity (in years) Amortized Cost Gross Unrealized Gains Gross Unrealized Losses Fair Value Short-term: Municipal bonds Less than 1 $ 14,834 $ 1 $ (3 ) $ 14,832 Corporate debt securities Less than 1 106,850 116 (13 ) 106,953 Commercial paper Less than 1 47,506 12 (9 ) 47,509 Government, federal agency, and other sovereign obligations Less than 1 9,862 10 — 9,872 Asset-backed securities Less than 1 11,541 — (19 ) 11,522 Total short-term marketable securities $ 190,593 $ 139 $ (44 ) $ 190,688 Long-term: Municipal bonds 1-2 $ 13,866 $ 50 $ (1 ) $ 13,915 Corporate debt securities 1-3 128,615 1,145 (25 ) 129,735 Asset-backed securities 1-3 151,855 870 (17 ) 152,708 Government, federal agency, and other sovereign obligations 1-2 4,422 22 — 4,444 Total long-term marketable securities $ 298,758 $ 2,087 $ (43 ) $ 300,802 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

FAIR VALUE MEASUREMENTS (Tables

FAIR VALUE MEASUREMENTS (Tables)	3 Months Ended
	Mar. 31, 2019
Fair Value, Assets Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
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) March 31, Level 1 Level 2 Level 3 Assets Cash equivalents $ 26,569 $ 9,598 $ 16,971 $ — Municipal bonds 28,747 — 28,747 — Corporate debt securities 236,688 — 236,688 — Commercial paper 47,509 — 47,509 — Asset-backed securities 164,230 — 164,230 — Government, federal agency, and other sovereign obligations 14,316 — 14,316 — Liabilities Business acquisition liabilities 5,289 — — 5,289 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 Business acquisition liabilities 10,118 — — 10,118
Fair Value Measurement Inputs and Valuation Techniques [Table Text Block]	The recurring Level 3 fair value measurements of our business acquisition liabilities include the following significant unobservable inputs, which have not materially changed since December 31, 2018 : Fair Value at (In thousands) March 31, Valuation technique Unobservable input Range Discount rate 8.5% Revenue-based payments $ 5,289 Discounted cash flow Probability of payment 75.0% - 100.0% Projected year of payment 2019 - 2029
Rollforward of contingent consideration	The following table provides a reconciliation of the beginning and ending balances of business acquisition liabilities: Three Months Ended (In thousands) March 31, March 31, Beginning balance $ 10,118 $ 15,919 Changes resulting from foreign currency fluctuations (58 ) 141 Contingent payments (5,350 ) (5,440 ) Changes in fair value of business acquisition liabilities 579 234 Ending balance $ 5,289 $ 10,854

INVENTORIES (Tables)

INVENTORIES (Tables)	3 Months Ended
	Mar. 31, 2019
Inventory Disclosure [Abstract]
Schedule of Inventory	(In thousands) March 31, December 31, 2018 Raw materials $ 27,157 $ 20,740 Work in process 11,216 13,179 Finished goods 105,007 97,335 Total inventories $ 143,380 $ 131,254

ACCRUED EXPENSES (Tables)

ACCRUED EXPENSES (Tables)	3 Months Ended
	Mar. 31, 2019
Payables and Accruals [Abstract]
Accrued Expenses	(In thousands) March 31, December 31, Compensation and other employee-related costs $ 26,107 $ 32,465 Legal and other settlements and expenses 1,643 6,684 Accrued non-income taxes 4,425 3,593 Royalties 2,417 2,500 Other 14,013 14,636 Total accrued expenses $ 48,605 $ 59,878

EQUITY (Tables)

EQUITY (Tables)	3 Months Ended
	Mar. 31, 2019
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 March 31, 2019 76,552,289 22,430,097 — 98,982,386 December 31, 2018 76,143,257 22,430,097 — 98,573,354
Schedule of Stockholders Equity	The following table summarizes changes in total equity: Three Months Ended Three Months Ended (In thousands) March 31, March 31, Total equity, beginning of period $ 1,185,516 $ 967,778 Net income 33,210 39,538 Stock-based compensation cost 6,541 6,110 Exercise of stock options 10,255 9,307 Other comprehensive income 1,692 4,135 Total equity, end of period $ 1,237,214 $ 1,026,868

EQUITY Accumulated Other Compre

EQUITY Accumulated Other Comprehensive Income (Tables)	3 Months Ended
	Mar. 31, 2019
Accumulated Other Comprehensive Income [Abstract]
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 income/(loss) and reclassifications out of accumulated other comprehensive income/(loss): (In thousands) Three Months 2018 Unrealized gain/(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, 2018 $ (168 ) $ (7,004 ) $ (7,172 ) Other comprehensive (loss)/income before reclassifications 2,353 (107 ) 2,246 Amounts reclassified from accumulated other comprehensive income, net of tax (554 ) — (554 ) Other comprehensive (loss)/income, net of tax 1,799 (107 ) 1,692 Accumulated other comprehensive loss, net of tax, at March 31, 2019 $ 1,631 $ (7,111 ) $ (5,480 ) (In thousands) Three Months 2017 Unrealized gain/(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, 2017 $ (313 ) $ (6,594 ) $ (6,907 ) Other comprehensive income before reclassifications (237 ) 4,371 4,134 Amounts reclassified from accumulated other comprehensive income, net of tax 1 — 1 Other comprehensive income, net of tax (236 ) 4,371 4,135 Accumulated other comprehensive loss, net of tax, at March 31, 2018 $ (549 ) $ (2,223 ) $ (2,772 )

STOCK-BASED COMPENSATION (Table

STOCK-BASED COMPENSATION (Tables)	3 Months Ended
	Mar. 31, 2019
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Grants in Period, Weighted Average Grant Date Fair Value	The weighted average grant date fair value per share of the options awarded to employees were as follows: Three Months Ended March 31, March 31, Weighted average grant date fair value per share $ 13.78 $ 13.74
Summary of Stock Option Activity	Stock option activity during the three months ended March 31, 2019 is summarized as follows: Option Shares (thousands) Weighted average exercise price Weighted average remaining contractual life (years) Aggregate intrinsic value (thousands) Outstanding at December 31, 2018 9,668 $ 31.45 Granted 1,802 45.66 Exercised (407 ) 25.60 Forfeited (311 ) 38.62 Outstanding at March 31, 2019 10,752 $ 33.84 7.7 $ 170,472 Exercisable at March 31, 2019 4,599 $ 24.78 6.2 $ 113,287 Expected to vest at March 31, 2019 6,153 $ 40.61 8.8 $ 57,185
Intrinsic Value and Stock-based Compensation Schedule	The intrinsic value of stock options exercised and the compensation cost related to stock options granted to employees and non-employees under our stock plans was as follows: Three Months Ended (In thousands) March 31, March 31, Intrinsic value of stock options exercised $ 8,424 $ 14,848 Stock-based compensation expense $ 6,448 $ 6,053 Net stock-based compensation capitalized into inventory 93 57 Total stock-based compensation cost $ 6,541 $ 6,110

INCOME TAXES (Tables)

INCOME TAXES (Tables)	3 Months Ended
	Mar. 31, 2019
Income Tax Disclosure [Abstract]
Effective income tax rate	The following table provides a summary of our effective tax rate: Three Months Ended March 31, March 31, Effective income tax rate 20.3 % 17.8 %

LEASES (Tables)

LEASES (Tables)	3 Months Ended
	Mar. 31, 2019
Leases [Abstract]
Schedule of Supplemental Balance Sheet Information Related to Leases [Table Text Block]	Amounts reported in the Consolidated Balance Sheet as of the quarter ended March 31, 2019 were as follows: (In thousands, except weighted average lease term and discount rate) Operating leases: Right of use assets $ 1,944 Lease liability - short term 1,141 Lease liability - long term 803 Total operating lease liability $ 1,944 Lease expense as of March 31, 2019 $ 719 Weighted-average remaining lease term - operating leases (in years) 2 Weighted-average discount rate 2.9 %
Schedule of Future Minimum Rental Payments for Operating Leases [Table Text Block]	Future minimum lease payments under non-cancellable leases as of the quarter ended March 31, 2019 are as follows: (In thousands) Operating Leases 2019 (excluding the three months ended March 31, 2019) $ 924 2020 775 2021 210 2022 74 2023 36 Thereafter — Total undiscounted leases payments $ 2,019 Less : imputed interest 75 Total lease liabilities $ 1,944

SEGMENT AND GEOGRAPHIC INFORM_2

SEGMENT AND GEOGRAPHIC INFORMATION (Tables)	3 Months Ended
	Mar. 31, 2019
Segment Reporting [Abstract]
Schedule of Revenue from External Customers by Geographical Area	The following table represents total sales by geographic area, based on the location of the customer: Three Months Ended (In thousands) March 31, March 31, United States $ 147,536 $ 145,618 International 35,411 28,793 Total sales $ 182,947 $ 174,411

BACKGROUND AND SUMMARY OF SIG_4

BACKGROUND AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Details) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2019USD ($)$ / shares	Mar. 31, 2018USD ($)$ / shares	Dec. 31, 2018USD ($)	Dec. 31, 2017USD ($)
Summary of Significant Accounting Policies
Revenues	$ 182,947	$ 174,411
Cash and cash equivalents	129,976	119,836	$ 139,647	$ 118,817
Restricted Cash	0	0	100	0
Capital Expenditures Incurred but Not yet Paid	3,600	7,700
Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents	129,976	119,836	139,747	118,817
Payments to Acquire Investments	127,911	118,403
Proceeds from Sale of Available-for-sale Securities	$ 11,773	$ 1,333
Diluted | $ / shares	$ 0.33	$ 0.39
Minimum
Summary of Significant Accounting Policies
Number of Products Launched Since Inception	190
Adjustments for New Accounting Pronouncement [Member]
Summary of Significant Accounting Policies
Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents	$ 129,976	$ 119,836	$ 139,747	$ 118,817
Spine [Member]
Summary of Significant Accounting Policies
Revenues	175,758	161,689
Emerging Technology [Member]
Summary of Significant Accounting Policies
Revenues	$ 7,189	$ 12,722

NOTE RECEIVABLE (Details)

NOTE RECEIVABLE (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Dec. 20, 2016	Sep. 01, 2016
Note Receivable
Proceeds from Collection of Notes Receivable	$ 29.3
Maximum
Note Receivable
Note Receivable, gross, noncurrent	$ 30
Minimum
Note Receivable
Note receivable, basis spread on variable rate	9.50%
Initial
Note Receivable
Note Receivable, gross, noncurrent			$ 25
Final
Note Receivable
Note Receivable, gross, noncurrent		$ 5
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_3

GOODWILL AND INTANGIBLE ASSETS (Details) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2019	Dec. 31, 2018	Sep. 05, 2018	Mar. 31, 2018	Dec. 31, 2017
Acquired Intangible Assets
Intangible assets, gross	$ 111,863	$ 111,537
Accumulated amortization	(27,594)	(24,214)
Intangible assets, net	84,269	87,323
Business Combination, Contingent Consideration, Liability	$ 5,289	$ 10,118		$ 10,854	$ 15,919
Supplier Network
Acquired Intangible Assets
Weighted average amortization period	10 years	10 years
Gross carrying amount	$ 4,000	$ 4,000
Accumulated amortization	(1,767)	(1,667)
Finite-lived intangible assets, net	$ 2,233	$ 2,333
Customer Relationships & Other Intangibles
Acquired Intangible Assets
Weighted average amortization period	6 years 8 months 18 days	6 years 8 months 18 days
Gross carrying amount	$ 42,530	$ 42,413
Accumulated amortization	(19,389)	(17,746)
Finite-lived intangible assets, net	$ 23,141	$ 24,667
Developed Technology Rights [Member]
Acquired Intangible Assets
Intangible Assets, Explanation of Significant Additions	19.8
Weighted average amortization period	8 years 7 months	8 years 7 months
Gross carrying amount	$ 57,272	$ 37,547
Accumulated amortization	(5,050)	(3,498)
Finite-lived intangible assets, net	$ 52,222	$ 34,049
Patents
Acquired Intangible Assets
Weighted average amortization period	16 years 4 months	16 years 6 months 1 day
Gross carrying amount	$ 8,061	$ 7,764
Accumulated amortization	(1,388)	(1,303)
Finite-lived intangible assets, net	$ 6,673	6,461
In Process Research and Development
Acquired Intangible Assets
Weighted average amortization period	8 years 6 months
In Process Research and Development
Acquired Intangible Assets
Indefinite-lived intangible assets		(19,813)
Accumulated amortization		$ 0
Acquisition 2018 [Member]
Acquired Intangible Assets
Payments to Acquire Businesses, Gross	$ 15,200
Business Combination, Contingent Consideration, Liability			$ 10,000

GOODWILL AND INTANGIBLE ASSET_4

GOODWILL AND INTANGIBLE ASSETS Goodwill rollforward (Details) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Goodwill [Line Items]
Goodwill	$ 123,680	$ 123,734	$ 123,890
Goodwill, Period Increase (Decrease)	0	0
Goodwill, Foreign Currency Translation Gain (Loss)	$ (54)	$ (156)

MARKETABLE SECURITIES (Details)

MARKETABLE SECURITIES (Details) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2019	Dec. 31, 2018
Schedule of Marketable Securities
Debt Securities, Available-for-sale, Current	$ 190,688	$ 199,937
Debt Securities, Available-for-sale, Noncurrent	300,802	263,117
Short-term Marketable Securities
Schedule of Marketable Securities
Debt Securities, Available-for-sale, Amortized Cost	(190,593)	(200,210)
Debt Securities, Available-for-sale, Accumulated Gross Unrealized Gain, before Tax	139	3
Debt Securities, Available-for-sale, Accumulated Gross Unrealized Loss, before Tax	(44)	(276)
Debt Securities, Available-for-sale, Current	190,688	199,937
Short-term Marketable Securities | Municipal Bonds
Schedule of Marketable Securities
Debt Securities, Available-for-sale, Amortized Cost	(14,834)	(14,923)
Debt Securities, Available-for-sale, Accumulated Gross Unrealized Gain, before Tax	1	0
Debt Securities, Available-for-sale, Accumulated Gross Unrealized Loss, before Tax	(3)	(25)
Debt Securities, Available-for-sale	$ 14,832	$ 14,898
Short-term Marketable Securities | Municipal Bonds | Maximum
Schedule of Marketable Securities
Contractual Maturity	1 year	1 year
Short-term Marketable Securities | Corporate Debt Securities
Schedule of Marketable Securities
Debt Securities, Available-for-sale, Amortized Cost	$ (106,850)	$ (118,823)
Debt Securities, Available-for-sale, Accumulated Gross Unrealized Gain, before Tax	116	0
Debt Securities, Available-for-sale, Accumulated Gross Unrealized Loss, before Tax	(13)	(185)
Debt Securities, Available-for-sale	$ 106,953	$ 118,638
Short-term Marketable Securities | Corporate Debt Securities | Maximum
Schedule of Marketable Securities
Contractual Maturity	1 year	1 year
Short-term Marketable Securities | Commercial Paper
Schedule of Marketable Securities
Debt Securities, Available-for-sale, Amortized Cost	$ (47,506)	$ (50,202)
Debt Securities, Available-for-sale, Accumulated Gross Unrealized Gain, before Tax	12	3
Debt Securities, Available-for-sale, Accumulated Gross Unrealized Loss, before Tax	(9)	(11)
Debt Securities, Available-for-sale	$ 47,509	$ 50,194
Short-term Marketable Securities | Commercial Paper | Maximum
Schedule of Marketable Securities
Contractual Maturity	1 year	1 year
Short-term Marketable Securities | Asset-backed Securities
Schedule of Marketable Securities
Debt Securities, Available-for-sale, Amortized Cost	$ (11,541)	$ (11,765)
Debt Securities, Available-for-sale, Accumulated Gross Unrealized Gain, before Tax	0	0
Debt Securities, Available-for-sale, Accumulated Gross Unrealized Loss, before Tax	(19)	(54)
Debt Securities, Available-for-sale	$ 11,522	$ 11,711
Short-term Marketable Securities | Asset-backed Securities | Maximum
Schedule of Marketable Securities
Contractual Maturity	1 year	1 year
Short-term Marketable Securities | Securities of U.S. government-sponsored agencies
Schedule of Marketable Securities
Debt Securities, Available-for-sale, Amortized Cost	$ (9,862)	$ (4,497)
Debt Securities, Available-for-sale, Accumulated Gross Unrealized Gain, before Tax	10	0
Debt Securities, Available-for-sale, Accumulated Gross Unrealized Loss, before Tax	0	(1)
Debt Securities, Available-for-sale	$ 9,872	$ 4,496
Short-term Marketable Securities | Securities of U.S. government-sponsored agencies | Maximum
Schedule of Marketable Securities
Contractual Maturity	1 year	1 year
Long-term Marketable Securities
Schedule of Marketable Securities
Debt Securities, Available-for-sale, Amortized Cost	$ (298,758)	$ (263,060)
Debt Securities, Available-for-sale, Accumulated Gross Unrealized Gain, before Tax	2,087	458
Debt Securities, Available-for-sale, Accumulated Gross Unrealized Loss, before Tax	(43)	(401)
Debt Securities, Available-for-sale, Noncurrent	300,802	263,117
Long-term Marketable Securities | Municipal Bonds
Schedule of Marketable Securities
Debt Securities, Available-for-sale, Amortized Cost	(13,866)	(2,676)
Debt Securities, Available-for-sale, Accumulated Gross Unrealized Gain, before Tax	50	0
Debt Securities, Available-for-sale, Accumulated Gross Unrealized Loss, before Tax	(1)	(4)
Debt Securities, Available-for-sale	$ 13,915	$ 2,672
Long-term Marketable Securities | Municipal Bonds | Minimum
Schedule of Marketable Securities
Contractual Maturity	1 year	1 year
Long-term Marketable Securities | Municipal Bonds | Maximum
Schedule of Marketable Securities
Contractual Maturity	2 years	2 years
Long-term Marketable Securities | Corporate Debt Securities
Schedule of Marketable Securities
Debt Securities, Available-for-sale, Amortized Cost	$ (128,615)	$ (127,676)
Debt Securities, Available-for-sale, Accumulated Gross Unrealized Gain, before Tax	1,145	196
Debt Securities, Available-for-sale, Accumulated Gross Unrealized Loss, before Tax	(25)	(295)
Debt Securities, Available-for-sale	$ 129,735	$ 127,577
Long-term Marketable Securities | Corporate Debt Securities | Minimum
Schedule of Marketable Securities
Contractual Maturity	1 year	1 year
Long-term Marketable Securities | Corporate Debt Securities | Maximum
Schedule of Marketable Securities
Contractual Maturity	3 years	3 years
Long-term Marketable Securities | Asset-backed Securities
Schedule of Marketable Securities
Debt Securities, Available-for-sale, Amortized Cost	$ (151,855)	$ (128,297)
Debt Securities, Available-for-sale, Accumulated Gross Unrealized Gain, before Tax	870	262
Debt Securities, Available-for-sale, Accumulated Gross Unrealized Loss, before Tax	(17)	(89)
Debt Securities, Available-for-sale	$ 152,708	$ 128,470
Long-term Marketable Securities | Asset-backed Securities | Minimum
Schedule of Marketable Securities
Contractual Maturity	1 year	1 year
Long-term Marketable Securities | Asset-backed Securities | Maximum
Schedule of Marketable Securities
Contractual Maturity	3 years	3 years
Long-term Marketable Securities | Securities of U.S. government-sponsored agencies
Schedule of Marketable Securities
Available-for-sale Securities, Amortized Cost Basis	$ 4,422	$ 4,411
Available-for-sale Securities, Accumulated Gross Unrealized Gain, before Tax	22	0
Available-for-sale Securities, Accumulated Gross Unrealized Loss, before Tax	0	13
Fair Value	$ 4,444	$ 4,398
Long-term Marketable Securities | Securities of U.S. government-sponsored agencies | Minimum
Schedule of Marketable Securities
Contractual Maturity	1 year	1 year
Long-term Marketable Securities | Securities of U.S. government-sponsored agencies | Maximum
Schedule of Marketable Securities
Contractual Maturity	3 years	3 years
Fair Value, Measurements, Recurring [Member] | Municipal Bonds
Schedule of Marketable Securities
Debt Securities, Available-for-sale	$ 28,747	$ 17,570
Fair Value, Measurements, Recurring [Member] | Corporate Debt Securities
Schedule of Marketable Securities
Debt Securities, Available-for-sale	236,688	246,215
Fair Value, Measurements, Recurring [Member] | Commercial Paper
Schedule of Marketable Securities
Debt Securities, Available-for-sale	47,509	50,194
Fair Value, Measurements, Recurring [Member] | Asset-backed Securities
Schedule of Marketable Securities
Debt Securities, Available-for-sale	164,230	140,181
Fair Value, Measurements, Recurring [Member] | Securities of U.S. government-sponsored agencies
Schedule of Marketable Securities
Debt Securities, Available-for-sale	14,316	8,894
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 3 [Member] | Municipal Bonds
Schedule of Marketable Securities
Debt Securities, Available-for-sale	0	0
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 3 [Member] | Corporate Debt Securities
Schedule of Marketable Securities
Debt Securities, Available-for-sale	0	0
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 3 [Member] | Commercial Paper
Schedule of Marketable Securities
Debt Securities, Available-for-sale	0	0
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 3 [Member] | Asset-backed Securities
Schedule of Marketable Securities
Debt Securities, Available-for-sale	0	0
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 3 [Member] | Securities of U.S. government-sponsored agencies
Schedule of Marketable Securities
Debt Securities, Available-for-sale	$ 0	$ 0
Revenue-based payments [Member] | Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 3 [Member] | Minimum
Schedule of Marketable Securities
Probability of Payment	75.00%
Revenue-based payments [Member] | Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 3 [Member] | Maximum
Schedule of Marketable Securities
Probability of Payment	100.00%

FAIR VALUE MEASUREMENTS (Detail

FAIR VALUE MEASUREMENTS (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018	Mar. 31, 2019	Dec. 31, 2018
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 business acquisition liabilities include the following significant unobservable inputs, which have not materially changed since December 31, 2018 : Fair Value at (In thousands) March 31, Valuation technique Unobservable input Range Discount rate 8.5% Revenue-based payments $ 5,289 Discounted cash flow Probability of payment 75.0% - 100.0% Projected year of payment 2019 - 2029
Contingent consideration	$ 10,118	$ 15,919	$ 5,289	$ 10,118
Contingent Consideration Payment [Roll Forward]
Contingent consideration, beginning balance	10,118	15,919
Contingent consideration currency translation loss/(gain)	(58)	141
Contingent Payments	5,350	5,440
Changes in fair value of contingent consideration	579	234
Contingent consideration, ending balance	5,289	$ 10,854
Fair Value, Measurements, Recurring [Member]
Fair Value, Assets and Liabilities Measured on Recurring Basis
Cash equivalents			26,569	48,040
Contingent consideration	10,118		5,289	10,118
Contingent Consideration Payment [Roll Forward]
Contingent consideration, beginning balance	10,118
Contingent consideration, ending balance	5,289
Fair Value, Measurements, Recurring [Member] | Level 1
Fair Value, Assets and Liabilities Measured on Recurring Basis
Cash equivalents			9,598	259
Contingent consideration	0		0	0
Contingent Consideration Payment [Roll Forward]
Contingent consideration, beginning balance	0
Contingent consideration, ending balance	0
Fair Value, Measurements, Recurring [Member] | Level 2
Fair Value, Assets and Liabilities Measured on Recurring Basis
Cash equivalents			16,971	47,781
Contingent consideration	0		0	0
Contingent Consideration Payment [Roll Forward]
Contingent consideration, beginning balance	0
Contingent consideration, ending balance	0
Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring Basis
Cash equivalents			0	0
Contingent consideration	10,118		5,289	10,118
Contingent Consideration Payment [Roll Forward]
Contingent consideration, beginning balance	10,118
Contingent consideration, ending balance	5,289
Municipal Bonds | Fair Value, Measurements, Recurring [Member]
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale			28,747	17,570
Municipal Bonds | Fair Value, Measurements, Recurring [Member] | Level 1
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale			0	0
Municipal Bonds | Fair Value, Measurements, Recurring [Member] | Level 2
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale			28,747	17,570
Municipal Bonds | Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale			0	0
Corporate Debt Securities | Fair Value, Measurements, Recurring [Member]
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale			236,688	246,215
Corporate Debt Securities | Fair Value, Measurements, Recurring [Member] | Level 1
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale			0	0
Corporate Debt Securities | Fair Value, Measurements, Recurring [Member] | Level 2
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale			236,688	246,215
Corporate Debt Securities | Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale			0	0
Commercial Paper | Fair Value, Measurements, Recurring [Member]
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale			47,509	50,194
Commercial Paper | Fair Value, Measurements, Recurring [Member] | Level 1
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale			0	0
Commercial Paper | Fair Value, Measurements, Recurring [Member] | Level 2
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale			47,509	50,194
Commercial Paper | Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale			0	0
Asset-backed Securities | Fair Value, Measurements, Recurring [Member]
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale			164,230	140,181
Asset-backed Securities | Fair Value, Measurements, Recurring [Member] | Level 1
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale			0	0
Asset-backed Securities | Fair Value, Measurements, Recurring [Member] | Level 2
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale			164,230	140,181
Asset-backed Securities | Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale			0	0
Securities of U.S. government-sponsored agencies | Fair Value, Measurements, Recurring [Member]
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale			14,316	8,894
Securities of U.S. government-sponsored agencies | Fair Value, Measurements, Recurring [Member] | Level 1
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale			0	0
Securities of U.S. government-sponsored agencies | Fair Value, Measurements, Recurring [Member] | Level 2
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale			14,316	8,894
Securities of U.S. government-sponsored agencies | Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring Basis
Debt Securities, Available-for-sale			0	$ 0
Revenue-based payments [Member] | Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 3 [Member]
Fair Value, Assets and Liabilities Measured on Recurring Basis
Contingent consideration	5,289		$ 5,289
Contingent Consideration Payment [Roll Forward]
Contingent consideration, ending balance	$ 5,289
Revenue-based payments [Member] | Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 3 [Member] | Minimum
Fair Value, Assets and Liabilities Measured on Recurring Basis
Probability of Payment	75.00%
Revenue-based payments [Member] | Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 3 [Member] | Maximum
Fair Value, Assets and Liabilities Measured on Recurring Basis
Probability of Payment	100.00%
Measurement Input, Discount Rate [Member] | Revenue-based payments [Member] | Fair Value, Measurements, Recurring [Member] | Fair Value, Inputs, Level 3 [Member] | Maximum
Fair Value, Assets and Liabilities Measured on Recurring Basis
Discount Rate	8.50%

INVENTORIES (Details)

INVENTORIES (Details) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Inventory Disclosure [Abstract]
Raw Materials	$ 27,157	$ 20,740
Work in process	11,216	13,179
Finished goods	105,007	97,335
Total inventories	$ 143,380	$ 131,254

ACCRUED EXPENSES (Details)

ACCRUED EXPENSES (Details) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Payables and Accruals [Abstract]
Compensation and other employee-related costs	$ 26,107	$ 32,465
Legal and other settlements and expenses	1,643	6,684
Accrued non-income taxes	4,425	3,593
Royalties	2,417	2,500
Other	14,013	14,636
Total accrued expenses	$ 48,605	$ 59,878

DEBT (Details)

DEBT (Details) - Revolving Credit Facility - USD ($) $ in Millions	3 Months Ended	9 Months Ended
	Mar. 31, 2019	Sep. 30, 2018	May 31, 2011
Debt Instrument
Credit facility, current borrowing capacity	$ 125		$ 50
Credit facility, maximum borrowing capacity	150
Credit facility, outstanding borrowings	$ 0
Credit facility, termination period without penalty	10 days
Fluctuating Rate Per Annum
Debt Instrument
Credit facility, variable rate	LIBOR
Credit facility, period of variable rate	1 month
Credit facility, basis spread on variable rate	0.75%
Fixed Rate
Debt Instrument
Credit facility, variable rate	LIBOR
Credit facility, basis spread on variable rate		0.75%
Fixed Rate | Minimum
Debt Instrument
Credit facility, period of variable rate	1 month
Fixed Rate | Maximum
Debt Instrument
Credit facility, period of variable rate	3 months
Letter of Credit
Debt Instrument
Credit facility, maximum borrowing capacity	$ 25

EQUITY (Textuals) (Details)

EQUITY (Textuals) (Details) - shares	Mar. 31, 2019	Dec. 31, 2018
Class of Stock
Common stock, shares authorized	785,000,000
Class A Common
Class of Stock
Common stock, shares authorized	500,000,000	500,000,000
Class B Common
Class of Stock
Common stock, shares authorized	275,000,000	275,000,000
Class C Common
Class of Stock
Common stock, shares authorized	10,000,000

EQUITY (Schedule of Issued and

EQUITY (Schedule of Issued and Outstanding Shares) (Details) - shares	Mar. 31, 2019	Dec. 31, 2018
Class of Stock
Common stock, shares issued	98,982,386	98,573,354
Common stock, shares outstanding	98,982,386	98,573,354
Class A Common
Class of Stock
Common stock, shares issued	76,552,289	76,143,257
Common stock, shares outstanding	76,552,289	76,143,257
Class B Common
Class of Stock
Common stock, shares issued	22,430,097	22,430,097
Common stock, shares outstanding	22,430,097	22,430,097
Class C Common
Class of Stock
Common stock, shares issued	0	0
Common stock, shares outstanding	0	0

EQUITY Stockholders' Equity Rol

EQUITY Stockholders' Equity Rollforward (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Increase (Decrease) in Stockholders' Equity
Total equity, beginning of period	$ 1,185,516	$ 967,778
Net income	33,210	39,538
Stock-based compensation cost	6,541	6,110
Exercise of stock options	10,255	9,307
Other comprehensive income	1,692	4,135
Total equity, end of period	$ 1,237,214	$ 1,026,868

EQUITY Accumulated Other Comp_2

EQUITY Accumulated Other Comprehensive Income (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018	Dec. 31, 2018	Dec. 31, 2017
Accumulated other comprehensive income/(loss), net of tax	$ (5,480)	$ (2,772)	$ (7,172)	$ (6,907)
Other comprehensive income before reclassifications	2,246	4,134
Amounts reclassified from accumulated other comprehensive income, net of tax	(554)	1
Other comprehensive income/(loss), net of tax	1,692	4,135
Foreign Currency Translation Adjustment
Accumulated other comprehensive income/(loss), net of tax	(7,111)	(2,223)	(7,004)	(6,594)
Other comprehensive income before reclassifications	(107)	4,371
Amounts reclassified from accumulated other comprehensive income, net of tax	0	0
Other comprehensive income/(loss), net of tax	(107)	4,371
Unrealized Gain/(Loss) on Marketable Securities, Net of Tax
Accumulated other comprehensive income/(loss), net of tax	1,631	(549)	$ (168)	$ (313)
Other comprehensive income before reclassifications	2,353	(237)
Amounts reclassified from accumulated other comprehensive income, net of tax	(554)	1
Other comprehensive income/(loss), net of tax	$ 1,799	$ (236)

STOCK-BASED COMPENSATION (Textu

STOCK-BASED COMPENSATION (Textuals) (Details) $ in Millions	3 Months Ended
	Mar. 31, 2019USD ($)shares
Share-based Compensation Arrangement by Share-based Payment Award
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 | $	$ 68.9
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	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
Number of shares available for grant	1,535,915
Shares reserved under the 2012 Equity Incentive Plan	14,889,882

STOCK-BASED COMPENSATION (Grant

STOCK-BASED COMPENSATION (Grant Date Fair Values of Options Awarded to Employees) (Details) - $ / shares	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Weighted average grant date fair value per share	$ 13.78	$ 13.74

STOCK-BASED COMPENSATION (Stock

STOCK-BASED COMPENSATION (Stock Option Activity) (Details) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2019USD ($)$ / sharesshares
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding
Number of shares outstanding beginning balance | shares	9,668
Number of shares granted | shares	1,802
Number of shares exercised | shares	(407)
Number of shares forfeited | shares	(311)
Number of shares outstanding ending balance | shares	10,752
Number of shares exercisable | shares	4,599
Number of shares expected to vest | shares	6,153
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding, Weighted Average Exercise Price
Weighted average exercise price per share outstanding beginning balance | $ / shares	$ 31.45
Weighted average exercise price per share granted | $ / shares	45.66
Weighted average exercise price per share exercised | $ / shares	25.60
Weighted average exercise price per share forfeited | $ / shares	38.62
Weighted average exercise price per share outstanding ending balance | $ / shares	33.84
Weighted average exercise price per share exercisable | $ / shares	24.78
Weighted average exercise price per share expected to vest | $ / shares	$ 40.61
Weighted average remaining contractual life outstanding	7 years 8 months
Weighted average remaining contractual life exercisable	6 years 2 months
Weighted average remaining contractual life expected to vest	8 years 9 months
Aggregate intrinsic value outstanding | $	$ 170,472
Aggregate intrinsic value exercisable | $	113,287
Aggregate intrinsic value expected to vest | $	$ 57,185

STOCK-BASED COMPENSATION (Compe

STOCK-BASED COMPENSATION (Compensation Expense Related to Stock Options and Their Intrinsic Values) (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Intrinsic value of stock options exercised	$ 8,424	$ 14,848
Stock-based compensation expense	6,448	6,053
Net stock-based compensation capitalized into inventory	93	57
Total stock-based compensation cost	$ 6,541	$ 6,110

INCOME TAXES (Details)

INCOME TAXES (Details)	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Income Tax Disclosure [Abstract]
Effective income tax rate	20.30%	17.80%

COMMITMENTS AND CONTINGENCIES (

COMMITMENTS AND CONTINGENCIES (Details) $ in Millions	3 Months Ended
	Mar. 31, 2019USD ($)	Mar. 11, 2015claim
Commitments and Contingencies Disclosure [Abstract]
prepaid royalty	$ 9
Accrual Reversal	2.5
Bianco Litigation
Loss Contingencies
Payments for Legal Settlements	$ 11.5
Flexuspine Inc. Litigation
Loss Contingencies
Loss Contingency, Pending Claims, Number | claim		5
Flexuspine Inc. Litigation | Minimum
Loss Contingencies
Loss Contingency, Pending Claims, Number | claim		1

LEASES (Details)

LEASES (Details)	Mar. 31, 2019
Leases [Abstract]
Lessee, Operating Lease, Term of Contract	12 years

LEASES Future minimum lease pay

LEASES Future minimum lease payments (Details) $ in Thousands	Mar. 31, 2019USD ($)
Leases [Abstract]
2019 (excluding the three months ended March 31, 2019)	$ 924
2020	775
2021	210
2022	74
2023	36
Thereafter	0
Total undiscounted leases payments	2,019
Less : imputed interest	75
Total operating lease liability	$ 1,944

LEASES Schedule of Supplemental

LEASES Schedule of Supplemental Balance Sheet Information Related to Leases (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2019USD ($)
Leases [Abstract]
Right of use assets	$ 1,944
Lease liability - short term	1,141
Lease liability - long term	803
Total operating lease liability	1,944
Lease expense as of March 31, 2019	$ 719
Weighted-average remaining lease term - operating leases (in years)	2 years
Weighted-average discount rate	2.90%

SEGMENT AND GEOGRAPHIC INFORM_3

SEGMENT AND GEOGRAPHIC INFORMATION (Geographic Location) (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2019USD ($)segments	Mar. 31, 2018USD ($)
Revenues from External Customers
Revenue from External Customers by Geographic Areas [Table Text Block]	$ 182,947	$ 174,411
Number of Reportable Segments | segments	1
United States
Revenues from External Customers
Revenue from External Customers by Geographic Areas [Table Text Block]	$ 147,536	145,618
International
Revenues from External Customers
Revenue from External Customers by Geographic Areas [Table Text Block]	$ 35,411	$ 28,793

SEGMENT AND GEOGRAPHIC INFORM_4

SEGMENT AND GEOGRAPHIC INFORMATION (Products) (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Revenue from External Customer
Revenues	$ 182,947	$ 174,411