Alphatec (ATEC) 10-Q 9 Aug 16 2016 Q2 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	6 Months Ended
	Jun. 30, 2016	Aug. 08, 2016
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	Jun. 30, 2016
Document Fiscal Year Focus	2,016
Document Fiscal Period Focus (Q1,Q2,Q3,FY)	Q2
Amendment Flag	false
Entity Common Stock, Shares Outstanding		102,494,745

CONDENSED CONSOLIDATED BALANCE

CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) - USD ($) $ in Thousands	Jun. 30, 2016	Dec. 31, 2015
Current assets:
Cash	$ 9,322	$ 11,229
Restricted cash	150	2,350
Accounts receivable, net	36,515	38,319
Inventories, net	44,141	44,908
Prepaid expenses and other current assets	3,559	4,689
Total current assets	93,687	101,495
Property and equipment, net	21,601	21,945
Intangible assets, net	19,756	21,616
Other assets	1,408	1,285
Total assets	136,452	146,341
Current liabilities:
Accounts payable	17,447	14,169
Accrued expenses	30,459	29,791
Deferred revenue	799	648
Common stock warrant liabilities	1,145	687
Current portion of long-term debt	75,376	79,742
Total current liabilities	125,226	125,037
Long-term debt, less current portion	187	480
Other long-term liabilities	33,800	33,797
Redeemable preferred stock, $0.0001 par value; 20,000 authorized at June 30, 2016 and December 31, 2015; 3,319 shares issued and outstanding at both June 30, 2016 and December 31, 2015	23,603	23,603
Commitments and contingencies
Stockholders’ deficit:
Common stock, $0.0001 par value; 200,000 authorized at June 30, 2016 and December 31, 2015; 102,495 and 102,158 shares issued and outstanding at June 30, 2016 and December 31, 2015, respectively	10	10
Treasury stock, at cost, 19 shares, at both June 30, 2016 and December 31, 2015	(97)	(97)
Additional paid-in capital	417,360	416,939
Shareholder note receivable	(5,000)	(5,000)
Accumulated other comprehensive loss	(19,547)	(21,188)
Accumulated deficit	(439,090)	(427,240)
Total stockholders’ deficit	(46,364)	(36,576)
Total liabilities and stockholders’ deficit	$ 136,452	$ 146,341

CONDENSED CONSOLIDATED BALANCE3

CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) (Parenthetical) - $ / shares	Jun. 30, 2016	Dec. 31, 2015
Statement of Financial Position [Abstract]
Redeemable preferred stock, par value (dollars per share)	$ 0.0001	$ 0.0001
Redeemable preferred stock, shares authorized	20,000,000	20,000,000
Redeemable preferred stock, shares issued	3,319,000	3,319,000
Redeemable preferred stock, shares outstanding	3,319,000	3,319,000
Common stock, par value (dollars per share)	$ 0.0001	$ 0.0001
Common stock, shares authorized	200,000,000	200,000,000
Common stock, shares issued	102,495,000	102,158,000
Common stock, shares outstanding	102,495,000	102,158,000
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		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
Income Statement [Abstract]
Revenues	$ 43,790	$ 46,633	$ 88,551	$ 95,280
Cost of revenues	15,495	18,745	29,027	34,080
Amortization of acquired intangible assets	377	361	737	730
Gross profit	27,918	27,527	58,787	60,470
Operating expenses:
Research and development	2,080	3,912	5,747	7,763
Sales and marketing	18,138	16,644	37,260	34,839
General and administrative	8,270	9,241	18,917	18,379
Amortization of acquired intangible assets	491	669	977	1,346
Restructuring expenses	103	(112)	789	(172)
Total operating expenses	29,082	30,354	63,690	62,155
Operating loss	(1,164)	(2,827)	(4,903)	(1,685)
Other income (expense):
Interest income	16	12	36	19
Interest expense	(3,724)	(3,040)	(7,081)	(6,411)
Other income (expense), net	239	2,161	1,284	724
Total other income (expense)	(3,469)	(867)	(5,761)	(5,668)
Pretax net loss	(4,633)	(3,694)	(10,664)	(7,353)
Income tax provision	600	253	1,186	1,155
Net loss	$ (5,233)	$ (3,947)	$ (11,850)	$ (8,508)
Net loss per basic and diluted share (dollars per share)	$ (0.05)	$ (0.04)	$ (0.12)	$ (0.09)
Shares used in calculating basic and diluted net loss per share	101,856	99,258	101,721	99,187

CONDENSED CONSOLIDATED STATEME5

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS (Unaudited) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
Statement of Comprehensive Income [Abstract]
Net loss	$ (5,233)	$ (3,947)	$ (11,850)	$ (8,508)
Foreign currency translation adjustments	849	1,539	1,641	(9,658)
Comprehensive loss	$ (4,384)	$ (2,408)	$ (10,209)	$ (18,166)

CONDENSED CONSOLIDATED STATEME6

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015
Operating activities:
Net loss	$ (11,850)	$ (8,508)
Adjustments to reconcile net loss to net cash provided by operating activities:
Depreciation and amortization	7,381	9,587
Stock-based compensation	363	2,518
Interest expense related to amortization of debt discount and debt issuance costs	2,560	2,494
Provision for doubtful accounts	470	231
Provision for excess and obsolete inventory	2,374	1,574
Deferred income tax expense	(26)	366
Other non-cash items	820	587
Changes in operating assets and liabilities:
Restricted cash	2,200	2,200
Accounts receivable	2,933	866
Inventories	(78)	(1,316)
Prepaid expenses and other current assets	1,292	1,075
Other assets	162	84
Accounts payable	3,077	1,657
Accrued expenses and other	(1,754)	(9,783)
Deferred revenues	148	(234)
Net cash provided by operating activities	10,072	3,398
Investing activities:
Purchases of property and equipment	(5,691)	(7,256)
Cash received from sale of assets	1,316	0
Net cash used in investing activities	(4,375)	(7,256)
Financing activities:
Borrowings under lines of credit	70,155	73,463
Repayments under lines of credit	(70,963)	(76,086)
Principal payments on capital lease obligations	(400)	(384)
Proceeds from sale of stock	58	0
Principal payments on notes payable and term loan	(4,605)	(4,351)
Net cash used in financing activities	(5,755)	(7,358)
Effect of exchange rate changes on cash	(1,849)	379
Net decrease in cash	(1,907)	(10,837)
Cash at beginning of period	11,229	19,735
Cash at end of period	9,322	8,898
Supplemental disclosure of cash flow information:
Cash paid for interest	3,861	3,727
Cash paid for income taxes	896	362
Purchases of property and equipment in accounts payable	$ 2,451	$ 400

The Company and Basis of Presen

The Company and Basis of Presentation	6 Months Ended
	Jun. 30, 2016
Accounting Policies [Abstract]
The Company and Basis of Presentation	T he Company and Basis of Presentation The Company Alphatec Holdings, Inc. (“Alphatec”, “Alphatec Holdings” or the “Company”), 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, 2015 , 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 consolidated financial statements for the year ended December 31, 2015 , which are included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2015 that was filed with the SEC on March 15, 2016 . Operating results for the three and six months ended June 30, 2016 are not necessarily indicative of the results that may be expected for the year ending December 31, 2016 , 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. Additionally, as discussed below, the Company has a significant amount of debt that is classified as current debt. These conditions raise substantial doubt about the Company's ability to continue as a going concern. 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 and introduction of new products. The Company's amended and restated credit facility (the "Amended Credit Facility") with MidCap Funding IV, LLC ("MidCap") matures in December 2016, which will require the Company to refinance the Amended Credit Facility with MidCap or to seek alternative financing. The Company has determined that it failed to comply with the fixed charge coverage ratio for January and June 2016, the fixed charge coverage ratio, senior leverage ratio and total leverage ratio covenants for March 2016, and the fixed charge coverage ratio and total leverage ratio covenants for April and May 2016, under its Amended Credit Facility with MidCap. The Company also did not meet a requirement for the percentage of the Company's total cash held in U.S. accounts for January, February, March, April, May and June 2016. The Company’s default under the MidCap credit facility also constitutes an event of default under the facility agreement (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 March 2016, the Company received waivers from MidCap and Deerfield for the January non-compliance. In May 2016, MidCap and Deerfield provided waivers for the February and March non-compliances, in June 2016, MidCap and Deerfield provided waivers for the April non-compliance and in August 2016, MidCap and Deerfield provided waivers for the May and June non-compliances. The Company can provide no assurance that it will be in compliance with the financial covenants for July 2016 or in the future. If the Company does not obtain waivers from MidCap or Deerfield for any existing or future non-compliances, they would have the right to call the debts due immediately, which would significantly impact the Company's ability to continue as a going concern. 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. As disclosed in Note 14, subsequent to the balance sheet date the Company entered into a purchase and sale agreement with a third party (the "PSA") to divest substantially all of its international business operations in exchange for $ 80 million in cash, subject to a working capital adjustment and a loan of up to $30 million , subject to the satisfaction of the closing conditions set forth therein. The Company intends to use the proceeds from the sale to pay down a portion of its debt and improve its liquidity position and future cash flows. The transaction is expected to close in the second half of 2016.

Summary of Significant Accounti

Summary of Significant Accounting Policies	6 Months Ended
	Jun. 30, 2016
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, 2015 , which are included in the Company’s Annual Report on Form 10-K that was filed with the SEC on March 15, 2016 . Except as discussed below, these accounting policies have not significantly changed during the six months ended June 30, 2016 . 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 June 30, 2016 or December 31, 2015 . 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 six months ended June 30, 2016 (in thousands): Common Stock Warrant Liabilities Balance at December 31, 2015 $ 687 Change in fair value 458 Balance at June 30, 2016 $ 1,145 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 replaces all current U.S. GAAP guidance on this topic and eliminates 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 for which the entity expects to be entitled in exchange for those goods or services. This guidance, including all subsequent clarifications, is effective for the Company for annual and interim reporting periods in fiscal years beginning after December 15, 2017 and can be applied either retrospectively to each period presented or as a cumulative-effect adjustment as of the date of adoption. The Company is evaluating the impact of adopting this new accounting standard 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 thereafter. The Company is 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, which amends current presentation guidance by requiring that debt issuance costs related to a recognized debt liability be presented in the balance sheet as a direct deduction from the carrying amount of that debt liability, consistent with debt discounts. Prior to the issuance this guidance, debt issuance costs were required to be presented as an asset in the balance sheet. The Company adopted the provisions of the new guidance during the interim period ended March 31, 2016 and prior period amounts have been reclassified to conform to the current period presentation. As of December 31, 2015, $0.4 million of debt issuance costs were reclassified in the consolidated balance sheet from prepaid expenses and other current assets to current portion of long-term debt. The adoption of ASU 2015-03 did not impact the Company's consolidated statement of operations, comprehensive loss or cash flows. In July 2015, the FASB issued new accounting guidance, which changes the measurement principle for inventory from the lower of cost or market to lower of cost and net realizable value for entities that do not measure inventory using the last-in, first-out or retail inventory method. The guidance also eliminates the requirement for these entities to consider replacement cost or net realizable value less an approximately normal profit margin when measuring inventory. The guidance is effective for annual periods beginning after December 15, 2016, and interim periods within those annual periods. The Company is evaluating the impact of adopting this new accounting standard on its financial statements. In February 2016, the FASB issued new accounting guidance, which changes several aspects of the accounting for leases, including the requirement that all leases with durations greater than twelve months be recognized on the balance sheet. The guidance is effective for annual periods and interim periods in fiscal years beginning after December 15, 2018. The Company is evaluating the impact of adopting this new accounting standard on its financial statements. In March 2016, the FASB issued new accounting guidance, which changes several aspects of the accounting for share-based payment award transactions, including accounting and cash flow classification for excess tax benefits and deficiencies, forfeitures, and tax withholding requirements and cash flow classification. The guidance is effective for annual periods and interim periods in fiscal years beginning after December 15, 2016. The Company is evaluating the impact of adopting this new accounting standard on its financial statements.

Select Balance Sheet Details

Select Balance Sheet Details	6 Months Ended
	Jun. 30, 2016
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): June 30, 2016 December 31, 2015 Accounts receivable $ 37,444 $ 39,380 Allowance for doubtful accounts (929 ) (1,061 ) Accounts receivable, net $ 36,515 $ 38,319 Inventories, net Inventories, net consist of the following (in thousands): June 30, 2016 December 31, 2015 Raw materials $ 6,938 $ 7,237 Work-in-process 1,270 1,908 Finished goods 57,434 55,393 65,642 64,538 Less reserve for excess and obsolete finished goods (21,501 ) (19,630 ) Inventories, net $ 44,141 $ 44,908 Property and Equipment, net Property and equipment, net consist of the following (in thousands except as indicated): Useful lives (in years) June 30, 2016 December 31, 2015 Surgical instruments 4 $ 69,419 $ 65,723 Machinery and equipment 7 10,380 15,520 Computer equipment 3 4,494 3,984 Office furniture and equipment 5 3,654 3,746 Leasehold improvements various 3,906 3,856 Building 39 54 65 Land n/a 11 9 Construction in progress n/a 59 354 91,977 93,257 Less accumulated depreciation and amortization (70,376 ) (71,312 ) Property and equipment, net $ 21,601 $ 21,945 Total depreciation expense was $2.5 million and $2.8 million for the three months ended June 30, 2016 and 2015 , respectively. Total depreciation expense was $5.3 million and $5.6 million for the six months ended June 30, 2016 and 2015 , respectively. At June 30, 2016 , assets recorded under capital leases of $2.6 million were included in the machinery and equipment balance and $0.1 million were included in the construction in progress balance. At December 31, 2015 , assets recorded under capital leases of $2.6 million were included in the machinery and equipment balance and $0.1 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): Remaining Avg. Useful lives (in years) June 30, 2016 December 31, 2015 Developed product technology 1 $ 21,745 $ 21,633 Distribution rights 4 2,393 2,100 Intellectual property — 1,004 1,004 License agreements 1 16,717 16,714 Core technology 4 4,144 4,086 Trademarks and trade names 2 3,281 3,245 Customer-related 9 19,336 19,169 Distribution network 5 4,027 4,027 Physician education programs — 2,549 2,513 Supply agreement — 225 225 75,421 74,716 Less accumulated amortization (55,665 ) (53,100 ) Intangible assets, net $ 19,756 $ 21,616 Total amortization expense was $1.0 million and $2.6 million for the three months ended June 30, 2016 and 2015 , respectively. Total amortization expense was $2.1 million and $4.0 million for the six months ended June 30, 2016 and 2015 , respectively. Future amortization expense related to intangible assets as of June 30, 2016 is as follows (in thousands): Year Ending December 31, Remainder of 2016 $ 2,029 2017 4,007 2018 2,867 2019 2,427 2020 1,823 Thereafter 6,603 $ 19,756 Accrued Expenses Accrued expenses consist of the following (in thousands): June 30, 2016 December 31, 2015 Commissions and sales milestones $ 5,810 $ 5,920 Payroll and payroll related 4,690 5,577 Litigation settlements 4,400 4,400 Accrued professional fees 2,207 2,203 Royalties 1,625 1,578 Restructuring and severance accruals 851 1,358 Accrued taxes 2,526 1,074 Accrued interest 970 999 Other 7,380 6,682 Total accrued expenses $ 30,459 $ 29,791

License and Consulting Agreemen

License and Consulting Agreements	6 Months Ended
	Jun. 30, 2016
Contractors [Abstract]
License and Consulting Agreements	License and Consulting Agreements The Company’s license and consulting agreements are described in Note 4 to its audited consolidated financial statements for the year ended December 31, 2015 , which are included in its Annual Report on Form 10-K which was filed with the SEC on March 15, 2016 .

Debt

Debt	6 Months Ended
	Jun. 30, 2016
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 June 30, 2016 , the Amended Credit Facility consisted of a $38 million term loan, $25 million of which was outstanding as of June 30, 2016 and a revolving line of credit with a maximum borrowing base of $40 million , of which $28 million was outstanding at June 30, 2016 . 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 June 30, 2016 , the revolving line of credit carried an interest rate of 6.5% 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. 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. 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 were due for the Third Term Loan Tranche. Thereafter, the Company is required to 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. 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. On March 11, 2016, the Company entered into a third amendment and waiver to the Amended Credit Facility with MidCap (the "Third Amendment to the Amended Credit Facility"). The Third Amendment to the Amended Credit Facility extended the maturity date of the Amended Credit Facility from August 30, 2016 to December 31, 2016 and contains an amendment fee in the amount of $0.5 million , which is due and payable at the earlier of the termination of the Amended Credit Facility or the maturity date. The Third Amendment to the Amended Credit Facility also contained a waiver of the December 2015 defaults under the Amended Credit Facility, provided a waiver for the fixed charge coverage ratio for January 2016 and eliminated the fixed charge coverage ratio covenant for February 2016. At June 30, 2016 , $0.4 million remains as unamortized debt discount 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 Company was not in compliance with certain of the financial covenants of the Amended Credit Facility during the six months ended June 30, 2016 , as disclosed in Note 1. There is no 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, 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, 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 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. 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 June 30, 2016 , Orthotec settlement payments of $25.2 million have been made, leaving remaining proceeds from the funds borrowed under the Facility Agreement of $0.2 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. The amounts borrowed under the Facility Agreement, which total $26.6 million in principal plus accrued amendment fee as of June 30, 2016 , are due in three annual payments beginning March 20, 2017. 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 $5.0 million under the term loan in July 2015 under the Second Amendment to the Amended Credit Facility. As of June 30, 2016 , 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 resulting in an expense of $0.6 million and $0.5 million for the three and six months ended June 30, 2016 , respectively, included in other income/expense. The change in the fair value of the warrants of $0.5 million for the six months ended June 30, 2016 is included in other non-cash items in the condensed consolidated statements of cash flows. The warrant liability of $1.1 million is recorded as common stock warrant liabilities within current liabilities on the condensed consolidated balance sheet as of June 30, 2016 . At June 30, 2016 , the outstanding warrants were valued using the Black-Scholes option pricing model. This is a Level 3 measurement using the following assumptions: June 30, 2016 Risk-free interest rate 0.8 % Dividend yield — % Expected volatility 82 % Expected life (years) 3.8 Prior to the expiration of the warrants, in connection with the PSA disclosed in Note 14, Deerfield has a right to convert its outstanding warrants into shares of the Company's common stock upon the closing of the transaction based on the Black-Scholes value of the warrant. If Deerfield does not convert such warrants prior to the end of the time period set forth in the warrants that it has to exercise such conversion, the warrants remain outstanding and exercisable with their terms. On February 5, 2016, the Company entered into a Limited Waiver and Second Amendment to the Facility Agreement (the “Facility Agreement Second Amendment”) with Deerfield. The Facility Agreement Second Amendment increased the interest rate under the Facility Agreement from 8.75% per annum to 14.75% per annum. In addition, the Facility Agreement Second Amendment provides that the Company may elect to have (i) until August 30, 2016, six percent ( 6% ), and (ii) thereafter, three percent ( 3% ), in each case, of the interest on the outstanding principal amount under the Facility Agreement paid in kind, which would be added to the outstanding principal amount under the Facility Agreement and bear interest at the interest rate of 14.75% per annum (the “PIK Interest”). All accrued and unpaid PIK Interest is due and payable when the outstanding amounts under the Facility Agreement are due and payable thereunder or are fully repaid, whichever occurs first. The Facility Agreement Second Amendment also contains an amendment fee in the amount of $0.6 million , which is due and payable in installments of $0.2 million on each of the third, fourth and fifth anniversaries of the Facility Agreement; provided that all unpaid amendment fees shall be due and payable when the outstanding amounts under the Facility Agreement are due and payable or are fully repaid, whichever occurs first. The Facility Agreement Second Amendment also changes the date from March 31, 2017 to March 31, 2018, as the date through which the Company must pay interest in the event the Company prepays amounts outstanding under the Facility Agreement prior to such date. The Second Amendment also contains a waiver of the defaults under the Facility Agreement for the fixed charge coverage ratio for the month of January 2016. The Facility Agreement 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. As a result of the Company's non-compliance with the MidCap covenants, the Company was in cross-default of the Facility Agreement for which it received waivers from Deerfield. 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 a 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, the amounts borrowed under the Facility Agreement are presented on the consolidated balance sheet as of June 30, 2016 under current liabilities, net of unamortized issuance discount. Principal payments on debt are as follows as of June 30, 2016 (in thousands): Year Ending December 31, Remainder of 2016 $ 53,360 2017 (1) 8,879 2018 (1) 8,879 2019 (1) 8,879 Total 79,997 Add: capital lease principal payments 878 Less: unamortized debt discount and debt issuance costs (5,312 ) Total 75,563 Less: current portion of long-term debt (1) (75,376 ) Long-term debt, net of current portion $ 187 (1) The amounts above are presented based on the contractual payment schedules in each of the respective agreements. However, the debt balance under the Facility Agreement is callable as of June 30, 2016 due to the events of default (See Note 1) and therefore, is presented as a current liability on the condensed consolidated balance sheet as of June 30, 2016 .

Commitments and Contingencies

Commitments and Contingencies	6 Months Ended
	Jun. 30, 2016
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 2017 . 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 2018. Future minimum annual lease payments under such leases are as follows as of June 30, 2016 (in thousands): Year Ending December 31, Operating Capital Remainder of 2016 $ 1,817 $ 429 2017 2,152 437 2018 1,688 68 2019 1,520 — 2020 and thereafter 2,396 — $ 9,573 934 Less: amount representing interest (56 ) Present value of minimum lease payments 878 Current portion of capital leases (691 ) Capital leases, less current portion $ 187 Rent expense under operating leases for the three months ended June 30, 2016 and 2015 was $1.0 million and $0.7 million , respectively. Rent expense under operating leases for the six months ended June 30, 2016 and 2015 was $1.8 million and $1.5 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 the Company's consolidated financial statements. An estimated loss contingency is accrued in the Company’s consolidated financial statements if it is probable that a liability has been incurred and the amount of the loss can be reasonably estimated. Because litigation is inherently unpredictable and unfavorable resolutions could occur, assessing contingencies is highly subjective and requires judgments about future events. When evaluating contingencies, the Company may be unable to provide a meaningful estimate due to a number of factors, including the procedural status of the matter in question, the presence of complex or novel legal theories, and/or the ongoing discovery and development of information important to the matters. In addition, damage amounts claimed in litigation against the Company may be unsupported, exaggerated or unrelated to reasonably possible outcomes, and as such are not meaningful indicators of the Company’s potential liability. 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	6 Months Ended
	Jun. 30, 2016
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 $49.0 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 June 30, 2016 , the Company has made installment payments in the aggregate of $25.2 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	6 Months Ended
	Jun. 30, 2016
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, performance-based restricted stock units 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 Six Months Ended 2016 2015 2016 2015 Numerator: Net loss $ (5,233 ) $ (3,947 ) $ (11,850 ) $ (8,508 ) Denominator: Weighted average common shares outstanding 102,311 100,162 102,231 100,054 Weighted average unvested common shares subject to repurchase (455 ) (904 ) (510 ) (867 ) Weighted average common shares outstanding—basic 101,856 99,258 101,721 99,187 Effect of dilutive securities: Conversion of preferred stock — — — — Options — — — — Warrants — — — — Weighted average common shares outstanding—diluted 101,856 99,258 101,721 99,187 Net loss per share: Basic and diluted $ (0.05 ) $ (0.04 ) $ (0.12 ) $ (0.09 ) The anti-dilutive securities not included in diluted net loss per share were as follows (in thousands): Three Months Ended Six Months Ended 2016 2015 2016 2015 Options to purchase common stock 7,305 6,954 7,423 7,135 Unvested restricted share awards 455 904 510 867 Warrants to purchase common stock 11,544 11,544 11,544 11,544 Total 19,304 19,402 19,477 19,546

Stock Benefit Plans and Stock-B

Stock Benefit Plans and Stock-Based Compensation	6 Months Ended
	Jun. 30, 2016
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 and July 2014, the Company granted 1,854,000 and 932,000 performance-based restricted stock units ("PSUs"), respectively, 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 2015 through December 2017 for the PSUs granted in 2015 and from July 2014 through December 2016 for the PSUs granted in 2014. 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 for the 2015 grants and $1.45 per share for the 2014 grants which was 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 PSUs granted in 2015 are deemed not probable of vesting and the PSUs granted on 2014 were deemed not probable of vesting as of March 31, 2016, which resulted in an adjustment to reduce the stock-based compensation expense by $0.5 million during the first quarter of the six-month period ended June 30, 2016 . The 2005 Plan expired in May 2016 and has not been replaced with a new equity compensation plan as of June 30, 2016 . The awards previously issued under the 2005 Plan remain outstanding.

Income Taxes

Income Taxes	6 Months Ended
	Jun. 30, 2016
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 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 by less than $0.1 million during the six months ended June 30, 2016 . The decrease in unrecognized tax benefits during the six months ended June 30, 2016 was primarily related to foreign currency fluctuations, partially offset by increases related to federal and state research credits. The unrecognized tax benefits at June 30, 2016 and December 31, 2015 were $10.3 million and $10.4 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 approximately $0.2 million . 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 provision consists primarily of income tax provisions related to state income taxes and operations in other foreign jurisdictions where the Company operates. The Company's effective tax rate of (9.1)% for the three months ended June 30, 2016 differs from the federal statutory rate of 35% primarily due to a full U.S. valuation allowance, state income taxes and foreign operations. 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	6 Months Ended
	Jun. 30, 2016
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 six months ended June 30, 2016 and 2015 , 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 six months ended June 30, 2016 totaled $8.2 million and $17.4 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 six months ended June 30, 2015 totaled $7.9 million and $15.4 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 Six Months Ended 2016 2015 2016 2015 United States $ 28,171 $ 27,247 $ 57,257 $ 57,714 International 15,619 19,386 31,294 37,566 Total consolidated revenues $ 43,790 $ 46,633 $ 88,551 $ 95,280 Total assets by region were as follows (in thousands): June 30, December 31, United States $ 84,620 $ 97,604 International 51,832 48,737 Total consolidated assets $ 136,452 $ 146,341

Restructuring

Restructuring	6 Months Ended
	Jun. 30, 2016
Restructuring and Related Activities [Abstract]
Restructuring	Restructuring In 2015, the Company initiated plans to close its operations in France. The Company recorded total costs of less than $0.1 million and $0.6 million during the three and six months ended June 30, 2016 , respectively, related to employee severance and related taxes in regards to this closure. 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. The Company incurred expenses of $0.1 million and $0.2 million during the three and six months ended June 30, 2016 , respectively, related to these restructuring activities. As of June 30, 2016 , the restructuring activities in France and California were substantially complete.

Related Party Transactions

Related Party Transactions	6 Months Ended
	Jun. 30, 2016
Related Party Transactions [Abstract]
Related Party Transactions	Related Party Transactions For the six months ended June 30, 2016 and 2015 , respectively, the Company incurred expenses of less than $0.1 million related to HealthpointCapital , LLC. As of June 30, 2016 , the Company also had a liability of less than $0.1 million payable to HealthpointCapital, LLC for travel and administrative expenses. Subsequent to the balance sheet date, the Company entered into a forbearance agreement with HealthpointCapital, LLC, HealthpointCapital Partners , L.P., and HealthpointCapital Partners II, L.P. (collectively, "HealthpointCapital"), pursuant to which HealthpointCapital, on behalf of the Company, paid $1.0 million of the $1.1 million payment due and payable by the Company to Orthotec on July 1, 2016 and agreed to not exercise its ability to seek an immediate repayment of such amount. Pursuant to this agreement, the Company is required to repay this amount, without interest, to HealthpointCapital by September 30, 2016.

Subsequent Events

Subsequent Events	6 Months Ended
	Jun. 30, 2016
Subsequent Events [Abstract]
Subsequent Events	Subsequent Events On July 25, 2016, the Company entered into the PSA with Globus Medical Ireland, Ltd. (the “Buyer”), a subsidiary of Globus Medical, Inc. (“Globus”), pursuant to which, and on the terms and subject to the conditions thereof, among other things, the Buyer agreed to acquire all of the Company’s international distribution operations and agreements, including the Company’s wholly-owned subsidiaries in Japan and Brazil and substantially all of the assets of the Company’s other sales operations in the United Kingdom and Italy. Under the terms of the PSA, at the closing (the “Closing”) of the transaction the Buyer will pay the Company $80 million in cash, subject to a working capital adjustment (the “Closing Payment”). At the Closing, the Company will use approximately $69 million of the Closing Payment to (i) repay in full all amounts outstanding and due under the Company’s Deerfield Facility Agreement and (ii) repay certain of its outstanding indebtedness under the Company’s MidCap Amended Credit Facility, in each case, including debt-related costs. At the Closing, the Company will enter into a five -year term credit facility agreement (the “Globus Facility Agreement”) with Globus, pursuant to which Globus will agree to loan the Company up to $30 million , subject to the terms and conditions set forth in the Globus Facility Agreement The transaction is expected to close in the second half of 2016 and is subject to the satisfaction of the closing conditions set forth in the PSA. As of June 30, 2016 , the criteria for reporting the transaction as discontinued operations were not met. On August 8, 2016, the Company entered into a fourth amendment to the Amended Credit Facility with MidCap (the "Fourth Amendment to the Amended Credit Facility"). The Fourth Amendment provides for a $2.2 million increase to the borrowing base until September 15, 2016, and includes an amendment fee of $0.2 million , which was due and payable on August 8, 2016. The Fourth Amendment to the Amended Credit Facility also contains a waiver for the May and June 2016 non-compliances.

Summary of Significant Accoun21

Summary of Significant Accounting Policies (Policies)	6 Months Ended
	Jun. 30, 2016
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation The accompanying condensed consolidated balance sheet as of December 31, 2015 , 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 consolidated financial statements for the year ended December 31, 2015 , which are included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2015 that was filed with the SEC on March 15, 2016 .
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 June 30, 2016 or December 31, 2015 . 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 replaces all current U.S. GAAP guidance on this topic and eliminates 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 for which the entity expects to be entitled in exchange for those goods or services. This guidance, including all subsequent clarifications, is effective for the Company for annual and interim reporting periods in fiscal years beginning after December 15, 2017 and can be applied either retrospectively to each period presented or as a cumulative-effect adjustment as of the date of adoption. The Company is evaluating the impact of adopting this new accounting standard 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 thereafter. The Company is 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, which amends current presentation guidance by requiring that debt issuance costs related to a recognized debt liability be presented in the balance sheet as a direct deduction from the carrying amount of that debt liability, consistent with debt discounts. Prior to the issuance this guidance, debt issuance costs were required to be presented as an asset in the balance sheet. The Company adopted the provisions of the new guidance during the interim period ended March 31, 2016 and prior period amounts have been reclassified to conform to the current period presentation. As of December 31, 2015, $0.4 million of debt issuance costs were reclassified in the consolidated balance sheet from prepaid expenses and other current assets to current portion of long-term debt. The adoption of ASU 2015-03 did not impact the Company's consolidated statement of operations, comprehensive loss or cash flows. In July 2015, the FASB issued new accounting guidance, which changes the measurement principle for inventory from the lower of cost or market to lower of cost and net realizable value for entities that do not measure inventory using the last-in, first-out or retail inventory method. The guidance also eliminates the requirement for these entities to consider replacement cost or net realizable value less an approximately normal profit margin when measuring inventory. The guidance is effective for annual periods beginning after December 15, 2016, and interim periods within those annual periods. The Company is evaluating the impact of adopting this new accounting standard on its financial statements. In February 2016, the FASB issued new accounting guidance, which changes several aspects of the accounting for leases, including the requirement that all leases with durations greater than twelve months be recognized on the balance sheet. The guidance is effective for annual periods and interim periods in fiscal years beginning after December 15, 2018. The Company is evaluating the impact of adopting this new accounting standard on its financial statements. In March 2016, the FASB issued new accounting guidance, which changes several aspects of the accounting for share-based payment award transactions, including accounting and cash flow classification for excess tax benefits and deficiencies, forfeitures, and tax withholding requirements and cash flow classification. The guidance is effective for annual periods and interim periods in fiscal years beginning after December 15, 2016. The Company is evaluating the impact of adopting this new accounting standard on its financial statements.

Summary of Significant Accoun22

Summary of Significant Accounting Policies (Tables)	6 Months Ended
	Jun. 30, 2016
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 six months ended June 30, 2016 (in thousands): Common Stock Warrant Liabilities Balance at December 31, 2015 $ 687 Change in fair value 458 Balance at June 30, 2016 $ 1,145

Select Balance Sheet Details (T

Select Balance Sheet Details (Tables)	6 Months Ended
	Jun. 30, 2016
Balance Sheet Related Disclosures [Abstract]
Accounts Receivable, net	Accounts receivable, net consist of the following (in thousands): June 30, 2016 December 31, 2015 Accounts receivable $ 37,444 $ 39,380 Allowance for doubtful accounts (929 ) (1,061 ) Accounts receivable, net $ 36,515 $ 38,319
Inventories, net	Inventories, net consist of the following (in thousands): June 30, 2016 December 31, 2015 Raw materials $ 6,938 $ 7,237 Work-in-process 1,270 1,908 Finished goods 57,434 55,393 65,642 64,538 Less reserve for excess and obsolete finished goods (21,501 ) (19,630 ) Inventories, net $ 44,141 $ 44,908
Property and Equipment, net	Property and equipment, net consist of the following (in thousands except as indicated): Useful lives (in years) June 30, 2016 December 31, 2015 Surgical instruments 4 $ 69,419 $ 65,723 Machinery and equipment 7 10,380 15,520 Computer equipment 3 4,494 3,984 Office furniture and equipment 5 3,654 3,746 Leasehold improvements various 3,906 3,856 Building 39 54 65 Land n/a 11 9 Construction in progress n/a 59 354 91,977 93,257 Less accumulated depreciation and amortization (70,376 ) (71,312 ) Property and equipment, net $ 21,601 $ 21,945
Intangible Assets, net	Intangible assets, net consist of the following (in thousands except for useful lives): Remaining Avg. Useful lives (in years) June 30, 2016 December 31, 2015 Developed product technology 1 $ 21,745 $ 21,633 Distribution rights 4 2,393 2,100 Intellectual property — 1,004 1,004 License agreements 1 16,717 16,714 Core technology 4 4,144 4,086 Trademarks and trade names 2 3,281 3,245 Customer-related 9 19,336 19,169 Distribution network 5 4,027 4,027 Physician education programs — 2,549 2,513 Supply agreement — 225 225 75,421 74,716 Less accumulated amortization (55,665 ) (53,100 ) Intangible assets, net $ 19,756 $ 21,616
Schedule of Intangible assets, future amortization expense	Future amortization expense related to intangible assets as of June 30, 2016 is as follows (in thousands): Year Ending December 31, Remainder of 2016 $ 2,029 2017 4,007 2018 2,867 2019 2,427 2020 1,823 Thereafter 6,603 $ 19,756
Accrued Expenses	Accrued expenses consist of the following (in thousands): June 30, 2016 December 31, 2015 Commissions and sales milestones $ 5,810 $ 5,920 Payroll and payroll related 4,690 5,577 Litigation settlements 4,400 4,400 Accrued professional fees 2,207 2,203 Royalties 1,625 1,578 Restructuring and severance accruals 851 1,358 Accrued taxes 2,526 1,074 Accrued interest 970 999 Other 7,380 6,682 Total accrued expenses $ 30,459 $ 29,791

Debt (Tables)

Debt (Tables)	6 Months Ended
	Jun. 30, 2016
Debt Disclosure [Abstract]
Fair Value Measurement Assumption Valuations	At June 30, 2016 , the outstanding warrants were valued using the Black-Scholes option pricing model. This is a Level 3 measurement using the following assumptions: June 30, 2016 Risk-free interest rate 0.8 % Dividend yield — % Expected volatility 82 % Expected life (years) 3.8
Principal Payments on Debt	Principal payments on debt are as follows as of June 30, 2016 (in thousands): Year Ending December 31, Remainder of 2016 $ 53,360 2017 (1) 8,879 2018 (1) 8,879 2019 (1) 8,879 Total 79,997 Add: capital lease principal payments 878 Less: unamortized debt discount and debt issuance costs (5,312 ) Total 75,563 Less: current portion of long-term debt (1) (75,376 ) Long-term debt, net of current portion $ 187 (1) The amounts above are presented based on the contractual payment schedules in each of the respective agreements. However, the debt balance under the Facility Agreement is callable as of June 30, 2016 due to the events of default (See Note 1) and therefore, is presented as a current liability on the condensed consolidated balance sheet as of June 30, 2016 .

Commitments and Contingencies (

Commitments and Contingencies (Tables)	6 Months Ended
	Jun. 30, 2016
Commitments and Contingencies Disclosure [Abstract]
Future Minimum Annual Lease Payments	Future minimum annual lease payments under such leases are as follows as of June 30, 2016 (in thousands): Year Ending December 31, Operating Capital Remainder of 2016 $ 1,817 $ 429 2017 2,152 437 2018 1,688 68 2019 1,520 — 2020 and thereafter 2,396 — $ 9,573 934 Less: amount representing interest (56 ) Present value of minimum lease payments 878 Current portion of capital leases (691 ) Capital leases, less current portion $ 187

Net Loss Per Share (Tables)

Net Loss Per Share (Tables)	6 Months Ended
	Jun. 30, 2016
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, performance-based restricted stock units 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 Six Months Ended 2016 2015 2016 2015 Numerator: Net loss $ (5,233 ) $ (3,947 ) $ (11,850 ) $ (8,508 ) Denominator: Weighted average common shares outstanding 102,311 100,162 102,231 100,054 Weighted average unvested common shares subject to repurchase (455 ) (904 ) (510 ) (867 ) Weighted average common shares outstanding—basic 101,856 99,258 101,721 99,187 Effect of dilutive securities: Conversion of preferred stock — — — — Options — — — — Warrants — — — — Weighted average common shares outstanding—diluted 101,856 99,258 101,721 99,187 Net loss per share: Basic and diluted $ (0.05 ) $ (0.04 ) $ (0.12 ) $ (0.09 )
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 Six Months Ended 2016 2015 2016 2015 Options to purchase common stock 7,305 6,954 7,423 7,135 Unvested restricted share awards 455 904 510 867 Warrants to purchase common stock 11,544 11,544 11,544 11,544 Total 19,304 19,402 19,477 19,546

Segment and Geographical Info27

Segment and Geographical Information (Tables)	6 Months Ended
	Jun. 30, 2016
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 Six Months Ended 2016 2015 2016 2015 United States $ 28,171 $ 27,247 $ 57,257 $ 57,714 International 15,619 19,386 31,294 37,566 Total consolidated revenues $ 43,790 $ 46,633 $ 88,551 $ 95,280
Schedule of Long Lived Assets by Geographical Areas	Total assets by region were as follows (in thousands): June 30, December 31, United States $ 84,620 $ 97,604 International 51,832 48,737 Total consolidated assets $ 136,452 $ 146,341

The Company and Basis of Pres28

The Company and Basis of Presentation - Additional Information (Details) $ in Millions	5 Months Ended	6 Months Ended
	Dec. 31, 2016USD ($)	Jun. 30, 2016market
Accounting Policies [Abstract]
Number of product markets (more than 50) | market		50
Scenario, Forecast [Member] | International Operations [Member] | Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations [Member] | Subsequent Event [Member]
Subsequent Event [Line Items]
Proceeds from sale of international operations	$ 80
Scenario, Forecast [Member] | Globus Facility Agreement [Member] | Foreign Line of Credit [Member] | Subsequent Event [Member]
Subsequent Event [Line Items]
Line of credit	$ 30

Summary of Significant Accoun29

Summary of Significant Accounting Policies - Additional Information (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2016	Dec. 31, 2015
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Roll Forward]
Dividend yield	0.00%
Fair Value, Inputs, Level 3 [Member]
Fair Value, Net Derivative Asset (Liability) Measured on Recurring Basis, Unobservable Input Reconciliation [Roll Forward]
Balance at December 31, 2015	$ 687
Change in fair value	458
Balance at June 30, 2016	$ 1,145
Accounting Standards Update 2015-03 [Member] | Long-term Debt, Current [Member]
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Debt issuance costs		$ 400
Accounting Standards Update 2015-03 [Member] | Long-term Debt, Current [Member]
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Debt issuance costs		$ (400)

Select Balance Sheet Details -

Select Balance Sheet Details - Accounts Receivable, Net (Details) - USD ($) $ in Thousands	Jun. 30, 2016	Dec. 31, 2015
Balance Sheet Related Disclosures [Abstract]
Accounts receivable	$ 37,444	$ 39,380
Allowance for doubtful accounts	(929)	(1,061)
Accounts receivable, net	$ 36,515	$ 38,319

Select Balance Sheet Details 31

Select Balance Sheet Details - Inventories, Net (Details) - USD ($) $ in Thousands	Jun. 30, 2016	Dec. 31, 2015
Balance Sheet Related Disclosures [Abstract]
Raw materials	$ 6,938	$ 7,237
Work-in-process	1,270	1,908
Finished goods	57,434	55,393
Inventory, gross, total	65,642	64,538
Less reserve for excess and obsolete finished goods	(21,501)	(19,630)
Inventories, net	$ 44,141	$ 44,908

Select Balance Sheet Details 32

Select Balance Sheet Details - Property and Equipment, Net (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015	Dec. 31, 2015
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 91,977		$ 91,977		$ 93,257
Less accumulated depreciation and amortization	(70,376)		(70,376)		(71,312)
Property and equipment, net	21,601		21,601		21,945
Depreciation	2,500	$ 2,800	$ 5,300	$ 5,600
Surgical instruments [Member]
Property, Plant and Equipment [Line Items]
Useful lives			4 years
Property and equipment, gross	69,419		$ 69,419		65,723
Machinery and equipment [Member]
Property, Plant and Equipment [Line Items]
Useful lives			7 years
Property and equipment, gross	10,380		$ 10,380		15,520
Capital leased assets, gross	2,600		$ 2,600		2,600
Computer equipment [Member]
Property, Plant and Equipment [Line Items]
Useful lives			3 years
Property and equipment, gross	4,494		$ 4,494		3,984
Office furniture and equipment [Member]
Property, Plant and Equipment [Line Items]
Useful lives			5 years
Property and equipment, gross	3,654		$ 3,654		3,746
Leasehold improvements [Member]
Property, Plant and Equipment [Line Items]
Various useful lives of leasehold improvements			various
Property and equipment, gross	3,906		$ 3,906		3,856
Building [Member]
Property, Plant and Equipment [Line Items]
Useful lives			39 years
Property and equipment, gross	54		$ 54		65
Land [Member]
Property, Plant and Equipment [Line Items]
Property and equipment, gross	11		11		9
Construction in progress [Member]
Property, Plant and Equipment [Line Items]
Property and equipment, gross	59		59		354
Capital leased assets, gross	$ 100		$ 100		$ 100

Select Balance Sheet Details 33

Select Balance Sheet Details - Intangible Assets, Net (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015	Dec. 31, 2015
Finite-Lived Intangible Assets [Line Items]
Intangible assets, Gross	$ 75,421		$ 75,421		$ 74,716
Less accumulated amortization	(55,665)		(55,665)		(53,100)
Intangible assets, net	19,756		19,756		21,616
Amortization	1,000	$ 2,600	$ 2,100	$ 4,000
Developed product technology [Member]
Finite-Lived Intangible Assets [Line Items]
Useful lives			1 year
Intangible assets, Gross	21,745		$ 21,745		21,633
Distribution rights [Member]
Finite-Lived Intangible Assets [Line Items]
Useful lives			4 years
Intangible assets, Gross	2,393		$ 2,393		2,100
Intellectual property [Member]
Finite-Lived Intangible Assets [Line Items]
Intangible assets, Gross	1,004		$ 1,004		1,004
Licensing agreements [Member]
Finite-Lived Intangible Assets [Line Items]
Useful lives			1 year
Intangible assets, Gross	16,717		$ 16,717		16,714
Core technology [Member]
Finite-Lived Intangible Assets [Line Items]
Useful lives			4 years
Intangible assets, Gross	4,144		$ 4,144		4,086
Trademarks and trade names [Member]
Finite-Lived Intangible Assets [Line Items]
Useful lives			2 years
Intangible assets, Gross	3,281		$ 3,281		3,245
Customer-related [Member]
Finite-Lived Intangible Assets [Line Items]
Useful lives			9 years
Intangible assets, Gross	19,336		$ 19,336		19,169
Distribution network [Member]
Finite-Lived Intangible Assets [Line Items]
Useful lives			5 years
Intangible assets, Gross	4,027		$ 4,027		4,027
Physician education programs [Member]
Finite-Lived Intangible Assets [Line Items]
Intangible assets, Gross	2,549		2,549		2,513
Supply agreement [Member]
Finite-Lived Intangible Assets [Line Items]
Intangible assets, Gross	$ 225		$ 225		$ 225

Select Balance Sheet Details 34

Select Balance Sheet Details - Schedule of Intangible Assets, Future Amortization Expense (Details) $ in Thousands	Jun. 30, 2016USD ($)
Balance Sheet Related Disclosures [Abstract]
Remainder of 2016	$ 2,029
2,017	4,007
2,018	2,867
2,019	2,427
2,020	1,823
Thereafter	6,603
Total	$ 19,756

Select Balance Sheet Details 35

Select Balance Sheet Details - Accrued Expenses (Details) - USD ($) $ in Thousands	Jun. 30, 2016	Dec. 31, 2015
Balance Sheet Related Disclosures [Abstract]
Commissions and sales milestones	$ 5,810	$ 5,920
Payroll and payroll related	4,690	5,577
Litigation settlements	4,400	4,400
Accrued professional fees	2,207	2,203
Royalties	1,625	1,578
Restructuring and severance accruals	851	1,358
Accrued taxes	2,526	1,074
Accrued interest	970	999
Other	7,380	6,682
Total accrued expenses	$ 30,459	$ 29,791

Debt - MidCap Facility Agreemen

Debt - MidCap Facility Agreement (Details) - USD ($)	Jul. 10, 2015	Aug. 30, 2013	Jul. 31, 2015	Jun. 30, 2016	Mar. 11, 2016	Jul. 09, 2015	Aug. 29, 2013
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
Amended Credit Facility with MidCap [Member] | Term Loan [Member]
Line of Credit Facility [Line Items]
Maximum borrowing capacity				38,000,000
Proceeds from lines of credit		$ 28,000,000	$ 5,000,000
Line of credit				$ 25,000,000
Interest rate description				("LIBOR") plus 8.0%
Basis spread				8.00%
Floor on interest rate				9.50%
Interest rate				9.50%
Amended Credit Facility with MidCap [Member] | Credit Facility [Member]
Line of Credit Facility [Line Items]
Line of credit				$ 28,000,000
Maximum borrowing base				$ 40,000,000
Interest rate description				LIBOR plus 6.0%
Basis spread				6.00%
Interest rate				6.50%
Amended Credit Facility with MidCap [Member] | Maximum [Member]
Line of Credit Facility [Line Items]
Additional interest rate to be charged in the event of default				5.00%
Second Amendment Credit Facility with MidCap [Member]
Line of Credit Facility [Line Items]
Debt issuance costs	$ 400,000			$ 400,000
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%
Third Amendment Credit Facility with MidCap [Member] | Credit Facility [Member]
Line of Credit Facility [Line Items]
Amendment fee amount					$ 500,000

Debt - Deerfield Facility Agree

Debt - Deerfield Facility Agreement (Details)	Feb. 05, 2016USD ($)	Jul. 10, 2015USD ($)	Nov. 21, 2014USD ($)$ / sharesshares	Mar. 20, 2014USD ($)$ / sharesshares	Apr. 30, 2014USD ($)	Mar. 31, 2014USD ($)	Jun. 30, 2016USD ($)paymentshares	Jun. 30, 2015USD ($)	Jun. 30, 2016USD ($)shares	Sep. 01, 2016	Dec. 31, 2015USD ($)	Mar. 17, 2014USD ($)$ / sharesshares
Line of Credit Facility [Line Items]
Restricted cash							$ 150,000		$ 150,000		$ 2,350,000
Common stock warrant liabilities							1,145,000		1,145,000		$ 687,000
Deerfield [Member]
Line of Credit Facility [Line Items]
Maximum borrowing capacity												$ 50,000,000
Transaction fee as percentage of principal amount												2.50%
Line of credit			$ 6,000,000	$ 20,000,000			26,600,000		26,600,000
Net proceeds from initial draw under Facility Agreement				19,500,000
Unamortized debt discount			200,000	$ 500,000
Net proceeds from draw under Facility Agreement			$ 5,900,000
Remaining borrowing capacity							$ 0		0
Equal annual payments | payment							3
Additional borrowings under the term loan		$ 5,000,000
Second Amendment with Deerfield [Member]
Line of Credit Facility [Line Items]
Debt instrument, stated interest rate	14.75%											8.75%
Portion of interest paid-in-kind, percentage	6.00%
Amendment fee amount	$ 600,000
Amendment fee, installment amount	$ 200,000
Orthotec LLC, Litigation Settlement [Member]
Line of Credit Facility [Line Items]
Payments of settlement					$ 15,750,000	$ 1,750,000
Orthotec LLC, Litigation Settlement [Member] | Deerfield [Member]
Line of Credit Facility [Line Items]
Payments of settlement									$ 25,200,000
Scenario, Forecast [Member] | Second Amendment with Deerfield [Member]
Line of Credit Facility [Line Items]
Portion of interest paid-in-kind, percentage										3.00%
Initial and Draw Warrants [Member] | Deerfield [Member]
Line of Credit Facility [Line Items]
Warrants outstanding (in shares) | shares							11,450,000		11,450,000
Gain (loss) from change in fair value of warrants							$ (500,000)
Initial and Draw Warrants [Member] | Deerfield [Member] | Other Income / Expense [Member]
Line of Credit Facility [Line Items]
Gain (loss) from change in fair value of warrants							$ 600,000	$ 500,000
Draw Warrants [Member] | Deerfield [Member]
Line of Credit Facility [Line Items]
Maximum borrowing capacity												$ 50,000,000
Exercise price of warrants (dollars per share) | $ / shares			$ 1.39	$ 1.39
Line of credit				$ 20,000,000
Number of warrants issued (in shares) | shares			1,200,000	4,000,000
Warrants value			$ 900,000	$ 4,700,000
Draw Warrants [Member] | 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
Initial Warrants [Member] | Deerfield [Member]
Line of Credit Facility [Line Items]
Number of securities called by warrants (in shares) | shares												6,250,000
Exercise price of warrants (dollars per share) | $ / shares												$ 1.39
Warrant amount reclassified as debt discount			$ 200,000	$ 2,300,000

Debt - Valuation Assumptions (D

Debt - Valuation Assumptions (Details)	6 Months Ended
	Jun. 30, 2016
Fair Value Measurements, Recurring and Nonrecurring, Valuation Techniques [Line Items]
Dividend yield	0.00%
Initial and Draw Warrants for Deerfield Facility Agreement [Member]
Fair Value Measurements, Recurring and Nonrecurring, Valuation Techniques [Line Items]
Risk-free interest rate	0.80%
Dividend yield	0.00%
Expected volatility	82.00%
Expected life (years)	3 years 9 months

Debt - Principal Payments on De

Debt - Principal Payments on Debt (Details) $ in Thousands	Jun. 30, 2016USD ($)
Debt Disclosure [Abstract]
Remainder of 2016	$ 53,360
2,017	8,879
2,018	8,879
2,019	8,879
Total	79,997
Add: capital lease principal payments	878
Less: unamortized debt discount and debt issuance costs	(5,312)
Total	75,563
Less: current portion of long-term debt	(75,376)
Long-term debt, net of current portion	$ 187

Commitments and Contingencies -

Commitments and Contingencies - Additional Information (Details) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
Loss Contingencies [Line Items]
Rent expense	$ 1	$ 0.7	$ 1.8	$ 1.5
Minimum [Member]
Loss Contingencies [Line Items]
Lease interest rate			6.60%
Maximum [Member]
Loss Contingencies [Line Items]
Lease interest rate			9.60%

Commitments and Contingencies41

Commitments and Contingencies - Future Minimum Annual Lease Payments (Details) $ in Thousands	Jun. 30, 2016USD ($)
Commitments and Contingencies Disclosure [Abstract]
Operating leases Remainder of 2016	$ 1,817
Operating leases 2017	2,152
Operating leases 2018	1,688
Operating leases 2019	1,520
Operating leases 2020 and thereafter	2,396
Total Operating leases	9,573
Capital leases Remainder of 2016	429
Capital leases 2017	437
Capital leases 2018	68
Capital leases 2019	0
Capital leases 2020 and thereafter	0
Total Capital leases	934
Less: amount representing interest	(56)
Present value of minimum lease payments	878
Current portion of capital leases	(691)
Capital leases, less current portion	$ 187

Orthotec Settlement - Additiona

Orthotec Settlement - Additional Information (Details) - Orthotec LLC, Litigation Settlement [Member]	Oct. 01, 2014USD ($)	Sep. 26, 2014USD ($)installment	Aug. 13, 2014USD ($)	Apr. 30, 2014USD ($)	Mar. 31, 2014USD ($)	Jun. 30, 2016USD ($)
Loss Contingencies [Line Items]
Judgment assessed by court for (against) company			$ 49,000,000
Payments of settlement				$ 15,750,000	$ 1,750,000
Number of quarterly installments | installment		28
Litigation settlement interest, quarterly installments, amount		$ 1,100,000
Deerfield [Member]
Loss Contingencies [Line Items]
Payments of settlement						$ 25,200,000
Beginning Fourth Quarter of 2014 [Member]
Loss Contingencies [Line Items]
Settlement amount, remaining balance	$ 31,500,000
Litigation settlement payments, quarterly payment 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		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
Numerator:
Net loss	$ (5,233)	$ (3,947)	$ (11,850)	$ (8,508)
Denominator:
Weighted average common shares outstanding (in shares)	102,311	100,162	102,231	100,054
Weighted average unvested common shares subject to repurchase (in shares)	(455)	(904)	(510)	(867)
Weighted average common shares outstanding—basic (in shares)	101,856	99,258	101,721	99,187
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	0	0	0
Weighted average common shares outstanding - diluted (in shares)	101,856	99,258	101,721	99,187
Net loss per share:
Net loss per basic and diluted share (dollars per share)	$ (0.05)	$ (0.04)	$ (0.12)	$ (0.09)

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		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Anti-dilutive securities not included in diluted net loss per share (in shares)	19,304	19,402	19,477	19,546
Options to purchase common stock
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Anti-dilutive securities not included in diluted net loss per share (in shares)	7,305	6,954	7,423	7,135
Unvested restricted share awards
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Anti-dilutive securities not included in diluted net loss per share (in shares)	455	904	510	867
Warrants to purchase common stock
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Anti-dilutive securities not included in diluted net loss per share (in shares)	11,544	11,544	11,544	11,544

Stock Benefit Plans and Stock45

Stock Benefit Plans and Stock-Based Compensation - Additional Information (Details) - USD ($) $ / shares in Units, $ in Millions	1 Months Ended		3 Months Ended
	Feb. 28, 2015	Jul. 31, 2014	Mar. 31, 2016
2005 Employee, Director and Consultant Stock Plan [Member] | Performance-based Restricted Stock Units [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Non-option equity instruments, granted (in shares)	1,854,000	932,000
Non-option equity instruments, grant date fair value (dollars per share)	$ 1.35	$ 1.45
2005 Employee, Director and Consultant Stock Plan [Member] | Performance-based Restricted Stock Units [Member] | Minimum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting percentage	0.00%
2005 Employee, Director and Consultant Stock Plan [Member] | Performance-based Restricted Stock Units [Member] | Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting percentage	200.00%
Change in Management Estimates Regarding Attainment of Performance Goals [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Reduction to compensation expense			$ 0.5

Income Taxes - Additional Infor

Income Taxes - Additional Information (Details) - USD ($) $ in Millions	3 Months Ended	6 Months Ended
	Jun. 30, 2016	Jun. 30, 2016	Dec. 31, 2015
Income Tax Disclosure [Abstract]
Unrecognized tax benefits increase (decrease) (less than $0.1 million)		$ (0.1)
Unrecognized tax benefits	$ 10.3	10.3	$ 10.4
Reasonably possible amount of unrecognized tax benefit change in the next twelve months	$ 0.2	$ 0.2
Effective income tax rate	(9.10%)
Federal statutory income tax rate		35.00%

Segment and Geographical Info47

Segment and Geographical Information - Additional Information (Details) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2016USD ($)location	Jun. 30, 2015USD ($)location	Jun. 30, 2016USD ($)segmentlocation	Jun. 30, 2015USD ($)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 | $	$ 43,790	$ 46,633	$ 88,551	$ 95,280
Japan [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Revenue | $	$ 8,200	$ 7,900	$ 17,400	$ 15,400

Segment and Geographical Info48

Segment and Geographical Information - Schedule of Revenues Attributed to Geographic Location of Customer (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
Segment Reporting, Revenue Reconciling Item [Line Items]
Total consolidated revenues	$ 43,790	$ 46,633	$ 88,551	$ 95,280
United States [Member] | Reportable Geographical Components [Member]
Segment Reporting, Revenue Reconciling Item [Line Items]
Total consolidated revenues	28,171	27,247	57,257	57,714
International [Member] | Reportable Geographical Components [Member]
Segment Reporting, Revenue Reconciling Item [Line Items]
Total consolidated revenues	$ 15,619	$ 19,386	$ 31,294	$ 37,566

Segment and Geographical Info49

Segment and Geographical Information - Schedule of Long Lived Assets by Geographical Areas (Details) - USD ($) $ in Thousands	Jun. 30, 2016	Dec. 31, 2015
Revenues from External Customers and Long-Lived Assets [Line Items]
Total consolidated assets	$ 136,452	$ 146,341
United States [Member] | Reportable Geographical Components [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Total consolidated assets	84,620	97,604
International [Member] | Reportable Geographical Components [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Total consolidated assets	$ 51,832	$ 48,737

Restructuring - Additional Info

Restructuring - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
Restructuring Cost and Reserve [Line Items]
Restructuring expenses	$ 103	$ (112)	$ 789	$ (172)
French Operations Closing [Member]
Restructuring Cost and Reserve [Line Items]
Restructuring costs incurred in closing of certain operations (less than $0.1 million and $0.6 million)	100		600
California Manufacturing Operations Restructuring Plan 2015 [Member]
Restructuring Cost and Reserve [Line Items]
Restructuring expenses	$ 100		$ 200

Related Party Transactions - Ad

Related Party Transactions - Additional Information (Details) - USD ($) $ in Thousands	Jul. 01, 2016	Apr. 30, 2014	Mar. 31, 2014	Jun. 30, 2016	Jun. 30, 2015
Related Party Transaction [Line Items]
Incurred expenses (less than $.1 million)					$ 100
HealthpointCapital, LLC [Member]
Related Party Transaction [Line Items]
Incurred expenses (less than $.1 million)				$ 100
Payable liability (less than $.1 million)				$ 100
Orthotec LLC, Litigation Settlement [Member]
Related Party Transaction [Line Items]
Payments of settlement		$ 15,750	$ 1,750
Orthotec LLC, Litigation Settlement [Member] | Subsequent Event [Member] | Forbearance Agreement, Settlement Payment [Member]
Related Party Transaction [Line Items]
Payments of settlement	$ 1,100
HealthpointCapital, LLC [Member] | Orthotec LLC, Litigation Settlement [Member] | Subsequent Event [Member] | Forbearance Agreement, Settlement Payment [Member]
Related Party Transaction [Line Items]
Payments of settlement	$ 1,000

Subsequent Events (Details)

Subsequent Events (Details) - USD ($) $ in Thousands	Aug. 08, 2016	Dec. 31, 2016	Jun. 30, 2016	Jun. 30, 2015
Subsequent Event [Line Items]
Repayments under lines of credit			$ 70,963	$ 76,086
Fourth Amendment to the Amended Credit Facility with MidCap [Member] | Subsequent Event [Member]
Subsequent Event [Line Items]
Line of credit facility, increase in maximum borrowing capacity	$ 2,200
Amendment fee amount	$ 200
Globus Facility Agreement [Member] | Foreign Line of Credit [Member] | Subsequent Event [Member] | Scenario, Forecast [Member]
Subsequent Event [Line Items]
Line of credit		$ 30,000
International Operations [Member] | Disposal Group, Held-for-sale or Disposed of by Sale, Not Discontinued Operations [Member] | Subsequent Event [Member] | Scenario, Forecast [Member]
Subsequent Event [Line Items]
Proceeds from sale of international operations		80,000
Repayments under lines of credit		$ 69,000
Debt instrument, term		5 years