Alphatec (ATEC) 10-K 26 Feb 25 2024 FY Annual report Financial data

Document and Entity Information

Document and Entity Information - USD ($) $ in Billions	12 Months Ended
	Dec. 31, 2024	Feb. 19, 2025	Jun. 28, 2024
Cover [Abstract]
Entity Registrant Name	ALPHATEC HOLDINGS, INC.
Entity Central Index Key	0001350653
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Document Type	10-K
Trading Symbol	ATEC
Document Period End Date	Dec. 31, 2024
Document Fiscal Year Focus	2024
Document Fiscal Period Focus (Q1,Q2,Q3,FY)	FY
Amendment Flag	false
Entity Well-known Seasoned Issuer	Yes
Entity Current Reporting Status	Yes
Entity Voluntary Filers	No
Entity Common Stock, Shares Outstanding		144,149,232
Entity Public Float			$ 1
Entity Emerging Growth Company	false
Entity Small Business	false
Entity Shell Company	false
ICFR Auditor Attestation Flag	true
Document Financial Statement Error Correction [Flag]	false
Entity File Number	000-52024
Entity Tax Identification Number	20-2463898
Entity Address, Address Line One	1950 Camino Vida Roble
Entity Address, City or Town	Carlsbad
Entity Address, State or Province	CA
Entity Address, Postal Zip Code	92008
City Area Code	760
Local Phone Number	431-9286
Document Annual Report	true
Document Transition Report	false
Entity Incorporation, State or Country Code	DE
Entity Interactive Data Current	Yes
Title of 12(b) Security	Common Stock, par value $0.0001 per share
Security Exchange Name	NASDAQ
Auditor Firm ID	34
Auditor Name	Deloitte & Touche LLP
Auditor Location	New York, New York, United States
Documents Incorporated by Reference	DOCUMENTS INCORPORATED BY REFERENCE The following documents (or parts thereof) are incorporated by reference into the following parts of this Form 10-K: Certain information required in Part III of this Annual Report on Form 10-K is incorporated from the Registrant’s Proxy Statement for the 2025 Annual Meeting of Stockholders.
Auditor Opinion	Opinion on the Financial Statements We have audited the accompanying consolidated balance sheets of Alphatec Holdings, Inc. and subsidiaries (the "Company") as of December 31, 2024 and 2023, the related consolidated statements of operations, comprehensive loss, stockholders' equity (deficit), and cash flows, for each of the three years in the period ended December 31, 2024, and the related notes (collectively referred to as the "financial statements"). In our opinion, the financial statements present fairly, in all material respects, the financial position of the Company as of December 31, 2024 and 2023, and the results of its operations and its cash flows for each of the three years in the period ended December 31, 2024, in conformity with accounting principles generally accepted in the United States of America. We have also audited, in accordance with the standards of the Public Company Accounting Oversight Board (United States) (PCAOB), the Company's internal control over financial reporting as of December 31, 2024, based on criteria established in Internal Control — Integrated Framework (2013) issued by the Committee of Sponsoring Organizations of the Treadway Commission and our report dated February 26, 2025, expressed an unqualified opinion on the Company's internal control over financial reporting.

CONSOLIDATED BALANCE SHEETS

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Current assets:
Cash and cash equivalents	$ 138,840	$ 220,970
Accounts receivable, net of allowances of $4,763 and $910, respectively	82,987	72,613
Inventories	175,264	136,842
Prepaid expenses and other current assets	20,308	20,666
Total current assets	417,399	451,091
Property and equipment, net	156,394	149,835
Right-of-use assets	34,701	26,410
Goodwill	70,976	73,003
Intangible assets, net	93,518	102,451
Other assets	2,722	2,418
Total assets	775,710	805,208
Current liabilities:
Accounts payable	52,984	48,985
Accrued expenses and other current liabilities	81,466	87,712
Contract liabilities	10,467	13,910
Short-term debt	1,656	1,808
Current portion of operating lease liabilities	6,453	5,159
Total current liabilities	153,026	157,574
Long-term debt	574,522	511,035
Operating lease liabilities, less current portion	27,305	23,677
Other long-term liabilities	11,423	11,203
Redeemable preferred stock, $0.0001 par value; 20,000 shares authorized, and 3,319 shares issued and outstanding at December 31, 2024 and 2023	23,603	23,603
Commitments and contingencies (Note 7)
Stockholders' (deficit) equity:
Common stock, $0.0001 par value; 200,000 authorized; 144,129 shares issued and outstanding at December 31, 2024, and 139,257 shares issued and 139,245 shares outstanding at December 31, 2023	14	14
Treasury stock, 1,808 shares at December 31, 2024 and December 31, 2023	(25,097)	(25,097)
Additional paid-in capital	1,305,677	1,230,484
Accumulated other comprehensive loss	(13,678)	(8,323)
Accumulated deficit	(1,281,085)	(1,118,962)
Total stockholders' (deficit) equity	(14,169)	78,116
Total liabilities and stockholders' (deficit) equity	$ 775,710	$ 805,208

CONSOLIDATED BALANCE SHEETS (Pa

CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Accounts receivable, net of allowances	$ 4,763	$ 910
Redeemable preferred stock, par value (dollars per share)	$ 0.0001	$ 0.0001
Redeemable preferred stock, shares authorized	20,000,000	20,000,000
Redeemable preferred stock, shares issued	3,319,000	3,319,000
Redeemable preferred stock, shares outstanding	3,319,000	3,319,000
Common stock, par value (dollars per share)	$ 0.0001	$ 0.0001
Common stock, shares authorized	200,000,000	200,000,000
Common stock, shares issued	144,129,000	139,257,000
Common stock, shares outstanding	144,129,000	139,245,000
Treasury stock, shares	1,808,000	1,808,000

CONSOLIDATED STATEMENTS OF OPER

CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Revenue:
Revenue	$ 611,562	$ 482,262	$ 350,867
Cost of sales	187,300	172,059	117,808
Gross profit	424,262	310,203	233,059
Operating expenses:
Research and development	80,718	70,115	44,033
Sales, general and administrative	450,199	374,080	300,013
Litigation-related expenses	9,799	22,287	23,943
Amortization expense	16,258	14,284	10,115
Transaction-related expenses	210	2,113	120
Restructuring expenses	3,247	719	1,810
Total operating expenses	560,431	483,598	380,034
Operating loss	(136,169)	(173,395)	(146,975)
Other expense, net:
Interest expense, net	(24,879)	(16,641)	(5,505)
Other (expense) income, net	(1,025)	3,121	471
Total other expense, net	(25,904)	(13,520)	(5,034)
Net loss before taxes	(162,073)	(186,915)	(152,009)
Income tax provision (benefit)	50	(277)	(716)
Net loss	$ (162,123)	$ (186,638)	$ (151,293)
Net loss per share, basic	$ (1.13)	$ (1.54)	$ (1.46)
Net loss per share, diluted	$ (1.13)	$ (1.54)	$ (1.46)
Weighted average shares outstanding, basic	142,946	121,242	103,373
Weighted average shares outstanding, diluted	142,946	121,242	103,373
Products and Services
Revenue:
Revenue	$ 611,562	$ 482,262	$ 350,867

CONSOLIDATED STATEMENTS OF COMP

CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Statement of Comprehensive Income [Abstract]
Net loss	$ (162,123)	$ (186,638)	$ (151,293)
Foreign currency translation adjustments	(5,355)	2,471	(4,758)
Comprehensive loss	$ (167,478)	$ (184,167)	$ (156,051)

CONSOLIDATED STATEMENTS OF STOC

CONSOLIDATED STATEMENTS OF STOCKHOLDERS' (DEFICIT) EQUITY - USD ($) shares in Thousands, $ in Thousands	Total	Common stock	Additional paid-in capital	Treasury Stock	Accumulated other comprehensive income (loss)	Accumulated deficit
Balance at Dec. 31, 2021	$ 80,674	$ 10	$ 892,828	$ (25,097)	$ (6,036)	$ (781,031)
Balance, shares at Dec. 31, 2021		99,537
Sales agent equity incentives	3,068		3,068
Sales agent equity incentives, shares		221
Stock-based compensation	37,591		37,591
Common stock issued for conversion of Series A preferred stock, shares		29
Common stock issued for warrant exercises	4,160	$ 1	4,159
Common stock issued for warrant exercises, shares		3,820
Common stock issued for employee stock purchase plan and stock option exercises	4,020		4,020
Common stock issued for employee stock purchase plan and stock option exercises, shares		806
Common stock issued for vesting of restricted stock units, net of shares withheld for tax liability	(11,220)		(11,220)
Common stock issued for vesting of restricted stock units, net of shares withheld for tax liability, shares		2,204
Reclassification of liability-classified awards	2,841		2,841
Common stock issued for asset acquisition	250		250
Common stock issued for asset acquisition, shares		23
Foreign currency translation adjustments	(4,758)				(4,758)
Net loss	(151,293)					(151,293)
Balance at Dec. 31, 2022	(34,667)	$ 11	933,537	(25,097)	(10,794)	(932,324)
Balance, shares at Dec. 31, 2022		106,640
Stock-based compensation	81,244		81,244
Common stock issued for warrant exercises	670	$ 1	669
Common stock issued for warrant exercises, shares		5,571
Common stock issued for employee stock purchase plan and stock option exercises	4,353		4,353
Common stock issued for employee stock purchase plan and stock option exercises, shares		774
Common stock issued for vesting of restricted stock units, net of shares withheld for tax liability	(6,061)		(6,061)
Common stock issued for vesting of restricted stock units, net of shares withheld for tax liability, shares		6,535
Reclassification of equity-based liability	3,561		3,561
Common stock offerings, net of offering costs of $12,136	213,183	$ 2	213,181
Common stock offerings, net of offering costs of $12,136, shares		19,725
Foreign currency translation adjustments	2,471				2,471
Net loss	(186,638)					(186,638)
Balance at Dec. 31, 2023	78,116	$ 14	1,230,484	(25,097)	(8,323)	(1,118,962)
Balance, shares at Dec. 31, 2023		139,245
Stock-based compensation	73,277		73,277
Common stock issued for warrant exercises	314		314
Common stock issued for warrant exercises, shares		63
Common stock issued for employee stock purchase plan and stock option exercises	4,865		4,865
Common stock issued for employee stock purchase plan and stock option exercises, shares		789
Common stock issued for vesting of restricted stock units, net of shares withheld for tax liability	(7,964)		(7,964)
Common stock issued for vesting of restricted stock units, net of shares withheld for tax liability, shares		4,014
Reclassification of equity-based liability	2,207		2,207
Issuance of common stock warrant	2,244		2,244
Common stock issued for asset acquisition	250		250
Common stock issued for asset acquisition, shares		18
Foreign currency translation adjustments	(5,355)				(5,355)
Net loss	(162,123)					(162,123)
Balance at Dec. 31, 2024	$ (14,169)	$ 14	$ 1,305,677	$ (25,097)	$ (13,678)	$ (1,281,085)
Balance, shares at Dec. 31, 2024		144,129

CONSOLIDATED STATEMENTS OF ST_2

CONSOLIDATED STATEMENTS OF STOCKHOLDERS' (DEFICIT) EQUITY (Parenthetical) $ in Thousands	12 Months Ended
	Dec. 31, 2023 USD ($)
Common stock, offering costs	$ 12,136

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Operating activities:
Net loss	$ (162,123)	$ (186,638)	$ (151,293)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation and amortization	78,418	56,139	41,168
Stock-based compensation	73,277	81,244	40,556
Amortization of debt discount and debt issuance costs	4,462	3,634	2,038
Amortization of right-of-use assets	4,902	3,543	2,760
Write-down for excess and obsolete inventories	15,421	13,608	9,792
Loss on disposal of assets	3,072	3,708	2,594
Other	5,194	455	1,187
Changes in operating assets and liabilities:
Accounts receivable	(14,589)	(12,795)	(18,832)
Inventories	(54,660)	(45,562)	(20,704)
Prepaid expenses and other current assets	(97)	(11,098)	552
Other assets	(466)	(541)	(109)
Accounts payable	9,671	6,989	9,796
Accrued expenses and other current liabilities	(1,781)	17,000	13,508
Lease liabilities	(5,495)	(3,602)	(2,678)
Contract liabilities	(3,261)	1,793	(2,280)
Other long-term liabilities	3,404	(6,362)	(3,189)
Net cash used in operating activities	(44,651)	(78,485)	(75,134)
Investing activities:
Purchases of property and equipment	(83,223)	(80,508)	(49,453)
Purchase of intangible assets	(9,913)	(6,467)	(8,827)
Acquisition of business, net of cash acquired		(55,000)
Net cash used in investing activities	(93,136)	(141,975)	(58,280)
Financing activities:
Proceeds from Revolving Credit Facility and line of credit	174,975	134,000	62,500
Repayment of Revolving Credit Facility and line of credit	(164,175)	(119,500)	(27,500)
Proceeds from term debt, net of debt discount	48,000	148,473
Net cash paid for common stock exercises	(560)	(1,064)	(3,041)
Payment of debt issuance costs	(140)	(3,321)	(1,315)
Proceeds from common stock offerings, net of offering costs		213,181
Repayment of OCEANEs		(13,315)
Other	(1,892)	(1,535)	584
Net cash provided by financing activities	56,208	356,919	31,228
Effect of exchange rate changes on cash	(551)	(185)	(366)
Net change in cash and cash equivalents	(82,130)	136,274	(102,552)
Cash and cash equivalents at beginning of year	220,970	84,696	187,248
Cash and cash equivalents at end of year	138,840	220,970	84,696
Supplemental disclosure of cash flow information:
Cash paid for interest	20,316	17,269	3,860
Cash paid for income taxes	275	333	272
Supplemental disclosure of noncash investing and financing activities:
Debt issuance costs			2,760
Financed insurance	1,156	1,328	1,959
Financed property and equipment			600
Purchases of property and equipment in accounts payable and accrued expenses	8,668	10,406	2,128
Purchase of intangible assets	250	99	750
Recognition of lease liability	11,923	424	1,694
Modification of lease liability for lease amendment			$ 4,288

Cybersecurity Risk Management,

Cybersecurity Risk Management, Strategy and Governance	12 Months Ended
	Dec. 31, 2024
Cybersecurity Risk Management, Strategy, and Governance [Line Items]
Cybersecurity Risk Management Processes for Assessing, Identifying, and Managing Threats [Text Block]	Item 1C. Cy bersecurity Cybersecurity Risk Management and Strategy We recognize the need to maintain the security and confidentiality of personal information, protected health information, and other confidential data that we collect and use in connection with our business, and the importance of assessing, identifying, and managing various cybersecurity risks that may impact our business. We have developed and implemented a cybersecurity risk management program intended to protect the confidentiality, integrity, and availability of our critical systems and information. Our cybersecurity risk management program includes a cybersecurity incident response plan. We design and assess our program based on various cybersecurity frameworks, most prominently the Health Information Trust Alliance (“HITRUST”) Common Security Framework, and Service Organization Controls (“SOC”) 2, developed by the American Institute of CPAs. In 2024, our cybersecurity systems, supporting infrastructure and EOS products received HITRUST e1 certification as they met the HITRUST CSF v11.20 certification criteria. We use this cybersecurity framework and information security controls as a guide to help us identify, assess, and manage cybersecurity risks relevant to our business. Our cybersecurity program includes annual review and assessment by external, independent third parties, who certify and report on these programs. As part of our enterprise risk management process, we assess the various cybersecurity risks that may impact our business and implement plans and initiatives that are intended to mitigate those risks. Our information security program includes: (i) risk assessments designed to help identify material cybersecurity risks to our critical systems, information, products, software, and services; (ii) an information security team principally responsible for managing our (1) information security risk assessment processes, (2) security controls, and (3) response to cybersecurity incidents; (iii) risk assessments and security tests, conducted internally and by external security and risk audit providers, as appropriate; (iv) new-hire and annual cybersecurity awareness training of our employees; (v) a cybersecurity incident response plan that includes procedures for responding to cybersecurity incidents; and (vi) third-party risk assessment procedures to review material third-party vendors and applications for information security. We have not identified any risks from known cybersecurity threats, including as a result of any prior cybersecurity incidents, that have materially affected or are reasonably likely to materially affect us, including our operations, business strategy, results of operations, or financial condition. Cybersecurity Governance Our Board considers cybersecurity risk as part of its risk oversight function and has delegated to the Audit Committee oversight over our information security and technology risks, including our information security, cybersecurity and related risk management programs. The Audit Committee oversees management’s implementation of our information security program and receives periodic reports from management on our material cybersecurity risks. Additionally, management updates the Audit Committee, as necessary, regarding material cybersecurity incidents. The full Board receives quarterly updates from management on our information security program. Our management team, including our IT management team, is responsible for assessing and managing our material risks from cybersecurity threats. The team has primary responsibility for our overall cybersecurity risk management program and supervises both our internal cybersecurity personnel and our retained external cybersecurity consultants. To support data security, we have established an integrated risk management framework with practices that are derived from industry standards, including ISO 27001, HITRUST Common Security Framework (CSF) 11.2 certification, the NIST Cybersecurity Framework, and data privacy regulations, including HIPAA and the General Data Protection Regulation. The data security controls from these standards and regulations are evaluated for our risk management framework based on the needs of our business and our clients, the nature of our industry, and applicable regulations. Our management team oversees efforts to prevent, detect, mitigate, and remediate cybersecurity risks and incidents through various means, which may include briefings from internal security personnel, threat intelligence and other information obtained from governmental, public, or private sources, including external consultants engaged by us, and alerts and reports produced by security tools deployed in the information technology environment.
Cybersecurity Risk Management Processes Integrated [Flag]	true
Cybersecurity Risk Management Processes Integrated [Text Block]	To support data security, we have established an integrated risk management framework with practices that are derived from industry standards, including ISO 27001, HITRUST Common Security Framework (CSF) 11.2 certification, the NIST Cybersecurity Framework, and data privacy regulations, including HIPAA and the General Data Protection Regulation.
Cybersecurity Risk Management Third Party Engaged [Flag]	true
Cybersecurity Risk Third Party Oversight and Identification Processes [Flag]	true
Cybersecurity Risk Materially Affected or Reasonably Likely to Materially Affect Registrant [Flag]	false
Cybersecurity Risk Board of Directors Oversight [Text Block]	Our Board considers cybersecurity risk as part of its risk oversight function and has delegated to the Audit Committee oversight over our information security and technology risks, including our information security, cybersecurity and related risk management programs. The Audit Committee oversees management’s implementation of our information security program and receives periodic reports from management on our material cybersecurity risks. Additionally, management updates the Audit Committee, as necessary, regarding material cybersecurity incidents. The full Board receives quarterly updates from management on our information security program.
Cybersecurity Risk Board Committee or Subcommittee Responsible for Oversight [Text Block]	Our Board considers cybersecurity risk as part of its risk oversight function and has delegated to the Audit Committee oversight over our information security and technology risks, including our information security, cybersecurity and related risk management programs.
Cybersecurity Risk Process for Informing Board Committee or Subcommittee Responsible for Oversight [Text Block]	The Audit Committee oversees management’s implementation of our information security program and receives periodic reports from management on our material cybersecurity risks. Additionally, management updates the Audit Committee, as necessary, regarding material cybersecurity incidents. The full Board receives quarterly updates from management on our information security program.
Cybersecurity Risk Role of Management [Text Block]	Our management team, including our IT management team, is responsible for assessing and managing our material risks from cybersecurity threats. The team has primary responsibility for our overall cybersecurity risk management program and supervises both our internal cybersecurity personnel and our retained external cybersecurity consultants. To support data security, we have established an integrated risk management framework with practices that are derived from industry standards, including ISO 27001, HITRUST Common Security Framework (CSF) 11.2 certification, the NIST Cybersecurity Framework, and data privacy regulations, including HIPAA and the General Data Protection Regulation. The data security controls from these standards and regulations are evaluated for our risk management framework based on the needs of our business and our clients, the nature of our industry, and applicable regulations.
Cybersecurity Risk Management Positions or Committees Responsible [Flag]	true
Cybersecurity Risk Management Positions or Committees Responsible [Text Block]	The team has primary responsibility for our overall cybersecurity risk management program and supervises both our internal cybersecurity personnel and our retained external cybersecurity consultants.
Cybersecurity Risk Management Positions or Committees Responsible Report to Board [Flag]	true

Pay vs Performance Disclosure

Pay vs Performance Disclosure - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Pay vs Performance Disclosure
Net Income (Loss)	$ (162,123)	$ (186,638)	$ (151,293)

Insider Trading Arrangements

Insider Trading Arrangements shares in Thousands	3 Months Ended
	Dec. 31, 2024 shares
Trading Arrangements, by Individual
Material Terms of Trading Arrangement	Adoption, Modification or Termination of Trading Arrangements A portion of the compensation of our directors and officers is in the form of equity awards, and, from time to time, directors and officers engage in open-market transactions with respect to the securities they acquire pursuant to such equity awards we have issued. Transactions in our securities by directors and officers are required to be made in accordance with our insider trading policy, which requires that the transactions comply with applicable U.S. federal securities laws that prohibit trading while in possession of material nonpublic information. Rule 10b5-1 under the Exchange Act provides an affirmative defense that enables directors and officers to prearrange transactions in our securities in a manner that avoids concerns about initiating transactions while in possession of material nonpublic information. The following table describes the contracts, instructions or written plans for the purchase or sale of securities adopted by our directors or officers (as defined in Rule 16a-1(f) under the Exchange Act) during the three months ended December 31, 2024, that are intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). No other Rule 10b5-1 trading arrangements or “non-Rule 10b5-1 trading arrangements” (as defined by S-K Item 408(c)) were entered into or terminated by our directors or officers during such period:
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false
J. Todd Koning [Member]
Trading Arrangements, by Individual
Name	J. Todd Koning
Title	Executive Vice President and Chief Financial Officer
Rule 10b5-1 Arrangement Adopted	true
Adoption Date	11/26/2024
Expiration Date	December 31, 2025
Aggregate Available	89,321
Karen McGinnis [Member]
Trading Arrangements, by Individual
Name	Karen McGinnis
Title	Member of the Board of Directors
Rule 10b5-1 Arrangement Adopted	true
Adoption Date	12/3/2024
Expiration Date	December 31, 2025
Aggregate Available	42,283

Organization and Significant Ac

Organization and Significant Accounting Policies	12 Months Ended
	Dec. 31, 2024
Accounting Policies [Abstract]
Organization and Significant Accounting Policies	1. Organization and Significant Accounting Policies The Company Alphatec Holdings, Inc. (the “Company”), through its wholly owned subsidiaries, Alphatec Spine, Inc. (“Alphatec Spine”), SafeOp Surgical, Inc. (“SafeOp”), and EOS imaging S.A.S. (“EOS”), is a medical technology company focused on the design, development, and advancement of technology for the better surgical treatment of spinal disorders. The Company, headquartered in Carlsbad, California, markets its products in the United States ("U.S.") and internationally via a network of independent sales agents and direct sales representatives. Basis of Presentation and Principles of Consolidation The accompanying consolidated financial statements have been prepared in accordance with generally accepted accounting principles in the United States of America ("U.S. GAAP") and include the accounts of the Company and its wholly owned subsidiaries. The Company translates the financial statements of its foreign subsidiaries using end-of-period exchange rates for assets and liabilities and average exchange rates during each reporting period for results of operations. All intercompany balances and transactions have been eliminated in consolidation. The Company operates in one reportable business segment. Reclassification Certain financial statement line items in the consolidated financial statements for the year ended December 31, 2022 have been aggregated to conform to the current year’s presentation. Use of Estimates The carrying amount of financial instruments consisting of cash and cash equivalents, accounts receivable, prepaid expenses and other current assets, accounts payable, accrued expenses, and short-term debt included in the Company’s consolidated financial statements are reasonable estimates of fair value due to their short maturities. Concentrations of Credit Risk and Significant Customers Financial instruments, which potentially subject the Company to concentrations of credit risk, consist primarily of cash, cash equivalents, and accounts receivable. The Company limits its exposure to credit loss by depositing its cash and investments with established financial institutions. Although the Company deposits its cash with multiple financial institutions, its deposits, at times, may exceed federally insured limits. The Company’s customers are primarily hospitals and surgical centers. No one single customer represented greater than 10 percent of consolidated revenues and accounts receivable for the years presented. Credit to customers is granted based on an analysis of the customers’ credit worthiness. Credit losses have not been significant. Cash and Cash Equivalents The company considers all highly liquid investments that are readily convertible into cash and have an original maturity of three months or less at the time of purchase to be cash equivalents. Accounts Receivable, net Accounts receivable are presented net of allowance for doubtful accounts. The Company makes judgments as to its ability to collect outstanding receivables and provides allowances for a portion of receivables when collection becomes doubtful. Provisions are made based upon a specific review of all significant outstanding invoices. In determining the provision for invoices not specifically reviewed, the Company analyzes historical collection experience. If the historical data used to calculate the allowance provided for doubtful accounts does not reflect the Company’s future ability to collect outstanding receivables or if the financial condition of customers were to deteriorate, resulting in impairment of their ability to make payments, an increase in the provision for doubtful accounts may be required. The Company’s accounts receivable have payment terms commensurate with the local business practice depending on the country of sale. The Company generally does not allow returns of products that have been delivered. The Company offers standard quality assurance warranty on its products. The Company had no material bad debt expense during the years presented. Excess and Obsolete Inventory Most of the Company’s inventory is comprised of finished goods, which is primarily produced by third-party suppliers. Specialized implants, fixation products, biologics, and imaging equipment are determined by utilizing a standard cost method that includes capitalized variances which approximates the weighted average cost. Component parts related to the imaging equipment are valued at weighted average cost. Inventories are stated at the lower of cost or net realizable value. The Company reviews the components of its inventory on a periodic basis for excess and obsolescence and adjusts inventory to its net realizable value as necessary. The Company records a lower of cost or net realizable value (“LCNRV”) inventory reserve for estimated excess and obsolete inventory based upon its expected use of inventory on hand. The Company’s inventory, which consists primarily of specialized implants, fixation products, and biologics is at risk of obsolescence due to the need to maintain substantial levels of inventory. In order to market its products effectively and meet the demands of interoperative product placement, the Company maintains and provides surgeons and hospitals with a variety of inventory products and sizes. For each surgery, fewer than all components will be consumed. The need to maintain and provide a wide variety of inventory causes inventory to be held that is not likely to be used. The Company’s estimates and assumptions for excess and obsolete inventory are reviewed and updated on a quarterly basis. The estimates and assumptions are determined primarily based on current usage of inventory and the age of inventory quantities on hand. Additionally, the Company considers recent sales experience to develop assumptions about future demand for its products, while considering product life cycles and new product launches. Increases in the LCNRV reserve for excess and obsolete inventory result in a corresponding charge to cost of sales. For the years ended December 31, 2024, 2023 and 2022, the Company recorded LCNRV charges for excess and obsolete inventory of $ 15.4 million, $ 13.6 million and $ 9.8 million, respectively, net of inventory sold of $ 3.4 million, $ 0.2 million and $ 1.5 million, respectively. For the years ended December 31, 2024, 2023 and 2022, the Company recorded a reduction of reserve for inventory that was disposed of $ 3.5 million, $ 12.9 million and $ 8.2 million , respectively. Property and Equipment, net Property and equipment are stated at cost, net of accumulated depreciation. Depreciation is computed using the straight-line method over the estimated useful lives of the related assets, generally ranging from three to seven years . Leasehold improvements and assets acquired under financing leases are amortized over the shorter of their useful lives or the remaining terms of the related leases. Operating Lease The Company determines whether a contract is a lease or contains a lease at inception by assessing whether there is an identified asset and whether the contract conveys the right to control the use of the identified asset in exchange for consideration over a period of time. If both criteria are met, the Company determines the initial classification and measurement of its right-of-use (“ROU”) asset and lease liability at the lease commencement date and thereafter, if modified. The Company recognizes a ROU asset and lease liability for its operating leases with lease terms greater than 12 months. The lease term includes any renewal options and termination options that the Company is reasonably assured to exercise. ROU assets and lease liabilities are based on the present value of lease payments over the lease term. The present value of operating lease payments is determined by using the incremental borrowing rate of interest that the Company would borrow on a collateralized basis for an amount equal to the lease payments in a similar economic environment. Rent expense for operating leases is recognized on a straight-line basis over the reasonably assured lease term based on the total lease payments and is included in cost of sales, research and development, and sales, general and administrative expenses in the consolidated statements of operations. The Company aggregates all lease and non-lease components for each class of underlying assets into a single lease component and variable charges for common area maintenance and other variable costs are recognized as expense as incurred. Total variable costs associated with leases were immaterial for all years presented. The Company had an immaterial amount of financing leases as of December 31, 2024 and 2023, which is included in property and equipment, net, accrued expenses and other current liabilities, and other long-term liabilities on the consolidated balance sheets. Valuation of Goodwill Goodwill represents the excess of the cost over the fair value of net assets acquired from the Company’s business combinations. The determination of the value of goodwill and intangible assets arising from business combinations and asset acquisitions requires extensive use of accounting estimates and judgments to allocate the purchase price to the fair value of the net tangible and intangible assets acquired. Goodwill is assessed for impairment using fair value measurement techniques on an annual basis or more frequently if facts and circumstance warrant such a review. Goodwill is considered to be impaired if the Company determines that the carrying value of the reporting unit exceeds its respective fair value. The Company’s annual evaluation for impairment of goodwill consists of one reporting unit. The Company completed its most recent annual evaluation for impairment of goodwill as of October 1, 2024 and determined that no impairment existed. In addition, no indicators of impairment were noted through December 31, 2024, and consequently no impairment charge was recorded during the years ended December 31, 2024 , 2023 and 2022. Valuation of Intangible Assets Intangible assets are comprised primarily of purchased technology, internally developed software, customer relationships, trade name, trademarks, and in-process research and development. The Company makes significant judgments in relation to the valuation of intangible assets resulting from business combinations and asset acquisitions. Intangible assets are generally amortized on a straight-line basis over their estimated useful lives of 2 to 12 years . The Company bases the useful lives and related amortization expense on the period of time it estimates the assets will generate net sales or otherwise be used. The Company also periodically reviews the lives assigned to its intangible assets to ensure that its initial estimates do not exceed any revised estimated periods from which the Company expects to realize cash flows. If a change were to occur in any of the above-mentioned factors or estimates, the likelihood of a material change in the Company’s reported results would increase. The Company evaluates its intangible assets with finite lives for indications of impairment whenever events or changes in circumstances indicate that the carrying value may not be recoverable. Factors that could trigger an impairment review include significant under-performance relative to expected historical or projected future operating results, significant changes in the manner of the Company’s use of the acquired assets or the strategy for its overall business or significant negative industry or economic trends. If this evaluation indicates that the value of the intangible asset may be impaired, the Company makes an assessment of the recoverability of the net carrying value of the asset over its remaining useful life. If this assessment indicates that the intangible asset is not recoverable, based on the estimated undiscounted future cash flows of the asset over the remaining amortization period, the Company reduces the net carrying value of the related intangible asset to fair value and may adjust the remaining amortization period. Significant judgment is required in the forecasts of future operating results that are used in the discounted cash flow valuation models. It is possible that plans may change and estimates used may prove to be inaccurate. If actual results, or the plans and estimates used in future impairment analyses, are lower than the original estimates used to assess the recoverability of these assets, the Company could incur additional impairment charges. There were no impairment charges during the years ended December 31, 2024, 2023 or 2022. In-process research and development ("IPR&D") and software in development have indefinite lives and are not amortized until the related products reach full commercial launch or when the projects are complete and their assets are ready for their intended use. Indefinite-lived intangible assets are considered to be impaired if the products do not reach commercial launch, if the project is not completed or not completed in a timely manner, or if the related products or projects are no longer technologically feasible. Impairment related to IPR&D and software in development is calculated as the excess of the asset's carrying value over its fair value. There were no impairment charges during the years ended December 31, 2024, 2023 or 2022. Impairment of Long-Lived Assets The Company assesses potential impairment to its long-lived assets when there is evidence that events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. An impairment loss is recognized when estimated future undiscounted cash flows related to the asset are less than its carrying amount. Any required impairment loss is measured as the amount by which the carrying amount of a long-lived asset exceeds its fair value and is recorded as a reduction in the carrying value of the related asset and a charge to operating results. There were no material impairment charges during the years ended December 31, 2024, 2023 or 2022. Warrants to Purchase Common Stock Warrants are accounted for in accordance with the applicable accounting guidance as either derivative liabilities or as equity instruments depending on the specific terms of the agreements. All warrants qualify for classification within stockholders' (deficit) equity. Fair Value Measurements The carrying amount of financial instruments consisting of cash and cash equivalents, accounts receivable, prepaid expenses and other current assets, accounts payable, accrued expenses, and short-term debt included in the Company’s consolidated financial statements are reasonable estimates of fair value due to their short maturities. Authoritative guidance establishes a three-tier fair value hierarchy, which prioritizes the inputs used in measuring fair value as follows: Level 1: Quoted prices in active markets for identical assets or liabilities. Level 2: Inputs other than Level 1 that are observable, either directly or indirectly, such as quoted prices for similar assets or liabilities, quoted prices in markets that are not active; or other inputs that can be corroborated by observable market data for substantially the full term of the assets or liabilities. Level 3: Unobservable inputs that are supported by little or no market activity and that are significant to the fair value of the assets or liabilities. Revenue Recognition The Company recognizes revenue from product sales in accordance with Financial Accounting Standards Board (“FASB”) Accounting Standards Codification (“ASC”) Revenue from Contracts with Customers (“Topic 606”). This standard applies to all contracts with customers, except for contracts that are within the scope of other standards, such as leases. Under Topic 606, an entity recognizes revenue when its customer obtains control of promised goods or services, in an amount that reflects the consideration that the entity expects to receive in exchange for those goods or services. To determine revenue recognition for arrangements that an entity determines are within the scope of Topic 606, the entity performs the following five steps: (i) identify the contract(s) with a customer; (ii) identify the performance obligations in the contract; (iii) determine the transaction price; (iv) allocate the transaction price to the performance obligations in the contract; and (v) recognize revenue when (or as) the entity satisfies a performance obligation. The Company only applies the five-step model to contracts when it is probable that the entity will collect the consideration it is entitled to in exchange for the goods or services it transfers to the customer. Sales are derived primarily from the sale of spinal implant products, imaging equipment, and related services to hospitals and medical centers. Revenue is recognized when obligations under the terms of a contract with customers are satisfied, which occurs with the transfer of control of products to customers, either upon shipment of the product or delivery of the product to the customer depending on the shipping terms, or when the products are used in a surgical procedure (implanted in a patient). Revenue from the sale of imaging equipment is recognized as each distinct performance obligation is fulfilled and control transfers to the customer, beginning with shipment or delivery, depending on the contract terms. Revenue from other distinct performance obligations, such as maintenance on imaging equipment and other imaging related services, is recognized in the period the service is performed, and makes up less than 10 % of the Company’s total revenue. In certain cases, the Company does offer the ability for customers to lease its imaging equipment, but such arrangements are immaterial to total revenue in the years presented. The Company generally does not allow returns of products that have been delivered. Costs incurred by the Company associated directly with sales contracts with customers are deferred over the performance obligation period and recognized in the same period as the related revenue, except for contracts that complete within one year or less, in which case the associated costs are expensed as incurred. Payment terms for sales to customers may vary but are commensurate with the general business practices in the country of sale. To the extent that the transaction price includes variable consideration, such as discounts, rebates, and customer payment penalties, the Company estimates the amount of variable consideration that should be included in the transaction price utilizing either the expected value method or the most likely amount method depending on the nature of the variable consideration. Variable consideration is included in the transaction price if, in the Company’s judgment, it is probable that a significant future reversal of cumulative revenue under the contract will not occur. Estimates of variable consideration and determination of whether to include estimated amounts in the transaction price are based largely on an assessment of the Company’s anticipated performance and all information that is reasonably available, including historical, current, and forecasted information. The Company records a contract asset when one or more performance obligations have been completed and revenue has been recognized, but the customer's payment is contingent on the satisfaction of additional performance obligations. The Company records a contract liability, or deferred revenue, when it has an obligation to provide a product or service to the customer and payment is received in advance of its performance. When the Company sells a product or service with a future performance obligation, revenue is deferred on the unfulfilled performance obligation and recognized over the related performance period. Generally, the Company estimates the selling price of promised services included in the equipment sales price using an expected cost plus a margin approach and/or the separately observable price of such service, if available. The transaction price for a contract’s various performance obligations is allocated using the relative standalone selling price method. The use of alternative estimates could result in a different amount of revenue deferral. Research and Development Expenses Research and development costs are expensed as incurred. Research and development expenses consist of costs associated with the design, development, testing, and enhancement of the Company's products. Research and development expenses also include salaries and related employee benefits, research-related overhead expenses, fees paid to external service providers and development consultants in the form of both cash and equity. Transaction-related Expenses Transaction-related costs are expensed as incurred. Transaction-related expenses consist of certain costs incurred related primarily to the acquisition and integration of Valence, as defined below. Product Shipment Cost Product shipment costs for surgical sets are included in sales, general and administrative expenses in the accompanying consolidated statements of operations. Product shipment costs total ed $ 21.8 million , $ 17.3 million and $ 14.8 million for the years ended December 31, 2024, 2023 and 2022 respectively. Stock-Based Compensation Stock-based compensation expense for equity-classified awards, principally related to restricted stock units ("RSUs") and performance restricted stock units ("PRSUs") is measured at the grant date based on the estimated fair value of the award. The fair value of equity instruments that are expected to vest is recognized and amortized over the requisite service period. The Company has granted awards with up to four year graded or cliff vesting terms. No exercise price or other monetary payment is required for receipt of the shares issued in settlement of the respective award; instead, consideration is furnished in the form of the participant’s service. The fair value of RSUs including PRSUs with pre-defined performance criteria is based on the stock price on the date of grant. Stock-based compensation recorded in the Company’s consolidated statements of operations is based on awards expected to ultimately vest and has been reduced for estimated forfeitures. The Company’s estimated forfeiture rates may differ from its actual forfeitures. The Company considers its historical experience of pre-vesting forfeitures on awards by each homogenous group of employees as the basis to arrive at its estimated annual pre-vesting forfeiture rates. The Company estimates the fair value of stock options issued under the Company’s equity incentive plans and shares issued to employees under the Company’s employee stock purchase plan (“ESPP”) using a Black-Scholes option-pricing model on the date of grant. The Black-Scholes option-pricing model incorporates various assumptions including expected volatility, expected term and risk-free interest rates. The expected volatility is based on the historical volatility of the Company’s common stock over the most recent period commensurate with the estimated expected term of the Company’s stock options and ESPP offering period which is derived from historical experience. The risk-free interest rate for periods within the contractual life of the option is based on the U.S. Treasury yield in effect at the time of grant. The Company has never declared or paid dividends and has no plans to do so in the foreseeable future. Awards to non-employees are accounted for under the same stock-based compensation provisions as employees, which require that the fair value of these instruments be recognized as an expense when earned. For Development Service Agreements, where the future payments for product and/or intellectual property rights may be paid in either cash or restricted shares of our common stock at the election of the developer, we estimate the fair value of those awards similar to a stock option, using a Black-Scholes option-pricing model on the date of grant. For Development Service Agreements where the future payments for product and/or intellectual property rights will be paid in restricted shares of our common stock, the fair value is based on the stock price on the date of grant. The stock-based compensation expense is recognized as earned once the award is deemed probable of achieving the pre-defined performance criteria. The stock-based compensation expense is included in cost of sales or research and development expense on the consolidated statements of operations commensurate with the nature of the services performed. Income Taxes The Company accounts for income taxes in accordance with provisions which set forth an asset and liability approach that requires the recognition of deferred tax assets and deferred tax liabilities for the expected future tax consequences of temporary differences between the carrying amounts and the tax bases of assets and liabilities. Valuation allowances are established when necessary to reduce deferred tax assets to the amount expected to be realized. In making such determination, a review of all available positive and negative evidence must be considered, including scheduled reversal of deferred tax liabilities, projected future taxable income, tax planning strategies, and recent financial performance. The Company recognizes interest and penalties related to uncertain tax positions as a component of the income tax provision. Net Loss per Share Basic net loss per share is calculated by dividing the net loss available to common stockholders by the weighted-average number of common shares outstanding for the year. If applicable, diluted net loss per share attributable to common stockholders is calculated by dividing net loss available to common stockholders by the diluted weighted-average number of common shares outstanding for the year determined using the treasury-stock method and the if-converted method for convertible debt. For purposes of this calculation, common stock subject to repurchase by the Company, common stock issuable upon conversion or exercise of convertible notes, preferred shares, options, and warrants are considered to be common stock equivalents and are only included in the calculation of diluted earnings per share when their effect is dilutive. Due to the Company’s net loss position, the effect of including common stock equivalents in the earnings per share calculation is anti-dilutive, and therefore not included. The following table sets forth the computation of basic and diluted loss per share (in thousands, except per share data): Year Ended December 31, 2024 2023 2022 Numerator: Net loss $ ( 162,123 ) $ ( 186,638 ) $ ( 151,293 ) Denominator: Weighted average common shares outstanding 142,946 121,242 103,373 Net loss per share, basic and diluted $ ( 1.13 ) $ ( 1.54 ) $ ( 1.46 ) The following potentially dilutive shares of common stock were excluded from the calculation of diluted net loss per share because their effect would have been anti-dilutive for the years presented (in thousands): Year Ended December 31, 2024 2023 2022 Options to purchase common stock and employee stock purchase plan 2,204 2,555 2,991 Unvested restricted stock units 7,426 7,713 8,533 Warrants to purchase common stock 9,316 8,219 15,491 Senior convertible notes 17,246 17,246 17,246 36,192 35,733 44,261 Recently Issued Accounting Pronouncements In December 2023, the FASB issued Accounting Standard Update ("ASU") No. 2023-09, Income Taxes (Topic 740): Improvement to Income Tax Disclosures to enhance the transparency of income tax disclosures. The guidance in ASU No. 2023-09 allows for a prospective method of transition, with the option to apply the standard retrospectively. The standard is effective for fiscal years beginning after December 15, 2024, with early adoption permitted. The Company is in the process of assessing the impact of this standard on its consolidated financial statements and related disclosures. In November 2024, the FASB issued ASU No. 2024-03, Income Statement-Reporting Comprehensive Income-Expense Disaggregation Disclosures (Topic 220-40). Additionally, in January 2025, the FASB issued ASU 2025-01 to clarify the effective date of ASU 2024-03. The standard provides guidance to expand disclosures related to the disaggregation of income statement expenses. The standard requires, in the notes to the financial statements, disclosure of specified information about certain costs and expenses, which includes purchases of inventory, employee compensation, depreciation and intangible asset amortization included in each relevant expense caption. This guidance is effective for fiscal years beginning after December 15, 2026, and interim periods within annual reporting periods beginning after December 15, 2027, on a retrospective or prospective basis, with early adoption permitted. The Company is in the process of assessing the impact of this standard on its consolidated financial statements and related disclosures. Recently Adopted Accounting Pronouncements In November 2023, the FASB issued ASU No. 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures that expands disclosure requirements for reportable segments, primarily through enhanced disclosure of significant segment expenses. The guidance in ASU No. 2023-07 allows for a retrospective method of transition. The standard is effective for fiscal years beginning after December 15, 2023, and interim periods in fiscal years beginning after December 15, 2024, with early adoption permitted. The Company adopted the new accounting pronouncement on January 1, 2024 . The adoption of this guidance did no t have an effect on the Company’s financial position, results of operations and cash flows. See Note 12 - Business Segment and Geographic Disclosure for additional disclosures.

Business Combination

Business Combination	12 Months Ended
	Dec. 31, 2024
Business Combinations [Abstract]
Business Combination	2. Business Combination The Company recognizes assets acquired, liabilities assumed, and any noncontrolling interest at fair value at the date of acquisition. On April 19, 2023, the Company entered into an Asset Purchase Agreement with Integrity Implants Inc. and Fusion Robotics, LLC (collectively, the “Sellers”), whereby the Company acquired certain assets, liabilities, employees, and contracts in connection with the Sellers’ navigation-enabled robotics platform (“Valence”). The Company paid the Sellers cash consideration of $ 55.0 million at closing, which represented the total purchase consideration. The acquisition was accounted for as a business combination and the Company did not acquire any material assets or assume any material liabilities in connection with the acquisition, excluding intangible assets and goo dwill. The acquisition is treated as an asset purchase for income tax purposes; therefore, the goodwill recorded is considered deductible for income tax purposes. Refer to Note 4 for further details on intangible assets and goodwill acquired.

Fair Value Measurements

Fair Value Measurements	12 Months Ended
	Dec. 31, 2024
Fair Value Disclosures [Abstract]
Fair Value Measurements	3. Fair Value Measurements Assets and liabilities measured at fair value on a recurring basis include the following as of December 31, 2024 and 2023 (in thousands): December 31, 2024 Level 1 Level 2 Level 3 Total Cash equivalents: Money market funds $ 57,006 — — $ 57,006 Total cash equivalents $ 57,006 — — $ 57,006 December 31, 2023 Level 1 Level 2 Level 3 Total Cash equivalents: Money market funds $ 76,662 — — $ 76,662 Total cash equivalents $ 76,662 — — $ 76,662 The Company did not have any transfers of assets and liabilities between the levels of the fair value measurement hierarchy during the years presented. Fair Value of Convertible Debt The fair value, based on a quoted market price (Level 1), of the Company’s outstanding 0.75 % Convertible Senior Notes due 2026 (the "2026 Notes") was approximately $ 299.6 million at December 31, 2024 and approximately $ 335.4 million at December 31, 2023.

Balance Sheet Details

Balance Sheet Details	12 Months Ended
	Dec. 31, 2024
Balance Sheet Related Disclosures [Abstract]
Balance Sheet Details	4. Balance Sheet Details Inventories Inventories consist of the following (in thousands): December 31, 2024 2023 Raw materials $ 19,378 $ 23,394 Work-in-process — 950 Finished goods 155,886 112,498 Inventories $ 175,264 $ 136,842 Property and Equipment, net Property and equipment, net consist of the following (in thousands, except as indicated): Useful Life December 31, (in years) 2024 2023 Surgical instruments 4 $ 283,597 $ 224,357 Machinery and equipment 7 12,710 11,633 Computer equipment 3 32,082 5,778 Office furniture and equipment 5 6,759 6,225 Leasehold improvements various 4,321 3,986 Construction in progress n/a 541 24,732 340,010 276,711 Less: accumulated depreciation ( 183,616 ) ( 126,876 ) Property and equipment, net $ 156,394 $ 149,835 Total depreciation expense was $ 62.1 million, $ 40.9 million and $ 31.0 million for the years ended December 31, 2024, 2023 and 2022 respectively. At December 31, 2024 and 2023, assets recorded under financing leases of $ 0.8 million and $ 1.1 million, respectively, were included in the property and equipment, net, balance. Amortization of assets under financing leases is included in depreciation expense. Goodwill The change in the carrying amount of goodwill during the year ended December 31, 2024 included the following (in thousands): December 31, 2023 $ 73,003 Foreign currency fluctuation ( 2,027 ) December 31, 2024 $ 70,976 Intangible Assets, net Intangible assets, net consist of the following (in thousands, except as indicated): Remaining Weighted Avg. Useful Life Gross Accumulated Intangible December 31, 2024: (in years) Amount Amortization Assets, net Developed product technology 5 $ 102,412 $ ( 38,055 ) $ 64,357 Internally developed software 3 4,283 ( 1,515 ) 2,768 Trademarks and trade names 7 5,267 ( 1,991 ) 3,276 Customer relationships 2 13,996 ( 10,094 ) 3,902 Distribution network – 2,413 ( 2,410 ) 3 Total amortized intangible assets 128,371 ( 54,065 ) 74,306 Software in development n/a 12,927 — 12,927 In-process research and development n/a 6,285 — 6,285 Total intangible assets $ 147,583 $ ( 54,065 ) $ 93,518 . Remaining Weighted Avg. Useful Life Gross Accumulated Intangible December 31, 2023: (in years) Amount Amortization Assets, net Developed product technology 6 $ 106,782 $ ( 26,560 ) $ 80,222 Trademarks and trade names 7 5,588 ( 1,561 ) 4,027 Customer relationships 3 14,504 ( 8,692 ) 5,812 Distribution network 1 2,413 ( 2,242 ) 171 Total amortized intangible assets 129,287 ( 39,055 ) 90,232 Software in development n/a 7,934 — 7,934 In-process research and development n/a 4,285 — 4,285 Total intangible assets $ 141,506 $ ( 39,055 ) $ 102,451 During the year ended December 31, 2023, in connection with the Company's acquisition of Valence, as further described in Note 2, the Company recorded additions to developed product technology and goodwill in the amount of $ 26.9 million and $ 24.6 million, respectively. The intangible asset acquired will be amortized on a straight-line basis over a useful life of seven years . Total amortization expense was $ 16.4 million , $ 15.2 million and $ 10.2 million for the years ended December 31, 2024, 2023 and 2022, respectively. Software in development assets begin amortizing when the projects are complete and the assets are ready for their intended use. In-process research and development assets and software in development assets begin amortizing when the related products reach full commercial launch. Future amortization expense related to intangible assets as of December 31, 2024 is as follows (in thousands): Year Ending December 31, 2025 $ 15,561 2026 15,573 2027 13,351 2028 11,166 2029 9,640 Thereafter 9,015 Total $ 74,306 Accrued Expenses and Other Current Liabilities Accrued expenses and other current liabilities consist of the following (in thousands): December 31, 2024 2023 Payroll and payroll related $ 29,103 $ 29,207 Commissions and sales milestones 25,778 21,414 Royalties 6,703 7,968 Accrued legal expenses 5,587 10,994 Taxes and fees 2,505 1,985 Inventory in-transit 2,418 2,251 Admin fees and rebates 2,300 2,732 Interest 1,402 1,753 Professional fees 1,353 1,384 Other 4,317 8,024 Total accrued expenses $ 81,466 $ 87,712 Other Long-Term Liabilities Other long-term liabilities consist of the following (in thousands): December 31, 2024 2023 Income tax-related liabilities $ 5,077 $ 5,838 Contract liabilities 3,131 2,561 Royalties 1,532 1,065 Other 1,684 1,739 Other long-term liabilities $ 11,423 $ 11,203

Contract Assets and Contract Li

Contract Assets and Contract Liabilities	12 Months Ended
	Dec. 31, 2024
Contract with Customer, Contract Asset, Contract Liability, and Receivable [Abstract]
Contract Assets and Contract Liabilities	5. Contract Assets and Contract Liabilities Contract assets are included within prepaid expenses and other current assets in the consolidated balance sheets. Contract assets relate to contracts with customers for which one or more performance obligations have been completed and revenue has been recognized, but the customer's payment is contingent on the satisfaction of additional performance obligations. The opening and closing balances of the Company's contract assets are as follows (in thousands): December 31, December 31, Contract assets $ 5,678 $ 3,865 The Company had current and non-current contract liabilities t otaling $ 10.5 million and $ 3.1 million, respectively, as of December 31, 2024. The Company had current and non-current contract liabilities totaling $ 13.9 million and $ 2.6 million, respectively, as of December 31, 2023. The non-current contract liabilities balance is included in other long-term liabilities on the consolidated balance sheets. Contract liabilities relate to contracts with customers for which partial or complete payment of the transaction price has been received from the customer and the related obligations must be completed before revenue can be recognized. These amounts primarily relate to undelivered equipment, services, or maintenance agreements. The Company recognized $ 24.8 million of revenue from its contract liabilities during the year ended December 31, 2024, of which $ 13.8 millio n was recognized from the beginning contract liabilities balance. The Company recognize d $ 28.2 million of revenue from its contract liabilities during the year ended December 31, 2023, of which $ 10.9 million was recognized from the beginning contract liabilities balance. The Company recognized $ 21.6 million of revenue from its contract liabilities during the year ended December 31, 2022, of which $ 12.9 million was recognized from the beginning contract liabilities balance.

Debt

Debt	12 Months Ended
	Dec. 31, 2024
Debt Disclosure [Abstract]
Debt	6. Debt Term Loan On January 6, 2023, the Company entered into a $ 150.0 million term loan credit facility with Braidwell Transaction Holdings, LLC (the “Braidwell Term Loan”). The Braidwell Term Loan provides for an initial term loan of $ 100.0 million which was funded on the closing date. On September 28, 2023, the Company drew an additional $ 50.0 million (the “delayed draw term loan(s)” or the “DDTL”). On October 29, 2024, the Company entered into an amendment of the Braidwell Term Loan, which provides for an additional term loan of $ 50.0 million, subject to the terms of the original term loan credit facility. The Braidwell Term Loan matures on January 6, 2028 . As of December 31, 2024, the outstanding balance under the Braidwell Term Loan was $ 200.0 million. In conjunction with the issuance of the Braidwell Term Loan, the Company incurred $ 3.6 million in debt issuance costs and $ 3.5 million in commitment fees. Commitment fees paid to the lender were accounted for as a debt discount. The debt issuance costs and debt discount were recorded as a direct reduction of the carrying amount of the loan on the consolidated balance sheets and are being amortized over the life of the loan. As of December 31, 2024, debt issuance costs and debt discount, net of accumulated amortization, associated with the Braidwell Term Loan were $ 2.5 million and $ 2.9 million, respectively. Borrowings under the Braidwell Term Loan bear interest at a rate per annum equal to the Term Secured Overnight Financing Rate for such SOFR business day ("SOFR") subject to a 3 % floor, plus 5.75 %. The applicable interest rate as of December 31, 2024 was 10.4 %. The loan agreement includes an undrawn commitment fee, which is calculated as 1 % per annum of the average daily undrawn portion of the DDTL. Interest and undrawn commitment fees incurred are due quarterly. The Company is also required to pay fees on any prepayment of the Braidwell Term Loan, ranging from 1.0 % to 3.0 % depending on the date of prepayment, and a final payment fee equal to 3.25 % of the principal amount of the loans drawn. The effective interest rate as of December 31, 2024 was 11.7 %. During the year ended December 31, 2024, the Company recognized interest expense on the Braidwell Term Loan of $ 18.9 million, which includes $ 0.7 million for the amortization of debt issuance costs and $ 0.3 million for the debt discount. During the year ended December 31, 2023, the Company recognized interest expense on the Braidwell Term Loan of $ 13.2 million, which includes $ 0.4 million for the amortization of debt issuance costs and $ 0.2 million for the debt discount. Upon the Braidwell Term Loan’s maturity, any outstanding principal balance, unpaid accrued interest, and all other obligations under the Braidwell Term Loan will be due and payable. The Braidwell Term Loan is secured by substantially all of the Company’s assets with the priority interest of the lenders in the Braidwell Term Loan and the Revolving Credit Facility, as defined below, subject to terms of a customary intercreditor agreement, which provides that the lenders under the Revolving Credit Facility have a priority with respect to the Company's accounts receivable, inventory, medical instruments, and items related to the foregoing, and the lenders under the Braidwell Term Loan have priority with respect to the remainder of the Company's assets. The loan agreement contains customary representations and warranties and affirmative and negative covenants. Under the loan agreement, the Company is required to maintain a minimum level of liquidity. The loan agreement also includes certain events of default, and upon the occurrence of such events of default, all outstanding loans under the Braidwell Term Loan may be accelerated and/or the lenders’ commitments terminated. The Company is in compliance with all required financial covenants as of December 31, 2024. Revolving Credit Facility In September 2022, the Company entered into a revolving credit facility (the “Revolving Credit Facility”) with entities affiliated with MidCap Financial Trust (“MidCap”). The Revolving Credit Facility originally provided up to $ 50.0 million in borrowing capacity to the Company with an accordion feature up to $ 75.0 million in borrowing capacity, based on a defined borrowing base. The borrowing base is calculated based on certain accounts receivable and inventory assets. The Company subsequently exercised the accordion feature and increased the borrowing capacity by $ 25.0 million up to the full $ 75.0 million borrowing capacity. The Revolving Credit Facility matures on the earlier of September 29, 2027 , or 90 days prior to the final maturity date of the Company’s 2026 Notes. As of December 31, 2024, the outstanding balance under the Revolving Credit Facility was $ 63.3 million. In January 2025, the Company repaid $ 52.8 million of the outstanding balance. In conjunction with obtaining the Revolving Credit Facility, the Company incurred $ 1.4 million in debt issuance costs. These costs were capitalized to other assets on the consolidated balance sheets and are being amortized over the life of the Revolving Credit Facility. As of December 31, 2024, and 2023, debt issuance costs, net of accumulated amortization, associated with the Revolving Credit Facility were $ 0.8 million and $ 1.0 million, respectively. The outstanding loans bear interest at the sum of SOFR plus 3.5 % per annum. The interest rate as of December 31, 2024 was 8.2 %. The loan agreements include an unused line fee, which is calculated as 0.5 % per annum of either the unused Revolving Credit Facility or a minimum balance. Interest and unused line fees incurred are due and capitalized to the outstanding principal balance monthly. The Company recognized interest expense on the Revolving Credit Facility of $ 3.4 million during the year ended December 31, 2024, which includes $ 0.2 million for the amortization of debt issuance costs. The Company recognized interest expense on the Revolving Credit Facility of $ 2.0 million during the year ended December 31, 2023, which includes $ 0.3 million for the amortization of debt issuance costs. The Company recognized interest expense on the Revolving Credit Facility of $ 0.2 million during the year ended December 31, 2022, which includes $ 0.1 million for the amortization of debt issuance costs. Upon the Revolving Credit Facility’s maturity, any outstanding principal balance, unpaid accrued interest, and all other obligations under the Revolving Credit Facility will be due and payable. The Revolving Credit Facility contains a lockbox arrangement clause requiring the Company to maintain a lockbox bank account. If the revolving loan availability is less than 30 % of the revolving loan limit for five consecutive business days, or the Company is in default, MidCap will apply funds collected from the Company's lockbox account to reduce the outstanding balance of the Revolving Credit Facility. As of December 31, 2024, the Company's loan availability level has not activated lockbox deductions, nor is it expected to for the next 12 months; therefore, the Company has determined that the outstanding balance under the Revolving Credit Facility is long-term debt on the consolidated balance sheets. The outstanding loans are secured by substantially all of the Company’s assets with the priority interest of the lenders subject to terms of a customary intercreditor agreement in connection with the Braidwell Term Loan. The loan agreements and other ancillary documents contain customary representations and warranties and affirmative and negative covenants. Under the loan agreements, the Company is required to maintain a minimum level of liquidity. The loan agreements also include certain events of default, and upon the occurrence of such events of default, all outstanding loans under the Revolving Credit Facility may be accelerated and/or the lenders’ commitments terminated. The Company is in compliance with all required financial covenants as of December 31, 2024. 0.75% Convertible Senior Notes due 2026 In August 2021, the Company issued $ 316.3 million aggregate principal amount of unsecured 2026 Notes with a stated interest rate of 0.75 % and a maturity date of August 1, 2026 . Interest on the 2026 Notes is payable semi-annually in arrears on February 1 and August 1 of each year, beginning on February 1, 2022 . The net proceeds from the sale of the 2026 Notes were approximately $ 306.2 million after deducting the initial purchasers’ offering expenses and before cash used for the privately negotiated capped call transactions (the "Capped Call Transactions"), as described below, the repurchase of stock , and the repayment of the outstanding unsecured term loan with Squadron Medical Finance Solutions, LLC (the “Squadron Medical Term Loan") and outstanding obligation under the Inventory Financing Agreement, as described below. The 2026 Notes do not contain any financial covenants . The 2026 Notes are convertible into shares of the Company’s common stock based upon an initial conversion rate of 54.5316 shares of the Company’s common stock per $ 1,000 principal amount of 2026 Notes (equivalent to an initial conversion price of approximately $ 18.34 per share). The conversion rate will be subject to adjustment upon the occurrence of certain specified events, including certain distributions and dividends to all or substantially all of the holders of the Company’s common stock. Based on the terms of the 2026 Notes, when a conversion notice is received, the Company has the option to pay or deliver cash, shares of the Company’s common stock, or a combination thereof. Holders of the 2026 Notes have the right to convert their notes in certain circumstances and during specified periods. Prior to the close of business on the business day immediately preceding February 2, 2026, holders may convert all or a portion of their 2026 Notes only under the following circumstances: (1) during any calendar quarter (and only during such calendar quarter) commencing after the calendar quarter ending on September 30, 2021, if the last reported sale price of the Company’s common stock for at least 20 trading days (whether or not consecutive) during a period of 30 consecutive trading days ending on, and including, the last trading day of the immediately preceding calendar quarter is greater than or equal to 130 % of the conversion price on each applicable trading day; (2) during the 5 consecutive business days immediately after any 10 consecutive trading day period (the “measurement period”) in which the trading price per $ 1,000 principal amount of 2026 Notes for each trading day of the measurement period was less than 98 % of the product of the last reported sale price of the Company’s common stock and the conversion rate on each such trading day; or (3) upon the occurrence of specified corporate events. From and after February 2, 2026 , holders of the 2026 Notes may convert their notes at any time at their election until the close of business on the second scheduled trading day immediately before the maturity date. As of December 31, 2024, none of the conditions permitting the holders of the 2026 Notes to convert have been met. The 2026 Notes are classified as long-term debt on the consolidated balance sheets as of December 31, 2024 and 2023. The 2026 Notes are redeemable, in whole or in part, at the Company’s option at any time, and from time to time, on or after August 6, 2024 and on or before the 40th scheduled trading day immediately before the maturity date, at a cash redemption price equal to the principal amount of the 2026 Notes to be redeemed, plus accrued and unpaid interest, if any, but only if the last reported sale price per share of the Company’s common stock exceeds 130 % of the conversion price for a specified period of time. In addition, calling any of the notes for redemption will constitute a “make-whole fundamental change” with respect to that note, in which case the conversion rate applicable to the conversion of that note will be increased in certain circumstances if such note is converted after it is called for redemption. If a fundamental change occurs prior to the maturity date, holders may require the Company to repurchase all or a portion of their 2026 Notes for cash at a price equal to 100 % of the principal amount of the 2026 Notes plus accrued and unpaid interest. No principal payments are otherwise due on the 2026 Notes prior to maturity. The Company recorded the full principal amount of the 2026 Notes as a long-term liability net of deferred issuance costs. The annual effective interest rate for the 2026 Notes is 1.4 %. The Company recognized interest expense on the 2026 Notes of $ 4.4 million during the years ended December 31, 2024, 2023 and 2022, which inclu des $ 2.0 million for the amortization of debt issuance costs during the years ended December 31, 2024, 2023 and 2022. The Company uses the if-converted method for assumed conversion of the 2026 Notes to compute the weighted average shares of common stock outstanding for diluted earnings per share, if applicable. The outstanding principal amount and carrying value of the 2026 Notes consist of the following (in thousands): December 31, Principal $ 316,250 Unamortized debt issuance costs ( 3,262 ) Net carrying value $ 312,988 Capped Call Transactions In connection with the offering of the 2026 Notes, the Company entered into the Capped Call Transactions with certain financial institutions. The Capped Call Transactions are expected generally to reduce the potential dilution and/or offset the cash payments the Company is required to make in excess of the principal amount of the 2026 Notes upon conversion of the 2026 Notes in the event that the market price per share of the Company’s common stock is greater than the strike price of the Capped Call Transactions with such reduction and/or offset subject to a cap. The Capped Call Transactions have an initial cap price of $ 27.68 per share of the Company’s common stock, which represents a premium of 100 % over the last reported sale price of the Company’s common stock on August 5, 2021, and is subject to certain adjustments under the terms of the Capped Call Transactions. Collectively, the Capped Call Transactions cover, initially, the number of shares of the Company’s common stock underlying the 2026 Notes, subject to anti-dilution adjustments substantially similar to those applicable to the 2026 Notes. The cost of the Capped Call Transactions was approximately $ 39.9 million. The Capped Call Transactions are separate transactions and are not part of the terms of the 2026 Notes and will not affect any holder’s rights under the notes. Holders of the 2026 Notes will not have any rights with respect to the Capped Call Transactions. The Capped Call Transactions meet all of the applicable criteria for equity classification and, as a result, the related $ 39.9 million cost was recorded as a reduction to additional paid-in capital on the Company’s consolidated statements of shareholders’ (deficit) equity for the year ended December 31, 2021. Other Debt Agreements The Company has two loan agreements under French government sponsored COVID-19 relief initiatives (“PGE” loans) which mature in 2027. Monthly and quarterly installments of principal and interest under each PGE loan agreement is due until the original principal amounts and applicable interest is fully repaid in 2027. The outstanding obligation under each loan as of December 31, 2024 w as $ 2.1 million and $ 0.9 million at weighted average interest rates of 0.95 % and 1.25 %, respectively, and weighted average costs of the state guaranty of 0.68 % and 1.0 %, respectively. Debt consists of the following (in thousands): December 31, 2024 2023 2026 Notes $ 316,250 $ 316,250 Other notes payable 432 1,175 PGE loans 3,052 4,537 Braidwell Term Loan, including final payment fee of $ 6,500 206,500 154,875 Revolving Credit Facility 63,284 49,720 Total 589,518 526,557 Less: unamortized debt discount and debt issuance costs ( 13,340 ) ( 13,714 ) Total 576,178 512,843 Less: short-term debt ( 1,656 ) ( 1,808 ) Total long-term debt $ 574,522 $ 511,035 Principal payments on debt are as follows as of December 31, 2024 (in thousands): 2025 $ 1,658 2026 317,483 2027 63,877 2028 206,500 Total 589,518 Less: unamortized debt discount and debt issuance costs ( 13,340 ) Total 576,178 Less: short-term debt ( 1,656 ) Long-term debt $ 574,522 OCEANE Convertible Bonds On May 31, 2018, EOS issued 4,344,651 OCEANEs denominated in Euros, due May 2023 for aggregate gross proceeds of $ 34.3 million. The OCEANEs were unsecured obligations of EOS, ranked equally with all other unsecured and unsubordinated obligations of EOS, and paid interest at a rate equal to 6 % per year, payable semiannually in arrears on May 31 and November 30 of each year, beginning November 30, 2018 . The OCEANEs matured on May 31, 2023 and the outstanding OCEANEs and accrued interest were paid in full on May 31, 2023. As of December 31, 2023, no OCEANEs remained outstanding. Interest expense was $ 0.3 million and $ 0.8 million for the years ended December 31, 2023 and 2022, respectively.

Commitments and Contingencies

Commitments and Contingencies	12 Months Ended
	Dec. 31, 2024
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	7. Commitments and Contingencies Leases The Company determines if an arrangement is a lease at inception by assessing whether there is an identified asset and whether the contract conveys the right to control the use of the identified asset in exchange for consideration over a period of time. If both criteria are met, the Company records the associated lease liability and corresponding ROU asset upon commencement of the lease using a discount rate based on the incremental borrowing rate of interest that the Company would borrow on a collateralized basis for an amount equal to the lease payments in a similar economic environment. Any short-term leases defined as twelve months or less or month-to-month leases are excluded and are expensed each month. Total costs associated with these short-term leases are immaterial to all periods presented. The Company leases office and storage facilities and equipment under various operating and financing lease agreements. The initial terms of these leases range from 1 to 10 years and generally provide for periodic rent increases. The Company’s lease agreements do not contain any material variable lease payments, residual value guarantees or material restrictive covenants. The Company aggregates all lease and non-lease components for each class of underlying assets into a single lease component and variable charges for common area maintenance and other variable costs are recognized as expense as incurred. Total variable costs associated with leases for the year ended December 31, 2024 were immaterial. The Company had an immaterial amount of financing leases as of December 31, 2024, which is included in property and equipment, net, accrued expenses and other current liabilities, and other long-term liabilities, on the consolidated balance sheets. On December 1, 2023, the Company entered into a nine-year operating lease in Paris, France that commenced on April 1, 2024 , and will terminate on December 31, 2032 . Future minimum annual lease payments for all operating leases of the Company are as follows as of December 31, 2024 (in thousands): 2025 $ 7,112 2026 6,615 2027 6,543 2028 6,026 2029 5,941 Thereafter 10,092 Total undiscounted lease payments 42,329 Less: imputed interest ( 8,571 ) Operating lease liability 33,758 Less: current portion of operating lease liability ( 6,453 ) Operating lease liability, less current portion $ 27,305 The Company’s weighted average remaining lease term and weighted average discount rate as of December 31, 2024 and December 31, 2023 are as follows: December 31, 2024 2023 Weighted average remaining lease term (years) 6.4 6.5 Weighted average discount rate 6.9 % 5.5 % Information related to the Company’s operating leases is as follows (in thousands): Year Ended December 31, 2024 2023 2022 Rent expense $ 7,393 $ 5,045 $ 4,643 Cash paid for amounts included in measurement of lease liabilities $ 6,296 $ 5,120 $ 4,409 Purchase Commitments The Company is obligated to certain minimum inventory purchase commitment requirements with a third-party supplier through December 2026. As of December 31, 2024, the remaining minimum purchase commitment required by the Company under the agreement w as $ 8.8 million. Litigation The Company is and may become involved in various legal proceedings arising from its business activities. While management is not aware of any litigation matter that in and of itself would have a material adverse impact on the Company’s consolidated results of operations, cash flows or financial position, litigation is inherently unpredictable, and depending on the nature and timing of a proceeding, an unfavorable resolution could materially affect the Company’s future consolidated results of operations, cash flows or financial position in a particular period. The Company assesses contingencies to determine the degree of probability and range of possible loss for potential accrual or disclosure in the Company’s consolidated financial statements. An estimated loss contingency is accrued in the Company’s consolidated financial statements if it is probable that a liability has been incurred and the amount of the loss can be reasonably estimated. Because litigation is inherently unpredictable and unfavorable resolutions could occur, assessing contingencies is highly subjective and requires judgments about future events. When evaluating contingencies, the Company may be unable to provide a meaningful estimate due to a number of factors, including the procedural status of the matter in question, the presence of complex or novel legal theories, and/or the ongoing discovery and development of information important to the matters. In addition, damage amounts claimed in litigation against the Company may be unsupported, exaggerated or unrelated to reasonably possible outcomes, and as such are not meaningful indicators of the Company’s potential liability. Indemnifications In the normal course of business, the Company enters into agreements under which it occasionally indemnifies third-parties for intellectual property infringement claims or claims arising from breaches of representations or warranties. In addition, from time to time, the Company provides indemnity protection to third-parties for claims relating to past performance arising from undisclosed liabilities, product liabilities, environmental obligations, representations and warranties, and other claims. In these agreements, the scope and amount of remedy, or the period in which claims can be made, may be limited. It is not possible to determine the maximum potential amount of future payments, if any, due under these indemnities due to the conditional nature of the obligations and the unique facts and circumstances involved in each agreement. In October 2017, NuVasive, Inc. filed a lawsuit in Delaware Chancery Court against Mr. Miles, the Company’s Chairman and CEO, who was a former officer and board member of NuVasive. The Company itself was not initially a named defendant in this lawsuit; however, in June 2018, NuVasive amended its complaint to add the Company as a defendant. In October 2018, the Delaware Court ordered that NuVasive advance legal fees for Mr. Miles’ defense in the lawsuit, as well as Mr. Miles’ legal fees incurred in pursuing advancement of his fees, pursuant to an indemnification agreement between NuVasive and Mr. Miles. As of December 31, 2024, the Company has not recorded any liability on the consolidated balance sheets related to this matter. Royalties The Company has entered into various intellectual property agreements requiring the payment of royalties based on the sale of products that utilize such intellectual property. These royalties primarily relate to products sold by Alphatec Spine and are based on fixed fees or calculated either as a percentage of net sales or on a per-unit sold basis. Royalties are included on the accompanying consolidated statements of operations as a component of cost of sales.

Equity

Equity	12 Months Ended
	Dec. 31, 2024
Equity [Abstract]
Equity	8. Equity Common Stock There were 200,000,000 shares of common stock authorized at December 31, 2024 and 2023. On October 27, 2023, the Company completed an underwritten public offering (the "Public Offering") of 14,300,000 shares of the Company’s common stock at a public offering price of $ 10.50 per share. On November 17, 2023, the underwriters exercised their option to purchase 470,769 additional shares. The net proceeds from the offering were approximately $ 145.8 million, including the underwriting discounts and commissions and offering expenses paid by the Company. On August 11, 2023, the Company completed an at the market offering of 668,484 shares of the Company’s common stock. The net proceeds from the offering were approximately $ 9.9 million, including the underwriting discounts and commissions and offering expenses paid by the Company. On April 19, 2023, the Company completed a registered securities offering (the “Offering”) of 4,285,715 shares of the Company’s common stock at a price of $ 14.00 per share. The net proceeds from the Offering were approximately $ 57.5 million, including the underwriting discounts and commissions and offering expenses paid by the Company. Redeemable Preferred Stock The Company issued shares of redeemable preferred stock in connection with its initial public offering in June 2006. As of December 31, 2024, and 2023, the redeemable preferred stock carrying value was $ 23.6 million and there were 20 million shares of redeemable preferred stock authorized. The redeemable preferred stock is not convertible into common stock but is redeemable at $ 9.00 per share, (i) upon the Company’s liquidation, dissolution or winding up, or the occurrence of certain mergers, consolidations or sales of all or substantially all of the Company’s assets, before any payment to the holders of the Company’s common stock, or (ii) at the Company’s option at any time. Holders of redeemable preferred stock are generally not entitled to vote on matters submitted to the stockholders, except with respect to certain matters that will affect them adversely as a class and are not entitled to receive dividends. The carrying value of the redeemable preferred stock was $ 7.11 per share at December 31, 2024 and 2023. The redeemable preferred stock is presented separately from stockholders’ equity in the consolidated balance sheets and any adjustments to its carrying value up to its redemption value of $ 9.00 per share are reported as a dividend. 2017 PIPE Warrants The 2017 common stock warrants (the “2017 PIPE Warrants”) had a five-year life and were exercisable by cash exercise only. The 2017 PIPE Warrants expired in 2022, and no 2017 PIPE warrants remained outstanding as of December 31, 2022. During the year ended December 31, 2022, there were approximately 2,312,000 2017 PIPE Warrant exercises for total cash proceeds of $ 3.5 million. 2018 PIPE Warrants The 2018 common stock warrants (the “2018 PIPE Warrants”) had a five-year life and were exercisable by cash or cashless exercise. The 2018 PIPE Warrants expired in May 2023, and no 2018 PIPE warrants remained outstanding as of December 31, 2023. During the year ended December 31, 2023, there were approximately 6,311,000 2018 PIPE Warrant exercises for total cash proceeds of $ 0.4 million. During the year ended December 31, 2022, there were approximately 2,168,000 2018 PIPE Warrant exercises for total cash proceeds of $ 0.4 million. SafeOp Surgical Merger Warrants The SafeOp common stock warrants (the “SafeOp Warrants”), had a five-year life and were exercisable by cash or cashless exercise. The SafeOp Warrants expired in May 2023, and no SafeOp Warrants remained outstanding as of December 31, 2023. During the year ended December 31, 2023, there were 937,000 cashless SafeOp Warrant exercises. During the year ended December 31, 2022, there were approximately 257,000 cashless SafeOp Warrant exercises. Squadron Medical Warrants In connection with debt financing entered into with Squadron Medical in 2018, and amended in 2019 and 2020, the Company issued common stock warrants to Squadron Medical and a participant lender (the “Squadron Medical Warrants”). The Squadron Medical Warrants expire in May 2027 and are exercisable by cash exercise. No Squadron Medical Warrants have been exercised as of December 31, 2024. Executive Warrants The Company issued warrants to its Chairman and Chief Executive Officer (the “Executive Warrants”). The Executive Warrants had a five-year term and are exercisable by cash or cashless exercise. In October 2022, the term was extended to seven years and in May 2024, the term was extended to nine years . No Executive Warrants have been exercised as of December 31, 2024. L-5 Healthcare Partners Warrants Pursuant to an order entered by the Delaware Chancery Court on September 27, 2024, the Company issued 1,133,160 common stock warrants, to L-5 Healthcare Partners, LLC, a stockholder of the Company (the "L-5 Healthcare Warrants"), at a purchase price of $ 1.98 per share, for each of the shares represented by the warrant, for a total purchase price of approximately $ 2.2 million. The L-5 Healthcare Warrants expire in August 2026 and are exercisable by cashless exercise. No L-5 Healthcare Warrants have been exercised as of December 31, 2024. A summary of all outstanding warrants as of December 31, 2024 is as follows (in thousands): Number of Strike Price Expiration 2018 Squadron Medical Warrants 845 $ 3.15 May 2027 2019 Squadron Medical Warrants 4,839 $ 2.17 May 2027 2020 Squadron Medical Warrants 1,076 $ 4.88 May 2027 Executive Warrants 1,327 $ 5.00 December 2026 L-5 Healthcare Warrants 1,133 $ 2.17 August 2026 Other* 96 $ 11.79 Various through June 2026 Total 9,316 *Represents weighted average strike price

Stock Benefit Plans and Stock-B

Stock Benefit Plans and Stock-Based Compensation	12 Months Ended
	Dec. 31, 2024
Share-Based Payment Arrangement [Abstract]
Stock Benefit Plans and Stock-Based Compensation	9. Stock Benefit Plans and Stock-Based Compensation 2016 Equity Incentive Plan In 2016 the Company adopted its 2016 Equity Incentive Plan (the “2016 Plan”), which replaced the Company’s 2005 Employee, Director and Consultant Stock Plan. Under the 2016 Plan, the Company is authorized to grant up to 26,383,000 shares of options, restricted stock, restricted stock unit awards and performance unit awards to employees, directors, and consultants of the Company. The Board of Directors determines the terms of the grants made under the 2016 Plan. Options granted under the 2016 Plan expire no later than ten years from the date of grant ( five years for incentive stock options granted to holders of more than 10% of the Company’s voting stock). Options generally vest over a four-year period and may be immediately exercisable upon a change of control of the Company. The exercise price of incentive stock options may not be less than 100 % of the fair value of the Company’s common stock on the date of grant. The exercise price of any option granted to a 10% stockholder may be no less than 110 % of the fair value of the Company’s common stock on the date of grant. Restricted stock unit awards and performance unit awards generally vest over a three or four year period and vest immediately upon a change in control of the Company. As of December 31, 2024 , approximately 4,209,000 shares of common stock remained available for issuance under the 2016 Plan. The 2016 Plan expires in May 2026. 2016 Employment Inducement Award Plan On October 4, 2016, the Company’s Board of Directors adopted the 2016 Employment Inducement Award Plan (the “Inducement Plan”). Under the Inducement Plan, the Company is authorized to grant up to 4,150,000 shares of options, restricted stock, restricted stock unit awards and performance unit awards to new employees of the Company by granting an award to such new employee as an inducement for the employee to begin employment with the Company. The terms of the Inducement Plan are substantially similar to the terms of the Company’s 2016 Plan with two principal exceptions: (i) incentive stock options may not be granted under the Inducement Plan; and (ii) the annual compensation paid by the Company to specified executives will be deductible only to the extent that it does not exceed $ 1.0 million. As of December 31, 2024 the Inducement Plan had approximately 320,000 shares of common stock reserved for issuance, which may only be granted to an employee who has not previously been an employee or member of the board of directors of the Company. 2019 Management Objective Strategic Incentive Plan Under the 2019 Management Objective Strategic Incentive Plan, the Company is authorized to grant up to 500,000 shares of common stock to third-party individuals or entities that do not qualify under the Company’s other existing equity plans. As of December 31, 2024 , approximately 486,000 restricted shares and approximately 12,500 common stock warrants have been granted under the 2019 Management Objective Strategic Incentive Plan. 2017 Distributor Inducement Plan Under the 2017 Distributor Inducement Plan, the Company is authorized to grant up to 1,500,000 shares of common stock to independent third-party sales agents whereby, upon the achievement of certain Company sales and/or distribution milestones the Company may grant to an independent sales agent shares of common stock or warrants to purchase shares of common stock. The warrants and restricted stock units issued under the plan are subject to time based or net sales-based vesting conditions. As of December 31, 2024 , approximately 345,000 warrants and approximately 731,000 shares of restricted common stock were granted under the 2017 Distributor Inducement Plan. As of December 31, 2024 , approximately 345,000 warrants and approximately 720,000 shares of common stock were earned or issued. 2017 Development Services Plan Under the 2017 Development Services Plan, the Company is authorized to issue up to 10,000,000 shares of common stock to third-parties upon the achievement of certain revenue milestones associated with certain developed products. Future payments for product and/or intellectual property development work may be paid in either cash or restricted shares of the Company’s common stock at the election of the developer, depending on the terms of the agreement. Each common stock issuance is contingent on net sales-based criteria and other provisions, including the satisfaction of applicable laws regarding the issuance of restricted shares to such developers. The Company has entered into Development Services Agreements for development of a wide variety of potential products and intellectual property, with the possibility of issuing shares of common stock. As of December 31, 2024, 3,858,000 shares have been earned or issued under the Development Services Plan. The Company recognizes stock-based compensation once the achievement of the performance criteria and vesting conditions are deemed probable. Stock-Based Compensation Costs The compensation cost that has been included in the Company’s consolidated statements of operations for all stock-based compensation arrangements is detailed as follows (in thousands): Year Ended December 31, 2024 2023 2022 Cost of sales $ 4,961 $ 25,082 $ 2,597 Research and development 27,030 18,741 5,016 Sales, general and administrative 41,286 37,421 32,943 Total $ 73,277 $ 81,244 $ 40,556 Stock Options A summary of the Company’s stock option activity under the equity plans and related information is as follows (in thousands, except as indicated and per share data): Shares Weighted Weighted Aggregate Outstanding at December 31, 2023 2,468 $ 3.20 Exercised ( 283 ) 2.52 Forfeited ( 27 ) 14.74 Outstanding at December 31, 2024 2,158 $ 3.15 3.00 $ 13,298 Options vested and expected to vest at 2,158 $ 3.15 3.00 $ 13,298 Options exercisable at 2,155 $ 3.13 2.99 $ 13,296 There were no stock options granted dur ing the years ended December 31, 2024, 2023 and 2022. The total intrinsic value of stock options exercised during the years ended December 31, 2024, 2023 and 2022 was $ 2.1 mil lion, $ 5.2 million and $ 3.4 million, respectively. The aggregate intrinsic value of options at December 31, 2024 is based on the Company’s closing stock price on the last business day of 2024 of $ 9.18 per shar e. As of December 31, 2024, there was nominal unrecognized compensation expense for stock options which is expected to be recognized on a straight-line basis over a weighted average period of approximately 0.43 years. Restricted Stock Units and Performance Based Restricted Stock Units The following table summarizes information about the restricted stock units and performance-based restricted units activity (in thousands, except as indicated and per share data): Shares Weighted Weighted Unvested at December 31, 2023 7,713 $ 13.56 Awarded 5,189 12.56 Vested ( 4,616 ) 7.10 Forfeited ( 860 ) 13.78 Unvested at December 31, 2024 7,426 $ 12.92 1.06 The weighted-average grant-date fair value per share of awards granted during the years ended December 31, 2024, 2023 and 2022 was $ 12.56 , $ 15.39 and $ 8.13 , respectively. The total fair value of RSUs that vested during the years ended December 31, 2024, 2023 and 2022 was $ 59.4 million, $ 104.3 million and $ 35.2 million, respectively. As of December 31, 2024, there was $ 50.0 million o f unrecognized compensation expense for restricted stock awards, restricted stock units, and performance-based restricted units which is expected to be recognized on a straight-line basis over a weighted average period of approximat ely 1.63 years. Employee Stock Purchase Plan In 2007, the Company adopted the ESPP. On June 14, 2023, the Company’s shareholders approved a third amendment to the ESPP which increased the number of shares of common stock available for purchase under the ESPP by 1,500,000 shares, resulting in total common stock reserved for issuance under the ESPP of 3,637,449 shares. As of December 31, 2024, approximately 714,000 shares were available under the ESPP for future issuance. The ESPP provides eligible employees with a means of acquiring equity in the Company at a discounted purchase price using their own accumulated payroll deductions. Under the terms of the ESPP, employees can elect to have up to 20 % of their annual compensation, up to a maximum of $ 21,250 per year, withheld to purchase shares of Company common stock for a purchase price equal to 85 % of the lower of the fair market value per share (at closing) of Company common stock on (i) the commencement date of the six-month offering period or (ii) the respective purchase date. During the years ended December 31, 2024, 2023 and 2022 there were approximately 529,000 , 375,000 and 429,000 shares of common stock, issued under the ESPP, respectively. The Company recogniz ed $ 2.2 million , $ 1.7 million and $ 1.6 million in expense related to the ESPP for the years ended December 31, 2024, 2023 and 2022, respectively. The Company estimates the fair value of shares issued to employees under the ESPP using the Black-Scholes option-pricing model. The assumptions used to estimate the fair value of stock purchase rights under the ESPP are as follows: Year Ended December 31, 2024 2023 2022 Risk-free interest rate 4.44 % - 5.41 % 4.54 % - 5.41 % 0.07 % - 4.54 % Expected dividend yield — — — Expected term (years) 0.50 0.41 - 0.60 0.50 - 0.60 Volatility 54.47 % - 91.91 % 40.87 % - 62.77 % 50.29 % - 64.53 % Common Stock Reserved for Future Issuance Common stock reserved for future issuance consists of the following (in thousands): December 31, 2024 Stock options outstanding 2,158 Unvested restricted stock units 7,426 Employee stock purchase plan 714 Senior convertible notes 17,246 Warrants outstanding 9,316 Authorized for future grant under the Distributor and 424 Authorized for future grant under the Management 1 Authorized for future grant under the Company 4,528 41,813

Income Taxes

Income Taxes	12 Months Ended
	Dec. 31, 2024
Income Tax Disclosure [Abstract]
Income Taxes	10. Income Taxes The components of the pretax loss are presented in the following table (in thousands): Year Ended December 31, 2024 2023 2022 U.S. Domestic $ ( 147,954 ) $ ( 178,313 ) $ ( 146,627 ) Foreign ( 14,119 ) ( 8,602 ) ( 5,382 ) Net loss before taxes $ ( 162,073 ) $ ( 186,915 ) $ ( 152,009 ) The components of the provision for income taxes are presented in the following table (in thousands): Year Ended December 31, 2024 2023 2022 Current income tax provision: Federal $ 78 $ 76 $ ( 764 ) State 349 332 ( 140 ) Foreign 209 145 301 Total current 636 553 ( 603 ) Deferred income tax provision: Federal 44 37 583 State ( 8 ) — 160 Foreign ( 622 ) ( 867 ) ( 856 ) Total deferred ( 586 ) ( 830 ) ( 113 ) Total income tax provision $ 50 $ ( 277 ) $ ( 716 ) The provision for income taxes differs from the amount of income tax determined by applying the applicable U.S. statutory federal income tax rate to pretax loss as a result of the following differences: December 31, 2024 2023 2022 Federal statutory rate 21.00 % 21.00 % 21.00 % Adjustments for tax effects of: State taxes, net ( 0.17 ) ( 0.13 ) 0.03 Stock-based compensation ( 3.57 ) ( 1.12 ) ( 1.79 ) Rate differential 0.32 0.18 0.43 Foreign taxes ( 0.02 ) ( 0.07 ) ( 0.05 ) Other permanent adjustments ( 0.71 ) ( 0.21 ) 0.21 Credits 2.06 1.53 0.00 Federal uncertain tax positions ( 1.14 ) ( 1.50 ) 0.03 Expiration of tax attribute ( 0.11 ) ( 0.09 ) ( 1.60 ) Liquidation entries — — 0.86 Other 0.55 0.70 ( 0.27 ) Valuation allowance ( 18.23 ) ( 20.12 ) ( 18.38 ) Effective income tax rate ( 0.02 )% 0.17 % 0.47 % Significant components of the Company’s deferred tax assets and liabilities as of December 31, 2024 and 2023 are as follows (in thousands): December 31, 2024 2023 Deferred tax assets: Net operating losses $ 176,352 $ 167,389 Interest 21,439 16,230 Capitalized research and development expenses 35,177 25,633 Inventory 16,183 12,095 Lease liability 8,388 7,268 Stock-based compensation 16,754 14,024 Accruals and reserves 7,277 6,162 Legal settlement 341 440 Income tax credit carryforwards 7,554 4,231 Total deferred tax assets 289,465 253,472 Valuation allowance ( 246,744 ) ( 211,454 ) Total deferred tax assets, net of valuation allowance 42,721 42,018 Deferred tax liabilities: Property and equipment ( 27,840 ) ( 26,367 ) Goodwill and intangibles ( 10,472 ) ( 13,399 ) Right-of-use assets ( 8,011 ) ( 6,837 ) Unrealized foreign exchange gain ( 396 ) ( 254 ) Total deferred tax liabilities ( 46,719 ) ( 46,857 ) Net deferred tax assets $ ( 3,998 ) $ ( 4,839 ) The realization of deferred tax assets is dependent on the Company’s ability to generate sufficient taxable income in future years in the associated jurisdiction to which the deferred tax assets relate. As of December 31, 2024, a valuation allowance of $ 246.7 million has been established against the deferred tax assets, as the Company has determined that it is currently not likely that these assets will be realized. During the years ended December 31, 2024, 2023 and 2022, the valuation allowance increased by $ 35.3 million, $ 43.6 million and $ 39.4 million, respectively. In determining the need for a valuation allowance, the Company considers all available positive and negative evidence, including scheduled reversals of deferred tax liabilities, projected future taxable income, tax planning strategies, and recent financial performance. Based on the review of all positive and negative evidence, including a three-year cumulative pretax loss, the Company determined that a full valuation allowance should be recorded against its deferred tax assets, with the exception of the net indefinite lived deferred tax liabilities and the Company’s Texas Temporary Credit for Business Loss Carryforwards. The following table summarizes the changes to unrecognized tax benefits (in thousands): Year ended December 31, 2024 2023 2022 Unrecognized tax benefit at the beginning of the year $ 9,065 $ 6,079 $ 15,165 Increases in tax positions for prior years 1,072 1,632 — Decreases in tax positions for prior years — — ( 8,929 ) Increases in tax positions for current year relating to ongoing operations 2,695 1,435 173 Decreases in tax positions as a result of a lapse of statute of limitations — ( 81 ) ( 330 ) Unrecognized tax benefits at the end of the year $ 12,832 $ 9,065 $ 6,079 At December 31, 2024, 2023 and 2022, $ 11.9 million, $ 8.6 million and $ 5.6 million, respectively, of the Company’s total unrecognized tax benefits, if recognized, would impact the effective income tax rate. In accordance with the disclosure requirements as described in ASC Topic 740, Income Taxes , the Company classifies uncertain tax positions as non-current income tax liabilities unless they are expected to be paid within one year. The Company recognizes interest and penalties related to income tax matters as a component of the income tax provision. As of December 31, 2024, 2023 and 2022, there wer e $ 0.18 million , $ 0.1 million and $ 0.04 million in accrued interest and penalties, respectively. The Company and its subsidiaries are subject to federal income tax as well as income tax of multiple state and foreign jurisdictions. With few exceptions, the Company is no longer subject to income tax examination by tax authorities in major jurisdictions for years prior to 2020. However, to the extent allowed by law, the taxing authorities may have the right to examine prior periods where net operating losses and tax credits were generated and carried forward and make adjustments up to the amount of the carryforwards. The Company is not currently under examination by the Internal Revenue Service, foreign or state and local tax authorities. At December 31, 2024, the Company had federal, state, and foreign net operating loss carryforwards of $ 604.6 million, $ 483.1 million and $ 119.1 million, respectively. Federal and state net operating losses generated after December 31, 2017 of $ 467.3 million and $ 94.6 million, respectively, can be carried forward indefinitely. The remaining federal and state net operating losses begin expiring at various dates begin ning in 2025 through 2044 , while foreign net operating losses in France carryforward indefinitely. At December 31, 2024, the Company had federal and state research and development tax cre dit carryforwards of $ 9.0 million and $ 7.8 million, respectively. The federal research and development tax credits begin expiring in 2042 and the state research and development tax credits do not have an expiration date and may be carried forward indefinitely. At December 31, 2024, the Company also had interest expense carryovers of $ 87.5 million which can be carried forward indefinitely. Utilization of the net operating loss and tax credit carryforwards may become subject to annual limitations due to ownership change limitations that could occur in the future as provided by Section 382 and 383 of the Internal Revenue Code of 1986, as amended (the “Internal Revenue Code”), as well as similar state provisions. These ownership changes may limit the amount of the net operating loss and tax credit carryforwards that can be utilized annually to offset future taxable income if the Company experiences a cumulative change in ownership of more than 50 % within a three-year testing period. The Company completed formal study through the year ended December 31, 2018 and determined ownership changes within the meaning of IRC Section 382 had occurred. The Company adjusted federal tax attribute carry forwards and deferred tax assets accordingly. The Company will make adjustments to the fully reserved attributes as further studies are completed.

Related Party Transactions

Related Party Transactions	12 Months Ended
	Dec. 31, 2024
Related Party Transactions [Abstract]
Related Party Transactions	11. Related Party Transactions The Company purchases inventory from an affiliate of Squadron Capital, LLC (the “Squadron Supplier Affiliate”). David Pelizzon, President and Director of Squadron Capital, LLC, currently serves on the Company’s Board of Directors. For the years ended December 31, 2024, 2023 and 2022, the Company purchased inventory in the amounts of $ 21.2 million, $ 19.6 million and $ 10.3 million, respectively, from the Squadron Supplier Affiliate. As of December 31, 2024 and 2023, the Company had $ 1.8 mil lion and $ 5.4 million, respectively, due to the Squadron Supplier Affiliate.

Business Segment and Geographic

Business Segment and Geographic Information	12 Months Ended
	Dec. 31, 2024
Segment Reporting [Abstract]
Business Segment and Geographic Information	12. Business Segment and Geographic Information The Company operates in one segment based upon the Company’s organizational structure, the way in which the operations and investments are managed and evaluated by the chief operating decision maker (“CODM”) as well as the lack of available discrete financial information at a level lower than the consolidated level. The CODM is the Chief Executive Officer . The Company shares common, centralized support functions which report directly to the CODM and decision-making regarding the Company’s overall operating performance and allocation of Company resources is assessed on a consolidated basis. Significant segment expenses regularly provided to the CODM are consolidated research and development expenses and consolidated sales, general and administrative expenses. Refer to the consolidated statements of operations for consolidated research and development expenses and consolidated sales, general and administrative expenses. The Company determined that consolidated net loss is the Company’s measure of segment profit or loss. Net revenue and property and equipment, net, by geographic region are as follows (in thousands): Revenue Property and equipment, net Year Ended December 31, December 31, (in thousands) 2024 2023 2022 2024 2023 United States $ 571,267 $ 445,351 $ 326,697 $ 154,772 $ 147,705 International 40,295 36,911 24,170 1,622 2,130 Total $ 611,562 $ 482,262 $ 350,867 $ 156,394 $ 149,835

Organization and Significant _2

Organization and Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2024
Accounting Policies [Abstract]
The Company	The Company Alphatec Holdings, Inc. (the “Company”), through its wholly owned subsidiaries, Alphatec Spine, Inc. (“Alphatec Spine”), SafeOp Surgical, Inc. (“SafeOp”), and EOS imaging S.A.S. (“EOS”), is a medical technology company focused on the design, development, and advancement of technology for the better surgical treatment of spinal disorders. The Company, headquartered in Carlsbad, California, markets its products in the United States ("U.S.") and internationally via a network of independent sales agents and direct sales representatives.
Basis of Presentation and Principles of Consolidation	Basis of Presentation and Principles of Consolidation The accompanying consolidated financial statements have been prepared in accordance with generally accepted accounting principles in the United States of America ("U.S. GAAP") and include the accounts of the Company and its wholly owned subsidiaries. The Company translates the financial statements of its foreign subsidiaries using end-of-period exchange rates for assets and liabilities and average exchange rates during each reporting period for results of operations. All intercompany balances and transactions have been eliminated in consolidation. The Company operates in one reportable business segment.
Reclassification	Reclassification Certain financial statement line items in the consolidated financial statements for the year ended December 31, 2022 have been aggregated to conform to the current year’s presentation.
Use of Estimates	Use of Estimates The carrying amount of financial instruments consisting of cash and cash equivalents, accounts receivable, prepaid expenses and other current assets, accounts payable, accrued expenses, and short-term debt included in the Company’s consolidated financial statements are reasonable estimates of fair value due to their short maturities.
Concentrations of Credit Risk and Significant Customers	Concentrations of Credit Risk and Significant Customers Financial instruments, which potentially subject the Company to concentrations of credit risk, consist primarily of cash, cash equivalents, and accounts receivable. The Company limits its exposure to credit loss by depositing its cash and investments with established financial institutions. Although the Company deposits its cash with multiple financial institutions, its deposits, at times, may exceed federally insured limits. The Company’s customers are primarily hospitals and surgical centers. No one single customer represented greater than 10 percent of consolidated revenues and accounts receivable for the years presented. Credit to customers is granted based on an analysis of the customers’ credit worthiness. Credit losses have not been significant.
Cash and Cash Equivalents	Cash and Cash Equivalents The company considers all highly liquid investments that are readily convertible into cash and have an original maturity of three months or less at the time of purchase to be cash equivalents.
Accounts Receivable, net	Accounts Receivable, net Accounts receivable are presented net of allowance for doubtful accounts. The Company makes judgments as to its ability to collect outstanding receivables and provides allowances for a portion of receivables when collection becomes doubtful. Provisions are made based upon a specific review of all significant outstanding invoices. In determining the provision for invoices not specifically reviewed, the Company analyzes historical collection experience. If the historical data used to calculate the allowance provided for doubtful accounts does not reflect the Company’s future ability to collect outstanding receivables or if the financial condition of customers were to deteriorate, resulting in impairment of their ability to make payments, an increase in the provision for doubtful accounts may be required. The Company’s accounts receivable have payment terms commensurate with the local business practice depending on the country of sale. The Company generally does not allow returns of products that have been delivered. The Company offers standard quality assurance warranty on its products. The Company had no material bad debt expense during the years presented.
Excess and Obsolete Inventory	Excess and Obsolete Inventory Most of the Company’s inventory is comprised of finished goods, which is primarily produced by third-party suppliers. Specialized implants, fixation products, biologics, and imaging equipment are determined by utilizing a standard cost method that includes capitalized variances which approximates the weighted average cost. Component parts related to the imaging equipment are valued at weighted average cost. Inventories are stated at the lower of cost or net realizable value. The Company reviews the components of its inventory on a periodic basis for excess and obsolescence and adjusts inventory to its net realizable value as necessary. The Company records a lower of cost or net realizable value (“LCNRV”) inventory reserve for estimated excess and obsolete inventory based upon its expected use of inventory on hand. The Company’s inventory, which consists primarily of specialized implants, fixation products, and biologics is at risk of obsolescence due to the need to maintain substantial levels of inventory. In order to market its products effectively and meet the demands of interoperative product placement, the Company maintains and provides surgeons and hospitals with a variety of inventory products and sizes. For each surgery, fewer than all components will be consumed. The need to maintain and provide a wide variety of inventory causes inventory to be held that is not likely to be used. The Company’s estimates and assumptions for excess and obsolete inventory are reviewed and updated on a quarterly basis. The estimates and assumptions are determined primarily based on current usage of inventory and the age of inventory quantities on hand. Additionally, the Company considers recent sales experience to develop assumptions about future demand for its products, while considering product life cycles and new product launches. Increases in the LCNRV reserve for excess and obsolete inventory result in a corresponding charge to cost of sales. For the years ended December 31, 2024, 2023 and 2022, the Company recorded LCNRV charges for excess and obsolete inventory of $ 15.4 million, $ 13.6 million and $ 9.8 million, respectively, net of inventory sold of $ 3.4 million, $ 0.2 million and $ 1.5 million, respectively. For the years ended December 31, 2024, 2023 and 2022, the Company recorded a reduction of reserve for inventory that was disposed of $ 3.5 million, $ 12.9 million and $ 8.2 million , respectively.
Property and Equipment, net	Property and Equipment, net Property and equipment are stated at cost, net of accumulated depreciation. Depreciation is computed using the straight-line method over the estimated useful lives of the related assets, generally ranging from three to seven years . Leasehold improvements and assets acquired under financing leases are amortized over the shorter of their useful lives or the remaining terms of the related leases.
Operating Lease	Operating Lease The Company determines whether a contract is a lease or contains a lease at inception by assessing whether there is an identified asset and whether the contract conveys the right to control the use of the identified asset in exchange for consideration over a period of time. If both criteria are met, the Company determines the initial classification and measurement of its right-of-use (“ROU”) asset and lease liability at the lease commencement date and thereafter, if modified. The Company recognizes a ROU asset and lease liability for its operating leases with lease terms greater than 12 months. The lease term includes any renewal options and termination options that the Company is reasonably assured to exercise. ROU assets and lease liabilities are based on the present value of lease payments over the lease term. The present value of operating lease payments is determined by using the incremental borrowing rate of interest that the Company would borrow on a collateralized basis for an amount equal to the lease payments in a similar economic environment. Rent expense for operating leases is recognized on a straight-line basis over the reasonably assured lease term based on the total lease payments and is included in cost of sales, research and development, and sales, general and administrative expenses in the consolidated statements of operations. The Company aggregates all lease and non-lease components for each class of underlying assets into a single lease component and variable charges for common area maintenance and other variable costs are recognized as expense as incurred. Total variable costs associated with leases were immaterial for all years presented. The Company had an immaterial amount of financing leases as of December 31, 2024 and 2023, which is included in property and equipment, net, accrued expenses and other current liabilities, and other long-term liabilities on the consolidated balance sheets.
Valuation of Goodwill	Valuation of Goodwill Goodwill represents the excess of the cost over the fair value of net assets acquired from the Company’s business combinations. The determination of the value of goodwill and intangible assets arising from business combinations and asset acquisitions requires extensive use of accounting estimates and judgments to allocate the purchase price to the fair value of the net tangible and intangible assets acquired. Goodwill is assessed for impairment using fair value measurement techniques on an annual basis or more frequently if facts and circumstance warrant such a review. Goodwill is considered to be impaired if the Company determines that the carrying value of the reporting unit exceeds its respective fair value. The Company’s annual evaluation for impairment of goodwill consists of one reporting unit. The Company completed its most recent annual evaluation for impairment of goodwill as of October 1, 2024 and determined that no impairment existed. In addition, no indicators of impairment were noted through December 31, 2024, and consequently no impairment charge was recorded during the years ended December 31, 2024 , 2023 and 2022.
Valuation of Intangible Assets	Valuation of Intangible Assets Intangible assets are comprised primarily of purchased technology, internally developed software, customer relationships, trade name, trademarks, and in-process research and development. The Company makes significant judgments in relation to the valuation of intangible assets resulting from business combinations and asset acquisitions. Intangible assets are generally amortized on a straight-line basis over their estimated useful lives of 2 to 12 years . The Company bases the useful lives and related amortization expense on the period of time it estimates the assets will generate net sales or otherwise be used. The Company also periodically reviews the lives assigned to its intangible assets to ensure that its initial estimates do not exceed any revised estimated periods from which the Company expects to realize cash flows. If a change were to occur in any of the above-mentioned factors or estimates, the likelihood of a material change in the Company’s reported results would increase. The Company evaluates its intangible assets with finite lives for indications of impairment whenever events or changes in circumstances indicate that the carrying value may not be recoverable. Factors that could trigger an impairment review include significant under-performance relative to expected historical or projected future operating results, significant changes in the manner of the Company’s use of the acquired assets or the strategy for its overall business or significant negative industry or economic trends. If this evaluation indicates that the value of the intangible asset may be impaired, the Company makes an assessment of the recoverability of the net carrying value of the asset over its remaining useful life. If this assessment indicates that the intangible asset is not recoverable, based on the estimated undiscounted future cash flows of the asset over the remaining amortization period, the Company reduces the net carrying value of the related intangible asset to fair value and may adjust the remaining amortization period. Significant judgment is required in the forecasts of future operating results that are used in the discounted cash flow valuation models. It is possible that plans may change and estimates used may prove to be inaccurate. If actual results, or the plans and estimates used in future impairment analyses, are lower than the original estimates used to assess the recoverability of these assets, the Company could incur additional impairment charges. There were no impairment charges during the years ended December 31, 2024, 2023 or 2022. In-process research and development ("IPR&D") and software in development have indefinite lives and are not amortized until the related products reach full commercial launch or when the projects are complete and their assets are ready for their intended use. Indefinite-lived intangible assets are considered to be impaired if the products do not reach commercial launch, if the project is not completed or not completed in a timely manner, or if the related products or projects are no longer technologically feasible. Impairment related to IPR&D and software in development is calculated as the excess of the asset's carrying value over its fair value. There were no impairment charges during the years ended December 31, 2024, 2023 or 2022.
Impairment of Long-Lived Assets	Impairment of Long-Lived Assets The Company assesses potential impairment to its long-lived assets when there is evidence that events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. An impairment loss is recognized when estimated future undiscounted cash flows related to the asset are less than its carrying amount. Any required impairment loss is measured as the amount by which the carrying amount of a long-lived asset exceeds its fair value and is recorded as a reduction in the carrying value of the related asset and a charge to operating results. There were no material impairment charges during the years ended December 31, 2024, 2023 or 2022.
Warrants to Purchase Common Stock	Warrants to Purchase Common Stock Warrants are accounted for in accordance with the applicable accounting guidance as either derivative liabilities or as equity instruments depending on the specific terms of the agreements. All warrants qualify for classification within stockholders' (deficit) equity.
Fair Value Measurements	Fair Value Measurements The carrying amount of financial instruments consisting of cash and cash equivalents, accounts receivable, prepaid expenses and other current assets, accounts payable, accrued expenses, and short-term debt included in the Company’s consolidated financial statements are reasonable estimates of fair value due to their short maturities. Authoritative guidance establishes a three-tier fair value hierarchy, which prioritizes the inputs used in measuring fair value as follows: Level 1: Quoted prices in active markets for identical assets or liabilities. Level 2: Inputs other than Level 1 that are observable, either directly or indirectly, such as quoted prices for similar assets or liabilities, quoted prices in markets that are not active; or other inputs that can be corroborated by observable market data for substantially the full term of the assets or liabilities. Level 3: Unobservable inputs that are supported by little or no market activity and that are significant to the fair value of the assets or liabilities.
Revenue Recognition	Revenue Recognition The Company recognizes revenue from product sales in accordance with Financial Accounting Standards Board (“FASB”) Accounting Standards Codification (“ASC”) Revenue from Contracts with Customers (“Topic 606”). This standard applies to all contracts with customers, except for contracts that are within the scope of other standards, such as leases. Under Topic 606, an entity recognizes revenue when its customer obtains control of promised goods or services, in an amount that reflects the consideration that the entity expects to receive in exchange for those goods or services. To determine revenue recognition for arrangements that an entity determines are within the scope of Topic 606, the entity performs the following five steps: (i) identify the contract(s) with a customer; (ii) identify the performance obligations in the contract; (iii) determine the transaction price; (iv) allocate the transaction price to the performance obligations in the contract; and (v) recognize revenue when (or as) the entity satisfies a performance obligation. The Company only applies the five-step model to contracts when it is probable that the entity will collect the consideration it is entitled to in exchange for the goods or services it transfers to the customer. Sales are derived primarily from the sale of spinal implant products, imaging equipment, and related services to hospitals and medical centers. Revenue is recognized when obligations under the terms of a contract with customers are satisfied, which occurs with the transfer of control of products to customers, either upon shipment of the product or delivery of the product to the customer depending on the shipping terms, or when the products are used in a surgical procedure (implanted in a patient). Revenue from the sale of imaging equipment is recognized as each distinct performance obligation is fulfilled and control transfers to the customer, beginning with shipment or delivery, depending on the contract terms. Revenue from other distinct performance obligations, such as maintenance on imaging equipment and other imaging related services, is recognized in the period the service is performed, and makes up less than 10 % of the Company’s total revenue. In certain cases, the Company does offer the ability for customers to lease its imaging equipment, but such arrangements are immaterial to total revenue in the years presented. The Company generally does not allow returns of products that have been delivered. Costs incurred by the Company associated directly with sales contracts with customers are deferred over the performance obligation period and recognized in the same period as the related revenue, except for contracts that complete within one year or less, in which case the associated costs are expensed as incurred. Payment terms for sales to customers may vary but are commensurate with the general business practices in the country of sale. To the extent that the transaction price includes variable consideration, such as discounts, rebates, and customer payment penalties, the Company estimates the amount of variable consideration that should be included in the transaction price utilizing either the expected value method or the most likely amount method depending on the nature of the variable consideration. Variable consideration is included in the transaction price if, in the Company’s judgment, it is probable that a significant future reversal of cumulative revenue under the contract will not occur. Estimates of variable consideration and determination of whether to include estimated amounts in the transaction price are based largely on an assessment of the Company’s anticipated performance and all information that is reasonably available, including historical, current, and forecasted information. The Company records a contract asset when one or more performance obligations have been completed and revenue has been recognized, but the customer's payment is contingent on the satisfaction of additional performance obligations. The Company records a contract liability, or deferred revenue, when it has an obligation to provide a product or service to the customer and payment is received in advance of its performance. When the Company sells a product or service with a future performance obligation, revenue is deferred on the unfulfilled performance obligation and recognized over the related performance period. Generally, the Company estimates the selling price of promised services included in the equipment sales price using an expected cost plus a margin approach and/or the separately observable price of such service, if available. The transaction price for a contract’s various performance obligations is allocated using the relative standalone selling price method. The use of alternative estimates could result in a different amount of revenue deferral.
Research and Development Expenses	Research and Development Expenses Research and development costs are expensed as incurred. Research and development expenses consist of costs associated with the design, development, testing, and enhancement of the Company's products. Research and development expenses also include salaries and related employee benefits, research-related overhead expenses, fees paid to external service providers and development consultants in the form of both cash and equity.
Transaction-related Expenses	Transaction-related Expenses Transaction-related costs are expensed as incurred. Transaction-related expenses consist of certain costs incurred related primarily to the acquisition and integration of Valence, as defined below.
Product Shipment Cost	Product Shipment Cost Product shipment costs for surgical sets are included in sales, general and administrative expenses in the accompanying consolidated statements of operations. Product shipment costs total ed $ 21.8 million , $ 17.3 million and $ 14.8 million for the years ended December 31, 2024, 2023 and 2022 respectively.
Stock-Based Compensation	Stock-Based Compensation Stock-based compensation expense for equity-classified awards, principally related to restricted stock units ("RSUs") and performance restricted stock units ("PRSUs") is measured at the grant date based on the estimated fair value of the award. The fair value of equity instruments that are expected to vest is recognized and amortized over the requisite service period. The Company has granted awards with up to four year graded or cliff vesting terms. No exercise price or other monetary payment is required for receipt of the shares issued in settlement of the respective award; instead, consideration is furnished in the form of the participant’s service. The fair value of RSUs including PRSUs with pre-defined performance criteria is based on the stock price on the date of grant. Stock-based compensation recorded in the Company’s consolidated statements of operations is based on awards expected to ultimately vest and has been reduced for estimated forfeitures. The Company’s estimated forfeiture rates may differ from its actual forfeitures. The Company considers its historical experience of pre-vesting forfeitures on awards by each homogenous group of employees as the basis to arrive at its estimated annual pre-vesting forfeiture rates. The Company estimates the fair value of stock options issued under the Company’s equity incentive plans and shares issued to employees under the Company’s employee stock purchase plan (“ESPP”) using a Black-Scholes option-pricing model on the date of grant. The Black-Scholes option-pricing model incorporates various assumptions including expected volatility, expected term and risk-free interest rates. The expected volatility is based on the historical volatility of the Company’s common stock over the most recent period commensurate with the estimated expected term of the Company’s stock options and ESPP offering period which is derived from historical experience. The risk-free interest rate for periods within the contractual life of the option is based on the U.S. Treasury yield in effect at the time of grant. The Company has never declared or paid dividends and has no plans to do so in the foreseeable future. Awards to non-employees are accounted for under the same stock-based compensation provisions as employees, which require that the fair value of these instruments be recognized as an expense when earned. For Development Service Agreements, where the future payments for product and/or intellectual property rights may be paid in either cash or restricted shares of our common stock at the election of the developer, we estimate the fair value of those awards similar to a stock option, using a Black-Scholes option-pricing model on the date of grant. For Development Service Agreements where the future payments for product and/or intellectual property rights will be paid in restricted shares of our common stock, the fair value is based on the stock price on the date of grant. The stock-based compensation expense is recognized as earned once the award is deemed probable of achieving the pre-defined performance criteria. The stock-based compensation expense is included in cost of sales or research and development expense on the consolidated statements of operations commensurate with the nature of the services performed.
Income Taxes	Income Taxes The Company accounts for income taxes in accordance with provisions which set forth an asset and liability approach that requires the recognition of deferred tax assets and deferred tax liabilities for the expected future tax consequences of temporary differences between the carrying amounts and the tax bases of assets and liabilities. Valuation allowances are established when necessary to reduce deferred tax assets to the amount expected to be realized. In making such determination, a review of all available positive and negative evidence must be considered, including scheduled reversal of deferred tax liabilities, projected future taxable income, tax planning strategies, and recent financial performance. The Company recognizes interest and penalties related to uncertain tax positions as a component of the income tax provision.
Net Loss per Share	Net Loss per Share Basic net loss per share is calculated by dividing the net loss available to common stockholders by the weighted-average number of common shares outstanding for the year. If applicable, diluted net loss per share attributable to common stockholders is calculated by dividing net loss available to common stockholders by the diluted weighted-average number of common shares outstanding for the year determined using the treasury-stock method and the if-converted method for convertible debt. For purposes of this calculation, common stock subject to repurchase by the Company, common stock issuable upon conversion or exercise of convertible notes, preferred shares, options, and warrants are considered to be common stock equivalents and are only included in the calculation of diluted earnings per share when their effect is dilutive. Due to the Company’s net loss position, the effect of including common stock equivalents in the earnings per share calculation is anti-dilutive, and therefore not included. The following table sets forth the computation of basic and diluted loss per share (in thousands, except per share data): Year Ended December 31, 2024 2023 2022 Numerator: Net loss $ ( 162,123 ) $ ( 186,638 ) $ ( 151,293 ) Denominator: Weighted average common shares outstanding 142,946 121,242 103,373 Net loss per share, basic and diluted $ ( 1.13 ) $ ( 1.54 ) $ ( 1.46 ) The following potentially dilutive shares of common stock were excluded from the calculation of diluted net loss per share because their effect would have been anti-dilutive for the years presented (in thousands): Year Ended December 31, 2024 2023 2022 Options to purchase common stock and employee stock purchase plan 2,204 2,555 2,991 Unvested restricted stock units 7,426 7,713 8,533 Warrants to purchase common stock 9,316 8,219 15,491 Senior convertible notes 17,246 17,246 17,246 36,192 35,733 44,261
Recently Issued and Adopted Accounting Pronouncements	Recently Issued Accounting Pronouncements In December 2023, the FASB issued Accounting Standard Update ("ASU") No. 2023-09, Income Taxes (Topic 740): Improvement to Income Tax Disclosures to enhance the transparency of income tax disclosures. The guidance in ASU No. 2023-09 allows for a prospective method of transition, with the option to apply the standard retrospectively. The standard is effective for fiscal years beginning after December 15, 2024, with early adoption permitted. The Company is in the process of assessing the impact of this standard on its consolidated financial statements and related disclosures. In November 2024, the FASB issued ASU No. 2024-03, Income Statement-Reporting Comprehensive Income-Expense Disaggregation Disclosures (Topic 220-40). Additionally, in January 2025, the FASB issued ASU 2025-01 to clarify the effective date of ASU 2024-03. The standard provides guidance to expand disclosures related to the disaggregation of income statement expenses. The standard requires, in the notes to the financial statements, disclosure of specified information about certain costs and expenses, which includes purchases of inventory, employee compensation, depreciation and intangible asset amortization included in each relevant expense caption. This guidance is effective for fiscal years beginning after December 15, 2026, and interim periods within annual reporting periods beginning after December 15, 2027, on a retrospective or prospective basis, with early adoption permitted. The Company is in the process of assessing the impact of this standard on its consolidated financial statements and related disclosures. Recently Adopted Accounting Pronouncements In November 2023, the FASB issued ASU No. 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures that expands disclosure requirements for reportable segments, primarily through enhanced disclosure of significant segment expenses. The guidance in ASU No. 2023-07 allows for a retrospective method of transition. The standard is effective for fiscal years beginning after December 15, 2023, and interim periods in fiscal years beginning after December 15, 2024, with early adoption permitted. The Company adopted the new accounting pronouncement on January 1, 2024 . The adoption of this guidance did no t have an effect on the Company’s financial position, results of operations and cash flows. See Note 12 - Business Segment and Geographic Disclosure for additional disclosures.

Organization and Significant _3

Organization and Significant Accounting Policies (Tables)	12 Months Ended
	Dec. 31, 2024
Accounting Policies [Abstract]
Computation of Basic and Diluted Loss Per Share	The following table sets forth the computation of basic and diluted loss per share (in thousands, except per share data): Year Ended December 31, 2024 2023 2022 Numerator: Net loss $ ( 162,123 ) $ ( 186,638 ) $ ( 151,293 ) Denominator: Weighted average common shares outstanding 142,946 121,242 103,373 Net loss per share, basic and diluted $ ( 1.13 ) $ ( 1.54 ) $ ( 1.46 )
Anti-Dilutive Securities of Common Stock Excluded from Calculation of Diluted Net Loss Per Share	The following potentially dilutive shares of common stock were excluded from the calculation of diluted net loss per share because their effect would have been anti-dilutive for the years presented (in thousands): Year Ended December 31, 2024 2023 2022 Options to purchase common stock and employee stock purchase plan 2,204 2,555 2,991 Unvested restricted stock units 7,426 7,713 8,533 Warrants to purchase common stock 9,316 8,219 15,491 Senior convertible notes 17,246 17,246 17,246 36,192 35,733 44,261

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	12 Months Ended
	Dec. 31, 2024
Fair Value Disclosures [Abstract]
Assets and Liabilities Measured at Fair Value on Recurring Basis	Assets and liabilities measured at fair value on a recurring basis include the following as of December 31, 2024 and 2023 (in thousands): December 31, 2024 Level 1 Level 2 Level 3 Total Cash equivalents: Money market funds $ 57,006 — — $ 57,006 Total cash equivalents $ 57,006 — — $ 57,006 December 31, 2023 Level 1 Level 2 Level 3 Total Cash equivalents: Money market funds $ 76,662 — — $ 76,662 Total cash equivalents $ 76,662 — — $ 76,662

Balance Sheet Details (Tables)

Balance Sheet Details (Tables)	12 Months Ended
	Dec. 31, 2024
Balance Sheet Related Disclosures [Abstract]
Inventories	Inventories consist of the following (in thousands): December 31, 2024 2023 Raw materials $ 19,378 $ 23,394 Work-in-process — 950 Finished goods 155,886 112,498 Inventories $ 175,264 $ 136,842
Property and Equipment, Net	Property and equipment, net consist of the following (in thousands, except as indicated): Useful Life December 31, (in years) 2024 2023 Surgical instruments 4 $ 283,597 $ 224,357 Machinery and equipment 7 12,710 11,633 Computer equipment 3 32,082 5,778 Office furniture and equipment 5 6,759 6,225 Leasehold improvements various 4,321 3,986 Construction in progress n/a 541 24,732 340,010 276,711 Less: accumulated depreciation ( 183,616 ) ( 126,876 ) Property and equipment, net $ 156,394 $ 149,835
Schedule of Goodwill	The change in the carrying amount of goodwill during the year ended December 31, 2024 included the following (in thousands): December 31, 2023 $ 73,003 Foreign currency fluctuation ( 2,027 ) December 31, 2024 $ 70,976
Intangible Assets, Net	Intangible assets, net consist of the following (in thousands, except as indicated): Remaining Weighted Avg. Useful Life Gross Accumulated Intangible December 31, 2024: (in years) Amount Amortization Assets, net Developed product technology 5 $ 102,412 $ ( 38,055 ) $ 64,357 Internally developed software 3 4,283 ( 1,515 ) 2,768 Trademarks and trade names 7 5,267 ( 1,991 ) 3,276 Customer relationships 2 13,996 ( 10,094 ) 3,902 Distribution network – 2,413 ( 2,410 ) 3 Total amortized intangible assets 128,371 ( 54,065 ) 74,306 Software in development n/a 12,927 — 12,927 In-process research and development n/a 6,285 — 6,285 Total intangible assets $ 147,583 $ ( 54,065 ) $ 93,518 . Remaining Weighted Avg. Useful Life Gross Accumulated Intangible December 31, 2023: (in years) Amount Amortization Assets, net Developed product technology 6 $ 106,782 $ ( 26,560 ) $ 80,222 Trademarks and trade names 7 5,588 ( 1,561 ) 4,027 Customer relationships 3 14,504 ( 8,692 ) 5,812 Distribution network 1 2,413 ( 2,242 ) 171 Total amortized intangible assets 129,287 ( 39,055 ) 90,232 Software in development n/a 7,934 — 7,934 In-process research and development n/a 4,285 — 4,285 Total intangible assets $ 141,506 $ ( 39,055 ) $ 102,451
Schedule of Intangible Assets, Future Expected Amortization Expense	Future amortization expense related to intangible assets as of December 31, 2024 is as follows (in thousands): Year Ending December 31, 2025 $ 15,561 2026 15,573 2027 13,351 2028 11,166 2029 9,640 Thereafter 9,015 Total $ 74,306
Accrued Expenses and Other Current Liabilities	Accrued expenses and other current liabilities consist of the following (in thousands): December 31, 2024 2023 Payroll and payroll related $ 29,103 $ 29,207 Commissions and sales milestones 25,778 21,414 Royalties 6,703 7,968 Accrued legal expenses 5,587 10,994 Taxes and fees 2,505 1,985 Inventory in-transit 2,418 2,251 Admin fees and rebates 2,300 2,732 Interest 1,402 1,753 Professional fees 1,353 1,384 Other 4,317 8,024 Total accrued expenses $ 81,466 $ 87,712
Schedule of Other Long-Term Liabilities	Other long-term liabilities consist of the following (in thousands): December 31, 2024 2023 Income tax-related liabilities $ 5,077 $ 5,838 Contract liabilities 3,131 2,561 Royalties 1,532 1,065 Other 1,684 1,739 Other long-term liabilities $ 11,423 $ 11,203

Contract Assets and Contract _2

Contract Assets and Contract Liabilities (Tables)	12 Months Ended
	Dec. 31, 2024
Contract with Customer, Contract Asset, Contract Liability, and Receivable [Abstract]
Opening and Closing Balances of Company's Contract Assets and Liabilities	The opening and closing balances of the Company's contract assets are as follows (in thousands): December 31, December 31, Contract assets $ 5,678 $ 3,865

Debt (Tables)

Debt (Tables)	12 Months Ended
	Dec. 31, 2024
Debt Disclosure [Abstract]
Outstanding Principal Amount and Carrying Value of Notes	The outstanding principal amount and carrying value of the 2026 Notes consist of the following (in thousands): December 31, Principal $ 316,250 Unamortized debt issuance costs ( 3,262 ) Net carrying value $ 312,988
Debt	Debt consists of the following (in thousands): December 31, 2024 2023 2026 Notes $ 316,250 $ 316,250 Other notes payable 432 1,175 PGE loans 3,052 4,537 Braidwell Term Loan, including final payment fee of $ 6,500 206,500 154,875 Revolving Credit Facility 63,284 49,720 Total 589,518 526,557 Less: unamortized debt discount and debt issuance costs ( 13,340 ) ( 13,714 ) Total 576,178 512,843 Less: short-term debt ( 1,656 ) ( 1,808 ) Total long-term debt $ 574,522 $ 511,035
Principal Payments on Debt	Principal payments on debt are as follows as of December 31, 2024 (in thousands): 2025 $ 1,658 2026 317,483 2027 63,877 2028 206,500 Total 589,518 Less: unamortized debt discount and debt issuance costs ( 13,340 ) Total 576,178 Less: short-term debt ( 1,656 ) Long-term debt $ 574,522 OCEANE Convertible Bonds On May 31, 2018, EOS issued 4,344,651 OCEANEs denominated in Euros, due May 2023 for aggregate gross proceeds of $ 34.3 million. The OCEANEs were unsecured obligations of EOS, ranked equally with all other unsecured and unsubordinated obligations of EOS, and paid interest at a rate equal to 6 % per year, payable semiannually in arrears on May 31 and November 30 of each year, beginning November 30, 2018 . The OCEANEs matured on May 31, 2023 and the outstanding OCEANEs and accrued interest were paid in full on May 31, 2023. As of December 31, 2023, no OCEANEs remained outstanding. Interest expense was $ 0.3 million and $ 0.8 million for the years ended December 31, 2023 and 2022, respectively.

Commitments and Contingencies (

Commitments and Contingencies (Tables)	12 Months Ended
	Dec. 31, 2024
Commitments and Contingencies Disclosure [Abstract]
Future minimum annual lease payments	Future minimum annual lease payments for all operating leases of the Company are as follows as of December 31, 2024 (in thousands): 2025 $ 7,112 2026 6,615 2027 6,543 2028 6,026 2029 5,941 Thereafter 10,092 Total undiscounted lease payments 42,329 Less: imputed interest ( 8,571 ) Operating lease liability 33,758 Less: current portion of operating lease liability ( 6,453 ) Operating lease liability, less current portion $ 27,305
Summary of Weighted-Average Remaining Lease Term and Discount Rate	The Company’s weighted average remaining lease term and weighted average discount rate as of December 31, 2024 and December 31, 2023 are as follows: December 31, 2024 2023 Weighted average remaining lease term (years) 6.4 6.5 Weighted average discount rate 6.9 % 5.5 %
Summary of Operating Leases	Information related to the Company’s operating leases is as follows (in thousands): Year Ended December 31, 2024 2023 2022 Rent expense $ 7,393 $ 5,045 $ 4,643 Cash paid for amounts included in measurement of lease liabilities $ 6,296 $ 5,120 $ 4,409

Equity (Tables)

Equity (Tables)	12 Months Ended
	Dec. 31, 2024
Equity [Abstract]
Summary of Outstanding Warrants	A summary of all outstanding warrants as of December 31, 2024 is as follows (in thousands): Number of Strike Price Expiration 2018 Squadron Medical Warrants 845 $ 3.15 May 2027 2019 Squadron Medical Warrants 4,839 $ 2.17 May 2027 2020 Squadron Medical Warrants 1,076 $ 4.88 May 2027 Executive Warrants 1,327 $ 5.00 December 2026 L-5 Healthcare Warrants 1,133 $ 2.17 August 2026 Other* 96 $ 11.79 Various through June 2026 Total 9,316 *Represents weighted average strike price

Stock Benefit Plans and Stock_2

Stock Benefit Plans and Stock-Based Compensation (Tables)	12 Months Ended
	Dec. 31, 2024
Share-Based Payment Arrangement [Abstract]
Summary of Compensation Cost for Stock-Based Compensation Arrangements	The compensation cost that has been included in the Company’s consolidated statements of operations for all stock-based compensation arrangements is detailed as follows (in thousands): Year Ended December 31, 2024 2023 2022 Cost of sales $ 4,961 $ 25,082 $ 2,597 Research and development 27,030 18,741 5,016 Sales, general and administrative 41,286 37,421 32,943 Total $ 73,277 $ 81,244 $ 40,556
Summary of Stock Option Activity	A summary of the Company’s stock option activity under the equity plans and related information is as follows (in thousands, except as indicated and per share data): Shares Weighted Weighted Aggregate Outstanding at December 31, 2023 2,468 $ 3.20 Exercised ( 283 ) 2.52 Forfeited ( 27 ) 14.74 Outstanding at December 31, 2024 2,158 $ 3.15 3.00 $ 13,298 Options vested and expected to vest at 2,158 $ 3.15 3.00 $ 13,298 Options exercisable at 2,155 $ 3.13 2.99 $ 13,296
Summary of Information about Restricted Stock Awards, Restricted Stock Units and Performance-Based Restricted Units Activity	The following table summarizes information about the restricted stock units and performance-based restricted units activity (in thousands, except as indicated and per share data): Shares Weighted Weighted Unvested at December 31, 2023 7,713 $ 13.56 Awarded 5,189 12.56 Vested ( 4,616 ) 7.10 Forfeited ( 860 ) 13.78 Unvested at December 31, 2024 7,426 $ 12.92 1.06
Schedule of Assumptions used to Estimate Fair Value of Stock Options Granted and Stock Purchase Rights under ESPP	The Company estimates the fair value of shares issued to employees under the ESPP using the Black-Scholes option-pricing model. The assumptions used to estimate the fair value of stock purchase rights under the ESPP are as follows: Year Ended December 31, 2024 2023 2022 Risk-free interest rate 4.44 % - 5.41 % 4.54 % - 5.41 % 0.07 % - 4.54 % Expected dividend yield — — — Expected term (years) 0.50 0.41 - 0.60 0.50 - 0.60 Volatility 54.47 % - 91.91 % 40.87 % - 62.77 % 50.29 % - 64.53 %
Summary of Common Stock Reserved for Future Issuance	Common stock reserved for future issuance consists of the following (in thousands): December 31, 2024 Stock options outstanding 2,158 Unvested restricted stock units 7,426 Employee stock purchase plan 714 Senior convertible notes 17,246 Warrants outstanding 9,316 Authorized for future grant under the Distributor and 424 Authorized for future grant under the Management 1 Authorized for future grant under the Company 4,528 41,813

Income Taxes (Tables)

Income Taxes (Tables)	12 Months Ended
	Dec. 31, 2024
Income Tax Disclosure [Abstract]
Components of Pretax Loss	The components of the pretax loss are presented in the following table (in thousands): Year Ended December 31, 2024 2023 2022 U.S. Domestic $ ( 147,954 ) $ ( 178,313 ) $ ( 146,627 ) Foreign ( 14,119 ) ( 8,602 ) ( 5,382 ) Net loss before taxes $ ( 162,073 ) $ ( 186,915 ) $ ( 152,009 )
Components of Provision for Income Taxes	The components of the provision for income taxes are presented in the following table (in thousands): Year Ended December 31, 2024 2023 2022 Current income tax provision: Federal $ 78 $ 76 $ ( 764 ) State 349 332 ( 140 ) Foreign 209 145 301 Total current 636 553 ( 603 ) Deferred income tax provision: Federal 44 37 583 State ( 8 ) — 160 Foreign ( 622 ) ( 867 ) ( 856 ) Total deferred ( 586 ) ( 830 ) ( 113 ) Total income tax provision $ 50 $ ( 277 ) $ ( 716 )
Schedule of Effective Income Tax Rate Reconciliation	The provision for income taxes differs from the amount of income tax determined by applying the applicable U.S. statutory federal income tax rate to pretax loss as a result of the following differences: December 31, 2024 2023 2022 Federal statutory rate 21.00 % 21.00 % 21.00 % Adjustments for tax effects of: State taxes, net ( 0.17 ) ( 0.13 ) 0.03 Stock-based compensation ( 3.57 ) ( 1.12 ) ( 1.79 ) Rate differential 0.32 0.18 0.43 Foreign taxes ( 0.02 ) ( 0.07 ) ( 0.05 ) Other permanent adjustments ( 0.71 ) ( 0.21 ) 0.21 Credits 2.06 1.53 0.00 Federal uncertain tax positions ( 1.14 ) ( 1.50 ) 0.03 Expiration of tax attribute ( 0.11 ) ( 0.09 ) ( 1.60 ) Liquidation entries — — 0.86 Other 0.55 0.70 ( 0.27 ) Valuation allowance ( 18.23 ) ( 20.12 ) ( 18.38 ) Effective income tax rate ( 0.02 )% 0.17 % 0.47 %
Significant Components of Company's Deferred Tax Assets and Liabilities	Significant components of the Company’s deferred tax assets and liabilities as of December 31, 2024 and 2023 are as follows (in thousands): December 31, 2024 2023 Deferred tax assets: Net operating losses $ 176,352 $ 167,389 Interest 21,439 16,230 Capitalized research and development expenses 35,177 25,633 Inventory 16,183 12,095 Lease liability 8,388 7,268 Stock-based compensation 16,754 14,024 Accruals and reserves 7,277 6,162 Legal settlement 341 440 Income tax credit carryforwards 7,554 4,231 Total deferred tax assets 289,465 253,472 Valuation allowance ( 246,744 ) ( 211,454 ) Total deferred tax assets, net of valuation allowance 42,721 42,018 Deferred tax liabilities: Property and equipment ( 27,840 ) ( 26,367 ) Goodwill and intangibles ( 10,472 ) ( 13,399 ) Right-of-use assets ( 8,011 ) ( 6,837 ) Unrealized foreign exchange gain ( 396 ) ( 254 ) Total deferred tax liabilities ( 46,719 ) ( 46,857 ) Net deferred tax assets $ ( 3,998 ) $ ( 4,839 )
Summary of Changes to Unrecognized Tax Benefits	The following table summarizes the changes to unrecognized tax benefits (in thousands): Year ended December 31, 2024 2023 2022 Unrecognized tax benefit at the beginning of the year $ 9,065 $ 6,079 $ 15,165 Increases in tax positions for prior years 1,072 1,632 — Decreases in tax positions for prior years — — ( 8,929 ) Increases in tax positions for current year relating to ongoing operations 2,695 1,435 173 Decreases in tax positions as a result of a lapse of statute of limitations — ( 81 ) ( 330 ) Unrecognized tax benefits at the end of the year $ 12,832 $ 9,065 $ 6,079

Business Segment and Geograph_2

Business Segment and Geographic Information (Tables)	12 Months Ended
	Dec. 31, 2024
Segment Reporting [Abstract]
Schedule of Net Revenue and Property and Equipment, Net, by Geographic Region	Net revenue and property and equipment, net, by geographic region are as follows (in thousands): Revenue Property and equipment, net Year Ended December 31, December 31, (in thousands) 2024 2023 2022 2024 2023 United States $ 571,267 $ 445,351 $ 326,697 $ 154,772 $ 147,705 International 40,295 36,911 24,170 1,622 2,130 Total $ 611,562 $ 482,262 $ 350,867 $ 156,394 $ 149,835

Organization and Significant _4

Organization and Significant Accounting Policies - Additional Information (Details)	12 Months Ended
	Dec. 31, 2024 USD ($) Segment Customer	Dec. 31, 2023 USD ($) Customer	Dec. 31, 2022 USD ($)
Significant Accounting Policies [Line Items]
Number of Reportable Segments | Segment	1
Write-down for excess and obsolete inventories	$ 15,421,000	$ 13,608,000	$ 9,792,000
Inventory sold, net	3,400,000	200,000	1,500,000
Reduction of reserve for inventory	3,500,000	12,900,000	8,200,000
Goodwill impairment charge	0	0	0
Intangible asset impairment charge	0	0	0
Impairment charges of Long-lived assets disposition	0	0	0
Impairment charges of Long-lived assets held for use	0	0	0
Sales, general and administrative	$ 450,199,000	374,080,000	300,013,000
Accounting Standards Update [Extensible Enumeration]	us-gaap:AccountingStandardsUpdate202307Member
Change in accounting principle, accounting standards update, adopted	true
Change in accounting principle, accounting standards update, adoption date	Jan. 01, 2024
Change in accounting principle, accounting standards update, immaterial effect	true
Product Shipment
Significant Accounting Policies [Line Items]
Sales, general and administrative	$ 21,800,000	17,300,000	14,800,000
In-Process Research and Development
Significant Accounting Policies [Line Items]
Intangible asset impairment charge	$ 0	$ 0	$ 0
Minimum
Significant Accounting Policies [Line Items]
Estimated useful lives of property and equipment	3 years
Intangible assets, amortization period	2 years
Maximum
Significant Accounting Policies [Line Items]
Estimated useful lives of property and equipment	7 years
Intangible assets, amortization period	12 years
Vesting period	4 years
Percentage of revenue from other distinct performance obligations of total revenue	10%
Sales | Customer Concentration Risk
Significant Accounting Policies [Line Items]
Concentration risk, number of customers | Customer	0	0
Accounts Receivable | Customer Concentration Risk
Significant Accounting Policies [Line Items]
Concentration risk, number of customers | Customer	0	0

Organization and Significant _5

Organization and Significant Accounting Policies - Computation of Basic and Diluted Loss Per Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Numerator:
Net loss	$ (162,123)	$ (186,638)	$ (151,293)
Denominator:
Weighted average shares outstanding, basic	142,946	121,242	103,373
Weighted average shares outstanding, diluted	142,946	121,242	103,373
Net loss per share, basic	$ (1.13)	$ (1.54)	$ (1.46)
Net loss per share, diluted	$ (1.13)	$ (1.54)	$ (1.46)

Organization and Significant _6

Organization and Significant Accounting Policies - Anti-Dilutive Securities of Common Stock Excluded from Calculation of Diluted Net Loss Per Share (Details) - shares shares in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Anti-dilutive securities not included in diluted net loss per share (in shares)	36,192	35,733	44,261
Options to purchase common stock and employee stock purchase plan
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Anti-dilutive securities not included in diluted net loss per share (in shares)	2,204	2,555	2,991
Unvested restricted stock units
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Anti-dilutive securities not included in diluted net loss per share (in shares)	7,426	7,713	8,533
Warrants to purchase common stock
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Anti-dilutive securities not included in diluted net loss per share (in shares)	9,316	8,219	15,491
Senior Convertible Notes
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Anti-dilutive securities not included in diluted net loss per share (in shares)	17,246	17,246	17,246

Business Combination - Addition

Business Combination - Additional Information (Details) $ in Millions	Apr. 19, 2023 USD ($)
Navigation-enabled Robotics Platform | Asset Purchase Agreement
Business Acquisition [Line Items]
Purchase price in cash	$ 55

Fair Value Measurements - Asset

Fair Value Measurements - Assets and Liabilities Measured at Fair Value on Recurring Basis (Details) - Recurring - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets measured at fair value on a recurring basis	$ 57,006	$ 76,662
Money Market Funds
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets measured at fair value on a recurring basis	57,006	76,662
Fair Value, Inputs, Level 1
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets measured at fair value on a recurring basis	57,006	76,662
Fair Value, Inputs, Level 1 | Money Market Funds
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets measured at fair value on a recurring basis	$ 57,006	$ 76,662

Fair Value Measurements - Addit

Fair Value Measurements - Additional Information (Details) - 2026 Notes - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Aug. 31, 2021
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Interest rate			0.75%
Fair value, inputs, level 1
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Interest rate	0.75%
Fair value of long-term debt	$ 299.6	$ 335.4
Debt maturity year	2026

Balance Sheet Details - Invento

Balance Sheet Details - Inventories (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Balance Sheet Related Disclosures [Abstract]
Raw materials	$ 19,378	$ 23,394
Work-in-process		950
Finished goods	155,886	112,498
Inventories	$ 175,264	$ 136,842

Balance Sheet Details - Propert

Balance Sheet Details - Property and Equipment, Net (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 340,010	$ 276,711
Less: accumulated depreciation	(183,616)	(126,876)
Property and equipment, net	$ 156,394	149,835
Surgical instruments
Property, Plant and Equipment [Line Items]
Useful Life (in years)	4 years
Property and equipment, gross	$ 283,597	224,357
Machinery and equipment
Property, Plant and Equipment [Line Items]
Useful Life (in years)	7 years
Property and equipment, gross	$ 12,710	11,633
Computer equipment
Property, Plant and Equipment [Line Items]
Useful Life (in years)	3 years
Property and equipment, gross	$ 32,082	5,778
Office furniture and equipment
Property, Plant and Equipment [Line Items]
Useful Life (in years)	5 years
Property and equipment, gross	$ 6,759	6,225
Leasehold improvements
Property, Plant and Equipment [Line Items]
Useful lives	various
Property and equipment, gross	$ 4,321	3,986
Construction in progress
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 541	$ 24,732

Balance Sheet Details - Additio

Balance Sheet Details - Additional Information (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Balance Sheet Related Disclosures [Line Items]
Depreciation	$ 62.1	$ 40.9	$ 31
Amortization expense	16.4	15.2	$ 10.2
Additions to goodwill		$ 24.6
Additions to definite-lived intangible assets, useful life		7 years
Developed Product Technology
Balance Sheet Related Disclosures [Line Items]
Additions to definite-lived intangible assets		$ 26.9
Property and equipment
Balance Sheet Related Disclosures [Line Items]
Financing leased assets, gross	$ 0.8	$ 1.1

Balance Sheet Details - Schedul

Balance Sheet Details - Schedule of Goodwill (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2024 USD ($)
Balance Sheet Related Disclosures [Abstract]
December 31, 2023	$ 73,003
Foreign currency fluctuation	(2,027)
December 31, 2024	$ 70,976

Balance Sheet Details - Intangi

Balance Sheet Details - Intangible Assets, Net (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Finite Lived Intangible Assets [Line Items]
Total amortized intangible assets, Gross Amount	$ 128,371	$ 129,287
Total amortized intangible assets, Accumulated Amortization	(54,065)	(39,055)
Total amortized intangible assets, net	74,306	90,232
Total Intangible assets, Gross Amount	147,583	141,506
Total intangible assets, net	$ 93,518	$ 102,451
Developed Technology
Finite Lived Intangible Assets [Line Items]
Intangible assets, net Remaining Weighted Avg. Useful Life	5 years	6 years
Total amortized intangible assets, Gross Amount	$ 102,412	$ 106,782
Total amortized intangible assets, Accumulated Amortization	(38,055)	(26,560)
Total amortized intangible assets, net	$ 64,357	$ 80,222
Internally Developed Software
Finite Lived Intangible Assets [Line Items]
Intangible assets, net Remaining Weighted Avg. Useful Life	3 years
Total amortized intangible assets, Gross Amount	$ 4,283
Total amortized intangible assets, Accumulated Amortization	(1,515)
Total amortized intangible assets, net	$ 2,768
Trademarks and trade names
Finite Lived Intangible Assets [Line Items]
Intangible assets, net Remaining Weighted Avg. Useful Life	7 years	7 years
Total amortized intangible assets, Gross Amount	$ 5,267	$ 5,588
Total amortized intangible assets, Accumulated Amortization	(1,991)	(1,561)
Total amortized intangible assets, net	$ 3,276	$ 4,027
Customer Relationships
Finite Lived Intangible Assets [Line Items]
Intangible assets, net Remaining Weighted Avg. Useful Life	2 years	3 years
Total amortized intangible assets, Gross Amount	$ 13,996	$ 14,504
Total amortized intangible assets, Accumulated Amortization	(10,094)	(8,692)
Total amortized intangible assets, net	3,902	$ 5,812
Distribution network
Finite Lived Intangible Assets [Line Items]
Intangible assets, net Remaining Weighted Avg. Useful Life		1 year
Total amortized intangible assets, Gross Amount	2,413	$ 2,413
Total amortized intangible assets, Accumulated Amortization	(2,410)	(2,242)
Total amortized intangible assets, net	3	171
Software in development
Finite Lived Intangible Assets [Line Items]
Indefinite-Lived Intangible Assets, Gross Amount	12,927	7,934
Indefinite-Lived Intangible Assets, net	12,927	7,934
In process research and development
Finite Lived Intangible Assets [Line Items]
Indefinite-Lived Intangible Assets, Gross Amount	6,285	4,285
Indefinite-Lived Intangible Assets, net	$ 6,285	$ 4,285

Balance Sheet Details - Sched_2

Balance Sheet Details - Schedule of Intangible Assets, Future Expected Amortization Expense (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Balance Sheet Related Disclosures [Abstract]
2025	$ 15,561
2026	15,573
2027	13,351
2028	11,166
2029	9,640
Thereafter	9,015
Total amortized intangible assets, net	$ 74,306	$ 90,232

Balance Sheet Details - Accrued

Balance Sheet Details - Accrued Expenses and Other Current Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Balance Sheet Related Disclosures [Abstract]
Payroll and payroll related	$ 29,103	$ 29,207
Commissions and sales milestones	25,778	21,414
Royalties	6,703	7,968
Accrued legal expenses	5,587	10,994
Taxes and fees	2,505	1,985
Inventory in-transit	2,418	2,251
Admin fees and rebates	2,300	2,732
Interest	1,402	1,753
Professional fees	1,353	1,384
Other	4,317	8,024
Total accrued expenses	$ 81,466	$ 87,712

Balance Sheet Details - Sched_3

Balance Sheet Details - Schedule of Other Long-Term Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Balance Sheet Related Disclosures [Abstract]
Income tax-related liabilities	$ 5,077	$ 5,838
Contract liabilities	3,131	2,561
Royalties	1,532	1,065
Other	1,684	1,739
Other long-term liabilities	$ 11,423	$ 11,203

Contract Assets and Contract _3

Contract Assets and Contract Liabilities - Additional Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Contract with Customer, Contract Asset, Contract Liability, and Receivable [Abstract]
Contract liabilities, current	$ 10,467	$ 13,910
Contract liabilities, non-current	3,131	2,561
Revenue recognized from contract liabilities	24,800	28,200	$ 21,600
Revenue from contract liabilities	$ 13,800	$ 10,900	$ 12,900

Contract Assets and Contract _4

Contract Assets and Contract Liabilities - Opening and Closing Balances of Company's Contract Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Contract with Customer, Contract Asset, Contract Liability, and Receivable [Abstract]
Contract assets	$ 5,678	$ 3,865

Debt - Term Loan (Details)

Debt - Term Loan (Details) - USD ($) $ in Thousands			12 Months Ended
	Oct. 29, 2024	Jan. 06, 2023	Dec. 31, 2024	Dec. 31, 2023	Sep. 28, 2023
Debt Instrument [Line Items]
Initial term loan facility			$ 576,178	$ 512,843
Braidwell Term Loan | Braidwell Transaction Holdings, LLC
Debt Instrument [Line Items]
Long term debt		$ 150,000
Initial term loan facility		$ 100,000
Debt instrument drew					$ 50,000
Credit facility outstanding balance			$ 200,000
Effective interest rate			11.70%
Debt instrument, maturity date		Jan. 06, 2028
Interest rate			10.40%
Interest expenses			$ 18,900	13,200
Amortization of debt issuance costs			700	400
Amortization of debt discount			300	$ 200
Debt discount			2,900
Debt issuance costs incurred		$ 3,600	$ 2,500
Commitment fees incurred		$ 3,500
Interest rate per annum		5.75%
Undrawn commitment fee		1%
Final payment fee percentage		3.25%
Interest rate terms		Borrowings under the Braidwell Term Loan bear interest at a rate per annum equal to the Term Secured Overnight Financing Rate for such SOFR business day ("SOFR") subject to a 3% floor, plus 5.75%.
Additional term loan	$ 50,000
Braidwell Term Loan | Braidwell Transaction Holdings, LLC | Minimum
Debt Instrument [Line Items]
Interest rate per annum		3%
Fee amount percentage		1%
Braidwell Term Loan | Braidwell Transaction Holdings, LLC | Maximum
Debt Instrument [Line Items]
Fee amount percentage		3%

Debt - Revolving Credit Facilit

Debt - Revolving Credit Facility (Details) - USD ($) $ in Thousands	1 Months Ended		12 Months Ended
	Jan. 31, 2025	Sep. 30, 2022	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Line of Credit Facility [Line Items]
Repayment of outstanding balance			$ 164,175	$ 119,500	$ 27,500
Revolving Credit Facility
Line of Credit Facility [Line Items]
Maximum borrowing capacity		$ 50,000	75,000
Increase in borrowing capacity			25,000
Credit facility outstanding balance			63,300
Credit facility matures date		Sep. 29, 2027
Credit facility, matures period prior to final maturity date of 2026 notes		90 days
Debt issuance costs incurred			1,400
Debt issuance costs, net of accumulated amortization			$ 800	1,000
Interest rate per annum			3.50%
Debt Instrument, Variable Interest Rate, Type [Extensible Enumeration]			us-gaap:SecuredOvernightFinancingRateSofrMember
Interest rate			8.20%
Unused line fee percentage per annum			0.50%
Lockbox arrangement, percentage of revolving loan limit maximum availability			30%
Lockbox arrangement, revolving loan limit number of consecutive business day			5 days
Interest expenses			$ 3,400	2,000	200
Amortization of debt issuance costs			$ 200	$ 300	$ 100
Revolving Credit Facility | Subsequent Event
Line of Credit Facility [Line Items]
Repayment of outstanding balance	$ 52,800

Debt - 0.75% Convertible Senior

Debt - 0.75% Convertible Senior Notes due 2026 (Details) - 0.75% Convertible Senior Notes due 2026	1 Months Ended	12 Months Ended
	Aug. 31, 2021 USD ($) $ / shares shares	Dec. 31, 2024 USD ($) Days	Dec. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)
Line Of Credit Facility [Line Items]
Aggregate principal amount of debt	$ 316,300,000
Interest rate	0.75%
Debt instrument, maturity date	Aug. 01, 2026
Debt instrument, frequency of periodic payment	semi-annually
Debt instrument, Date of first payment	Feb. 01, 2022
Net proceeds	$ 306,200,000
Payment terms		Interest on the 2026 Notes is payable semi-annually in arrears on February 1 and August 1 of each year, beginning on February 1, 2022.
Debt instrument covenant description		The 2026 Notes do not contain any financial covenants
Initial conversion rate | shares	54.5316
Debt instrument converted principal amount	$ 1,000
Conversion price per share | $ / shares	$ 18.34
Consecutive trading days | Days		30
Threshold percentage of par value trigger	130%	98%
Number of conversion price, consecutive business days | Days		5
Number of conversion price, consecutive trading days | Days		10
Debt instrument converted principal amount		$ 1,000,000
Debt conversion start date		Feb. 02, 2026
Convertible notes redemption start date	Aug. 06, 2024
Convertible notes, redemption price percentage	100%
Principal payments due	$ 0
Effective interest rate		1.40%
Interest expenses		$ 4,400,000	$ 4,400,000	$ 4,400,000
Amortization of debt issuance costs		$ 2,000,000	$ 2,000,000	$ 2,000,000
Minimum
Line Of Credit Facility [Line Items]
Threshold trading days | Days		20
Maximum
Line Of Credit Facility [Line Items]
Threshold percentage of par value trigger		130%

Debt - Outstanding Principal Am

Debt - Outstanding Principal Amount and Carrying Value of Notes (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Debt Instrument [Line Items]
Principal	$ 589,518	$ 526,557
Net carrying value	576,178	512,843
2026 Notes
Debt Instrument [Line Items]
Principal	316,250	$ 316,250
Unamortized debt issuance costs	(3,262)
Net carrying value	$ 312,988

Debt - Capped Call Transactions

Debt - Capped Call Transactions (Details) - 0.75% Convertible Senior Notes due 2026 $ in Millions		12 Months Ended
	Aug. 05, 2021 USD ($) $ / shares	Dec. 31, 2021 USD ($)
Debt Instrument [Line Items]
Initial cap price | $ / shares	27.68
Percentage of premium over last reported sale price of common stock	100%
Cost of capped call transactions	$ 39.9
Reduction to additional paid-in capital		$ 39.9

Debt - Other Debt Agreements (D

Debt - Other Debt Agreements (Details) - EOS Imaging S.A. $ in Millions	12 Months Ended
	Dec. 31, 2024 USD ($) Agreement
Line Of Credit Facility [Line Items]
Number of loan agreements | Agreement	2
Loan One
Line Of Credit Facility [Line Items]
Outstanding loan obligation	$ 2.1
Weighted average interest rate on loan	0.95%
Percentage of weighted average cost of state guaranty	0.68%
Loan Two
Line Of Credit Facility [Line Items]
Outstanding loan obligation	$ 0.9
Weighted average interest rate on loan	1.25%
Percentage of weighted average cost of state guaranty	1%

Debt - Debt (Details)

Debt - Debt (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Debt Instrument [Line Items]
Total	$ 589,518	$ 526,557
Less: unamortized debt discount and debt issuance costs	(13,340)	(13,714)
Net carrying value	576,178	512,843
Less: short-term debt	(1,656)	(1,808)
Total long-term debt	574,522	511,035
Revolving Credit Facility
Debt Instrument [Line Items]
Total	63,284	49,720
Other Notes Payable
Debt Instrument [Line Items]
Total	432	1,175
2026 Notes
Debt Instrument [Line Items]
Total	316,250	316,250
Net carrying value	312,988
PGE Loans
Debt Instrument [Line Items]
Total	3,052	4,537
Braidwell Term Loan
Debt Instrument [Line Items]
Total	$ 206,500	$ 154,875

Debt - Debt (Parenthetical) (De

Debt - Debt (Parenthetical) (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Braidwell Term Loan
Debt Instrument [Line Items]
Final payment fee	$ 6,500	$ 6,500

Debt - Principal Payments on De

Debt - Principal Payments on Debt (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Debt Disclosure [Abstract]
2025	$ 1,658
2026	317,483
2027	63,877
2028	206,500
Total	589,518	$ 526,557
Less: unamortized debt discount and debt issuance costs	(13,340)	(13,714)
Net carrying value	576,178	512,843
Less: short-term debt	(1,656)	(1,808)
Total long-term debt	$ 574,522	$ 511,035

Debt - OCEANE Convertible Bonds

Debt - OCEANE Convertible Bonds (Details)		12 Months Ended
	May 31, 2018 USD ($) ConvertibleBond	Dec. 31, 2024 USD ($)	Dec. 31, 2023 USD ($)	Dec. 31, 2022 USD ($)
Debt Instrument [Line Items]
OCEANEs remained outstanding		$ 576,178,000	$ 512,843,000
Carrying value of OCEANEs		$ 589,518,000	526,557,000
OCEANE Convertible Bonds | EOS Imaging S.A.
Debt Instrument [Line Items]
Number of OCEANE convertible bonds issued | ConvertibleBond	4,344,651
Aggregate gross proceeds	$ 34,300,000
Interest rate	6%
Payment terms		The OCEANEs were unsecured obligations of EOS, ranked equally with all other unsecured and unsubordinated obligations of EOS, and paid interest at a rate equal to 6% per year, payable semiannually in arrears on May 31 and November 30 of each year, beginning November 30, 2018.
Debt instrument, frequency of periodic payment	semiannually
Debt instrument, Date of first payment	Nov. 30, 2018
Debt instrument, maturity date	May 31, 2023
OCEANEs remained outstanding			0
Interest expenses			$ 300,000	$ 800,000

Debt - Squadron Medical Credit

Debt - Squadron Medical Credit Agreement (Details) - shares shares in Thousands	Dec. 31, 2024	Dec. 31, 2023
Line Of Credit Facility [Line Items]
Issuance of common stock	144,129	139,257
Number of warrants outstanding	9,316

Commitments and Contingencies -

Commitments and Contingencies - Additional Information (Details) $ in Millions	12 Months Ended
	Dec. 31, 2024 USD ($)
Loss Contingencies [Line Items]
Lessee operating lease, description	Any short-term leases defined as twelve months or less or month-to-month leases are excluded and are expensed each month. Total costs associated with these short-term leases are immaterial to all periods presented.
Remaining minimum purchase commitment required	$ 8.8
Paris, France
Loss Contingencies [Line Items]
Operating lease term	9 years
Lease agreement commencement date	Apr. 01, 2024
Lease agreement expiry date	Dec. 31, 2032
Minimum
Loss Contingencies [Line Items]
Operating lease term	1 year
Maximum
Loss Contingencies [Line Items]
Operating lease term	10 years

Commitments and Contingencies_2

Commitments and Contingencies - Future Minimum Annual Lease Payments (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Commitments and Contingencies Disclosure [Abstract]
2025	$ 7,112
2026	6,615
2027	6,543
2028	6,026
2029	5,941
Thereafter	10,092
Total undiscounted lease payments	42,329
Less: imputed interest	(8,571)
Operating lease liability	33,758
Less: current portion of operating lease liability	(6,453)	$ (5,159)
Operating lease liability, less current portion	$ 27,305	$ 23,677

Commitments and Contingencies_3

Commitments and Contingencies - Summary of Weighted-Average Remaining Lease Term and Discount Rate (Details)	Dec. 31, 2024	Dec. 31, 2023
Commitments and Contingencies Disclosure [Abstract]
Weighted average remaining lease term (years)	6 years 4 months 24 days	6 years 6 months
Weighted average discount rate	6.90%	5.50%

Commitments and Contingencies_4

Commitments and Contingencies - Summary of Operating Leases (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Commitments and Contingencies Disclosure [Abstract]
Rent expense	$ 7,393	$ 5,045	$ 4,643
Cash paid for amounts included in measurement of lease liabilities	$ 6,296	$ 5,120	$ 4,409

Equity - Additional Information

Equity - Additional Information (Details) - USD ($)						1 Months Ended			12 Months Ended
	Sep. 27, 2024	Nov. 17, 2023	Oct. 27, 2023	Aug. 11, 2023	Apr. 19, 2023	May 31, 2024	Oct. 31, 2022	Dec. 31, 2017	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Subsidiary Sale Of Stock [Line Items]
Common stock, par value									$ 0.0001	$ 0.0001
Common stock, shares authorized									200,000,000	200,000,000
Net proceeds from offering										$ 213,181,000
Redeemable preferred stock carrying value									$ 23,603,000	$ 23,603,000
Redeemable preferred stock authorized									20,000,000	20,000,000
Redeemable preferred stock, price per share									$ 0.0001	$ 0.0001
Warrants outstanding									9,316,000
Patrick S. Miles
Subsidiary Sale Of Stock [Line Items]
Warrant extended term						9 years	7 years
Warrant expiration period								5 years
Number of warrants exercised									0
SafeOp Surgical, Inc.
Subsidiary Sale Of Stock [Line Items]
Warrant expiration period									5 years
Number of warrants exercised										937,000	257,000
Warrants outstanding										0
Squadron Medical | Participant Lender
Subsidiary Sale Of Stock [Line Items]
Warrants expiration month and year									2027-05
Number of warrants exercised									0
2017 PIPE Warrants
Subsidiary Sale Of Stock [Line Items]
Warrant expiration period									5 years
Proceeds from exercise of warrant											$ 3,500,000
Number of warrants exercised											2,312,000
Warrants outstanding											0
2018 Common Stock Warrants
Subsidiary Sale Of Stock [Line Items]
Proceeds from exercise of warrant										$ 400,000	$ 400,000
Number of warrants exercised										6,311,000	2,168,000
Warrants outstanding										0
Executive Warrants
Subsidiary Sale Of Stock [Line Items]
Warrants outstanding									1,327,000
Exercise price of warrants									$ 5
L-5 Healthcare Partners Warrants | Healthcare Partners, LLC
Subsidiary Sale Of Stock [Line Items]
Common stock issued	1,133,160
Warrants expiration month and year	2026-08
Warrant purchase price per share	$ 1.98
Warrant purchase price	$ 2,200,000
Redeemable Preferred Stock
Subsidiary Sale Of Stock [Line Items]
Redeemable preferred stock carrying value									$ 23,600,000	$ 23,600,000
Redeemable preferred stock authorized									20,000,000	20,000,000
Redeemable preferred stock redemption, price per share									$ 9	$ 9
Redeemable preferred stock, price per share									$ 7.11	$ 7.11
Common Stock
Subsidiary Sale Of Stock [Line Items]
Common stock issued										19,725,000
Underwritten Public Offering
Subsidiary Sale Of Stock [Line Items]
Additional common stock shares granted to purchase, optional		470,769
Net proceeds from offering		$ 145,800,000
Underwritten Public Offering | Common Stock
Subsidiary Sale Of Stock [Line Items]
Shares offering price per share			$ 10.5
Common stock issued			14,300,000
Market Offering
Subsidiary Sale Of Stock [Line Items]
Number of shares issued in transaction				668,484
Net proceeds from offering				$ 9,900,000
Registered Securities Offering
Subsidiary Sale Of Stock [Line Items]
Number of shares issued in transaction					4,285,715
Net proceeds from offering					$ 57,500,000
Registered Securities Offering | Common Stock
Subsidiary Sale Of Stock [Line Items]
Shares offering price per share					$ 14

Equity - Summary of Outstanding

Equity - Summary of Outstanding Warrants (Details)	12 Months Ended
	Dec. 31, 2024 $ / shares shares
Class Of Warrant Or Right [Line Items]
Number of Warrants	9,316,000
2018 Squadron Medical Warrants
Class Of Warrant Or Right [Line Items]
Number of Warrants	845,000
Strike Price | $ / shares	$ 3.15
Expiration	May 2027
2019 Squadron Medical Warrants
Class Of Warrant Or Right [Line Items]
Number of Warrants	4,839,000
Strike Price | $ / shares	$ 2.17
Expiration	May 2027
2020 Squadron Medical Warrants
Class Of Warrant Or Right [Line Items]
Number of Warrants	1,076,000
Strike Price | $ / shares	$ 4.88
Expiration	May 2027
Executive Warrants
Class Of Warrant Or Right [Line Items]
Number of Warrants	1,327,000
Strike Price | $ / shares	$ 5
Expiration	December 2026
L-5 Healthcare Warrants
Class Of Warrant Or Right [Line Items]
Number of Warrants	1,133,000
Strike Price | $ / shares	$ 2.17
Expiration	August 2026
Other Warrants
Class Of Warrant Or Right [Line Items]
Number of Warrants	96,000
Strike Price | $ / shares	$ 11.79
Expiration	Various through June 2026

Stock Benefit Plans and Stock_3

Stock Benefit Plans and Stock-Based Compensation - Additional Information (Details) - USD ($)		3 Months Ended	12 Months Ended
	Jun. 16, 2021	Sep. 30, 2016	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022	Jun. 14, 2023	Apr. 08, 2020	Jul. 31, 2019	Dec. 31, 2017	Oct. 04, 2016
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance			41,813,000
Straight-line basis over a weighted average period			5 months 4 days
Stock-based compensation			$ 73,277,000	$ 81,244,000	$ 40,556,000
Common Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock issued				19,725,000
Number of warrants available to be granted			345,000
Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period			4 years
Employee Stock Option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance			2,158,000
Stock options granted			0	0	0
Total intrinsic value of stock options exercised			$ 2,100,000	$ 5,200,000	$ 3,400,000
Share price			$ 9.18
Unvested Restricted Stock Award
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Restricted shares granted under the plan			5,189,000
Straight-line basis over a weighted average period			1 year 7 months 17 days
Weighted average grant-date fair value of awards granted			$ 12.56	$ 15.39	$ 8.13
Unrecognized compensation expense for restricted stock awards, restricted stock units and performance-based restricted units expected to be recognized			$ 50,000,000
Total fair value of awards vested			$ 59,400,000	$ 104,300,000	$ 35,200,000
ESPP
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance			714,000,000			3,637,449
Number of shares available for grant						1,500,000
Employee stock purchase plan, maximum annual compensation percentage	20%
Employee stock purchase plan, maximum annual compensation amount	$ 21,250
Purchase price equal to the lower of the fair market value per share (at closing) of Company common stock	85%
Employee stock purchase plan, offering period	6 months
Shares of common stock issued under the ESPP			529,000	375,000	429,000
Stock-based compensation			$ 2,200,000	$ 1,700,000	$ 1,600,000
2016 Equity Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares available for grant			4,209,000
2016 Equity Incentive Plan | Board of Directors Chairman
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share authorized grant of warrants		26,383,000
2016 Equity Incentive Plan | Employee Stock Option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expiration period		10 years
Award vesting period		4 years
Exercise price minimum percentage of market price on grant date		100%
2016 Equity Incentive Plan | Employee Stock Option | 10 Percent Stockholder
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expiration period		5 years
Exercise price minimum percentage of market price on grant date		110%
Inducement Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance			320,000
Maximum award to be deductible other than options										$ 1,000,000
Inducement Plan | Board of Directors Chairman
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share authorized grant of warrants										4,150,000
2019 Management Objective Strategic Incentive Plan | Common Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares available for grant			12,500
2019 Management Objective Strategic Incentive Plan | Board of Directors Chairman | Common Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share authorized grant of warrants								500,000
2019 Management Objective Strategic Incentive Plan | Unvested Restricted Stock Award
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares available for grant			486,000
2017 Distributor Inducement Plan | Common Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock issued			720,000
Number of warrants available to be granted			345,000
2017 Distributor Inducement Plan | Board of Directors Chairman | Common Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share authorized grant of warrants									1,500,000
2017 Distributor Inducement Plan | Restricted Common Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Restricted shares granted under the plan			731,000
Two Thousand Seventeen Development Services Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock issued			3,858,000
Two Thousand Seventeen Development Services Plan | Board of Directors Chairman | Common Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares available for grant							10,000,000

Stock Benefit Plans and Stock_4

Stock Benefit Plans and Stock-Based Compensation - Summary of Compensation Cost for Stock-Based Compensation Arrangements (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation expense	$ 73,277	$ 81,244	$ 40,556
Cost of sales
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation expense	4,961	25,082	2,597
Research and development
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation expense	27,030	18,741	5,016
Sales, General and Administrative
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation expense	$ 41,286	$ 37,421	$ 32,943

Stock Benefit Plans and Stock_5

Stock Benefit Plans and Stock-Based Compensation - Summary of Stock Option Activity (Details) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2024 USD ($) $ / shares shares
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding [Roll Forward]
Shares Outstanding, Beginning balance | shares	2,468
Shares, Exercised | shares	(283)
Shares, Forfeited | shares	(27)
Shares Outstanding, Ending balance | shares	2,158
Shares, Options vested and expected to vest | shares	2,158
Shares, Options exercisable | shares	2,155
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding, Weighted Average Exercise Price [Abstract]
Weighted average exercise price, Outstanding, Beginning balance | $ / shares	$ 3.2
Weighted average exercise price,Exercised | $ / shares	2.52
Weighted average exercise price, Forfeited | $ / shares	14.74
Weighted average exercise price, Outstanding, Ending balance | $ / shares	3.15
Weighted average exercise price, Options vested and expected to vest | $ / shares	3.15
Weighted average exercise price, Options exercisable | $ / shares	$ 3.13
Share-based Compensation Arrangement by Share-based Payment Award, Options, Additional Disclosures [Abstract]
Weighted average remaining contractual term, Outstanding, balance	3 years
Weighted average remaining contractual term, Options vested and expected to vest	3 years
Weighted average remaining contractual term, Options exercisable	2 years 11 months 26 days
Aggregate intrinsic value, Outstanding | $	$ 13,298
Aggregate intrinsic value, Options vested and expected to vest | $	13,298
Aggregate intrinsic value, Options exercisable | $	$ 13,296

Stock Benefit Plans and Stock_6

Stock Benefit Plans and Stock-Based Compensation - Summary of Information about Restricted Stock Awards, Restricted Stock Units and Performance-Based Restricted Units Activity (Details) - Unvested restricted stock units - $ / shares shares in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Number of Shares [Roll Forward]
Shares, Unvested beginning balance	7,713
Shares, Awarded	5,189
Shares, Vested	(4,616)
Shares, Forfeited	(860)
Shares, Unvested ending balance	7,426	7,713
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Weighted Average Grant Date Fair Value [Abstract]
Weighted average grant date fair value, Unvested beginning balance	$ 13.56
Weighted average grant date fair value, Awarded	12.56	$ 15.39	$ 8.13
Weighted average grant date fair value, Vested	7.1
Weighted average grant date fair value, Forfeited	13.78
Weighted average grant date fair value, Unvested ending balance	$ 12.92	$ 13.56
Weighted average remaining recognition period (in years)	1 year 21 days

Stock Benefit Plans and Stock_7

Stock Benefit Plans and Stock-Based Compensation - Schedule of Assumptions used to Estimate Fair Value of Stock Options Granted and Stock Purchase Rights under ESPP (Details) - ESPP	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk-free interest rate, minimum	4.44%	4.54%	0.07%
Risk-free interest rate, maximum	5.41%	5.41%	4.54%
Weighted average expected life (years)	6 months
Volatility, minimum	54.47%	40.87%	50.29%
Volatility, maximum	91.91%	62.77%	64.53%
Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Weighted average expected life (years)		7 months 6 days	7 months 6 days
Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Weighted average expected life (years)		4 months 28 days	6 months

Stock Benefit Plans and Stock_8

Stock Benefit Plans and Stock-Based Compensation - Summary Common Stock Reserved for Future Issuance (Details) shares in Thousands	Dec. 31, 2024 shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance	41,813
Unvested Restricted Stock Award
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance	7,426
Senior Convertible Notes
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance	17,246
Warrants Outstanding
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance	9,316
Authorized for Future Grant Under the Distributor and Development Services Plans
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance	424
Authorized for Future Grant Under the Management Objective Strategic Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance	1
Authorized for Future Grant Under the Company Equity Plans
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance	4,528
Employee Stock Option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance	2,158
Employee Stock Purchase Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance	714

Income Taxes - Components of Pr

Income Taxes - Components of Pretax Loss (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Income Tax Disclosure [Abstract]
U.S. Domestic	$ (147,954)	$ (178,313)	$ (146,627)
Foreign	(14,119)	(8,602)	(5,382)
Net loss before taxes	$ (162,073)	$ (186,915)	$ (152,009)

Income Taxes - Components of _2

Income Taxes - Components of Provision for Income Taxes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Current income tax provision:
Federal	$ 78	$ 76	$ (764)
State	349	332	(140)
Foreign	209	145	301
Total current	636	553	(603)
Deferred income tax provision:
Federal	44	37	583
State	(8)		160
Foreign	(622)	(867)	(856)
Total deferred	(586)	(830)	(113)
Total income tax provision	$ 50	$ (277)	$ (716)

Income Taxes - Schedule of Effe

Income Taxes - Schedule of Effective Income Tax Rate Reconciliation (Details)	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Income Tax Disclosure [Abstract]
Federal statutory rate	21%	21%	21%
Adjustments for tax effects of:
State taxes, net	(0.17%)	(0.13%)	0.03%
Stock-based compensation	(3.57%)	(1.12%)	(1.79%)
Rate differential	0.32%	0.18%	0.43%
Foreign taxes	(0.02%)	(0.07%)	(0.05%)
Other permanent adjustments	(0.71%)	(0.21%)	0.21%
Credits	2.06%	1.53%	0%
Federal uncertain tax positions	(1.14%)	(1.50%)	0.03%
Expiration of tax attribute	(0.11%)	(0.09%)	(1.60%)
Liquidation entries	0%	0%	0.86%
Other	0.55%	0.70%	(0.27%)
Valuation allowance	(18.23%)	(20.12%)	(18.38%)
Effective income tax rate	(0.02%)	0.17%	0.47%

Income Taxes - Significant Comp

Income Taxes - Significant Components of Company's Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2024	Dec. 31, 2023
Deferred tax assets:
Net operating losses	$ 176,352	$ 167,389
Interest	21,439	16,230
Capitalized research and development expenses	35,177	25,633
Inventory	16,183	12,095
Lease liability	8,388	7,268
Stock-based compensation	16,754	14,024
Accruals and reserves	7,277	6,162
Legal settlement	341	440
Income tax credit carryforwards	7,554	4,231
Total deferred tax assets	289,465	253,472
Valuation allowance	(246,744)	(211,454)
Total deferred tax assets, net of valuation allowance	42,721	42,018
Deferred tax liabilities:
Property and equipment	(27,840)	(26,367)
Goodwill and intangibles	(10,472)	(13,399)
Right-of-use assets	(8,011)	(6,837)
Unrealized foreign exchange gain	(396)	(254)
Total deferred tax liabilities	(46,719)	(46,857)
Net deferred tax liabilities	$ (3,998)	$ (4,839)

Income Taxes - Additional Infor

Income Taxes - Additional Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2018
Operating Loss Carryforwards [Line Items]
Deferred tax asset, valuation allowance	$ 246,744	$ 211,454
Deferred tax asset, valuation allowance increase (decrease)	$ 35,300	43,600	$ 39,400
Number of years cumulative pretax loss	3 years
Unrecognized tax benefits, if recognized, would impact the effective income tax rate	$ 11,900	8,600	5,600
Accrued interest and penalties	180	$ 100	$ 40
Operating loss carryforwards state	483,100
Operating loss carryforwards federal	604,600
Operating loss carryforwards foreign	119,100
Federal and state net operating loss carryforwards, expiring year				2044
Federal research and development tax credit carryforwards	9,000
Deferred tax asset interest expense carryovers	87,500
State research and development tax credit carryforwards	$ 7,800
Cumulative change in ownership percentage	50%
Period for cumulative change in ownership	3 years
Federal
Operating Loss Carryforwards [Line Items]
Operating losses after December 31, 2017	$ 467,300
Research and development tax credit carryforwards, expiring year	2042
State
Operating Loss Carryforwards [Line Items]
Operating losses after December 31, 2017	$ 94,600

Income Taxes - Summary of Chang

Income Taxes - Summary of Changes to Unrecognized Tax Benefits (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns [Roll Forward]
Unrecognized tax benefit at the beginning of the year	$ 9,065	$ 6,079	$ 15,165
Increases in tax positions for prior years	1,072	1,632
Decrease in tax positions for prior years			(8,929)
Increase in tax positions for current year relating to ongoing operations	2,695	1,435	173
Decrease in tax positions as a result of a lapse of statute of limitations		(81)	(330)
Unrecognized tax benefits at the end of the year	$ 12,832	$ 9,065	$ 6,079

Related Party Transactions - Ad

Related Party Transactions - Additional Information (Details) - Squadron Supplier Affiliate - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Related Party Transaction [Line Items]
Purchased inventory from related party	$ 21.2	$ 19.6	$ 10.3
Due to Affiliate	$ 1.8	$ 5.4

Business Segment and Geograph_3

Business Segment and Geographic Information - Additional Information (Details)	12 Months Ended
	Dec. 31, 2024 Segment
Segment Reporting [Abstract]
Number of operating segments	1
Segment Reporting, CODM, Profit (Loss) Measure, How Used, Description	The Company determined that consolidated net loss is the Company’s measure of segment profit or loss.
Segment Reporting, CODM, Individual Title and Position or Group Name [Extensible Enumeration]	srt:ChiefExecutiveOfficerMember

Business Segment and Geograph_4

Business Segment and Geographic Information - Schedule of Net Revenue and Property and Equipment, Net, by Geographic Region (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Revenues From External Customers And Long Lived Assets [Line Items]
Revenue	$ 611,562	$ 482,262	$ 350,867
Property and equipment, net	156,394	149,835
United States
Revenues From External Customers And Long Lived Assets [Line Items]
Revenue	571,267	445,351	326,697
Property and equipment, net	154,772	147,705
International
Revenues From External Customers And Long Lived Assets [Line Items]
Revenue	40,295	36,911	$ 24,170
Property and equipment, net	$ 1,622	$ 2,130