Alphatec (ATEC) 10-Q/A 10 Feb 16 2015 Q3 Quarterly report (amended) Financial data

Document and Entity Information

Document and Entity Information - shares	9 Months Ended
	Sep. 30, 2015	Nov. 02, 2015
Document And Entity Information [Abstract]
Entity Registrant Name	Alphatec Holdings, Inc.
Entity Central Index Key	1,350,653
Current Fiscal Year End Date	--12-31
Entity Filer Category	Accelerated Filer
Document Type	10-Q
Trading Symbol	ATEC
Document Period End Date	Sep. 30, 2015
Document Fiscal Year Focus	2,015
Document Fiscal Period Focus	Q3
Amendment Flag	false
Entity Common Stock, Shares Outstanding		101,101,329

CONDENSED CONSOLIDATED BALANCE

CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) - USD ($) $ in Thousands	Sep. 30, 2015	Dec. 31, 2014
Current assets:
Cash	$ 10,502	$ 19,735
Restricted cash	3,450	4,400
Accounts receivable, net	36,252	40,440
Inventories, net	42,328	41,747
Prepaid expenses and other current assets	5,225	5,466
Deferred income tax assets	2,518	1,324
Total current assets	100,275	113,112
Property and equipment, net	23,720	26,040
Goodwill	0	171,333
Intangibles, net	22,943	30,259
Other assets	1,446	4,179
Total assets	148,384	344,923
Current liabilities:
Accounts payable	10,827	10,130
Accrued expenses	27,216	35,393
Deferred revenue	831	1,300
Common stock warrant liabilities	687	8,702
Current portion of long-term debt	79,300	8,076
Total current liabilities	118,814	63,601
Long-term debt, less current portion	700	74,597
Other long-term liabilities	29,814	32,220
Deferred income tax liabilities	1,623	1,948
Redeemable preferred stock, $0.0001 par value; 20,000 authorized at September 30, 2015 and December 31, 2014; 3,319 shares issued and outstanding at both September 30, 2015 and December 31, 2014	23,603	23,603
Stockholders’ (deficit) equity:
Common stock, $0.0001 par value; 200,000 authorized at September 30, 2015 and December 31, 2014; 100,144 and 99,856 shares issued and outstanding at September 30, 2015 and December 31, 2014, respectively	10	10
Treasury stock, at cost, 19 shares, at both September 30, 2015 and December 31, 2014	(97)	(97)
Additional paid-in capital	416,620	413,921
Shareholder note receivable	(5,000)	(5,000)
Accumulated other comprehensive loss	(20,350)	(11,316)
Accumulated deficit	(417,337)	(248,564)
Total stockholders’ (deficit) equity	(26,154)	148,954
Total liabilities and stockholders’ (deficit) equity	$ 148,384	$ 344,923

CONDENSED CONSOLIDATED BALANCE3

CONDENSED CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares	Sep. 30, 2015	Dec. 31, 2014
Statement of Financial Position [Abstract]
Redeemable preferred stock, par value	$ 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	$ 0.0001	$ 0.0001
Common stock, shares authorized	200,000,000	200,000,000
Common stock, shares issued	100,144,000	99,856,000
Common stock, shares outstanding	100,144,000	99,856,000
Treasury stock, shares	19,000	19,000

CONDENSED CONSOLIDATED STATEMEN

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS (Unaudited) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014
Income Statement [Abstract]
Revenues	$ 42,996	$ 51,013	$ 138,276	$ 153,353
Cost of revenues	14,154	14,272	48,234	46,305
Amortization of acquired intangible assets	363	435	1,093	1,328
Gross profit	28,479	36,306	88,949	105,720
Operating expenses:
Research and development	1,898	4,423	9,661	13,138
In-process research and development	274	527	274	527
Sales and marketing	17,134	18,649	51,973	56,545
General and administrative	8,094	10,213	26,473	33,676
Amortization of acquired intangible assets	521	742	1,867	2,257
Goodwill and intangible impairment	165,171	0	165,171	0
Restructuring expenses	335	20	163	706
Total operating expenses	193,427	34,574	255,582	106,849
Operating income (loss)	(164,948)	1,732	(166,633)	(1,129)
Other income (expense):
Interest income	18	2	37	8
Interest expense	(3,110)	(3,875)	(9,521)	(9,310)
Other income (expense), net	6,058	(928)	6,782	(1,230)
Total other income (expense)	2,966	(4,801)	(2,702)	(10,532)
Pretax net loss	(161,982)	(3,069)	(169,335)	(11,661)
Income tax (benefit) provision	(1,717)	(28)	(562)	948
Net loss	$ (160,265)	$ (3,041)	$ (168,773)	$ (12,609)
Net loss per basic share	$ (1.61)	$ (0.03)	$ (1.70)	$ (0.13)
Net loss per diluted share	$ (1.61)	$ (0.04)	$ (1.70)	$ (0.13)
Shares used in calculating basic net loss per share	99,376	97,391	99,258	97,040
Shares used in calculating diluted net loss per share	99,376	98,329	99,258	97,258

CONDENSED CONSOLIDATED STATEME5

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS (Unaudited) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014
Statement of Comprehensive Income [Abstract]
Net loss	$ (160,265)	$ (3,041)	$ (168,773)	$ (12,609)
Foreign currency translation adjustments	624	(9,093)	(9,034)	(9,815)
Comprehensive loss	$ (159,641)	$ (12,134)	$ (177,807)	$ (22,424)

CONDENSED CONSOLIDATED STATEME6

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014
Operating activities:
Net loss	$ (168,773)	$ (12,609)
Adjustments to reconcile net loss to net cash provided by (used in) by operating activities:
Depreciation and amortization	14,099	14,006
Stock-based compensation	2,440	3,641
Interest expense related to amortization of debt discount and debt issuance costs	3,630	4,354
Goodwill and intangible impairment	165,171	0
Provision for doubtful accounts	465	443
Provision for excess and obsolete inventory	1,529	2,553
Deferred income tax expense	(1,320)	338
Non-cash in-process research and development expenses	98	102
Other non-cash items	(4,983)	2,655
Changes in operating assets and liabilities:
Restricted cash	3,300	(2,001)
Accounts receivable	3,475	373
Inventories	(2,202)	(3,134)
Prepaid expenses and other current assets	1,871	4,143
Other assets	15	(202)
Accounts payable	(277)	(261)
Accrued expenses and other	(12,644)	(34,684)
Deferred revenues	(328)	(1)
Net cash provided by (used in) operating activities	5,566	(20,284)
Investing activities:
Purchases of property and equipment	(8,738)	(7,751)
Cash received from sale of assets	0	300
Net cash used in investing activities	(8,738)	(7,451)
Financing activities:
Borrowings under lines of credit	105,523	122,066
Repayments under lines of credit	(110,354)	(115,068)
Principal payments on capital lease obligations	(555)	(605)
Proceeds from notes payable	5,000	24,500
Principal payments on notes payable	(6,163)	(3,836)
Net cash (used in) provided by financing activities	(6,549)	27,057
Effect of exchange rate changes on cash	488	(498)
Net decrease in cash	(9,233)	(1,176)
Cash at beginning of period	19,735	21,345
Cash at end of period	10,502	20,169
Supplemental disclosure of cash flow information:
Cash paid for interest	5,677	4,074
Cash paid for income taxes	580	487
Purchases of property and equipment in accounts payable	2,458	2,217
Non-cash debt discount	0	500
Initial fair value of warrant liability	0	10,368
Purchase of property and equipment through capital lease	$ 243	$ 759

The Company and Basis of Presen

The Company and Basis of Presentation	9 Months Ended
	Sep. 30, 2015
Accounting Policies [Abstract]
The Company and Basis of Presentation	T he Company and Basis of Presentation The Company Alphatec Holdings, Inc., through its wholly owned subsidiary, Alphatec Spine, Inc. and its subsidiaries (“Alphatec Spine”), designs, develops, manufactures and markets products for the surgical treatment of spine disorders. In addition to its U.S. operations, the Company also markets its products in over 50 international markets through the distribution channels of Alphatec Spine and its affiliate, Scient’x S.A.S., and its subsidiaries (“Scient’x”), via a direct sales force in Italy and the United Kingdom and via independent distributors in the rest of Europe, the Middle East and Africa. In South America and Latin America, the Company conducts its operations through its Brazilian subsidiary, Cibramed Productos Medicos. In Japan, the Company markets its products through its subsidiary, Alphatec Pacific, Inc. and its subsidiaries (“Alphatec Pacific”). Basis of Presentation The accompanying condensed consolidated balance sheet as of December 31, 2014 , which has been derived from audited financial statements, and the unaudited interim condensed consolidated financial statements have been prepared by the Company in accordance with U.S. generally accepted accounting principles (“GAAP”) and the rules and regulations of the Securities and Exchange Commission (“SEC”) related to a quarterly report on Form 10-Q. Certain information and note disclosures normally included in annual audited financial statements prepared in accordance with GAAP have been condensed or omitted pursuant to those rules and regulations, although the Company believes that the disclosures made in this quarterly report on Form 10-Q are adequate to make the information not misleading. The interim unaudited condensed consolidated financial statements reflect all adjustments, including normal recurring adjustments which, in the opinion of management, are necessary for a fair statement of the financial position and results of operations for the periods presented. These unaudited condensed consolidated financial statements should be read in conjunction with the Company’s audited financial statements for the year ended December 31, 2014 , which are included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2014 that was filed with the SEC on February 26, 2015 . Operating results for the three and nine months ended September 30, 2015 are not necessarily indicative of the results that may be expected for the year ending December 31, 2015 , or any other future periods. The Company has incurred significant net losses since inception and has relied on its ability to fund its operations through revenues from the sale of its products, equity financings and debt financings. As the Company has incurred losses, successful transition to profitability is dependent upon achieving a level of revenues adequate to support the Company’s cost structure. This may not occur and, unless and until it does, the Company will continue to need to raise additional capital. The accompanying Condensed Consolidated Financial Statements have been prepared assuming that the Company will continue as a going concern and do not include any adjustments that might result from the outcome of this uncertainty. A going concern basis of accounting contemplates the recovery of the Company’s assets and the satisfaction of its liabilities in the normal course of business. Operating losses and negative cash flows may continue for at least the next year as the Company continues to incur costs related to the execution of its operating plan, introduction of new products and expansion into new geographies. The Company's amended and restated credit facility (the "Amended Credit Facility") with MidCap Financial, LLC ("MidCap") matures in August 2016, which will require the Company to refinance the Amended Credit Facility with MidCap or to seek alternative financing. Management intends to pursue additional opportunities to raise additional capital through public or private equity offerings, debt financings, receivables financings or collaborations or partnerships with other companies to further support its planned operations. However, there is no assurance that it will be able to do so. Restatement of Condensed Consolidated Financial Statements The Company has determined that it failed to comply with the fixed charge coverage ratio covenant under its Amended Credit Facility with MidCap for June, August and September of 2015. The Company’s default under the MidCap credit facility also constitutes an event of default under the Facility Agreement with Deerfield Private Design Fund II, L.P., Deerfield Private Design International II, L.P., Deerfield Special Situations Fund, L.P., and Deerfield Special Situations International Master Fund, L.P., (collectively "Deerfield"). In January and February of 2016, MidCap and Deerfield provided a waiver of the Company’s failure to comply with the covenant during such periods. The Company can provide no assurance that it will be in compliance with the financial covenants in the future. As a result of these events of default, the Company has determined to restate the condensed consolidated balance sheet as of September 30, 2015 to classify the amounts due under the Deerfield Facility Agreement as current portion of long-term debt, rather than long-term debt, less current portion. As a result of this error correction, the current portion of the long-term debt increased from $59.0 million as previously reported to $79.3 million and the amount of long-term debt less current portion decreased from $20.9 million as previously reported to $0.7 million . This correction had no effect on the other condensed consolidated financial statements included in the Company’s Quarterly Report on Form 10-Q for the quarter ended September 30, 2015 that was filed with the Securities and Exchange Commission (the “SEC”) on November 3, 2015.

Summary of Significant Accounti

Summary of Significant Accounting Policies	9 Months Ended
	Sep. 30, 2015
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	Summary of Significant Accounting Policies The Company’s significant accounting policies are described in Note 2 to its audited consolidated financial statements for the year ended December 31, 2014 , which are included in the Company’s Annual Report on Form 10-K that was filed with the SEC on February 26, 2015 . Except as discussed below, these accounting policies have not significantly changed during the nine months ended September 30, 2015 . Goodwill The Company accounts for goodwill in accordance with authoritative guidance which requires that goodwill be tested for impairment at least annually. The Company tests goodwill for impairment as of December 31 of each year, or more frequently if events and circumstances warrant. These assets are impaired if the Company determines that their carrying values may not be recoverable based on an assessment of certain events or changes in circumstances. If the assets are considered to be impaired, the Company recognizes the amount by which the carrying value of the assets exceeds the fair value of the assets as an impairment loss . In the third quarter of 2015, the market value of the Company’s common stock substantially declined. As a result of this decline, the Company determined that it had an indicator of impairment of its goodwill, and an interim test of goodwill impairment was required. As a result, the Company reviewed its goodwill for impairment under a two-part test in accordance with authoritative guidance. The Company estimated the fair value in step one of the goodwill impairment test based on a combination of the income approach which included discounted cash flows as well as a market approach that utilized the guideline company market information. The fair value measurements utilized to perform the impairment analysis are categorized within Level 3 of the fair value hierarchy. The Company’s discounted cash flows required management judgment with respect to forecasted sales, launch of new products, gross margin, selling, general and administrative expenses, capital expenditures and the selection and use of an appropriate discount rate and terminal rate. For purposes of calculating the discounted cash flows, the Company used estimated revenue growth rates between 3% and 13% for the discrete forecast period. Cash flows beyond the discrete forecast period were estimated using a terminal value calculation, which incorporated historical and forecasted financial trends and considered long-term earnings growth rates for publicly traded peer companies. Future cash flows were then discounted to present value at a discount rate of 13.5% , and terminal value growth rate of 3% . The Company's market capitalization was also considered in assessing the reasonableness of the Company’s fair value as determined in step one of the goodwill impairment test. The Company’s assessment resulted in a fair value that was lower than the Company’s carrying value of net assets at September 30, 2015. Based upon step one of the test, the Company determined that its goodwill was impaired and that step two of the test was required to measure the amount of goodwill impairment. As a result of step two, in the third quarter of 2015 the Company recorded a charge of $164.3 million , representing the write-off of the remaining balance of goodwill. Due to the length of time necessary to measure impairment of goodwill, the goodwill impairment analysis was not completed as of the time of the filing of this Quarterly Report on Form 10-Q and is subject to change. The Company expects to complete the step two impairment analysis prior to reporting its financial results for the fourth quarter of 2015 and will record any adjustments to this preliminary estimate at that time. Fair Value Measurements The carrying amount of financial instruments consisting of cash, restricted cash, trade accounts receivable, prepaid expenses and other current assets, accounts payable, accrued expenses, accrued compensation and current portion of long-term debt included in the Company’s consolidated financial statements are reasonable estimates of fair value due to their short maturities. Based on the borrowing rates currently available to the Company for loans with similar terms, management believes the fair value of long-term debt approximates its carrying value. Authoritative guidance establishes a three-tier fair value hierarchy, which prioritizes the inputs used in measuring fair value as follows: Level 1: Observable inputs such as quoted prices in active markets; Level 2: Inputs, other than the quoted prices in active markets, that are observable either directly or indirectly; and Level 3: Unobservable inputs in which there is little or no market data, which require the reporting entity to develop its own assumptions. The Company does not maintain any financial instruments that are considered to be Level 1 or Level 2 instruments as of September 30, 2015 or December 31, 2014 . The Company classifies its common stock warrant liabilities within Level 3 of the fair value hierarchy because they are valued using valuation models with significant unobservable inputs. The following table provides a reconciliation of liabilities measured at fair value using significant unobservable inputs (Level 3) for the nine months ended September 30, 2015 (in thousands): Common Stock Warrant Liabilities Balance at December 31, 2014 $ 8,702 Changes in fair value (8,015 ) Balance at September 30, 2015 $ 687 Common stock warrant liabilities are measured at fair value using the Black-Scholes option pricing valuation model. The assumptions used in the Black-Scholes option pricing valuation model for the common stock warrant liabilities were: (a) a risk-free interest rate based on the rates for U.S. Treasury zero-coupon bonds with maturities similar to those of the remaining contractual term of the warrants; (b) an assumed dividend yield of zero based on the Company’s expectation that it will not pay dividends in the foreseeable future; (c) an expected term based on the remaining contractual term of the warrants; and (d) an expected volatility based upon the Company's historical volatility over the remaining contractual term of the warrants. The significant unobservable input used in measuring the fair value of the common stock warrant liabilities associated with the Deerfield Facility Agreement (described in Note 5 below) is the expected volatility. Significant increases in volatility would result in a higher fair value measurement. Recent Accounting Pronouncements In May 2014, the Financial Accounting Standards Board ("FASB") issued new accounting guidance related to revenue recognition. This new standard will replace all current U.S. GAAP guidance on this topic and eliminate all industry-specific guidance. The new revenue recognition standard provides a unified model to determine when and how revenue is recognized. The core principle is that a company should recognize revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration to which the entity expects to be entitled in exchange for those goods or services. On August 12, 2015, the FASB issued guidance deferring the effective date by one year to December 15, 2017 for annual reporting periods beginning after that date. The FASB also permitted early adoption of the standard, but not before the original effective date of December 15, 2016. The Company is currently evaluating the impact, if any, the adoption of this standard will have on its financial statements. In August 2014, the FASB issued guidance related to disclosures of uncertainties about an entity’s ability to continue as a going concern. The guidance requires management to evaluate whether there are conditions and events that raise substantial doubt about the entity’s ability to continue as a going concern within one year after the financial statements are issued. Management will be required to make this evaluation for both annual and interim reporting periods and will have to make certain disclosures if it concludes that substantial doubt exists or when its plans alleviate substantial doubt about the entity’s ability to continue as a going concern. Substantial doubt exists when relevant conditions and events, considered in the aggregate, indicate that it is probable that the entity will be unable to meet its obligations as they become due within one year after the date that the financial statements are issued. The guidance is effective for annual periods ending after December 15, 2016 and for interim reporting periods within annual periods beginning after December 15, 2016, with early adoption permitted. The Company is currently evaluating the impact of this guidance and expects to adopt the standard for the annual reporting period ending December 31, 2016. In April 2015, the FASB issued guidance that amends existing guidance to require the presentation of debt issuance costs in the balance sheet as a deduction from the carrying amount of the related debt liability instead of a deferred charge. The guidance will not change the amortization of debt issuance costs, which will continue to follow the existing accounting guidance. The guidance is effective for annual reporting periods beginning after December 15, 2015, but early adoption is permitted. The Company is currently evaluating the impact of adopting this new accounting standard on its financial statements.

Select Balance Sheet Details

Select Balance Sheet Details	9 Months Ended
	Sep. 30, 2015
Balance Sheet Related Disclosures [Abstract]
Select Balance Sheet Details	Select Balance Sheet Details Accounts Receivable, net Accounts receivable, net consist of the following (in thousands): September 30, 2015 December 31, 2014 Accounts receivable $ 37,298 $ 41,233 Allowance for doubtful accounts (1,046 ) (793 ) Accounts receivable, net $ 36,252 $ 40,440 Inventories, net Inventories, net consist of the following (in thousands) September 30, 2015 December 31, 2014 Gross Reserve for excess and obsolete Net Gross Reserve for excess and obsolete Net Raw materials $ 6,449 $ — $ 6,449 $ 5,020 $ — $ 5,020 Work-in-process 1,898 — 1,898 1,032 — 1,032 Finished goods 53,930 (19,949 ) 33,981 57,020 (21,325 ) 35,695 Inventories $ 62,277 $ (19,949 ) $ 42,328 $ 63,072 $ (21,325 ) $ 41,747 Property and Equipment, net Property and equipment, net consist of the following (in thousands except as indicated): Useful lives (in years) September 30, 2015 December 31, 2014 Surgical instruments 4 $ 64,838 $ 62,872 Machinery and equipment 7 15,585 15,382 Computer equipment 3 3,700 3,180 Office furniture and equipment 5 3,752 3,789 Leasehold improvements various 3,854 3,841 Building 39 66 65 Land n/a 9 9 Construction in progress n/a 468 1,320 92,272 90,458 Less accumulated depreciation and amortization (68,552 ) (64,418 ) Property and equipment, net $ 23,720 $ 26,040 Total depreciation expense was $3.4 million and $2.9 million for the three months ended September 30, 2015 and 2014 , respectively. Total depreciation expense was $9.1 million and $9.2 million for the nine months ended September 30, 2015 and 2014 , respectively. At September 30, 2015 , assets recorded under capital leases of $3.2 million were included in the machinery and equipment balance and $0.2 million were included in the construction in progress balance. At December 31, 2014 , assets recorded under capital leases of $3.2 million were included in the machinery and equipment balance and $0.6 million were included in the construction in progress balance. Amortization of assets under capital leases was included in depreciation expense. Intangible Assets, net Intangible assets, net consist of the following (in thousands except for useful lives): Useful lives (in years) September 30, 2015 December 31, 2014 Developed product technology 3-8 $ 21,825 $ 22,526 Distribution rights 3 2,100 2,095 Intellectual property 5 1,004 1,004 License agreements 1-7 16,716 16,716 Core technology 10 4,187 4,554 Trademarks and trade names 3-9 3,307 3,559 Customer-related 12-15 19,458 20,493 Distribution network 10-12 4,027 4,027 Physician education programs 10 2,575 2,802 Supply agreement 10 225 225 75,424 78,001 Less accumulated amortization (52,481 ) (47,742 ) Intangible assets, net $ 22,943 $ 30,259 Total amortization expense was $1.1 million and $1.6 million for the three months ended September 30, 2015 and 2014 , respectively. Total amortization expense was $5.0 million and $4.8 million for the nine months ended September 30, 2015 and 2014 , respectively. On June 19, 2015, the Company entered into an exclusive distribution agreement with a third party to market a biologic product that would replace its existing NEXoss Synthetic Bone Graft (See Note 4). The Company expensed $0.3 million as an impairment charge in cost of goods sold in the nine months ended September 30, 2015 for the write-off of an intangible asset related to this product. Additionally, due to a revised marketing strategy for the Company's Epicage interbody fusion device, the Company evaluated the related intangible asset for impairment in June 2015. As a result of this impairment analysis the Company expensed $0.9 million as an impairment charge in cost of goods sold in the nine months ended September 30, 2015 for the write-off of an intangible asset related to this product. In connection with the step two goodwill impairment test (see Note 2) the Company determined that the physician education intangible acquired in the Scient’x acquisition was impaired. As a result, the Company expensed $0.9 million included in goodwill and intangible impairment in the three and nine months ended September 30, 2015. Prior to the impairment, amortization of the physician education intangible asset had been recorded in amortization of acquired intangible assets within operating expenses. Future amortization expense related to intangible assets as of September 30, 2015 is as follows (in thousands): Year Ending December 31, Remainder of 2015 $ 1,036 2016 4,059 2017 4,053 2018 2,884 2019 2,441 Thereafter 8,470 $ 22,943 Accrued Expenses Accrued expenses consist of the following (in thousands): September 30, 2015 December 31, 2014 Legal $ 554 $ 967 Accounting 1,017 1,262 Severance 322 318 Restructuring 137 531 Sales milestones 133 107 Accrued taxes 729 1,344 Deferred rent 462 785 Royalties 1,712 2,129 Commissions 5,189 6,152 Payroll and related 5,359 8,291 Litigation settlements 4,400 7,393 Accrued interest 1,017 946 Other 6,185 5,168 Total accrued expenses $ 27,216 $ 35,393 Goodwill The changes in the carrying amount of goodwill from December 31, 2014 through September 30, 2015 are as follows (in thousands): Balance at December 31, 2014 $ 171,333 Goodwill impairment (164,266 ) Effect of foreign exchange rate on goodwill (7,067 ) Balance at September 30, 2015 $ — In the third quarter of 2015, the market value of the Company’s common stock substantially declined. As a result of this decline, the Company determined that it had an indicator of impairment of its goodwill, and an interim test of goodwill impairment was required (See Note 2). As a result of this interim test, the Company recorded a charge of $164.3 million , representing the write-off of the balance of goodwill in the three and nine months ended September 30, 2015. Due to the length of time necessary to measure impairment of goodwill, the goodwill impairment analysis was not completed as of the time of the filing of this Quarterly Report on Form 10-Q and is subject to change. The Company expects to complete the step two impairment analysis prior to reporting its financial results for the fourth quarter of 2015 and will record any adjustments to this preliminary estimate at that time.

License and Consulting Agreemen

License and Consulting Agreements	9 Months Ended
	Sep. 30, 2015
Contractors [Abstract]
License and Consulting Agreements	License and Consulting Agreements The Company’s license and consulting agreements are described below and in Note 5 to its audited consolidated financial statements for the year ended December 31, 2014 , which are included in its Annual Report on Form 10-K which was filed with the SEC on February 26, 2015. License Agreements In June 2015 the Company entered into an exclusive distribution agreement with a third party supplier pursuant to which the Company acquired exclusive worldwide distribution rights to market a synthetic biologic product under the Company's own brand name (the "Biologic Supply Agreement"). The Biologic Supply Agreement requires the Company to make minimum payments to the third party supplier for the Company's worldwide distribution rights under the agreement to remain exclusive. Asset Purchase Agreement In July 2014, the Company entered into an asset purchase and product development services agreement (the "Asset Purchase Agreement") whereby the Company purchased rights to the conceptual design for an intervertebral implant device. The financial terms of the Agreement include payments in cash and the Company's common stock upon achievement of various milestones. The Company treated this arrangement as an asset acquisition. In the three months ended September 30, 2014, the Company made cash payments totaling $0.2 million and issued 72,992 shares of the Company's common stock valued at $0.1 million . The Company recognized the cash and stock payments of $0.3 million as in-process research and development expense in the three and nine months ended September 30, 2014. Under the terms of the Asset Purchase Agreement, for milestones achieved in September 2015, the Company was obligated to pay $0.2 million cash compensation and issue 72,992 shares of the Company's common stocks valued at $0.1 million . The Company expensed $0.3 million as in-process research and development in the three and nine months ended September 30, 2015.

Debt

Debt	9 Months Ended
	Sep. 30, 2015
Debt Disclosure [Abstract]
Debt	Debt MidCap Facility Agreement On August 30, 2013, the Company entered into the Amended Credit Facility with MidCap. The Amended Credit Facility amended and restated the prior credit facility that the Company had with MidCap (the "Prior Credit Facility"). Pursuant to the Amended Credit Facility, the Company increased the borrowing limit from $50 million to $73 million . The Company also extended the maturity of the credit facility to August 2016 . In July 2015, the Company further amended the Amended Credit Facility to provide for an additional term loan of $5 million . As of September 30, 2015 , the Amended Credit Facility consisted of a $38 million term loan, $28 million of which was drawn at closing and the remaining $5 million of which was drawn in April 2014, a $5 million term loan drawn in July 2015 and a revolving line of credit with a maximum borrowing base of $40 million , of which $27.0 million was outstanding under the revolving line of credit at September 30, 2015 . The Company used the term loan proceeds of $28 million drawn at closing to repay a portion of the outstanding balance on the prior revolving line of credit. The term loan interest rate is priced at the London Interbank Offered Rate ("LIBOR") plus 8.0% , subject to a 9.5% floor, and the revolving line of credit interest rate remains priced at LIBOR plus 6.0% , reset monthly. At September 30, 2015 , the revolving line of credit carried an interest rate of 6.2% and the term loan carries an interest rate of 9.5% . The borrowing base is determined, from time to time, based on the value of domestic eligible accounts receivable and domestic eligible inventory. As collateral for the Amended Credit Facility, the Company granted MidCap a security interest in substantially all of its assets, including all accounts receivable and all securities evidencing its interests in its subsidiaries. In addition to monthly payments of interest, monthly repayments of $0.5 million are due through maturity, with the remaining principal due upon maturity. In connection with the execution of the Amended Credit Facility, the Company incurred an additional $0.4 million in costs that were capitalized as debt issuance costs. At September 30, 2015 , $0.3 million remains as unamortized debt issuance costs related to the prior and Amended Credit Facility within the unaudited consolidated balance sheet, which will be amortized over the remaining term of the Amended Credit Facility. The Amended Credit Facility includes traditional lending and reporting covenants including a fixed charge coverage ratio, a senior leverage ratio and a total leverage ratio to be maintained by the Company. The Amended Credit Facility also includes several event of default provisions, such as payment default and insolvency conditions, which could cause interest to be charged at a rate which is up to five percentage points above the rate effective immediately before the event of default or result in MidCap’s right to declare all outstanding obligations immediately due and payable. In February 2013, the Company and MidCap entered into a first amendment to the Credit Facility (the "First Amendment to the Credit Facility”). The First Amendment to the Credit Facility allowed the Company to exclude payments related to an acquisition and a settlement agreement from calculation of the fixed charge coverage ratio and the senior leverage ratio. In conjunction with the First Amendment to the Credit Facility, the Company paid MidCap a fee of $0.1 million . On March 17, 2014, the Company entered into a first amendment to the Amended Credit Facility with MidCap (the "First Amendment to the Amended Credit Facility"). Under the First Amendment to the Amended Credit Facility, MidCap gave the Company its consent to enter into the Facility Agreement (defined below) and make settlement payments in connection with the Orthotec litigation. The First Amendment to the Amended Credit Facility also added a total leverage ratio financial covenant. On July 10, 2015, the Company entered into a Second Amendment to the Amended Credit Facility with MidCap (the "Second Amendment to the Amended Credit Facility") to increase the term loan commitment from $33 million to $38 million . The Company borrowed the additional $5 million under the term loan on July 10, 2015, which is the third term loan tranche under the Amended Credit Facility (the "Third Term Loan Tranche"). Until January 1, 2016, only interest payments are due for the Third Term Loan Tranche. Thereafter, the Company will pay an amount equal to $0.5 million on the first day of each calendar month as an amortization payment in respect of all tranches of the term loan. The Company paid MidCap, a commitment fee equal to 1.0% of the principal amount of the funds disbursed in the Third Term Loan Tranche. The Company was in compliance with all of the covenants of the Amended Credit Facility as of September 30, 2015 , except for the non-compliance disclosed in Note 1. The Company has obtained waivers in January and February of 2016 from MidCap to cure the breach of the fixed charge coverage ratio covenant for each of June, August and September of 2015. There is not assurance that the Company will be in compliance with the financial covenants of the Amended Credit Facility in the future. Deerfield Facility Agreement On March 17, 2014, the Company entered into the facility agreement with Deerfield (the "Facility Agreement"), pursuant to which Deerfield agreed to loan the Company up to $50 million , subject to the terms and conditions set forth in the Facility Agreement. Under the terms of the Facility Agreement, the Company had the option, but was not required, upon certain conditions to draw the entire amount available under the Facility Agreement, at any time until January 30, 2015 (the “Draw Period”), provided that the initial draw be used for a portion of the payments made in connection with the Orthotec settlement described in Note 7 below. The Company agreed to pay Deerfield, upon each disbursement of funds under the Facility Agreement, a transaction fee equal to 2.5% of the principal amount of the funds disbursed. Amounts borrowed under the Facility Agreement bear interest at a rate of 8.75% per annum and are payable on the third, fourth and fifth anniversary date of the first amount borrowed under the Facility Agreement, with the final payment due on March 20, 2019. The Facility Agreement also contains various representations and warranties, and affirmative and negative covenants, customary for financings of this type, including restrictions on the ability of the Company and its subsidiaries to incur additional indebtedness or liens on its assets, except as permitted under the Facility Agreement. As security for the Company's repayment of its obligations under the Facility Agreement, the Company granted to Deerfield a security interest in substantially all of the Company's property and interests in property, which is subordinated to the security interest granted under the Amended Credit Facility. In connection with the execution of the Facility Agreement on March 17, 2014, the Company issued to Deerfield warrants to purchase an aggregate of 6,250,000 shares of the Company’s common stock, which are immediately exercisable and have an exercise price equal to $1.39 per share (the “Initial Warrants”). Additionally, the Company agreed that each disbursement borrowing under the Facility Agreement be accompanied by the issuance to Deerfield of warrants to purchase up to 10,000,000 shares of the Company’s common stock, in proportion to the amount of draw compared to the total $50 million facility (the "Draw Warrants"). On March 20, 2014, the Company made an initial draw of $20 million under the Facility Agreement and received net proceeds of $19.5 million to fund the portion of the settlement payment obligations that were due in 2014 to Orthotec, LLC. The $0.5 million transaction fee is recorded as a debt discount and is being amortized over the term of the draw, which ends March 20, 2019. In connection with this borrowing, the Company issued Draw Warrants to purchase 4,000,000 shares of common stock at an exercise price of $1.39 per share, which were valued at $4.7 million and recorded as a debt discount, which is being amortized over the term of the $20 million draw. Additionally, $2.3 million of the value of the Initial Warrants was reclassified as a debt discount and is being amortized through interest expense over the term of the debt using the effective interest method. On November 21, 2014, the Company made a second draw of $6.0 million under the Facility Agreement and received net proceeds of $5.9 million to fund a portion of the Orthotec settlement payments due through 2016. The $0.2 million transaction fee was recorded as a debt discount and is being amortized over the remaining term of the draw, which ends March 20, 2019. In connection with this second draw, the Company issued Draw Warrants to purchase 1,200,000 shares of common stock at an exercise price of $1.39 per share, which were valued at $0.9 million and were recorded as a debt discount, which is being amortized over the term of the debt using the effective interest method. Additionally, $0.2 million of the value of the Initial Warrants was reclassified as a debt discount and is being amortized through interest expense over the term of the debt using the effective interest method. No amounts remain available for the Company to borrow under the Facility Agreement. As of September 30, 2015, Orthotec settlement payments of $21.9 million have been made, leaving remaining proceeds from the funds borrowed under the Facility Agreement of $3.5 million , which was classified as short-term restricted cash, as its use is limited under the terms of the Facility Agreement for the payments of amounts due under the Orthotec litigation settlement agreement. Additionally, a payment of $1.1 million was made on October 1, 2015. The amounts borrowed under the Facility Agreement, which total $26.0 million in principal as of September 30, 2015 , are due in three equal annual payments beginning March 20, 2017. As a result of the Company's non-compliance with the MidCap fixed charge coverage ratio covenant, the Company was in cross-default of the Facility Agreement, for which the Company received a waiver from Deerfield in February 2016 for the months of June, August and September 2015. There is no assurance that the Company will be in compliance with the financial covenants of the Amended Credit Facility in the foreseeable future, which would result in cross-default under the Facility Agreement in which case Deerfield would have the right to call the debt outstanding under the Facility Agreement due immediately. Accordingly, as disclosed in Note 1, the amounts borrowed under the Facility Agreement are presented on the condensed consolidated balance sheet as of September 30, 2015 under current liabilities, net of unamortized issuance discount. As of September 30, 2015 , the outstanding Initial Warrants and Draw Warrants to purchase an aggregate of 11,450,000 shares of common stock were revalued to their fair value with a charge to other income expense of $6.3 million and $8.0 million for the three months and nine months ended September 30, 2015 , respectively. The change in the fair value of the warrants of $8.0 million for the nine months ended September 30, 2015 is included in other non-cash items in the condensed consolidated statements of cash flow. The warrant liability of $0.7 million is recorded as common stock warrant liabilities within current liabilities on the condensed consolidated balance sheet as of September 30, 2015 . On July 10, 2015, the Company entered into a First Amendment to the Facility Agreement (the “Facility Agreement First Amendment”), with Deerfield. The Facility Agreement First Amendment permitted, among other things, the Company to enter into and borrow the additional $5 million under the term loan in July 2015 under the Second Amendment to the Amended Credit Facility. At September 30, 2015 , the outstanding warrants were valued using the Black-Scholes option pricing model. This is a Level 3 measurement using the following assumptions: September 30, 2015 Risk-free interest rate 1.3 % Dividend yield — % Expected volatility 63 % Expected life (years) 4.5 Principal payments on debt are as follows as of September 30, 2015 (in thousands): Year Ending December 31, Remainder of 2015 (1) $ 2,058 2016 (1) 56,173 2017 (1) 8,667 2018 (1) 8,667 2019 (1) 8,666 Thereafter — Total 84,231 Add: capital lease principal payments 1,471 Less: debt discount (5,765 ) Total 79,937 Less: current portion of long-term debt (1) (79,253 ) Long-term debt, net of current portion $ 684 (1) The amounts above are presented based on the contractual payment schedules in each of the respective agreements. However, the debt balance under the Amended Credit Facility and the Facility Agreement was callable as of September 30, 2015 due to the event of default (See Note 1 and Note 5) and therefore, is presented as a current liability on the condensed consolidated balance sheet as of September 30, 2015.

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
	Sep. 30, 2015
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies Leases The Company leases certain equipment under capital leases which expire on various dates through September 2018 . The leases bear interest at rates ranging from 6.6% to 9.6% per annum, are generally due in monthly principal and interest installments and are collateralized by the related equipment. The Company also leases its buildings and certain equipment and vehicles under operating leases which expire on various dates through January 2019 . Future minimum annual lease payments under such leases are as follows as of September 30, 2015 (in thousands): Year Ending December 31, Operating Capital Remainder of 2015 $ 899 $ 224 2016 2,318 877 2017 846 437 2018 272 68 2019 137 — $ 4,472 1,606 Less: amount representing interest (135 ) Present value of minimum lease payments 1,471 Current portion of capital leases (799 ) Capital leases, less current portion $ 672 Rent expense under operating leases for the three months ended September 30, 2015 and 2014 was $0.8 million . Rent expense under operating leases for the nine months ended September 30, 2015 and 2014 was $2.3 million and $2.6 million , respectively. 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 our 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. 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 calculated either as a percentage of net sales or in one instance on a per-unit sold basis. Royalties are included on the accompanying condensed consolidated statement of operations as a component of cost of revenues.

Orthotec Settlement

Orthotec Settlement	9 Months Ended
	Sep. 30, 2015
Commitments and Contingencies Disclosure [Abstract]
Orthotec Settlement	Orthotec Settlement On September 26, 2014, the Company entered into a Settlement and Release Agreement, dated as of August 13, 2014, by and among the Company and its direct subsidiaries, including Alphatec Spine, Inc., Alphatec Holdings International C.V., Scient'x S.A.S. and Surgiview S.A.S.; HealthpointCapital, LLC, HealthpointCapital Partners, L.P., HealthpointCapital Partners II, L.P., John H. Foster and Mortimer Berkowitz III; and Orthotec, LLC and Patrick Bertranou, (the "Settlement Agreement"). Pursuant to the Settlement Agreement, the Company agreed to pay Orthotec, LLC $49 million in cash, including initial cash payments totaling $1.75 million , which the Company previously paid in March 2014, and an additional lump sum payment of $15.75 million , which the Company previously paid in April 2014. The Company agreed to pay the remaining $31.5 million in 28 quarterly installments of $1.1 million and then one additional quarterly installment of $0.7 million , commencing October 1, 2014. As of September 30, 2015 , the Company has made installment payments in the aggregate of $21.9 million . The Company has the right to prepay the amounts due without penalty. In addition, the unpaid balance of the amounts due accrues interest at the rate of 7% per year beginning May 15, 2014 until the amounts due are paid in full. The accrued but unpaid interest will be paid in quarterly installments of $1.1 million (or the full amount of the accrued but unpaid interest if less than $1.1 million ) following the full payment of the $31.5 million in quarterly installments described above. No interest will accrue on the accrued interest. The Settlement Agreement provided for mutual releases of all claims in the Orthotec, LLC v. Surgiview, S.A.S, et al. matter in the Superior Court of California, Los Angeles County and all other related litigation matters involving the Company and its directors and affiliates.

Net Loss Per Share

Net Loss Per Share	9 Months Ended
	Sep. 30, 2015
Earnings Per Share [Abstract]
Net Loss Per Share	Net Loss Per Share Basic earnings per share (“EPS”) is calculated by dividing the net income or loss available to common stockholders by the weighted average number of common shares outstanding for the period, without consideration for common stock equivalents. Diluted EPS is computed by dividing the net income available to common stockholders by the weighted average number of common shares outstanding for the period and the weighted average number of dilutive common stock equivalents outstanding for the period determined using the treasury-stock method. For purposes of this calculation, common stock subject to repurchase by the Company, 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 (in thousands, except per share data): Three Months Ended Nine Months Ended 2015 2014 2015 2014 Numerator: Net loss for basic earnings per share $ (160,265 ) $ (3,041 ) $ (168,773 ) $ (12,609 ) Decrease in fair value of warrants — (513 ) — (520 ) Diluted net loss applicable to common stockholders $ (160,265 ) $ (3,554 ) $ (168,773 ) $ (13,129 ) Denominator: Weighted average common shares outstanding 100,144 98,126 100,092 97,864 Weighted average unvested common shares subject to repurchase (768 ) (735 ) (834 ) (824 ) Weighted average common shares outstanding—basic 99,376 97,391 99,258 97,040 Effect of dilutive securities: Conversion of preferred stock — — — — Options — — — — Warrants — 938 — 218 Weighted average common shares outstanding—diluted 99,376 98,329 99,258 97,258 Net loss per share: Basic $ (1.61 ) $ (0.03 ) $ (1.70 ) $ (0.13 ) Diluted $ (1.61 ) $ (0.04 ) $ (1.70 ) $ (0.13 ) The anti-dilutive securities not included in diluted net loss per share were as follows (in thousands): Three Months Ended Nine Months Ended 2015 2014 2015 2014 Options to purchase common stock 7,859 6,904 8,029 7,199 Unvested restricted share awards 768 735 834 824 Warrants to purchase common stock 11,544 594 11,544 6,844 Total 20,171 8,233 20,407 14,867

Stock Benefit Plans and Stock-B

Stock Benefit Plans and Stock-Based Compensation	9 Months Ended
	Sep. 30, 2015
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Stock Benefit Plans and Stock-Based Compensation	Stock Benefit Plans and Stock-Based Compensation In February 2015, the Company granted 1,854,000 performance-based restricted stock units ("PSUs") to certain employees under its 2005 Employee, Director and Consultant Stock Plan (the "2005 Plan"). The PSUs vest based upon the Company's achievement of certain performance goals over the period from January 1, 2015 through December 31, 2017. The number of PSUs that may vest varies between 0% - 200% based on the achievement of such goals. The PSUs were valued at $1.35 per share based on the closing price of the Company's common stock on the date of grant. For purposes of measuring compensation expense, the amount of PSUs ultimately expected to vest is estimated at each reporting date based on management’s expectations regarding the relevant performance criteria. The recognition of compensation expense associated with PSUs requires judgment in assessing the probability of meeting the performance goals, as well as defined criteria for assessing achievement of the performance-related goals. The awards are deemed probable of vesting as of September 30, 2015 .

Income Taxes

Income Taxes	9 Months Ended
	Sep. 30, 2015
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes To calculate its interim tax provision, at the end of each interim period the Company estimates the annual effective tax rate and applies that to its ordinary quarterly earnings. In addition, the effect of changes in enacted tax laws or rates or tax status is recognized in the interim period in which the change occurs. The computation of the annual estimated effective tax rate at each interim period requires certain estimates and significant judgment including, but not limited to, the expected operating income for the year, projections of the proportion of income earned and taxed in foreign jurisdictions, permanent and temporary differences between book and tax amounts, and the likelihood of recovering deferred tax assets generated in the current year. The accounting estimates used to compute the provision for income taxes may change as new events occur, additional information is obtained or as the tax environment changes. The Company recognizes interest and penalties related to uncertain tax positions as a component of the income tax provision. The Company’s unrecognized tax benefits decreased less than $0.2 million during the nine months ended September 30, 2015 . The decrease in unrecognized tax benefits during the nine months ended September 30, 2015 was primarily related to foreign currency fluctuations and changes in prior year uncertain tax positions within the Company's foreign subsidiaries, partially offset by an increase related to state research credits and uncertain tax positions within the Company’s foreign subsidiaries. The unrecognized tax benefits at September 30, 2015 and December 31, 2014 were $8.7 million and $8.9 million , respectively. With the facts and circumstances currently available to the Company, it is reasonably possible that the amount that could reverse over the next 12 months is insignificant. Additionally, the French restructuring (see Note 12) may result in limitations on the Company’s ability to utilize its French net operating loss carryforwards to offset future taxable income. The income tax benefit consists primarily of the income tax benefit related to the reversal of the deferred tax liabilities associated with tax deductible goodwill, partially offset by income tax provisions related to state income taxes and operations in other foreign jurisdictions where the Company operates. The tax impact of the $165.2 million impairment charge (see note 2) in the current quarter is a $1.5 million income tax benefit as a result of the reversal of the deferred tax liabilities on the tax deductible goodwill due to the Company having a valuation allowance against deferred tax assets. The Company is not currently under examination by the Internal Revenue Service, or by any foreign, state or local tax authorities.

Segment and Geographical Inform

Segment and Geographical Information	9 Months Ended
	Sep. 30, 2015
Segment Reporting [Abstract]
Segment and Geographical Information	Segment and Geographical Information Operating segments are defined as components of an enterprise for which separate financial information is available and evaluated regularly by the chief operating decision maker, or decision-making group, in deciding how to allocate resources and in assessing performance. The Company has one operating and one reportable business segment. During the three and nine months ended September 30, 2015 and 2014 , the Company operated in two geographic regions, the U.S. and International, which consists of locations outside of the U.S. In the International geographic region, sales in Japan for the three and nine months ended September 30, 2015 totaled $8.3 million and $23.7 million , respectively, which represented greater than 10 percent of the Company’s consolidated revenues for such periods. In the International geographic region, sales in Japan for the three and nine months ended September 30, 2014 totaled $8.5 million and $23.8 million , respectively, which represented greater than 10 percent of the Company’s consolidated revenues for such periods. Revenues attributed to the geographic location of the customer were as follows (in thousands): Three Months Ended Nine Months Ended September 30, September 30, 2015 2014 2015 2014 United States $ 27,385 $ 34,808 $ 85,099 $ 101,376 International 15,611 16,205 53,177 51,977 Total consolidated revenues $ 42,996 $ 51,013 $ 138,276 $ 153,353 Total assets by region were as follows (in thousands): September 30, December 31, United States $ 99,710 $ 200,978 International 48,674 143,945 Total consolidated assets $ 148,384 $ 344,923

Restructuring

Restructuring	9 Months Ended
	Sep. 30, 2015
Restructuring and Related Activities [Abstract]
Restructuring	Restructuring On September 16, 2013, the Company announced that Scient'x began a process to significantly restructure its business operations in France in an effort to improve operating efficiencies and rationalize its cost structure. The restructuring included a reduction in Scient'x's workforce and closing of the manufacturing facilities in France. The Company has recorded total costs of $10.3 million to date associated with this restructuring, which includes employee severance, social plan benefits and related taxes, facility closing costs, manufacturing transfer costs, and contract termination costs, in accordance with ASC Topic 420, Accounting for Costs Associated with Exit or Disposal Activities, and ASC Topic 712 , Non Retirement Postemployment Benefits. The Company has substantially completed the activities associated with the Scient'x restructuring as of September 30, 2015 , and substantially all of the costs have been paid. On July 6, 2015, the Company announced a restructuring of its manufacturing operations in California in an effort to improve its cost structure. The restructuring includes a reduction in workforce and closing the California manufacturing facility. Restructuring liabilities are measured at fair value and recognized as incurred. The restructuring will take place over the next year and the Company estimates that it will incur termination benefits, accelerated depreciation, facility closing and other restructuring costs of up to $4 million . Certain restructuring costs are based upon estimates. Actual amounts paid may ultimately be different from these estimates. If additional costs are incurred, such additional costs will be recognized when they occur.

Related Party Transactions

Related Party Transactions	9 Months Ended
	Sep. 30, 2015
Related Party Transactions [Abstract]
Related Party Transactions	Related Party Transactions For the nine months ended September 30, 2015 and 2014 , the Company incurred expenses of $0.1 million related to HealthpointCapital, LLC. As of September 30, 2015 , the Company also had a liability of $0.1 million payable to HealthpointCapital, LLC for travel and administrative expenses. The Company has entered into indemnification agreements with certain of its directors which are named defendants in the New York Orthotec matter (see Note 7 – Orthotec Settlement). The indemnification agreements require the Company to indemnify these individuals to the fullest extent permitted by applicable law and to advance expenses incurred by them in connection with any proceeding against them to which they may be entitled to indemnification by the Company. For the nine months ended September 30, 2015 and 2014 , the Company incurred legal expenses of zero and less than $0.1 million , respectively, in connection with the Company’s indemnification obligations for two former directors of Scient'x in the New York Orthotec matter.

Subsequent Events

Subsequent Events	9 Months Ended
	Sep. 30, 2015
Subsequent Events [Abstract]
Subsequent Events	Subsequent Event On November 2, 2015, the Company entered into a first amendment (the "First Amendment") to the collaboration agreement with Elite Medical Holdings, LLC and Pac 3 Surgical Products, LLC (the "Collaborators") (the "Collaboration Agreement"). Under the Collaboration Agreement, the Collaborators agreed to provide services related to the development and commercialization of the Company’s current products and products in the Company’s product pipeline. As consideration for the services, the Collaboration Agreement provides that the Company will issue an aggregate $8.0 million of the Company’s common stock, based on a per share price of $1.95 per share, which was the average of the closing price of the Company’s common stock on The NASDAQ Global Select Market on each of the four days prior to the effective date and the effective of the Collaboration Agreement. Pursuant to the First Amendment, in exchange for a "lock up" restriction on selling or transferring each tranche of shares issued to the Collaborators and a maximum value cap (as discussed below), the Company has agreed to make a cash payment to the Collaborators in the event that the shares in such tranche do not have a minimum amount of value based on the market value of the Company’s common stock at the end of the lock up period applicable to such tranche of shares. In addition, in the event that at the end of a lock up period the value of a tranche of shares issued to the Collaborators exceeds a certain amount, the Collaborators have agreed to forfeit shares back to the Company, so as to limit the maximum amount of value derived from such shares at the end of a lock up period. Pursuant to the First Amendment, the shares issued to the Collaborators in each of 2014, 2015 and 2016 are subject to a lock up that lasts until the first quarter of 2017, 2018 and 2019, respectively. The valuation of each tranche of shares occurs at the end of the applicable lock up period. Based on the closing price of the Company’s common stock on October 30, 2015, the Company could have an additional liability of $3.5 million for shares of the Company’s common stock previously issued under the Collaboration Agreement, with $2.1 million payable in 2017 and $1.4 million million payable in 2018. In addition, based on the closing price of the Company’s common stock on October 30, 2015, the Company could have an additional liability of $2.8 million for shares of the Company’s common stock issuable under the remaining terms of the Collaboration Agreement (assuming that all of the shares issuable under the Collaboration Agreement are issued), with $0.7 million payable in 2018 (in addition to the amount above payable in 2018), and $2.1 million payable in 2019. If the Collaborators elect to sell, assign or transfer: (i) more than 20% of the shares issued to the Collaborators prior to the first valuation date; or (ii) any of the Collaborator shares still subject to a lockup after the first valuation date, all of the aforementioned restrictions on transfer and valuation minimums and maximums are null and void. Other than as set forth in the First Amendment, the Collaboration Agreement remains in full force and effect.

The Company and Basis of Pres21

The Company and Basis of Presentation The Company and Basis of Presentation (Policies)	9 Months Ended
	Sep. 30, 2015
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation The accompanying condensed consolidated balance sheet as of December 31, 2014 , which has been derived from audited financial statements, and the unaudited interim condensed consolidated financial statements have been prepared by the Company in accordance with U.S. generally accepted accounting principles (“GAAP”) and the rules and regulations of the Securities and Exchange Commission (“SEC”) related to a quarterly report on Form 10-Q. Certain information and note disclosures normally included in annual audited financial statements prepared in accordance with GAAP have been condensed or omitted pursuant to those rules and regulations, although the Company believes that the disclosures made in this quarterly report on Form 10-Q are adequate to make the information not misleading. The interim unaudited condensed consolidated financial statements reflect all adjustments, including normal recurring adjustments which, in the opinion of management, are necessary for a fair statement of the financial position and results of operations for the periods presented. These unaudited condensed consolidated financial statements should be read in conjunction with the Company’s audited financial statements for the year ended December 31, 2014 , which are included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2014 that was filed with the SEC on February 26, 2015 .

Summary of Significant Accoun22

Summary of Significant Accounting Policies (Policies)	9 Months Ended
	Sep. 30, 2015
Accounting Policies [Abstract]
Goodwill	Goodwill The Company accounts for goodwill in accordance with authoritative guidance which requires that goodwill be tested for impairment at least annually. The Company tests goodwill for impairment as of December 31 of each year, or more frequently if events and circumstances warrant. These assets are impaired if the Company determines that their carrying values may not be recoverable based on an assessment of certain events or changes in circumstances. If the assets are considered to be impaired, the Company recognizes the amount by which the carrying value of the assets exceeds the fair value of the assets as an impairment loss . In the third quarter of 2015, the market value of the Company’s common stock substantially declined. As a result of this decline, the Company determined that it had an indicator of impairment of its goodwill, and an interim test of goodwill impairment was required. As a result, the Company reviewed its goodwill for impairment under a two-part test in accordance with authoritative guidance. The Company estimated the fair value in step one of the goodwill impairment test based on a combination of the income approach which included discounted cash flows as well as a market approach that utilized the guideline company market information. The fair value measurements utilized to perform the impairment analysis are categorized within Level 3 of the fair value hierarchy. The Company’s discounted cash flows required management judgment with respect to forecasted sales, launch of new products, gross margin, selling, general and administrative expenses, capital expenditures and the selection and use of an appropriate discount rate and terminal rate. For purposes of calculating the discounted cash flows, the Company used estimated revenue growth rates between 3% and 13% for the discrete forecast period. Cash flows beyond the discrete forecast period were estimated using a terminal value calculation, which incorporated historical and forecasted financial trends and considered long-term earnings growth rates for publicly traded peer companies. Future cash flows were then discounted to present value at a discount rate of 13.5% , and terminal value growth rate of 3% . The Company's market capitalization was also considered in assessing the reasonableness of the Company’s fair value as determined in step one of the goodwill impairment test. The Company’s assessment resulted in a fair value that was lower than the Company’s carrying value of net assets at September 30, 2015. Based upon step one of the test, the Company determined that its goodwill was impaired and that step two of the test was required to measure the amount of goodwill impairment. As a result of step two, in the third quarter of 2015 the Company recorded a charge of $164.3 million , representing the write-off of the remaining balance of goodwill.
Fair Value Measurements	Fair Value Measurements The carrying amount of financial instruments consisting of cash, restricted cash, trade accounts receivable, prepaid expenses and other current assets, accounts payable, accrued expenses, accrued compensation and current portion of long-term debt included in the Company’s consolidated financial statements are reasonable estimates of fair value due to their short maturities. Based on the borrowing rates currently available to the Company for loans with similar terms, management believes the fair value of long-term debt approximates its carrying value. Authoritative guidance establishes a three-tier fair value hierarchy, which prioritizes the inputs used in measuring fair value as follows: Level 1: Observable inputs such as quoted prices in active markets; Level 2: Inputs, other than the quoted prices in active markets, that are observable either directly or indirectly; and Level 3: Unobservable inputs in which there is little or no market data, which require the reporting entity to develop its own assumptions. The Company does not maintain any financial instruments that are considered to be Level 1 or Level 2 instruments as of September 30, 2015 or December 31, 2014 . The Company classifies its common stock warrant liabilities within Level 3 of the fair value hierarchy because they are valued using valuation models with significant unobservable inputs.
Warrants to Purchase Common Stock	Common stock warrant liabilities are measured at fair value using the Black-Scholes option pricing valuation model. The assumptions used in the Black-Scholes option pricing valuation model for the common stock warrant liabilities were: (a) a risk-free interest rate based on the rates for U.S. Treasury zero-coupon bonds with maturities similar to those of the remaining contractual term of the warrants; (b) an assumed dividend yield of zero based on the Company’s expectation that it will not pay dividends in the foreseeable future; (c) an expected term based on the remaining contractual term of the warrants; and (d) an expected volatility based upon the Company's historical volatility over the remaining contractual term of the warrants. The significant unobservable input used in measuring the fair value of the common stock warrant liabilities associated with the Deerfield Facility Agreement (described in Note 5 below) is the expected volatility. Significant increases in volatility would result in a higher fair value measurement.
Recent Accounting Pronouncements	Recent Accounting Pronouncements In May 2014, the Financial Accounting Standards Board ("FASB") issued new accounting guidance related to revenue recognition. This new standard will replace all current U.S. GAAP guidance on this topic and eliminate all industry-specific guidance. The new revenue recognition standard provides a unified model to determine when and how revenue is recognized. The core principle is that a company should recognize revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration to which the entity expects to be entitled in exchange for those goods or services. On August 12, 2015, the FASB issued guidance deferring the effective date by one year to December 15, 2017 for annual reporting periods beginning after that date. The FASB also permitted early adoption of the standard, but not before the original effective date of December 15, 2016. The Company is currently evaluating the impact, if any, the adoption of this standard will have on its financial statements. In August 2014, the FASB issued guidance related to disclosures of uncertainties about an entity’s ability to continue as a going concern. The guidance requires management to evaluate whether there are conditions and events that raise substantial doubt about the entity’s ability to continue as a going concern within one year after the financial statements are issued. Management will be required to make this evaluation for both annual and interim reporting periods and will have to make certain disclosures if it concludes that substantial doubt exists or when its plans alleviate substantial doubt about the entity’s ability to continue as a going concern. Substantial doubt exists when relevant conditions and events, considered in the aggregate, indicate that it is probable that the entity will be unable to meet its obligations as they become due within one year after the date that the financial statements are issued. The guidance is effective for annual periods ending after December 15, 2016 and for interim reporting periods within annual periods beginning after December 15, 2016, with early adoption permitted. The Company is currently evaluating the impact of this guidance and expects to adopt the standard for the annual reporting period ending December 31, 2016. In April 2015, the FASB issued guidance that amends existing guidance to require the presentation of debt issuance costs in the balance sheet as a deduction from the carrying amount of the related debt liability instead of a deferred charge. The guidance will not change the amortization of debt issuance costs, which will continue to follow the existing accounting guidance. The guidance is effective for annual reporting periods beginning after December 15, 2015, but early adoption is permitted. The Company is currently evaluating the impact of adopting this new accounting standard on its financial statements.

Summary of Significant Accoun23

Summary of Significant Accounting Policies (Tables)	9 Months Ended
	Sep. 30, 2015
Accounting Policies [Abstract]
Reconciliation of liabilities measured at fair value using significant unobservable inputs	The following table provides a reconciliation of liabilities measured at fair value using significant unobservable inputs (Level 3) for the nine months ended September 30, 2015 (in thousands): Common Stock Warrant Liabilities Balance at December 31, 2014 $ 8,702 Changes in fair value (8,015 ) Balance at September 30, 2015 $ 687

Select Balance Sheet Details (T

Select Balance Sheet Details (Tables)	9 Months Ended
	Sep. 30, 2015
Balance Sheet Related Disclosures [Abstract]
Accounts Receivable, net	Accounts receivable, net consist of the following (in thousands): September 30, 2015 December 31, 2014 Accounts receivable $ 37,298 $ 41,233 Allowance for doubtful accounts (1,046 ) (793 ) Accounts receivable, net $ 36,252 $ 40,440
Inventories, net	Inventories, net consist of the following (in thousands) September 30, 2015 December 31, 2014 Gross Reserve for excess and obsolete Net Gross Reserve for excess and obsolete Net Raw materials $ 6,449 $ — $ 6,449 $ 5,020 $ — $ 5,020 Work-in-process 1,898 — 1,898 1,032 — 1,032 Finished goods 53,930 (19,949 ) 33,981 57,020 (21,325 ) 35,695 Inventories $ 62,277 $ (19,949 ) $ 42,328 $ 63,072 $ (21,325 ) $ 41,747
Property and Equipment, net	Property and equipment, net consist of the following (in thousands except as indicated): Useful lives (in years) September 30, 2015 December 31, 2014 Surgical instruments 4 $ 64,838 $ 62,872 Machinery and equipment 7 15,585 15,382 Computer equipment 3 3,700 3,180 Office furniture and equipment 5 3,752 3,789 Leasehold improvements various 3,854 3,841 Building 39 66 65 Land n/a 9 9 Construction in progress n/a 468 1,320 92,272 90,458 Less accumulated depreciation and amortization (68,552 ) (64,418 ) Property and equipment, net $ 23,720 $ 26,040
Intangible Assets, net	Intangible assets, net consist of the following (in thousands except for useful lives): Useful lives (in years) September 30, 2015 December 31, 2014 Developed product technology 3-8 $ 21,825 $ 22,526 Distribution rights 3 2,100 2,095 Intellectual property 5 1,004 1,004 License agreements 1-7 16,716 16,716 Core technology 10 4,187 4,554 Trademarks and trade names 3-9 3,307 3,559 Customer-related 12-15 19,458 20,493 Distribution network 10-12 4,027 4,027 Physician education programs 10 2,575 2,802 Supply agreement 10 225 225 75,424 78,001 Less accumulated amortization (52,481 ) (47,742 ) Intangible assets, net $ 22,943 $ 30,259
Schedule of Intangible assets, future amortization expense	Future amortization expense related to intangible assets as of September 30, 2015 is as follows (in thousands): Year Ending December 31, Remainder of 2015 $ 1,036 2016 4,059 2017 4,053 2018 2,884 2019 2,441 Thereafter 8,470 $ 22,943
Accrued Expenses	Accrued expenses consist of the following (in thousands): September 30, 2015 December 31, 2014 Legal $ 554 $ 967 Accounting 1,017 1,262 Severance 322 318 Restructuring 137 531 Sales milestones 133 107 Accrued taxes 729 1,344 Deferred rent 462 785 Royalties 1,712 2,129 Commissions 5,189 6,152 Payroll and related 5,359 8,291 Litigation settlements 4,400 7,393 Accrued interest 1,017 946 Other 6,185 5,168 Total accrued expenses $ 27,216 $ 35,393
Schedule of changes in carrying amount of goodwill	The changes in the carrying amount of goodwill from December 31, 2014 through September 30, 2015 are as follows (in thousands): Balance at December 31, 2014 $ 171,333 Goodwill impairment (164,266 ) Effect of foreign exchange rate on goodwill (7,067 ) Balance at September 30, 2015 $ —

Debt (Tables)

Debt (Tables)	9 Months Ended
	Sep. 30, 2015
Debt Disclosure [Abstract]
Level 3 Measurement Assumptions	At September 30, 2015 , the outstanding warrants were valued using the Black-Scholes option pricing model. This is a Level 3 measurement using the following assumptions: September 30, 2015 Risk-free interest rate 1.3 % Dividend yield — % Expected volatility 63 % Expected life (years) 4.5
Principal Payments on Debt	Principal payments on debt are as follows as of September 30, 2015 (in thousands): Year Ending December 31, Remainder of 2015 (1) $ 2,058 2016 (1) 56,173 2017 (1) 8,667 2018 (1) 8,667 2019 (1) 8,666 Thereafter — Total 84,231 Add: capital lease principal payments 1,471 Less: debt discount (5,765 ) Total 79,937 Less: current portion of long-term debt (1) (79,253 ) Long-term debt, net of current portion $ 684 (1) The amounts above are presented based on the contractual payment schedules in each of the respective agreements. However, the debt balance under the Amended Credit Facility and the Facility Agreement was callable as of September 30, 2015 due to the event of default (See Note 1 and Note 5) and therefore, is presented as a current liability on the condensed consolidated balance sheet as of September 30, 2015.

Commitments and Contingencies (

Commitments and Contingencies (Tables)	9 Months Ended
	Sep. 30, 2015
Commitments and Contingencies Disclosure [Abstract]
Future Minimum Annual Lease Payments	Future minimum annual lease payments under such leases are as follows as of September 30, 2015 (in thousands): Year Ending December 31, Operating Capital Remainder of 2015 $ 899 $ 224 2016 2,318 877 2017 846 437 2018 272 68 2019 137 — $ 4,472 1,606 Less: amount representing interest (135 ) Present value of minimum lease payments 1,471 Current portion of capital leases (799 ) Capital leases, less current portion $ 672

Net Loss Per Share (Tables)

Net Loss Per Share (Tables)	9 Months Ended
	Sep. 30, 2015
Earnings Per Share [Abstract]
Weighted Average Number of Common Shares Outstanding	For purposes of this calculation, common stock subject to repurchase by the Company, 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 (in thousands, except per share data): Three Months Ended Nine Months Ended 2015 2014 2015 2014 Numerator: Net loss for basic earnings per share $ (160,265 ) $ (3,041 ) $ (168,773 ) $ (12,609 ) Decrease in fair value of warrants — (513 ) — (520 ) Diluted net loss applicable to common stockholders $ (160,265 ) $ (3,554 ) $ (168,773 ) $ (13,129 ) Denominator: Weighted average common shares outstanding 100,144 98,126 100,092 97,864 Weighted average unvested common shares subject to repurchase (768 ) (735 ) (834 ) (824 ) Weighted average common shares outstanding—basic 99,376 97,391 99,258 97,040 Effect of dilutive securities: Conversion of preferred stock — — — — Options — — — — Warrants — 938 — 218 Weighted average common shares outstanding—diluted 99,376 98,329 99,258 97,258 Net loss per share: Basic $ (1.61 ) $ (0.03 ) $ (1.70 ) $ (0.13 ) Diluted $ (1.61 ) $ (0.04 ) $ (1.70 ) $ (0.13 )
Weighted-Average Anti-Dilutive Securities Not Included in Diluted Net Loss Per Share	The anti-dilutive securities not included in diluted net loss per share were as follows (in thousands): Three Months Ended Nine Months Ended 2015 2014 2015 2014 Options to purchase common stock 7,859 6,904 8,029 7,199 Unvested restricted share awards 768 735 834 824 Warrants to purchase common stock 11,544 594 11,544 6,844 Total 20,171 8,233 20,407 14,867

Segment and Geographical Info28

Segment and Geographical Information (Tables)	9 Months Ended
	Sep. 30, 2015
Segment Reporting [Abstract]
Schedule of Revenues Attributed to Geographic Location of Customer	Revenues attributed to the geographic location of the customer were as follows (in thousands): Three Months Ended Nine Months Ended September 30, September 30, 2015 2014 2015 2014 United States $ 27,385 $ 34,808 $ 85,099 $ 101,376 International 15,611 16,205 53,177 51,977 Total consolidated revenues $ 42,996 $ 51,013 $ 138,276 $ 153,353
Schedule of Long Lived Assets by Geographical Areas	Total assets by region were as follows (in thousands): September 30, December 31, United States $ 99,710 $ 200,978 International 48,674 143,945 Total consolidated assets $ 148,384 $ 344,923

The Company and Basis of Pres29

The Company and Basis of Presentation - Additional Information (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2015USD ($)Market	Dec. 31, 2014USD ($)
Error Corrections and Prior Period Adjustments Restatement [Line Items]
Current portion of long-term debt	$ 79,300	$ 8,076
Long-term debt, less current portion	$ 700	$ 74,597
Number of market for products (more than 50) | Market	50
Scenario, Previously Reported [Member]
Error Corrections and Prior Period Adjustments Restatement [Line Items]
Current portion of long-term debt	$ 59,000
Long-term debt, less current portion	$ 20,900

Summary of Significant Accoun30

Summary of Significant Accounting Policies (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2015USD ($)
Goodwill [Line Items]
Revenue growth rate	3.00%
Discount rate	13.50%
Goodwill impairment	$ 164,266
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance at December 31, 2014	8,702
Balance at September 30, 2015	$ 687
Minimum [Member]
Goodwill [Line Items]
Revenue growth rate	3.00%
Maximum [Member]
Goodwill [Line Items]
Revenue growth rate	13.00%
Deerfield [Member]
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Changes in fair value	$ (8,015)

Select Balance Sheet Details -

Select Balance Sheet Details - Accounts Receivable, Net (Details) - USD ($) $ in Thousands	Sep. 30, 2015	Dec. 31, 2014
Balance Sheet Related Disclosures [Abstract]
Accounts receivable	$ 37,298	$ 41,233
Allowance for doubtful accounts	(1,046)	(793)
Accounts receivable, net	$ 36,252	$ 40,440

Select Balance Sheet Details 32

Select Balance Sheet Details - Inventories, Net (Details) - USD ($) $ in Thousands	Sep. 30, 2015	Dec. 31, 2014
Balance Sheet Related Disclosures [Abstract]
Raw materials, Gross	$ 6,449	$ 5,020
Work-in-process, Gross	1,898	1,032
Finished goods, Gross	53,930	57,020
Inventory, Gross, Total	62,277	63,072
Finished goods, Reserve for excess and obsolete	(19,949)	(21,325)
Inventories, net, Reserve for excess and obsolete	(19,949)	(21,325)
Raw materials, Net	6,449	5,020
Work-in-process, Net	1,898	1,032
Finished goods, Net	33,981	35,695
Inventories, Net	$ 42,328	$ 41,747

Select Balance Sheet Details 33

Select Balance Sheet Details - Property and Equipment, Net (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014	Dec. 31, 2014
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 92,272		$ 92,272		$ 90,458
Less accumulated depreciation and amortization	(68,552)		(68,552)		(64,418)
Property and equipment, net	23,720		23,720		26,040
Depreciation	3,400	$ 2,900	$ 9,100	$ 9,200
Surgical instruments [Member]
Property, Plant and Equipment [Line Items]
Useful lives			4 years
Property and equipment, gross	64,838		$ 64,838		62,872
Machinery and equipment [Member]
Property, Plant and Equipment [Line Items]
Useful lives			7 years
Property and equipment, gross	15,585		$ 15,585		15,382
Capital leased assets, gross	3,200		$ 3,200		3,200
Computer equipment [Member]
Property, Plant and Equipment [Line Items]
Useful lives			3 years
Property and equipment, gross	3,700		$ 3,700		3,180
Office furniture and equipment [Member]
Property, Plant and Equipment [Line Items]
Useful lives			5 years
Property and equipment, gross	3,752		$ 3,752		3,789
Leasehold improvements [Member]
Property, Plant and Equipment [Line Items]
Various useful lives of leasehold improvements			various
Property and equipment, gross	3,854		$ 3,854		3,841
Building [Member]
Property, Plant and Equipment [Line Items]
Useful lives			39 years
Property and equipment, gross	66		$ 66		65
Land [Member]
Property, Plant and Equipment [Line Items]
Property and equipment, gross	9		9		9
Construction in progress [Member]
Property, Plant and Equipment [Line Items]
Property and equipment, gross	468		468		1,320
Capital leased assets, gross	$ 200		$ 200		$ 600

Select Balance Sheet Details 34

Select Balance Sheet Details - Intangible Assets, Net (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014	Dec. 31, 2014
Finite-Lived Intangible Assets [Line Items]
Intangible assets, Gross	$ 75,424		$ 75,424		$ 78,001
Less accumulated amortization	(52,481)		(52,481)		(47,742)
Intangible assets, net	22,943		22,943		30,259
Amortization	1,100	$ 1,600	5,000	$ 4,800
Developed product technology [Member]
Finite-Lived Intangible Assets [Line Items]
Intangible assets, Gross	21,825		$ 21,825		22,526
Developed product technology [Member] | Minimum [Member]
Finite-Lived Intangible Assets [Line Items]
Useful lives			3 years
Developed product technology [Member] | Maximum [Member]
Finite-Lived Intangible Assets [Line Items]
Useful lives			8 years
Distribution rights [Member]
Finite-Lived Intangible Assets [Line Items]
Useful lives			3 years
Intangible assets, Gross	2,100		$ 2,100		2,095
Intellectual property [Member]
Finite-Lived Intangible Assets [Line Items]
Useful lives			5 years
Intangible assets, Gross	1,004		$ 1,004		1,004
License agreements [Member]
Finite-Lived Intangible Assets [Line Items]
Intangible assets, Gross	16,716		$ 16,716		16,716
License agreements [Member] | Minimum [Member]
Finite-Lived Intangible Assets [Line Items]
Useful lives			1 year
License agreements [Member] | Maximum [Member]
Finite-Lived Intangible Assets [Line Items]
Useful lives			7 years
License agreements [Member] | NEXoss Synthetic Bone Graft [Member]
Finite-Lived Intangible Assets [Line Items]
Impairment charges	300		$ 300
License agreements [Member] | Epicage Interbody Fusion Device [Member]
Finite-Lived Intangible Assets [Line Items]
Impairment charges	900		$ 900
Core technology [Member]
Finite-Lived Intangible Assets [Line Items]
Useful lives			10 years
Intangible assets, Gross	4,187		$ 4,187		4,554
Trademarks and trade names [Member]
Finite-Lived Intangible Assets [Line Items]
Intangible assets, Gross	3,307		$ 3,307		3,559
Trademarks and trade names [Member] | Minimum [Member]
Finite-Lived Intangible Assets [Line Items]
Useful lives			3 years
Trademarks and trade names [Member] | Maximum [Member]
Finite-Lived Intangible Assets [Line Items]
Useful lives			9 years
Customer-related [Member]
Finite-Lived Intangible Assets [Line Items]
Intangible assets, Gross	19,458		$ 19,458		20,493
Customer-related [Member] | Minimum [Member]
Finite-Lived Intangible Assets [Line Items]
Useful lives			12 years
Customer-related [Member] | Maximum [Member]
Finite-Lived Intangible Assets [Line Items]
Useful lives			15 years
Distribution network [Member]
Finite-Lived Intangible Assets [Line Items]
Intangible assets, Gross	4,027		$ 4,027		4,027
Distribution network [Member] | Minimum [Member]
Finite-Lived Intangible Assets [Line Items]
Useful lives			10 years
Distribution network [Member] | Maximum [Member]
Finite-Lived Intangible Assets [Line Items]
Useful lives			12 years
Physician education programs [Member]
Finite-Lived Intangible Assets [Line Items]
Useful lives			10 years
Intangible assets, Gross	2,575		$ 2,575		2,802
Impairment charges			$ 900
Supply Agreement [Member]
Finite-Lived Intangible Assets [Line Items]
Useful lives			10 years
Intangible assets, Gross	$ 225		$ 225		$ 225

Select Balance Sheet Details 35

Select Balance Sheet Details - Schedule of Intangible assets, future amortization expense (Details) $ in Thousands	Sep. 30, 2015USD ($)
Balance Sheet Related Disclosures [Abstract]
Remainder of 2015	$ 1,036
2,016	4,059
2,017	4,053
2,018	2,884
2,019	2,441
Thereafter	8,470
Total	$ 22,943

Select Balance Sheet Details 36

Select Balance Sheet Details - Accrued Expense (Details) - USD ($) $ in Thousands	Sep. 30, 2015	Dec. 31, 2014
Balance Sheet Related Disclosures [Abstract]
Legal	$ 554	$ 967
Accounting	1,017	1,262
Severance	322	318
Restructuring	137	531
Sales milestones	133	107
Accrued taxes	729	1,344
Deferred rent	462	785
Royalties	1,712	2,129
Commissions	5,189	6,152
Payroll and related	5,359	8,291
Litigation settlements	4,400	7,393
Accrued interest	1,017	946
Other	6,185	5,168
Total accrued expenses	$ 27,216	$ 35,393

Select Balance Sheet Details 37

Select Balance Sheet Details - Schedule of Changes in Carrying Amount of Goodwill (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2015USD ($)
Goodwill [Roll Forward]
Balance at December 31, 2014	$ 171,333
Goodwill impairment	(164,266)
Effect of foreign exchange rate on goodwill	(7,067)
Balance at September 30, 2015	0
Goodwill impairment	$ 164,266

License and Consulting Agreem38

License and Consulting Agreements License and Consulting Agreements (Details) - USD ($) $ in Thousands	1 Months Ended	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014
Research and Development Assets Acquired Other than Through Business Combination [Line Items]
Payments to acquire intangible assets	$ 200
Stock shares issued to purchase assets	72,992
In-process research and development		$ 274	$ 527	$ 274	$ 527
Asset Purchase Agreement [Member]
Research and Development Assets Acquired Other than Through Business Combination [Line Items]
Payments to acquire intangible assets			$ 200
Stock shares issued to purchase assets			72,992
Value of stock issued of purchase of Assets	$ 100		$ 100
In-process research and development		$ 300	$ 300		$ 300

Debt - Additional Information (

Debt - Additional Information (Details)	Jul. 10, 2015USD ($)	Jul. 01, 2015USD ($)	Nov. 21, 2014USD ($)$ / sharesshares	Mar. 20, 2014USD ($)$ / sharesshares	Aug. 30, 2013USD ($)	Jul. 31, 2015USD ($)	Apr. 30, 2014USD ($)	Feb. 28, 2013USD ($)	Sep. 30, 2015USD ($)shares	Sep. 30, 2015USD ($)paymentshares	Jul. 09, 2015USD ($)	Dec. 31, 2014USD ($)	Mar. 17, 2014USD ($)$ / sharesshares	Aug. 29, 2013USD ($)
Line of Credit Facility [Line Items]
Unamortized debt issuance and debt discount costs									$ 5,765,000	$ 5,765,000
Amendment fee								$ 100,000
Restricted cash									3,450,000	3,450,000		$ 4,400,000
Common stock warrant liabilities									687,000	687,000		$ 8,702,000
Prior Credit Facility with MidCap [Member]
Line of Credit Facility [Line Items]
Maximum borrowing capacity														$ 50,000,000
Amended Credit Facility with MidCap [Member]
Line of Credit Facility [Line Items]
Maximum borrowing capacity					$ 73,000,000
Term loan payments										500,000
Debt issuance costs					400,000
Unamortized debt issuance and debt discount costs									300,000	300,000
Amended Credit Facility with MidCap [Member] | Term Loan [Member]
Line of Credit Facility [Line Items]
Maximum borrowing capacity									$ 38,000,000	$ 38,000,000
Proceeds from lines of credit					$ 28,000,000	$ 5,000,000	$ 5,000,000
Basis spread										8.00%
Interest rate description										("LIBOR") plus 8.0%
Floor on interest rate										9.50%
Interest rate									9.50%	9.50%
Amended Credit Facility with MidCap [Member] | Credit Facility [Member]
Line of Credit Facility [Line Items]
Maximum borrowing base									$ 40,000,000	$ 40,000,000
Line of credit									$ 27,000,000	$ 27,000,000
Basis spread										6.00%
Interest rate description										LIBOR plus 6.0%
Interest rate									6.20%	6.20%
Second Amendment Credit Facility with MidCap [Member] | Term Loan [Member]
Line of Credit Facility [Line Items]
Maximum borrowing capacity	$ 38,000,000										$ 33,000,000
Proceeds from lines of credit	$ 5,000,000
Monthly payments for term loan										$ 500,000
Commitment fee percentage										1.00%
Deerfield [Member]
Line of Credit Facility [Line Items]
Maximum borrowing capacity													$ 50,000,000
Line of credit			$ 6,000,000	$ 20,000,000		$ 5,000,000			$ 26,000,000	$ 26,000,000
Transaction fee as percentage of principal amount													2.50%
Debt instrument, stated interest rate													8.75%
Number of securities called by warrants (in shares) | shares													6,250,000
Exercise price of warrants (dollars per share) | $ / shares			$ 1.39	$ 1.39									$ 1.39
Net proceeds from initial draw under Facility Agreement				$ 19,500,000
Transaction fee			$ 200,000	$ 500,000
Number of warrants issued (in shares) | shares			1,200,000	4,000,000
Warrants value			$ 900,000	$ 4,700,000
Warrant amount reclassified as debt discount				$ 2,300,000					$ 200,000	$ 200,000
Net proceeds from draw under Facility Agreement			$ 5,900,000
Equal annual payments | payment										3
Warrants outstanding (in shares) | shares									11,450,000	11,450,000
Changes in fair value									$ 6,300,000
Changes in fair value										$ (8,015,000)
Maximum [Member]
Line of Credit Facility [Line Items]
Additional interest rate to be charged in the event of default									5.00%	5.00%
Maximum [Member] | Deerfield [Member]
Line of Credit Facility [Line Items]
Number of securities called by warrants associated with each disbursement borrowing (in shares) | shares													10,000,000
Orthotec LLC, Litigation Settlement [Member] | Deerfield [Member]
Line of Credit Facility [Line Items]
Litigation settlement expense		$ 1,100,000								$ 21,900,000

Debt - Valuation Assumptions (D

Debt - Valuation Assumptions (Details)	9 Months Ended
	Sep. 30, 2015
Debt Disclosure [Abstract]
Risk-free interest rate	1.30%
Dividend yield	0.00%
Expected volatility	63.00%
Expected life (years)	4 years 6 months

Debt - Principal Payments on De

Debt - Principal Payments on Debt (Details) $ in Thousands	Sep. 30, 2015USD ($)
Debt Disclosure [Abstract]
Remainder of 2015 (1)	$ 2,058
2,016	56,173
2,017	8,667
2,018	8,667
2,019	8,666
Thereafter	0
Total	84,231
Add: capital lease principal payments	1,471
Less: debt discount	(5,765)
Total	79,937
Less: current portion of long-term debt (1)	(79,253)
Long-term debt, net of current portion	$ 684

Commitments and Contingencies -

Commitments and Contingencies - Additional Information (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014
Loss Contingencies [Line Items]
Capital leases expire date			Sep. 30, 2018
Rent expense	$ 0.8	$ 0.8	$ 2.3	$ 2.6
Minimum [Member]
Loss Contingencies [Line Items]
Lease interest rate			6.60%
Maximum [Member]
Loss Contingencies [Line Items]
Lease interest rate			9.60%

Commitments and Contingencies43

Commitments and Contingencies - Future Minimum Annual Lease Payments (Details) $ in Thousands	Sep. 30, 2015USD ($)
Commitments and Contingencies Disclosure [Abstract]
Operating leases Remainder of 2015	$ 899
Operating leases 2016	2,318
Operating leases 2017	846
Operating leases 2018	272
Operating leases 2019	137
Operating leases, Future Minimum Payments Due, Total	4,472
Capital leases Remainder of 2015	224
Capital leases 2016	877
Capital leases 2017	437
Capital leases 2018	68
Capital leases 2019	0
Total Capital leases	1,606
Less: amount representing interest	(135)
Present value of minimum lease payments	1,471
Current portion of capital leases	(799)
Capital leases, less current portion	$ 672

Orthotec Settlement (Details)

Orthotec Settlement (Details) - Orthotec LLC, Litigation Settlement [Member]	Mar. 15, 2014USD ($)Installment	Apr. 30, 2014USD ($)	Mar. 31, 2014USD ($)	Sep. 30, 2015USD ($)
Loss Contingencies [Line Items]
Judgment assessed by court for (against) company	$ (49,000,000)
Payments of settlement		$ 15,750,000	$ 1,750,000	$ 21,900,000
Number of quarterly installments | Installment	28
Litigation settlement interest, quarterly installments, amount	$ 1,100,000
Beginning Fourth Quarter of 2014 [Member]
Loss Contingencies [Line Items]
Judgment assessed by court for (against) company	(31,500,000)
Litigation settlement, quarterly installments, amount	$ 1,100,000
Litigation settlement interest rate	7.00%
Litigation settlement interest, quarterly installments, amount	$ 1,100,000
Final Installment [Member]
Loss Contingencies [Line Items]
Number of quarterly installments | Installment	1
Litigation settlement, final installment amount	$ 700,000

Net Loss Per Share - Weighted A

Net Loss Per Share - Weighted Average Number of Common Shares Outstanding (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014
Numerator:
Net loss for basic earnings per share	$ (160,265)	$ (3,041)	$ (168,773)	$ (12,609)
Decrease in fair value of warrants	0	(513)	0	(520)
Diluted net loss applicable to common stockholders	$ (160,265)	$ (3,554)	$ (168,773)	$ (13,129)
Denominator:
Weighted average common shares outstanding (in shares)	100,144	98,126	100,092	97,864
Weighted average unvested common shares subject to repurchase (in shares)	(768)	(735)	(834)	(824)
Weighted average common shares outstanding—basic (in shares)	99,376	97,391	99,258	97,040
Effect of dilutive securities:
Dilutive effect of conversion of preferred stock, in shares	0	0	0	0
Dilutive effect of options, in shares	0	0	0	0
Dilutive effect of warrants, in shares	0	938	0	218
Shares used in calculating diluted net loss per share	99,376	98,329	99,258	97,258
Net loss per basic share	$ (1.61)	$ (0.03)	$ (1.70)	$ (0.13)
Net loss per diluted share	$ (1.61)	$ (0.04)	$ (1.70)	$ (0.13)

Net Loss Per Share - Weighted-A

Net Loss Per Share - Weighted-Average Anti-Dilutive Securities Not Included in Diluted Net Loss Per Share (Details) - shares shares in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Anti-dilutive securities not included in diluted net loss per share	20,171	8,233	20,407	14,867
Options to purchase common stock [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Anti-dilutive securities not included in diluted net loss per share	7,859	6,904	8,029	7,199
Unvested restricted share awards [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Anti-dilutive securities not included in diluted net loss per share	768	735	834	824
Warrants to purchase common stock [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Anti-dilutive securities not included in diluted net loss per share	11,544	594	11,544	6,844

Stock Benefit Plans and Stock47

Stock Benefit Plans and Stock-Based Compensation (Details) - 2005 Employee, Director and Consultant Stock Plan [Member] - Performance-based Restricted Stock Units [Member]	1 Months Ended
	Feb. 28, 2015$ / sharesshares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Non-option equity instruments, granted shares | shares	1,854,000
Non-option equity instruments, grant date fair value (dollars per share) | $ / shares	$ 1.35
Minimum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting percentage	0.00%
Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting percentage	200.00%

Income Taxes - Additional Infor

Income Taxes - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014	Dec. 31, 2014
Income Tax Disclosure [Abstract]
Unrecognized tax benefits increase (decrease) (less than $0.2 million)			$ (200)
Unrecognized tax benefits	$ 8,700		8,700		$ 8,900
Goodwill and intangible impairment	165,171	$ 0	$ 165,171	$ 0
Income tax benefit	$ 1,500

Segment and Geographical Info49

Segment and Geographical Information - Additional Information (Details) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2015USD ($)Location	Sep. 30, 2014USD ($)Location	Sep. 30, 2015USD ($)SegmentLocation	Sep. 30, 2014USD ($)Location
Revenues from External Customers and Long-Lived Assets [Line Items]
Number of operating segments | Segment			1
Number of reportable business segments | Segment			1
Number of geographic regions | Location	2	2	2	2
Revenue | $	$ 42,996	$ 51,013	$ 138,276	$ 153,353
Japan [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Revenue | $	$ 8,300	$ 8,500	$ 23,700	$ 23,800

Segment and Geographical Info50

Segment and Geographical Information - Schedule of Revenues Attributed to Geographic Location of Customer (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2015	Sep. 30, 2014	Sep. 30, 2015	Sep. 30, 2014
Segment Reporting, Revenue Reconciling Item [Line Items]
Total consolidated revenues	$ 42,996	$ 51,013	$ 138,276	$ 153,353
Reportable Geographical Components [Member] | United States [Member]
Segment Reporting, Revenue Reconciling Item [Line Items]
Total consolidated revenues	27,385	34,808	85,099	101,376
Reportable Geographical Components [Member] | International [Member]
Segment Reporting, Revenue Reconciling Item [Line Items]
Total consolidated revenues	$ 15,611	$ 16,205	$ 53,177	$ 51,977

Segment and Geographical Info51

Segment and Geographical Information - Schedule of Long Lived Assets by Geographical Areas (Details) - USD ($) $ in Thousands	Sep. 30, 2015	Dec. 31, 2014
Revenues from External Customers and Long-Lived Assets [Line Items]
Total consolidated assets	$ 148,384	$ 344,923
Reportable Geographical Components [Member] | United States [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Total consolidated assets	99,710	200,978
Reportable Geographical Components [Member] | International [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Total consolidated assets	$ 48,674	$ 143,945

Restructuring - Additional Info

Restructuring - Additional Information (Details) $ in Millions	Sep. 30, 2015USD ($)
Scient'x Business Operations Restructuring Plan France 2015 [Member]
Restructuring Cost and Reserve [Line Items]
Total restructuring costs incurred	$ 10.3
California Manufacturing Operations Restructuring Plan 2015 [Member]
Restructuring Cost and Reserve [Line Items]
Expected restructuring costs remaining	$ 4

Related Party Transactions - Ad

Related Party Transactions - Additional Information (Details)	9 Months Ended
	Sep. 30, 2015USD ($)Director	Sep. 30, 2014USD ($)
Related Party Transaction [Line Items]
Incurred expenses		$ 100,000
Healthpoint Capital [Member]
Related Party Transaction [Line Items]
Incurred expenses	$ 100,000
Payable liability	100,000
New York Orthotec matter [Member]
Related Party Transaction [Line Items]
Legal expenses (less than $0.1 million)	$ 0	$ 100,000
Number of former directors | Director	2

Subsequent Events (Details)

Subsequent Events (Details) - Payment Guarantee [Member] - USD ($) $ in Millions	Nov. 02, 2015	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Subsequent event [Member]
Subsequent Event [Line Items]
Threshold percentage of shares sold by collaborators, trigger for modification of terms	20.00%
Stock Issued [Member] | Subsequent event [Member]
Subsequent Event [Line Items]
Shortfall additional liability	$ 3.5
Stock Issuable [Member] | Subsequent event [Member]
Subsequent Event [Line Items]
Shortfall additional liability	$ 2.8
Scenario, Forecast [Member] | Stock Issued [Member]
Subsequent Event [Line Items]
Projected liability			$ 1.4	$ 2.1
Scenario, Forecast [Member] | Stock Issuable [Member]
Subsequent Event [Line Items]
Projected liability		$ 2.1	$ 0.7