Alphatec (ATEC) 10-Q 11 May 20 2020 Q1 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	3 Months Ended
	Mar. 31, 2020	May 04, 2020
Cover [Abstract]
Entity Registrant Name	ALPHATEC HOLDINGS, INC.
Entity Central Index Key	0001350653
Current Fiscal Year End Date	--12-31
Entity Filer Category	Accelerated Filer
Document Type	10-Q
Trading Symbol	ATEC
Document Period End Date	Mar. 31, 2020
Document Fiscal Year Focus	2020
Document Fiscal Period Focus (Q1,Q2,Q3,FY)	Q1
Entity Current Reporting Status	Yes
Amendment Flag	false
Entity Small Business	true
Entity Emerging Growth Company	false
Entity Common Stock, Shares Outstanding		63,432,932
Entity Shell Company	false
Entity File Number	000-52024
Entity Tax Identification Number	20-2463898
Entity Address, Address Line One	5818 El Camino Real
Entity Address, City or Town	Carlsbad
Entity Address, State or Province	CA
Entity Address, Postal Zip Code	92008
City Area Code	760
Local Phone Number	431-9286
Document Quarterly Report	true
Document Transition Report	false
Entity Incorporation, State or Country Code	DE
Entity Interactive Data Current	Yes
Title of 12(b) Security	Common stock, par value $.0001 per share
Security Exchange Name	NASDAQ

CONDENSED CONSOLIDATED BALANCE

CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Current assets:
Cash	$ 27,466	$ 47,113
Accounts receivable, net	15,375	16,150
Inventories, net	37,872	34,854
Prepaid expenses and other current assets	10,646	9,880
Current assets of discontinued operations	353	321
Total current assets	91,712	108,318
Property and equipment, net	20,919	19,722
Right-of-use asset	1,601	1,860
Goodwill	13,897	13,897
Intangibles, net	25,165	25,605
Other assets	493	493
Noncurrent assets of discontinued operations	52	53
Total assets	153,839	169,948
Current liabilities:
Accounts payable	11,800	7,772
Accrued expenses	23,772	26,416
Current portion of long-term debt	916	489
Current portion of lease liability	1,356	1,314
Current liabilities of discontinued operations	399	399
Total current liabilities	38,243	36,390
Long-term debt, less current portion	53,033	53,448
Operating lease liability, less current portion	559	925
Other long-term liabilities	10,971	11,951
Redeemable preferred stock, $0.0001 par value; 20,000 shares authorized at March 31, 2020 and December 31, 2019; 3,319 shares issued and outstanding at both March 31, 2020 and December 31, 2019	23,603	23,603
Commitments and contingencies
Stockholders' equity:
Common stock, $0.0001 par value; 200,000 authorized; 63,403 shares issued and 63,260 outstanding at March 31, 2020, net of 143 unvested shares; and 61,718 shares issued and 61,400 shares outstanding, net of 318 unvested shares at December 31, 2019	6	6
Treasury stock, 2 shares, at cost	(97)	(97)
Additional paid-in capital	611,091	606,558
Shareholder note receivable	(5,000)	(5,000)
Accumulated other comprehensive income	1,157	1,088
Accumulated deficit	(579,727)	(558,924)
Total stockholders’ equity	27,430	43,631
Total liabilities and stockholders’ equity	153,839	169,948
Series A Convertible Preferred Stock
Stockholders' equity:
Convertible preferred stock
Series B Convertible Preferred Stock
Stockholders' equity:
Convertible preferred stock

CONDENSED CONSOLIDATED BALANC_2

CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) (Parenthetical) - $ / shares	Mar. 31, 2020	Dec. 31, 2019
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	63,403,000	61,718,000
Common stock, shares outstanding	63,260,000	61,400,000
Common stock, unvested shares	143,000	318,000
Treasury stock, shares	2,000	2,000
Series A Convertible Preferred Stock
Convertible preferred stock, par value (dollars per share)	$ 0.0001	$ 0.0001
Convertible preferred stock, shares authorized	15,000	15,000
Convertible preferred stock, shares issued	0	0
Convertible preferred stock, shares outstanding	0	0
Series B Convertible Preferred Stock
Convertible preferred stock, par value (dollars per share)	$ 0.0001	$ 0.0001
Convertible preferred stock, shares authorized	45,000	45,000
Convertible preferred stock, shares issued	0	0
Convertible preferred stock, shares outstanding	0	0

CONDENSED CONSOLIDATED STATEMEN

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS (Unaudited) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Revenue:
Revenue	$ 30,115	$ 24,555
Cost of revenue	9,084	7,987
Gross profit	21,031	16,568
Operating expenses:
Research and development	3,749	3,372
Sales, general and administrative	28,003	21,097
Litigation-related	2,643	2,623
Amortization of intangible assets	172	182
Transaction-related	4,272
Restructuring		60
Total operating expenses	38,839	27,334
Operating loss	(17,808)	(10,766)
Other expense:
Other expense, net	(2,874)	(2,119)
Loss from continuing operations before taxes	(20,682)	(12,885)
Income tax provision	40	31
Loss from continuing operations	(20,722)	(12,916)
Loss from discontinued operations, net of applicable taxes		(52)
Net loss	$ (20,722)	$ (12,968)
Loss per share, basic and diluted:
Continuing operations	$ (0.33)	$ (0.29)
Discontinued operations	0	0
Net loss per share, basic and diluted	$ (0.33)	$ (0.29)
Shares used in calculating basic and diluted net loss per share	62,568	45,020
United States Product
Revenue:
Revenue	$ 29,070	$ 22,955
International Supply Agreement
Revenue:
Revenue	$ 1,045	$ 1,600

CONDENSED CONSOLIDATED STATEM_2

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS (Unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Statement Of Income And Comprehensive Income [Abstract]
Net loss	$ (20,722)	$ (12,968)
Foreign currency translation adjustments related to continuing operations	69	75
Comprehensive loss	$ (20,653)	$ (12,893)

CONDENSED CONSOLIDATED STATEM_3

CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY (Unaudited) - USD ($) shares in Thousands, $ in Thousands	Total	Series A Convertible Preferred Stock	Common Stock	Additional paid-in capital	Shareholder note receivable	Treasury stock	Accumulated other comprehensive income (loss)	Accumulated deficit
Balance at Dec. 31, 2018	$ 17,574		$ 4	$ 523,525	$ (5,000)	$ (97)	$ 1,064	$ (501,922)
Balance, shares at Dec. 31, 2018		4	43,368
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock-based compensation	1,565			1,565
Distributor equity incentives	42			42
Distributor equity incentives, shares			15
Common stock issued for conversion of Series A preferred stock, shares		(4)	1,858
Recognition of beneficial conversion feature - SafeOp Convertible Notes	242			242
Common stock issued for stock option exercises	14			14
Common stock issued for stock option exercises, shares			8
Common stock issued for vesting of restricted stock awards, net of shares repurchased for tax liability	(183)			(183)
Common stock issued for vesting of restricted stock awards, net of shares repurchased for tax liability, shares			442
Issuance of common stock for acquisition of SafeOp - Milestone 2	2,889			2,889
Issuance of common stock for acquisition of SafeOp - Milestone 2, shares			887
Foreign currency translation adjustments	75						75
Net loss	(12,968)							(12,968)
Balance at Mar. 31, 2019	9,250		$ 4	528,094	(5,000)	(97)	1,139	(514,890)
Balance, shares at Mar. 31, 2019			46,578
Balance at Dec. 31, 2019	43,631		$ 6	606,558	(5,000)	(97)	1,088	(558,924)
Balance, shares at Dec. 31, 2019			61,400
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Cumulative effect of change in accounting principle	(81)							(81)
Stock-based compensation	3,630			3,630
Distributor equity incentives	70			70
Common stock issued for warrant exercises	1,158			1,158
Common stock issued for warrant exercises, shares			1,390
Common stock issued for employee stock purchase plan and stock option exercises	83			83
Common stock issued for employee stock purchase plan and stock option exercises, shares			76
Common stock issued for vesting of restricted stock awards, net of shares repurchased for tax liability	(408)			(408)
Common stock issued for vesting of restricted stock awards, net of shares repurchased for tax liability, shares			394
Foreign currency translation adjustments	69						69
Net loss	(20,722)							(20,722)
Balance at Mar. 31, 2020	$ 27,430		$ 6	$ 611,091	$ (5,000)	$ (97)	$ 1,157	$ (579,727)
Balance, shares at Mar. 31, 2020			63,260

CONDENSED CONSOLIDATED STATEM_4

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Operating activities:
Net loss	$ (20,722)	$ (12,968)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation and amortization	2,454	1,785
Stock-based compensation	3,568	1,612
Amortization of debt discount and debt issuance costs	1,238	503
Amortization of right-of-use asset	259	217
Provision for doubtful accounts	(5)	66
Provision for excess and obsolete inventory	1,722	1,997
Deferred income tax benefit		4
Beneficial conversion feature from convertible notes		242
Loss (Gain) on disposal of instruments	32	(275)
Accretion to contingent consideration		289
Changes in operating assets and liabilities:
Accounts receivable, net	782	1,268
Inventories, net	(4,741)	(4,398)
Prepaid expenses and other current assets	(983)	198
Other assets		69
Other long-term assets		(2,612)
Accrued expenses and other	(2,643)	(1,071)
Accounts payable	3,414	3,319
Lease liability	(324)	2,910
Other long-term liabilities	(1,099)	(1,099)
Net cash used in operating activities	(17,048)	(7,944)
Investing activities:
Purchases of property and equipment	(2,629)	(1,068)
Net cash used in investing activities	(2,629)	(1,068)
Financing activities:
Proceeds from sale of common stock, net	833	14
Borrowings under lines of credit	29,544	26,433
Repayments under lines of credit	(30,408)	(26,822)
Principal payments on capital lease obligations	(8)	(5)
Debt issuance costs		(300)
Principal payments on term loan and notes payable		(3,022)
Net cash used in financing activities	(39)	(3,702)
Effect of exchange rate changes on cash	69	79
Net decrease in cash	(19,647)	(12,635)
Cash at beginning of period, including discontinued operations	47,113	29,054
Cash at end of period, including discontinued operations	27,466	16,419
Supplemental disclosure of cash flow information:
Cash paid for interest	1,646	1,357
Cash paid for income taxes	25	23
Supplemental disclosure of noncash investing and financing activities:
Purchases of property and equipment in accounts payable	$ 1,297	785
SafeOp Surgical, Inc.
Supplemental disclosure of noncash investing and financing activities:
Common stock issued for achievement of SafeOp contingent consideration		$ 2,889

The Company and Basis of Presen

The Company and Basis of Presentation	3 Months Ended
	Mar. 31, 2020
Organization Consolidation And Presentation Of Financial Statements [Abstract]
The Company and Basis of Presentation	1. The Company and Basis of Presentation The Company Alphatec Holdings, Inc. (the “Company”), through its wholly owned subsidiaries, Alphatec Spine, Inc. (“Alphatec Spine”) and SafeOp Surgical, Inc. (“SafeOp”), designs, develops, and markets technology for the treatment of spinal disorders. The Company markets its products in the U.S. via independent sales agents and a direct sales force. On March 8, 2018, the Company completed its acquisition of SafeOp, a Delaware corporation, pursuant to a reverse triangular merger of SafeOp into a newly-created wholly-owned subsidiary of the Company, with SafeOp being the surviving corporation and a wholly-owned subsidiary of the Company. See Note 8 for further information. On September 1, 2016, the Company completed the sale of its international distribution operations and agreements (collectively, the “International Business”) to Globus Medical Ireland, Ltd., a subsidiary of Globus Medical, Inc., and its affiliated entities (collectively “Globus”). As a result of this transaction, the International Business has been excluded from continuing operations for all periods presented in this Quarterly Report on Form 10-Q and is reported as discontinued operations. See Note 4 for additional information on the divestiture of the International Business. Basis of Presentation The accompanying condensed consolidated balance sheet as of December 31, 2019, 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 unaudited interim 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, 2019, which are included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2019 that was filed with the SEC on March 17, 2020. Operating results for the three months ended March 31, 2020 are not necessarily indicative of the results that may be expected for the year ending December 31, 2020, or any other future periods. Liquidity The accompanying consolidated financial statements have been prepared on a going concern basis, which contemplates the realization of assets and satisfaction of liabilities in the normal course of business. These financial statements do not include any adjustments related to the recovery of the recorded assets or the classification of the liabilities that might be necessary should the Company be unable to continue as a going concern. At each reporting period, the Company evaluates whether there are conditions or events that raise substantial doubt about the Company’s ability to continue as a going concern within twelve months after the date the consolidated financial statements are issued. The Company’s evaluation entails analyzing prospective operating budgets and forecasts for expectations of the Company’s cash needs and comparing those needs to the current cash and cash equivalent balances, and availability under existing credit facilities. The Company’s working capital at March 31, 2020 was $53.8 million (including cash of $27.5 million). In April 2020, the Company completed a $20 million draw on its credit facility with Squadron Medical Finance Solutions LLC (“Squadron Capital,” or “Squadron”). The Company’s capital requirements over the next twelve months will depend on many factors, including the ability to achieve anticipated revenue, manage operating expense and the timing of required investments in inventory and instrument sets to support its customers. The Company has experienced negative operating cash flows for all historical periods presented and it expects these losses to continue into the foreseeable future, particularly as the COVID-19 pandemic impacts operations and surgical volumes. The severity of the impact of the COVID-19 pandemic on the Company’s business will depend on a number of factors, including, but not limited to, the duration, extent and severity of the pandemic and its impact on the Company's customers, all of which are uncertain and cannot be predicted. To reduce expenditures and preserve cash, the Company recently implemented several cost-containment measures, including expense management programs and reductions in projected inventory and capital spending. The company believes it has sufficient As more fully described in Note 5, the Company’s existing credit agreements with MidCap Funding IV Trust (“MidCap”) and Squadron (collectively, the “current lenders”) include a financial covenant that required the Company to maintain a minimum cash balance of $5.0 million through March 31, 2020. The Company was in compliance with this covenant at March 31, 2020. The minimum cash covenant converted to a minimum fixed charge coverage ratio as of April 1, 2020. The Company did not meet the fixed charge ratio as of April 2020 and is required to certify its debt covenant compliance with its lenders by May 31, 2020. In order to avoid a default on its existing credit agreements, the Company plans to refinance its existing debt. This factor indicates substantial doubt exists, but management’s plans are to refinance the debt. On May 9, 2020, the Company executed a commitment letter for $35 million in additional secured financing from Squadron. This capital will be made available under the same material terms and conditions as the existing term loan with Squadron. Under the terms of the amended facility, the maturity date on the entire term loan will be extended to May 2025. A portion of the proceeds from the expanded facility will be used to retire the Company’s outstanding obligation under its working capital revolver with MidCap Funding. The expanded Squadron credit facility, as proposed, does not include any financial covenants. ATEC expects this transaction to close before the end of May 2020. Management believes the credit refinancing of existing debt under the commitment letter with Squadron is probable to occur, and as such, alleviates any substantial doubt about the Company’s ability to continue as a going concern . COVID-19 The Company is subject to risks and uncertainties as a result of the COVID-19 pandemic. In late 2019, a novel strain of coronavirus, COVID-19, was reported to have surfaced in Wuhan, China. Since then, COVID-19 has spread to countries globally, including the United States and mostly all European countries. To date, COVID-19 has had, and may continue to have, an adverse impact on the Company’s operations, supply chains, distribution channels and expenses as a result of the preventive and precautionary measures that the Company, its customers, other businesses, and governments are taking, including the deferral of elective medical procedures and diversion of capital and other resources. As information surrounding COVID-19 continues to evolve, the extent of the impact on the Company's business is highly uncertain and difficult to predict. As a result of the pandemic, hospitals and health institutions are diverting resources and deferring elective surgical procedures to treat COVID-19 patients. To date, these measures have impacted, and will continue to impact, the abilities of these institutions to meet their normal recurring business obligations, including those to the Company. Furthermore, capital markets and economies worldwide have been negatively impacted by COVID-19, and it is possible this impact could cause a local and/or global economic recession. As the extent of such economic disruption continues to remain uncertain, the results of the COVID-19 pandemic could have a material adverse effect on the business. The severity of the impact of the COVID-19 pandemic on the Company's business will depend on a number of factors, including, but not limited to, the duration, extent and severity of the pandemic and its impact on the Company's customers, all of which are uncertain and cannot be predicted. The Company's future results of operations and liquidity could be adversely impacted by delays in payments of outstanding receivable amounts beyond normal payment terms, supply chain disruptions and uncertain demand, and the impact of any initiatives or programs that the Company may undertake to address financial and operations challenges faced by its customers. As of the date of issuance of these condensed consolidated financial statements, the extent to which the pandemic may materially impact the Company's financial condition, liquidity, or results of operations is uncertain. Reclassification Certain amounts in the consolidated financial statements for the three months ended March 31, 2019 have been reclassified to conform to the current period's presentation. These reclassifications include stock-based compensation expense, which was reclassified to correctly present employee expenses consistent with their function, out of research and development and into sales, general and administrative expense on the Company’s consolidated statements of operations. This resulted in a reclassification of $0.1 million of stock compensation expense for the three months ended March 31, 2019. In addition, certain amounts in the Consolidated Statement of Cash Flow for the three months ended March 31, 2019 have been reclassified to conform to current period's presentation. None of the adjustments had any effect on the prior period net loss .

Summary of Significant Accounti

Summary of Significant Accounting Policies	3 Months Ended
	Mar. 31, 2020
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	2. 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, 2019, which are included in the Company’s Annual Report on Form 10-K that was filed with the SEC on March 17, 2020. Except as discussed below, these accounting policies have not changed during the three months ended March 31, 2020. Transaction-related Expenses The Company expensed certain costs related to the tender offer for the acquisition of EOS Imaging, which primarily include third-party advisory fees, legal fees and commitment fees related to transaction financing arrangements. Fair Value Measurements T he 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: Level 2: Level 3: The Company does not maintain any financial assets that are considered to be Level 1, Level 2 or Level 3 instruments as of March 31, 2020. During the second quarter of 2019, the Company issued a liability classified equity award to one of its executive officers. The award will be earned over a 4 year vesting period and upon a specific market condition. As the award will be cash settled, it is classified as a liability within Level 3 of the fair value hierarchy as the Company is using a probability-weighted income approach, utilizing significant unobservable inputs including the probability of achieving the specified market condition with the valuation updated at each reporting period. The full fair value of the cash settled award was $0.6 million as of March 31, 2020 and is being recognized ratably as the underlying service period is provided. The following table provides a reconciliation of liabilities measured at fair value using significant unobservable inputs (Level 3) for the three months ended March 31, 2020 (in thousands): Level 3 Liabilities Balance at January 1, 2020 $ 266 Vested portion of liability classified equity award 107 Change in fair value measurement (238 ) Balance at March 31, 2020 $ 135 Recent Accounting Pronouncements Recently Adopted Accounting Pronouncements In November 2019, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2019-08, Compensation—Stock Compensation (Topic 718) and Revenue from Contracts with Customers (Topic 606), which clarifies that an entity must measure and classify share-based payment awards granted to a customer by applying the guidance in Topic 718. Accounting Standard Codification (“ASC”) 2019-08 is effective for annual reporting periods beginning after December 15, 2019, including interim reporting periods within those annual reporting periods. The Company adopted the guidance effective January 1, 2020 and recorded a cumulative adjustment of $0.1 million to accumulated deficit as of January 1, 2020. In January 2017, the FASB issued ASU 2017-04, Intangibles – Goodwill and Other In August 2018, the FASB issued ASU 2018-15, Intangibles—Goodwill and Other—Internal-Use Software (Subtopic 350-40), which aligns the accounting for cloud computing implementation costs with that of costs to develop or obtain internal-use software, meaning such costs that are part of the application development stage are capitalized as an asset and amortized over the term of the arrangement, otherwise, such costs are expensed as incurred. It also clarifies the classification of amounts related to capitalized implementation costs in the financial statements. ASC 2018-15 is effective for annual reporting periods beginning after December 15, 2019, including interim reporting periods within those annual reporting periods. Early adoption is permitted. The Company adopted the guidance effective January 1, 2020. It did not have a material impact on the Company’s consolidated financial statements. Recently Issued Accounting Pronouncements The Company has evaluated all recent accounting pronouncements issued by the Financial Accounting Standards Board in the form of Accounting Standards Updates through the date these financial statements were available to be issued and found no recent accounting pronouncements issued, but not yet effective that when adopted, would have a material impact on the financial statements of the Company.

Select Condensed Consolidated B

Select Condensed Consolidated Balance Sheet Details	3 Months Ended
	Mar. 31, 2020
Balance Sheet Related Disclosures [Abstract]
Select Condensed Consolidated Balance Sheet Details	3. Select Condensed Consolidated Balance Sheet Details Accounts Receivable, net Accounts receivable, net consist of the following (in thousands): March 31, 2020 December 31, 2019 Accounts receivable $ 15,664 $ 16,436 Allowance for doubtful accounts (289 ) (286 ) Accounts receivable, net $ 15,375 $ 16,150 Inventories, net Inventories, net consist of the following (in thousands): March 31, 2020 December 31, 2019 Raw materials $ 5,402 $ 5,822 Work-in-process 2,052 1,578 Finished goods 56,005 51,669 63,459 59,069 Less reserve for excess and obsolete finished goods (25,587 ) (24,215 ) Inventories, net $ 37,872 $ 34,854 Property and Equipment, net Property and equipment, net consist of the following (in thousands except as indicated): Useful lives (in years) March 31, 2020 December 31, 2019 Surgical instruments 4 $ 59,807 $ 58,502 Machinery and equipment 7 6,426 6,038 Computer equipment 3 3,879 3,594 Office furniture and equipment 5 1,351 1,297 Leasehold improvements various 1,761 1,761 Construction in progress n/a 216 496 73,440 71,688 Less accumulated depreciation and amortization (52,521 ) (51,966 ) Property and equipment, net $ 20,919 $ 19,722 Total depreciation expense was $2.0 million and $1.6 million for the three months ended March 31, 2020 and 2019, respectively. At both March 31, 2020 and December 31, 2019, assets recorded under capital leases of $0.1 million were included in the machinery and equipment balance. Amortization of assets under capital leases is included in depreciation expense. Intangible Assets, net Intangible assets, net consist of the following (in thousands, except as indicated): Remaining Avg. Useful lives (in years) March 31, 2020 December 31, 2019 Developed technology 10 $ 26,976 $ 26,976 Intellectual property — 1,004 1,004 License agreements 1 5,536 5,536 Trademarks and trade names — 792 792 Customer-related 4 7,458 7,458 Distribution network 3 4,027 4,027 In process research and development 19 8,800 8,800 54,593 54,593 Less accumulated amortization (29,428 ) (28,988 ) Intangible assets, net $ 25,165 $ 25,605 Total amortization expense attributed to intangible assets was $0.2 million for both the three months ended March 31, 2020 and 2019, respectively. Developed technology and in process research and development intangibles are expected to begin amortizing when the relevant products reach full commercial launch. Future amortization expense related to intangible assets as of March 31, 2020 is as follows (in thousands): Year Ending December 31, Remainder of 2020 $ 1,428 2021 1,888 2022 1,888 2023 1,888 2024 1,785 Thereafter 16,288 $ 25,165 Accrued Expenses Accrued expenses consist of the following (in thousands): March 31, 2020 December 31, 2019 Commissions and sales milestones $ 4,129 $ 5,299 Payroll and payroll related 3,598 7,949 Litigation settlement obligation - short-term portion 4,400 4,400 Professional fees 5,999 3,945 Royalties 2,170 1,981 Restructuring 17 29 Taxes 103 82 Interest 170 155 Other 3,186 2,576 Total accrued expenses $ 23,772 $ 26,416 Other Long-Term Liabilities Other long-term liabilities consist of the following (in thousands): March 31, 2020 December 31, 2019 Litigation settlement obligation - long-term portion $ 9,865 $ 10,712 Line of credit exit fee 600 600 Tax liabilities 371 373 Other 135 266 Other long-term liabilities $ 10,971 $ 11,951

Discontinued Operations

Discontinued Operations	3 Months Ended
	Mar. 31, 2020
Discontinued Operations And Disposal Groups [Abstract]
Discontinued Operations	4. Discontinued Operations In connection with the sale of the International Business, the Company entered into a product manufacture and supply agreement (the “Supply Agreement”) with Globus, pursuant to which the Company supplies to Globus certain of its implants and instruments (the “Products”), previously offered for sale by the Company in international markets at agreed-upon prices for a minimum term of three years, with the option for Globus to extend the term for up to two additional twelve month periods subject to Globus meeting specified purchase requirements. During the first quarter of 2019, Globus notified the Company that it will exercise the option to extend the agreement an additional twelve months through August 2020. In accordance with authoritative guidance, sales to Globus are reported under continuing operations as the Company has continuing involvement under the Supply Agreement. For the three months ended March 31, 2020, the Company recorded $1.0 million in revenue and $1.0 million in cost of revenue from the Supply Agreement in continuing operations and for the three months ended March 31, 2019, the Company recorded $1.6 million in revenue and $1.4 million in cost of revenue in continuing operations. Sales, general and administrative expense pertaining to discontinued operations on the Company’s condensed consolidated statements of operations were immaterial for the three months ended March 31, 2020 and 2019.

Debt

Debt	3 Months Ended
	Mar. 31, 2020
Debt Disclosure [Abstract]
Debt	5. Debt MidCap Facility Agreement The Company’s Amended Credit Facility with MidCap provides for a revolving credit commitment up to $22.5 million and provided for a term loan commitment up to $5 million. As of March 31, 2020, $11.9 million was outstanding under the revolving line of credit. The principal balance outstanding under the revolving line of credit is due in December 2022. Amounts outstanding under the revolving line of credit accrue interest at the London Interbank Offered Rate (“ As collateral for the Amended Credit Facility, MidCap has a first lien security interest in and a second lien on substantially all other assets. At March 31, 2020, $0.9 million remains as an unamortized debt discount related to the Amended Credit Facility on the condensed consolidated balance sheet, which will be amortized over the remaining term of the Amended Credit Facility. Squadron Credit Agreement On November 6, 2018, the Company closed a $35 million Term Loan with Squadron, a provider of debt financing to growing companies in the orthopedic industry. The debt has a five-year maturity and bears interest at LIBOR plus 8% (10.0% as of March 31, 2020 As collateral for the Term Loan, Squadron has a first lien security interest in substantially all assets except for . In connection with the financing, the Company issued initial warrants to Squadron to purchase 845,000 shares of common stock at an exercise price of $3.15 per share. The warrants have a seven-year term and are immediately exercisable. In March 2019, the Company expanded the credit facility with Squadron for up to $30 million in additional secured financing. This additional financing has been made available under the Company’s existing credit facility with Squadron. the first draw under the expanded credit facility, the Company issued to Squadron warrants to purchase 4,838,710 shares of the Company’s common stock at an exercise price of $2.17 per share. The warrants have a seven-year term and are immediately exercisable. utilizing the Monte-Carlo simulation model as described further in Note 10 and are recorded within equity in accordance with authoritative accounting guidance and with a proportional amount, calculated by taking the draw amount divided by the total expanded credit facility, recorded as a debt discount. The total debt discount will be amortized into interest expense through maturity of the debt utilizing the effective interest rate method. No additional warrants were issued upon draws subsequent to June 2019. The value of the additional warrants issued that are allocated to the remaining balance available for draw on the expanded credit facility were recorded as a deferred cost asset within prepaid and other assets on the condensed consolidated balance sheet as of March 31, 2020 and are being amortized into interest expense on a ratable basis over the term of the debt. As of March 31, 2020, the debt is recorded at its carrying value of $39.0 million, net of issuance costs of $6.0 million, including all amounts paid to third parties to secure the debt and the fair value of the warrants issued. The debt issuance costs are being amortized into interest expense over the five-year term utilizing the effective interest rate method. The total principal outstanding under the Term Loan as of March 31, 2020 is $45.0 million. Inventory Financing The Company has an Inventory Financing Agreement with a key inventory and instrument components supplier whereby the Company may draw up to $3.0 million for the purchase of inventory to accrue interest at a rate of LIBOR plus 8% subject to a 10% floor and 13% ceiling. All principal will become due and payable upon maturity on November 6, 2023 and all interest will be paid monthly. The obligation outstanding under the Inventory Financing Agreement as of March 31, 2020 was $3.0 million. Principal payments remaining on the Company's debt are as follows as of March 31, 2020 (in thousands): Year Ending December 31, Remainder of 2020 $ 885 2021 4,483 2022 19,607 2023 35,820 Total 60,795 Add: capital lease principal payments 92 Less: unamortized debt discount and debt issuance costs (6,938 ) Total 53,949 Less: current portion of long-term debt (916 ) Long-term debt, net of current portion $ 53,033 Covenants The Company’s various credit agreements include several event of default provisions, such as payment default, insolvency conditions and a material adverse effect clause, 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 the lenders’ right to declare all outstanding obligations immediately due and payable. Furthermore, the credit agreements contain various covenants, including monthly compliance certifications and compliance with government regulations and maintenance of insurance, and prohibitions against certain specified actions, including acquiring any new equipment financings over a specified amount. The credit agreements also contain various negative covenants including a $5 million minimum liquidity requirement through March 31, 2020. The minimum liquidity covenant will be replaced by a fixed charge ratio, pursuant to which operating cash to fixed charges (as defined) must equal at least 1:1 on a rolling 12-month basis, beginning April 2020. The Company was in compliance with the covenants under the credit agreement at March 31, 2020.

Commitments and Contingencies

Commitments and Contingencies	3 Months Ended
	Mar. 31, 2020
Commitments And Contingencies Disclosure [Abstract]
Commitments and Contingencies	6. Commitments and Contingencies Leases On December 4, 2019, the Company entered into a new lease agreement for a new headquarters location which will consist of 121,541 square feet of office, engineering, and research and development space in Carlsbad, California. The term of the new lease is currently anticipated to commence November 15, 2020 and terminate November 30, 2030. The Company will recognize a right-of-use (“ROU”) asset and liability upon taking control of the premises, currently anticipated to be the lease commencement date. Operating Lease The Company leases its buildings and certain equipment under operating leases which expire on various dates through 2021. Upon the Company’s adoption of ASU 2016-02 , Leases (Topic 842), as of January 1, 2019 the Company recognized a ROU asset and lease liability for its building lease, assuming a 10.5% discount rate. Any short-term leases defined as 12 months or less or month-to-month leases were excluded and continue to be expensed each month. Total costs associated with these leases for the three months ended March 31, 2020 was immaterial. The Company determines if an arrangement is a lease at inception. The Company has operating leases for its buildings and certain equipment with lease terms of one year to 5.5 years, some of which include options to extend and/or terminate the lease. The exercise of lease renewal options is at the Company’s sole discretion and were not included in the calculation of the Company’s lease liability as the Company is not able to determine without uncertainty if the renewal option will be exercised. The depreciable life of assets and leasehold improvements are limited to the expected term unless there is a transfer of title or purchase option reasonably certain of exercise. The Company’s lease agreements do not contain any variable lease payments, residual value guarantees or any restrictive covenants. The Company’s ROU asset represents the right to use an underlying asset for the lease term and lease liabilities represent the obligation to make lease payments arising from the lease. Operating lease ROU assets and liabilities are recognized at commencement date of the lease or the ASC 842 adoption date, whichever is later, based on the present value of lease payments over the lease term. When readily determinable, the Company uses the implicit rate in determining the present value of lease payments, or 10.5% as of the adoption date. When leases do not provide an implicit rate, the Company uses its incremental borrowing rate based on the information available at the lease commencement date or adoption date, including the lease term. The operating lease ROU asset also includes any lease payments made and excludes lease incentives. Lease expense for lease payments is recognized on a straight-line basis over the lease term. Future minimum annual lease payments under such leases are as follows as of March 31, 2020 (in thousands): Undiscounted lease payments: Year Ending December 31, Remainder of 2020 $ 1,114 2021 916 2022 39 Total undiscounted lease payments 2,069 Less: present value adjustment (154 ) Operating lease liability 1,915 Less: current portion of operating lease liability (1,356 ) Operating lease liability, less current portion $ 559 As of March 31, 2020, the Company’s remaining lease term is years The Company paid $0.4 million and $0.3 million on its operating lease agreements 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. In February 2018, NuVasive, Inc. filed suit against the Company in the United States District Court for the Southern District of California (NuVasive, Inc. v. Alphatec Holdings, Inc. et al., Case No. 3:18-cv-00347-CAB-MDD (S.D. Cal.)), alleging that certain of the Company’s products (including components of its Battalion™ Lateral System), infringe, or contribute to the infringement of, U.S. Patent Nos. 7,819,801, 8,355,780, 8,439,832, 8,753,270, 9,833,227 (entitled “Surgical access system and related methods”), U.S. Patent No. 8,361,156 (entitled “Systems and methods for spinal fusion”), and U.S. Design Patent Nos. D652,519 (“Dilator”) and D750,252 (“Intervertebral Implant”). NuVasive seeks unspecified monetary damages and an injunction against future purported infringement. In March 2018, the Company moved to dismiss NuVasive’s claims of infringement of its design patents for failure to state a cognizable legal claim. In May 2018, the Court ruled that NuVasive failed to state a plausible claim for infringement of the asserted design patents and dismissed those claims with prejudice. The Company filed its answer, affirmative defenses and counterclaims to NuVasive’s remaining claims in May 2018. Also in March 2018, NuVasive moved for a preliminary injunction. In March 2018, the Court denied that motion without prejudice for failure to comply with the Court’s chambers rules. In April 2018, NuVasive again moved for a preliminary injunction. In July 2018, after a hearing on the matter in June 2018, the Court denied that motion on the grounds that NuVasive failed to establish either likelihood of success on the merits of its remaining claims or that it would suffer irreparable harm absent the preliminary injunction. In September 2018, NuVasive filed an Amended Complaint, asserting additional infringement claims of U.S. Patent Nos. 9,924,859, 9,974,531 and 8,187,334. The Company filed its answer, affirmative defenses and counterclaims to these new claims in October 2018. Also in October 2018, NuVasive moved to dismiss the Company’s counterclaims that NuVasive intentionally had misled the U.S. Patent and Trademark Office as a means of obtaining certain patents asserted against the Company. In January 2019, the Court denied NuVasive’s motion as to all but one of the Company’s counterclaims, but granted the Company leave to amend its counterclaim to cure the dismissal. The Company amended that counterclaim in February 2019 and, that same month, NuVasive again moved to dismiss it. In March 2019, the Court denied NuVasive’s motion. NuVasive filed its Answer to the amended counterclaim in April 2019. In December 2018, the Company filed a petition with the Patent Trial and Appeal Board (“PTAB”) challenging the validity of certain claims of the ’156 and ’334 Patents. In February 2019, upon joint motion of the parties, the Court stayed all proceedings in this matter, except as noted above, pending PTAB’s determination of whether to institute inter partes review (“IPR”) of the asserted claims of the two patents at issue and vacated the trial date. In July 2019, PTAB instituted IPR of the validity of asserted claims of the two patents at issue and held a hearing on the matter in April 2020. The Company expects PTAB to issue its final decisions regarding the validity of these claims in the second half of 2020. Also in July 2019, the parties submitted a joint statement to the Court regarding PTAB’s decisions and the parties’ respective recommendations regarding the stay of proceedings. In August 2019, the Court vacated the stay as to asserted claims concerning those patents at issue not presently before PTAB and continued the stay as to the ‘156 and ‘334 Patents. In January 2020, NuVasive filed a Motion for Partial Summary Judgment of infringement and validity of the ’832, ’780 and ’270 Patents and the Company filed a Motion for Summary Judgment of non-infringement of all asserted claims and of invalidity of the ’832 Patent and for dismissal of NuVasive’s claim for lost profits and its allegations of assignor estoppel. A hearing on the matters was held on March 13, 2020. On April 10, 2020, the Court granted NuVasive’s Motion as to the alleged infringement of the ’832 Patent only and denied NuVasive’s Motion in all other respects. On April 24, the Court granted the Company’s Motion as to dismissal of the allegations of assignor estoppel and denied the Company’s Motion in all other respects. Trial, which was originally set for April 27, 2020, has been taken off calendar due to increasing uncertainties surrounding the current public health crisis. A new trial date has not been set. The Company believes that the allegations lack merit and intends to vigorously defend all claims asserted. A liability is recorded in the consolidated financial statements if it is believed to be probable that a loss has been incurred and the amount of the loss can be reasonably estimated. It is impossible at this time to assess whether the outcome of this proceeding will have a material adverse effect on the Company’s consolidated results of operations, cash flows or financial position. Therefore, in accordance with authoritative accounting guidance, the Company has not recorded any accrual for a contingent liability associated with this legal proceeding based on its belief that a liability, while possible, is not probable and any range of potential future charge cannot be reasonably estimated at this time. Indemnifications In the normal course of business, the Company enters into agreements under which it occasionally indemnifies third-parties for intellectual property infringement claims or claims arising from breaches of representations or warranties. In addition, from time to time, the Company provides indemnity protection to third-parties for claims relating to past performance arising from undisclosed liabilities, product liabilities, environmental obligations, representations and warranties, and other claims. In these agreements, the scope and amount of remedy, or the period in which claims can be made, may be limited. It is not possible to determine the maximum potential amount of future payments, if any, due under these indemnities due to the conditional nature of the obligations and the unique facts and circumstances involved in each agreement. In October 2017, NuVasive filed a lawsuit in Delaware Chancery Court against Mr. Miles, the Company’s Chairman and CEO, who was a former officer and board member of NuVasive. The Company itself was not initially a named defendant in this lawsuit; however, on June 28, 2018, NuVasive amended its complaint to add the Company as a defendant. As of March 31, 2020, the Company has not recorded any liability on the condensed consolidated balance sheet related to this matter. On October 12, 2018, the Delaware Court ordered that NuVasive begin advancing a portion of the legal fees for Mr. Miles’ defense in the lawsuit, as well as Mr. Miles’ legal fees incurred in pursuing advancement of his fees, pursuant to an indemnification agreement between NuVasive and Mr. Miles. Royalties The Company has entered into various intellectual property agreements requiring the payment of royalties based on the sale of products that utilize such intellectual property. These royalties primarily relate to products sold by Alphatec Spine and are based on fixed fees or calculated either as a percentage of net sales or on a per-unit sold basis. Royalties are included on the accompanying consolidated statements of operations as a component of cost of revenue. As of March 31, 2020, the Company is obligated to pay guaranteed minimum royalty payments under these agreements of approximately $5.1 million through 2024 and beyond.

Orthotec Settlement

Orthotec Settlement	3 Months Ended
	Mar. 31, 2020
Commitments And Contingencies Disclosure [Abstract]
Orthotec Settlement	7. 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 one additional quarterly installment of $0.7 million, commencing October 1, 2014. The payments set forth above are guaranteed by Stipulated Judgments held against the Company, HealthpointCapital Partners, L.P., HealthpointCapital Partners II, L.P., HealthpointCapital, LLC, John H. Foster and Mortimer Berkowitz III and, in the event of a default, will be entered and enforced against these entities and/or individuals in that order. In September 2014, the Company and HealthpointCapital entered into an agreement for joint payment of settlement whereby HealthpointCapital has agreed to contribute $5 million to the $49 million settlement amount. The $5 million is classified within stockholders’ equity on the Company’s condensed consolidated balance sheet due to the related party nature with HealthpointCapital and its affiliates. See Note 12 for further information. As of March 31, 2020, the Company has made installment payments in the aggregate of $41.7 million, with a remaining outstanding balance of $16.1 million (including interest). 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 until 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 provides 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. A reconciliation of the total net settlement obligation is as follows (in thousands): March 31 2020 December 31, 2019 Litigation settlement obligation - short-term portion $ 4,400 $ 4,400 Litigation settlement obligation - long-term portion 9,865 10,712 Total 14,265 15,112 Future Interest 1,868 2,121 Total settlement obligation, gross 16,133 17,233 Related party receivable - included in stockholders' equity (5,000 ) (5,000 ) Total settlement obligation, net $ 11,133 $ 12,233

Acquisition of SafeOp Surgical,

Acquisition of SafeOp Surgical, Inc.	3 Months Ended
	Mar. 31, 2020
Business Combinations [Abstract]
Acquisition of SafeOp Surgical, Inc.	8. Acquisition of SafeOp Surgical, Inc. On March 8, 2018, the Company acquired SafeOp, a privately-held provider of neuromonitoring technology designed to enable effective intra-operative nerve health assessment. At the time of the acquisition, SafeOp had FDA 510(k) approval for a somatosensory evoked potential (“SSEP”) monitoring technology. The Company has developed a product that will allow for both free run and triggered specific recording of muscle activity, also known as Electromyography (“EMG”). The Company received FDA clearance for SafeOp’s EMG technology in February 2019 to complement the SSEP solution, and anticipates commercialization of the combined technology solution in mid-2019. In addition to expanding the Company’s market presence in lateral spine surgery, the Company believes that the SafeOp solution will allow it to integrate neuromonitoring into its broader product portfolio and accelerate the transition to procedural integration of the entire portfolio. As part of the consideration paid, in March 2018, the Company also issued $3 million in convertible notes that were convertible into a total of 987,578 shares of common stock, which included total interest incurred, and issued warrants to purchase 2.2 million shares of common stock at an exercise price of $3.50 per share and contain a five year life. The convertible notes matured on March 9, 2019 and were settled in cash. Upon maturity, the Company recognized the value associated with the beneficial conversion feature calculated at issuance of $0.2 million within interest expense on the Company’s condensed consolidated statements of operations for the three months ended March 31, 2019. Shares of common stock were issued upon achievement of post-closing milestones as described further below. The warrants issued remain outstanding as of March 31, 2020. The first of the two milestones was achieved during the year ended December 31, 2018 and resulted in the issuance of 443,421 shares of common stock as payment. The second milestone pertaining to regulatory approval was achieved and the Company issued 886,843 shares of common stock as payment during the three months ended March 31, 2019.

Net Loss Per Share

Net Loss Per Share	3 Months Ended
	Mar. 31, 2020
Earnings Per Share [Abstract]
Net Loss Per Share	9. 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, convertible preferred stock, options, convertible notes 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. The following table presents the computation of basic and diluted net loss per share for continuing and discontinued operations (in thousands, except per share amounts): Three Months Ended March 31, 2020 2019 Numerator: Net loss, basic and diluted $ (20,722 ) $ (12,968 ) Denominator: Weighted average common shares outstanding 62,732 45,310 Weighted average unvested common shares subject to repurchase (164 ) (290 ) Weighted average common shares outstanding—basic and diluted 62,568 45,020 Net loss per share, basic and diluted: $ (0.33 ) $ (0.29 ) The anti-dilutive securities not included in diluted net As of March 31, 2020 2019 Options to purchase common stock 4,195 4,670 Unvested restricted share awards 6,487 3,761 Series A Convertible Preferred Stock 67 164 Warrants to purchase common stock 24,372 22,302 Total 35,121 30,897

Stock Benefit Plans and Equity

Stock Benefit Plans and Equity Transactions	3 Months Ended
	Mar. 31, 2020
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Stock Benefit Plans and Equity Transactions	10. Stock Benefit Plans and Equity Transactions Stock Benefit Plans On October 25, 2018, the Company’s Board of Directors adopted an amendment to the Company’s 2016 Equity Incentive Award Plan, which increased the maximum aggregate number of shares with respect to one or more stock rights that may be granted to any one person during any fiscal year from 500,000 to 1,250,000. Total stock-based compensation for the three months ended March 31, 2020 and 2019 is as follows (in thousands): Three Months Ended March 31, 2020 2019 Cost of revenues $ 107 $ 28 Research and development 291 143 Sales, general and administrative 3,170 1,441 Total $ 3,568 $ 1,612 Shares Reserved for Future Issuance As of March 31, 2020, the Company had reserved shares of its common stock for future issuance as follows (in thousands): Stock options outstanding 4,195 Unvested restricted stock award 6,487 Employee stock purchase plan 114 Series A convertible preferred stock 67 Warrants outstanding 24,325 Authorized for future grant under the Distributor and Development Services plans 3,908 Authorized for future grant under the Management Objective Strategic Incentive Plan 445 Authorized for future grant under the Company equity plans 1,092 Total 40,633 Series A Convertible Preferred Stock In March 2017, the Company completed a private placement (the “2017 Private Placement”) with certain institutional and accredited investors, including certain directors, executive officers and employees of the Company (collectively, the “Purchasers”), providing for the sale by the Company of 1,809,628 shares of the Company’s common stock at a purchase price of $2.00 per share and 15,245 shares of newly designated Series A Convertible Preferred Stock at a purchase price of $1,000 per share (which shares were convertible into approximately 7,622,372 shares of common stock). Except as otherwise required by law, the holders of Series A Convertible Preferred Stock have no right to vote on matters submitted to a vote of the Company’s stockholders. During the three months ended March 31, 2020 there were no shares of Series A Convertible Preferred Stock converted into shares of common stock. During the three months ended March 31, 2019, 3,715 shares of Series A Convertible Preferred Stock were converted into 1,857,586 shares of common stock. As of March 31, 2020, there were 135 shares of Series A Convertible Preferred Stock outstanding, which are convertible into 67,338 shares of common stock. 2017 Warrants In connection with the 2017 Private Placement, the Company issued warrants to purchase up to 9,432,000 shares of the Company’s common stock at an exercise price of $2.00 per share (the “2017 Common Stock Warrants”). The Company also issued warrants to purchase common stock to the exclusive placement agents for the issuance (the “2017 Banker Warrants”). The 2017 Banker Warrants were for the purchase of up to an aggregate of 471,600 shares of the Company’s common stock with substantially the same terms as the 2017 Common Stock Warrants, except that they have an exercise price equal $2.50 per share. The 2017 Common Stock Warrants and the 2017 Banker Warrants (collectively, the “2017 Warrants”) expire on June 15, 2022. The 2017 Warrants may not be exercised by the holder to the extent that the holder, together with its affiliates, would beneficially own, after such exercise more than 4.99% of the shares of the Company’s common stock then outstanding (subject to the right of the holder to increase or decrease such beneficial ownership limitation upon notice to the Company, provided that such limitation cannot exceed 9.99%) and provided that any increase in the beneficial ownership limitation shall not be effective until 61 days after such notice is delivered. During the three months ended March 31, 2020, there were 0.1 million 2017 Warrant exercises for total cash proceeds of $0.3 million. There were no 2017 Warrant exercises for the three months ended March 31, 2019. There were no 2017 Banker Warrant exercises for the three months ended March 31, 2020 and March 31, 2019 , All the 2017 Warrants were deemed to qualify for equity classification under authoritative accounting guidance. Series B Convertible Preferred Stock On March 8, 2018, the Company completed the 2018 Private Placement to certain institutional and accredited investors, including certain directors and executive officers of the Company, at a purchase price of $1,000 per share, 45,200 of newly designated Series B Convertible Preferred Stock, which shares of preferred stock were automatically converted into 14,349,236 shares of the Company’s common stock upon approval by the Company’s stockholders at the 2018 annual meeting of stockholders held in May 2018, and warrants to purchase up to 12,196,851 shares of common stock at an exercise price of $3.50 per share (the “2018 Common Stock Warrants”). The 2018 Common Stock Warrants became exercisable following stockholder approval at the 2018 annual meeting of stockholders, are subject to certain ownership limitations in certain cases, and expire five years after the date of such stockholder approval. The gross proceeds from the 2018 Private Placement were approximately $45.2 million. 2018 Warrants The 2018 Common Stock Warrants (the “2018 Warrants”) have a five year life and are exercisable for cash or by cashless exercise. Some of the 2018 Warrants may not be exercised by the holder to the extent that the holder, together with its affiliates, would beneficially own, after such exercise more than 4.99% of the shares of the Company’s common stock then outstanding (subject to the right of the holder to increase or decrease such beneficial ownership limitation upon notice to the Company, provided that such limitation cannot exceed 9.99%) and provided that any increase in the beneficial ownership limitation shall not be effective until 61 days after such notice is delivered. In addition to the 12,196,851 During the three months ended March 31, 2020, 2.1 million of the 2018 Warrants were exercised for total proceeds of $0.9 million. There were no 2018 Warrants exercised during the three months ended March 31, 2019. A total of 11,663,147 2018 Warrants remained outstanding as of March 31, 2020. All the 2018 Warrants were deemed to qualify for equity classification under authoritative accounting guidance. Squadron Warrants As further described in Note 5, during the year ended December 31, 2018, in connection with the initial debt financing with Squadron, the Company issued warrants to purchase 845,000 shares of common stock at an exercise price of $3.15 per share. An additional 4,838,710 warrants were issued at an exercise price of $2.17 per share during the second quarter of 2019, in conjunction with the Company’s draw on the expanded credit facility for total warrants outstanding to Squadron of 5,683,710. The warrants have a seven-year term and are immediately exercisable. In accordance with authoritative accounting guidance, the warrants qualified for equity treatment upon issuance and the portion allocated to the outstanding debt were recorded as a debt discount to the face of the debt liability based on fair value to be amortized into interest expense over the life of the debt agreement. As the warrants provide for partial price protection that allow for a reduction in the price in the event of a lower per share priced issuance, the warrants were valued utilizing a Monte Carlo simulation that considers the probabilities of future financings. The Monte Carlo model simulates the present value of the potential outcomes of future stock prices of the Company over the seven-year life of the warrants. The projection of stock prices is based on the risk-free rate of return and the volatility of the stock price of the Company and correlates future equity raises based on the probabilities provided. A summary of all outstanding warrants is as follows: Number of Warrants Strike Price 2017 Common Stock Warrants 3,107,000 $ 2.00 2017 Banker Warrants 148,554 $ 2.50 2018 Common Stock Warrants 11,663,147 $ 3.50 Merger Warrants 2,199,682 $ 3.50 Executive 1,327,434 $ 5.00 Squadron Capital 845,000 $ 3.15 Squadron Capital 4,838,710 $ 2.17 Other 195,312 $ 3.85 * Total 24,324,839 * Represents weighted average exercise price. 2017 Distributor Inducement Plan In December 2017, the Board of Directors approved and adopted the 2017 Distributor Inducement Plan which authorizes the Company to issue to distributors restricted shares of common stock of the Company and/or warrants to purchase the Company’s common stock. The warrants are issuable with an exercise price equal to the fair market value of the common stock on the date of issuance. Each warrant and common stock issuance is subject to a time-based or net sales-based vesting provision. The Board of Directors authorized the grant of up to 1,000,000 shares of common stock under the 2017 Distributor Inducement Plan and also authorized the grant of warrants to purchase 50,000 shares of common stock, and 75,000 restricted stock units to a distributor of which 75,000 were earned and issued. These warrants and restricted stock units are subject to time based and net sales based vesting conditions. As of March 31, 2020, 260,000 warrants and 92,000 shares of common stock were earned and issued under the 2017 Distributor Inducement Plan. Total expense for the plan was $0.1 million for the three months ended March 31, 2020 2017 Development Services Plan In December 2017, the Board approved and adopted the 2017 Development Services Plan which authorizes the Company to enter into Development Services Agreements with third-party individuals or entities whereby, upon the achievement of certain Company financial and commercial revenue milestones, future royalty payments for product and/or intellectual property development work may be paid in either cash or restricted shares of Company common stock at the option of the developer. Each common stock issuance would be subject to net sales-based vesting provisions and satisfaction of applicable laws and market regulations regarding the issuance of restricted shares to such developers. The Board of Directors authorized the grant of up to 3,000,000 shares of common stock under the Development Services Plan. As of March 31, 2020, 2.4 million shares of restricted common stock have been granted under the 2017 Development Services Plan, but none are deemed probable of election as of March 31, 2020. In addition, no common stock elections or cash payouts have been made as of March 31, 2020. Management Objective Strategic Incentive Plan In July 2019, the Board of Directors approved and adopted the 2019 Management Objective Strategic Incentive Plan which authorizes the Company to grant restricted stock to individuals or entities that do not qualify under the other existing equity plans. The Board of Directors authorized the grant of up to 500,000 shares of common stock with a maximum grant of 50,000 shares per participant under the plan. As of March 31, 2020, 55,000 restricted shares have been granted under the 2019 Management Objective Strategic Incentive Plan. Total expense for the plan was immaterial for the three months ended March 31, 2020.

Income Taxes

Income Taxes	3 Months Ended
	Mar. 31, 2020
Income Tax Disclosure [Abstract]
Income Taxes	11. 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. Intraperiod tax allocation rules require the Company to allocate the provision for income taxes between continuing operations and other categories of earnings, such as discontinued operations. In periods in which the Company has a year-to-date pre-tax loss from continuing operations and pre-tax income in other categories of earnings, such as discontinued operations, the Company must allocate the tax provision to the other categories of earnings, and then record a related tax benefit in continuing operations The unrecognized tax benefits at March 31, 2020 and December 31, 2019 were $2.5 million for both periods, with no changes occurring during the year-to-date period. With the information currently available to the Company, it is reasonably possible there will not be a reversal to the tax reserves over the next twelve-month period. The Company recognizes interest and penalties related to uncertain tax positions as a component of the income tax provision. The Company is not currently under examination by the Internal Revenue Service, foreign, or state or local tax authorities. For the three months ended March 31, 2020, the Company had an effective tax rate of 0% and recognized an immaterial amount of income tax benefit from continuing operations .

Related Party Transactions

Related Party Transactions	3 Months Ended
	Mar. 31, 2020
Related Party Transactions [Abstract]
Related Party Transactions	12. Related Party Transactions In July 2016, 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 contractual rights to seek an immediate repayment of such amount. Pursuant to this forbearance agreement, the Company repaid this amount in September 2016. The Company and HealthpointCapital also entered into an agreement for joint payment of settlement whereby HealthpointCapital has agreed to contribute $5 million to the $49 million Orthotec settlement amount. During the second quarter of 2018, HealthpointCapital Partners, L.P., and HealthpointCapital Partners II, L.P. distributed its holdings in the Company’s common stock to its limited partners. As a result, the fund is no longer a shareholder of the Company as of March 31, 2020 classified within stockholders’ equity on the Company’s condensed consolidated balance sheets due to the related party nature with HealthpointCapital affiliates.

Restructuring

Restructuring	3 Months Ended
	Mar. 31, 2020
Restructuring And Related Activities [Abstract]
Restructuring	13. Restructuring In connection with the sale of the International Business (described in Note 4), the Company terminated employment agreements with several executive officers, including the chief executive officer and the chief financial officer, and commenced an employee headcount reduction program. In conjunction with the restructuring program, the Company recorded restructuring expenses related to severance liabilities and post-employment benefits. A rollforward of the accrued restructuring liability is presented below (in thousands): Balance at January 1, 2020 $ 24 Accrued restructuring charges — Payments (7 ) Balance at March 31, 2020 $ 17 All activities and costs are expected to be completed during 2020.

Subsequent Event

Subsequent Event	3 Months Ended
	Mar. 31, 2020
Subsequent Events [Abstract]
Subsequent Event	14. Subsequent Event Salary-to-Equity Conversion Program Effective April 5, 2020, the Company implemented a voluntary salary-to-equity conversion program for certain employees whose annual payroll costs exceed $100,000, including the Company’s executive officers. The program permits each participant to make a voluntary election to reduce the participant’s compensation rate through July 11, 2020 from 10% to 75%. In exchange for the compensation reduction, each participant will be granted a restricted stock unit equal to the dollar amount of compensation reduction divided by the 30-day volume weighted average price of the Company’s common stock as of close of market on April 3, 2020. The restricted stock units granted under the program will fully vest on July 10, 2020. The restricted stock units will also vest upon a change in control of the Company and will be subject to certain accelerated vesting in the event of the participant’s death or disability. The temporary reduction in compensation to the participants shall not be treated as a reduction in base annual salary rate for purposes of any other benefits plans in which the participants are enrolled or eligible to participate, including in any bonus plans of the Company. Paycheck Protection Program Loan On April 23, 2020, the Company received the proceeds from a loan in the amount of approximately $4.3 million (the “PPP Loan”) from Silicon Valley Bank, as lender, pursuant to the Paycheck Protection Program (“PPP”) of the Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”). The PPP Loan matures on April 21, 2022 and bears interest at a rate of 1.0% per annum. Commencing November 21, 2020, the Company is required to pay the lender equal monthly payments of principal and interest as required to fully amortize by April 21, 2022 the principal amount outstanding on the PPP Loan as of October 21, 2020. The PPP Loan is evidenced by a promissory note dated April 21, 2020, which contains customary events of default relating to, among other things, payment defaults and breaches of representations and warranties. The PPP Loan may be prepaid by the Company at any time prior to maturity with no prepayment penalties. All or a portion of the PPP Loan may be forgiven by the U.S. Small Business Administration (“SBA”) upon application by the Company beginning 60 days but not later than 120 days after loan approval and upon documentation of expenditures in accordance with the SBA requirements. Under the CARES Act, loan forgiveness is available for the sum of documented payroll costs, covered rent payments, covered mortgage interest and covered utilities during the eight-week period beginning on the date of loan approval. For purposes of the CARES Act, payroll costs exclude compensation of an individual employee in excess of $100,000, prorated annually. Not more than 25% of the forgiven amount may be for non-payroll costs. Forgiveness is reduced if full-time headcount declines, or if salaries and wages for employees with salaries of $100,000 or less annually are reduced by more than 25%. In the event the PPP Loan, or any portion thereof, is forgiven pursuant to the PPP, the amount forgiven is applied to outstanding principal. No assurance is provided that the Company will apply for and obtain forgiveness of the PPP Loan in whole or in part. The Company intends to use all proceeds from the PPP Loan to retain employees and maintain payroll. Termination of Tender Offer Agreement and Commitment Letter On April 27, 2020, the Company announced that it has terminated the Tender Offer Agreement with EOS Imaging S.A., or EOS. This decision follows the Company’s consideration and analysis of the expected ongoing market effects of the COVID-19 pandemic, including the magnitude and duration of its impact on capital equipment priorities and purchases in significant EOS markets, including the United States. Based upon its assessment, the Company concluded that a “Material Adverse Effect” (as defined in the Tender Offer Agreement) has occurred, resulting in circumstances that are no longer conducive to completion of the transaction described in the Tender Offer Agreement. The Company notified EOS of its termination decision, as required by the Tender Offer Agreement, in a letter dated April 24, 2020. On April 27, 2020, the Company also announced that, in connection with the termination of the Tender Offer Agreement, the Company and Perceptive Credit Holdings III, LP have agreed to terminate the debt refinancing commitment letter, including the exclusivity obligations thereunder, entered into in connection with the EOS transaction. Expanded Credit Facility With Squadron Capital On May 9, 2020, the Company executed a commitment letter for $35 million in additional secured financing from Squadron. This capital will be made available under the same material terms and conditions as the existing term loan with Squadron, subject to customary closing conditions. Under the terms of the amended facility, the maturity date on the entire term loan will be extended to May 2025. A portion of the proceeds from the expanded facility will be used to retire the Company’s outstanding obligation under its working capital revolver with MidCap. In connection with the additional commitment, the Company will issue warrants to purchase 1.076 million shares of ATEC common stock at an exercise price of $4.88 per share. ATEC expects this transaction to close before the end of May 2020.

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	3 Months Ended
	Mar. 31, 2020
Accounting Policies [Abstract]
Transaction-related Expenses	Transaction-related Expenses The Company expensed certain costs related to the tender offer for the acquisition of EOS Imaging, which primarily include third-party advisory fees, legal fees and commitment fees related to transaction financing arrangements.
Fair Value Measurements	Fair Value Measurements T he 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: Level 2: Level 3: The Company does not maintain any financial assets that are considered to be Level 1, Level 2 or Level 3 instruments as of March 31, 2020. During the second quarter of 2019, the Company issued a liability classified equity award to one of its executive officers. The award will be earned over a 4 year vesting period and upon a specific market condition. As the award will be cash settled, it is classified as a liability within Level 3 of the fair value hierarchy as the Company is using a probability-weighted income approach, utilizing significant unobservable inputs including the probability of achieving the specified market condition with the valuation updated at each reporting period. The full fair value of the cash settled award was $0.6 million as of March 31, 2020 and is being recognized ratably as the underlying service period is provided. The following table provides a reconciliation of liabilities measured at fair value using significant unobservable inputs (Level 3) for the three months ended March 31, 2020 (in thousands): Level 3 Liabilities Balance at January 1, 2020 $ 266 Vested portion of liability classified equity award 107 Change in fair value measurement (238 ) Balance at March 31, 2020 $ 135
Recent Accounting Pronouncements	Recent Accounting Pronouncements Recently Adopted Accounting Pronouncements In November 2019, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2019-08, Compensation—Stock Compensation (Topic 718) and Revenue from Contracts with Customers (Topic 606), which clarifies that an entity must measure and classify share-based payment awards granted to a customer by applying the guidance in Topic 718. Accounting Standard Codification (“ASC”) 2019-08 is effective for annual reporting periods beginning after December 15, 2019, including interim reporting periods within those annual reporting periods. The Company adopted the guidance effective January 1, 2020 and recorded a cumulative adjustment of $0.1 million to accumulated deficit as of January 1, 2020. In January 2017, the FASB issued ASU 2017-04, Intangibles – Goodwill and Other In August 2018, the FASB issued ASU 2018-15, Intangibles—Goodwill and Other—Internal-Use Software (Subtopic 350-40), which aligns the accounting for cloud computing implementation costs with that of costs to develop or obtain internal-use software, meaning such costs that are part of the application development stage are capitalized as an asset and amortized over the term of the arrangement, otherwise, such costs are expensed as incurred. It also clarifies the classification of amounts related to capitalized implementation costs in the financial statements. ASC 2018-15 is effective for annual reporting periods beginning after December 15, 2019, including interim reporting periods within those annual reporting periods. Early adoption is permitted. The Company adopted the guidance effective January 1, 2020. It did not have a material impact on the Company’s consolidated financial statements. Recently Issued Accounting Pronouncements The Company has evaluated all recent accounting pronouncements issued by the Financial Accounting Standards Board in the form of Accounting Standards Updates through the date these financial statements were available to be issued and found no recent accounting pronouncements issued, but not yet effective that when adopted, would have a material impact on the financial statements of the Company.

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Tables)	3 Months Ended
	Mar. 31, 2020
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 three months ended March 31, 2020 (in thousands): Level 3 Liabilities Balance at January 1, 2020 $ 266 Vested portion of liability classified equity award 107 Change in fair value measurement (238 ) Balance at March 31, 2020 $ 135

Select Condensed Consolidated_2

Select Condensed Consolidated Balance Sheet Details (Tables)	3 Months Ended
	Mar. 31, 2020
Balance Sheet Related Disclosures [Abstract]
Accounts receivable, net	Accounts receivable, net consist of the following (in thousands): March 31, 2020 December 31, 2019 Accounts receivable $ 15,664 $ 16,436 Allowance for doubtful accounts (289 ) (286 ) Accounts receivable, net $ 15,375 $ 16,150
Inventories, net	Inventories, net consist of the following (in thousands): March 31, 2020 December 31, 2019 Raw materials $ 5,402 $ 5,822 Work-in-process 2,052 1,578 Finished goods 56,005 51,669 63,459 59,069 Less reserve for excess and obsolete finished goods (25,587 ) (24,215 ) Inventories, net $ 37,872 $ 34,854
Property and equipment, net	Property and equipment, net consist of the following (in thousands except as indicated): Useful lives (in years) March 31, 2020 December 31, 2019 Surgical instruments 4 $ 59,807 $ 58,502 Machinery and equipment 7 6,426 6,038 Computer equipment 3 3,879 3,594 Office furniture and equipment 5 1,351 1,297 Leasehold improvements various 1,761 1,761 Construction in progress n/a 216 496 73,440 71,688 Less accumulated depreciation and amortization (52,521 ) (51,966 ) Property and equipment, net $ 20,919 $ 19,722
Intangible assets, net	Intangible assets, net consist of the following (in thousands, except as indicated): Remaining Avg. Useful lives (in years) March 31, 2020 December 31, 2019 Developed technology 10 $ 26,976 $ 26,976 Intellectual property — 1,004 1,004 License agreements 1 5,536 5,536 Trademarks and trade names — 792 792 Customer-related 4 7,458 7,458 Distribution network 3 4,027 4,027 In process research and development 19 8,800 8,800 54,593 54,593 Less accumulated amortization (29,428 ) (28,988 ) Intangible assets, net $ 25,165 $ 25,605
Schedule of intangible assets, future expected amortization expense	Developed technology and in process research and development intangibles are expected to begin amortizing when the relevant products reach full commercial launch. Future amortization expense related to intangible assets as of March 31, 2020 is as follows (in thousands): Year Ending December 31, Remainder of 2020 $ 1,428 2021 1,888 2022 1,888 2023 1,888 2024 1,785 Thereafter 16,288 $ 25,165
Accrued expenses	Accrued expenses consist of the following (in thousands): March 31, 2020 December 31, 2019 Commissions and sales milestones $ 4,129 $ 5,299 Payroll and payroll related 3,598 7,949 Litigation settlement obligation - short-term portion 4,400 4,400 Professional fees 5,999 3,945 Royalties 2,170 1,981 Restructuring 17 29 Taxes 103 82 Interest 170 155 Other 3,186 2,576 Total accrued expenses $ 23,772 $ 26,416
Schedule of Other Long-Term Liabilities	Other long-term liabilities consist of the following (in thousands): March 31, 2020 December 31, 2019 Litigation settlement obligation - long-term portion $ 9,865 $ 10,712 Line of credit exit fee 600 600 Tax liabilities 371 373 Other 135 266 Other long-term liabilities $ 10,971 $ 11,951

Debt (Tables)

Debt (Tables)	3 Months Ended
	Mar. 31, 2020
Debt Disclosure [Abstract]
Principal Payments Remaining on Debt	Principal payments remaining on the Company's debt are as follows as of March 31, 2020 (in thousands): Year Ending December 31, Remainder of 2020 $ 885 2021 4,483 2022 19,607 2023 35,820 Total 60,795 Add: capital lease principal payments 92 Less: unamortized debt discount and debt issuance costs (6,938 ) Total 53,949 Less: current portion of long-term debt (916 ) Long-term debt, net of current portion $ 53,033

Commitments and Contingencies (

Commitments and Contingencies (Tables)	3 Months Ended
	Mar. 31, 2020
Commitments And Contingencies Disclosure [Abstract]
Future minimum annual lease payments	Future minimum annual lease payments under such leases are as follows as of March 31, 2020 (in thousands): Undiscounted lease payments: Year Ending December 31, Remainder of 2020 $ 1,114 2021 916 2022 39 Total undiscounted lease payments 2,069 Less: present value adjustment (154 ) Operating lease liability 1,915 Less: current portion of operating lease liability (1,356 ) Operating lease liability, less current portion $ 559

Orthotec Settlement (Tables)

Orthotec Settlement (Tables)	3 Months Ended
	Mar. 31, 2020
Commitments And Contingencies Disclosure [Abstract]
Schedule of Reconciliation of Total Net Settlement Obligation	A reconciliation of the total net settlement obligation is as follows (in thousands): March 31 2020 December 31, 2019 Litigation settlement obligation - short-term portion $ 4,400 $ 4,400 Litigation settlement obligation - long-term portion 9,865 10,712 Total 14,265 15,112 Future Interest 1,868 2,121 Total settlement obligation, gross 16,133 17,233 Related party receivable - included in stockholders' equity (5,000 ) (5,000 ) Total settlement obligation, net $ 11,133 $ 12,233

Net Loss Per Share (Tables)

Net Loss Per Share (Tables)	3 Months Ended
	Mar. 31, 2020
Earnings Per Share [Abstract]
Computation of Basic and Diluted Net Loss Per Share for Continuing and Discontinued Operations	The following table presents the computation of basic and diluted net loss per share for continuing and discontinued operations (in thousands, except per share amounts): Three Months Ended March 31, 2020 2019 Numerator: Net loss, basic and diluted $ (20,722 ) $ (12,968 ) Denominator: Weighted average common shares outstanding 62,732 45,310 Weighted average unvested common shares subject to repurchase (164 ) (290 ) Weighted average common shares outstanding—basic and diluted 62,568 45,020 Net loss per share, basic and diluted: $ (0.33 ) $ (0.29 )
Anti-dilutive securities not included in diluted net loss per share	The anti-dilutive securities not included in diluted net As of March 31, 2020 2019 Options to purchase common stock 4,195 4,670 Unvested restricted share awards 6,487 3,761 Series A Convertible Preferred Stock 67 164 Warrants to purchase common stock 24,372 22,302 Total 35,121 30,897

Stock Benefit Plans and Equit_2

Stock Benefit Plans and Equity Transactions (Tables)	3 Months Ended
	Mar. 31, 2020
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Summary of Total Stock Based Compensation	Total stock-based compensation for the three months ended March 31, 2020 and 2019 is as follows (in thousands): Three Months Ended March 31, 2020 2019 Cost of revenues $ 107 $ 28 Research and development 291 143 Sales, general and administrative 3,170 1,441 Total $ 3,568 $ 1,612
Summary of Common Stock Reserved for Future Issuance	As of March 31, 2020, the Company had reserved shares of its common stock for future issuance as follows (in thousands): Stock options outstanding 4,195 Unvested restricted stock award 6,487 Employee stock purchase plan 114 Series A convertible preferred stock 67 Warrants outstanding 24,325 Authorized for future grant under the Distributor and Development Services plans 3,908 Authorized for future grant under the Management Objective Strategic Incentive Plan 445 Authorized for future grant under the Company equity plans 1,092 Total 40,633
Summary of Outstanding Warrants	A summary of all outstanding warrants is as follows: Number of Warrants Strike Price 2017 Common Stock Warrants 3,107,000 $ 2.00 2017 Banker Warrants 148,554 $ 2.50 2018 Common Stock Warrants 11,663,147 $ 3.50 Merger Warrants 2,199,682 $ 3.50 Executive 1,327,434 $ 5.00 Squadron Capital 845,000 $ 3.15 Squadron Capital 4,838,710 $ 2.17 Other 195,312 $ 3.85 * Total 24,324,839 * Represents weighted average exercise price.

Restructuring (Tables)

Restructuring (Tables)	3 Months Ended
	Mar. 31, 2020
Restructuring And Related Activities [Abstract]
Rollforward of accrued restructuring liability	A rollforward of the accrued restructuring liability is presented below (in thousands): Balance at January 1, 2020 $ 24 Accrued restructuring charges — Payments (7 ) Balance at March 31, 2020 $ 17

The Company and Basis of Pres_2

The Company and Basis of Presentation - Additional Information (Details) - USD ($) $ in Thousands	May 09, 2020	Mar. 27, 2019	Nov. 06, 2018	Mar. 31, 2020	Mar. 31, 2019	Apr. 30, 2020	Dec. 31, 2019
Company And Basis Of Presentation [Line Items]
Working capital				$ 53,800
Cash				27,466			$ 47,113
Stock-based compensation				3,568	$ 1,612
Reclassification
Company And Basis Of Presentation [Line Items]
Stock-based compensation					$ 100
Subsequent Event | Expanded Credit Facility
Company And Basis Of Presentation [Line Items]
Debt instrument, maturity date	May 31, 2025
Squadron Credit Agreement
Company And Basis Of Presentation [Line Items]
Debt instrument, maturity date		Nov. 30, 2023	Nov. 30, 2023
Squadron Credit Agreement | Subsequent Event | Expanded Credit Facility
Company And Basis Of Presentation [Line Items]
Maximum borrowing capacity	$ 35,000
Current Lenders
Company And Basis Of Presentation [Line Items]
Minimum financial covenant cash balance				$ 5,000
Term Loan | Squadron Credit Agreement | Subsequent Event
Company And Basis Of Presentation [Line Items]
Amount drawn on credit facility						$ 20,000

Summary of Significant Accoun_4

Summary of Significant Accounting Policies - Additional Information (Details) - USD ($) $ in Thousands	Jan. 01, 2020	Mar. 31, 2020
Significant Accounting Policies [Line Items]
Cumulative adjustment to accumulated deficit		$ (81)
ASU No. 2019-08
Significant Accounting Policies [Line Items]
Cumulative adjustment to accumulated deficit	$ 100
Fair value, inputs, level 3
Significant Accounting Policies [Line Items]
Vesting period		4 years
Fair value of the cash settled award		$ 600

Summary of Significant Accoun_5

Summary of Significant Accounting Policies - Reconciliation of Liabilities (Details) - Fair value, inputs, level 3 $ in Thousands	3 Months Ended
	Mar. 31, 2020USD ($)
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Roll Forward]
Beginning balance	$ 266
Vested portion of liability classified equity award	107
Change in fair value measurement	(238)
Ending balance	$ 135

Select Condensed Consolidated_3

Select Condensed Consolidated Balance Sheet Details - Accounts Receivable, Net (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Balance Sheet Related Disclosures [Abstract]
Accounts receivable	$ 15,664	$ 16,436
Allowance for doubtful accounts	(289)	(286)
Accounts receivable, net	$ 15,375	$ 16,150

Select Condensed Consolidated_4

Select Condensed Consolidated Balance Sheet Details - Inventories, Net (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Balance Sheet Related Disclosures [Abstract]
Raw materials	$ 5,402	$ 5,822
Work-in-process	2,052	1,578
Finished goods	56,005	51,669
Inventory, gross, total	63,459	59,069
Less reserve for excess and obsolete finished goods	(25,587)	(24,215)
Inventories, net	$ 37,872	$ 34,854

Select Condensed Consolidated_5

Select Condensed Consolidated Balance Sheet Details - Property and Equipment, Net (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Dec. 31, 2019
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 73,440	$ 71,688
Less accumulated depreciation and amortization	(52,521)	(51,966)
Property and equipment, net	$ 20,919	19,722
Surgical instruments
Property, Plant and Equipment [Line Items]
Useful lives	4 years
Property and equipment, gross	$ 59,807	58,502
Machinery and equipment
Property, Plant and Equipment [Line Items]
Useful lives	7 years
Property and equipment, gross	$ 6,426	6,038
Computer equipment
Property, Plant and Equipment [Line Items]
Useful lives	3 years
Property and equipment, gross	$ 3,879	3,594
Office furniture and equipment
Property, Plant and Equipment [Line Items]
Useful lives	5 years
Property and equipment, gross	$ 1,351	1,297
Leasehold improvements
Property, Plant and Equipment [Line Items]
Various useful lives of leasehold improvements	various
Property and equipment, gross	$ 1,761	1,761
Construction in progress
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 216	$ 496

Select Condensed Consolidated_6

Select Condensed Consolidated Balance Sheet Details - Additional Information (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019	Dec. 31, 2019
Property, Plant and Equipment [Line Items]
Depreciation	$ 2	$ 1.6
Amortization of intangible assets	0.2	$ 0.2
Machinery and equipment
Property, Plant and Equipment [Line Items]
Capital leased assets, gross	$ 0.1		$ 0.1

Select Condensed Consolidated_7

Select Condensed Consolidated Balance Sheet Details - Intangible Assets, Net (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Dec. 31, 2019
Finite Lived Intangible Assets [Line Items]
Intangible assets, Gross	$ 54,593	$ 54,593
Less accumulated amortization	(29,428)	(28,988)
Intangible assets, net	$ 25,165	25,605
Developed technology
Finite Lived Intangible Assets [Line Items]
Useful lives	10 years
Intangible assets, Gross	$ 26,976	26,976
Intellectual property
Finite Lived Intangible Assets [Line Items]
Intangible assets, Gross	$ 1,004	1,004
License agreements
Finite Lived Intangible Assets [Line Items]
Useful lives	1 year
Intangible assets, Gross	$ 5,536	5,536
Trademarks and trade names
Finite Lived Intangible Assets [Line Items]
Intangible assets, Gross	$ 792	792
Customer-related
Finite Lived Intangible Assets [Line Items]
Useful lives	4 years
Intangible assets, Gross	$ 7,458	7,458
Distribution network
Finite Lived Intangible Assets [Line Items]
Useful lives	3 years
Intangible assets, Gross	$ 4,027	4,027
In process research and development
Finite Lived Intangible Assets [Line Items]
Useful lives	19 years
Intangible assets, Gross	$ 8,800	$ 8,800

Select Condensed Consolidated_8

Select Condensed Consolidated Balance Sheet Details - Schedule of Intangible Assets, Future Expected Amortization Expense (Details) $ in Thousands	Mar. 31, 2020USD ($)
Balance Sheet Related Disclosures [Abstract]
Remainder of 2020	$ 1,428
2021	1,888
2022	1,888
2023	1,888
2024	1,785
Thereafter	16,288
Total	$ 25,165

Select Condensed Consolidated_9

Select Condensed Consolidated Balance Sheet Details - Accrued Expenses (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Balance Sheet Related Disclosures [Abstract]
Commissions and sales milestones	$ 4,129	$ 5,299
Payroll and payroll related	3,598	7,949
Litigation settlement obligation - short-term portion	4,400	4,400
Professional fees	5,999	3,945
Royalties	2,170	1,981
Restructuring	17	29
Taxes	103	82
Interest	170	155
Other	3,186	2,576
Total accrued expenses	$ 23,772	$ 26,416

Select Condensed Consolidate_10

Select Condensed Consolidated Balance Sheet Details - Schedule of Other Long-Term Liabilities (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Balance Sheet Related Disclosures [Abstract]
Litigation settlement obligation - long-term portion	$ 9,865	$ 10,712
Line of credit exit fee	600	600
Tax liabilities	371	373
Other	135	266
Other long-term liabilities	$ 10,971	$ 11,951

Discontinued Operations - Addit

Discontinued Operations - Additional Information (Details) $ in Thousands	Sep. 01, 2016option	Mar. 31, 2020USD ($)	Mar. 31, 2019USD ($)
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Contracts revenue		$ 30,115	$ 24,555
Cost of revenues		9,084	7,987
Supply agreement
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Contracts revenue		1,000	1,600
Cost of revenues		$ 1,000	$ 1,400
Discontinued operations, disposed of by sale | International Operations
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Supply commitment term	3 years
Supply agreement, number of annual options to extend | option	2
Supply agreement, extended term			12 months
Supply agreement, extended period			2020-08

Debt - MidCap Facility Agreemen

Debt - MidCap Facility Agreement (Details) - Amended credit facility with MidCap	3 Months Ended
	Mar. 31, 2020USD ($)
Line of Credit Facility [Line Items]
Unamortized debt discount	$ 900,000
Revolving credit facility
Line of Credit Facility [Line Items]
Maximum borrowing capacity	22,500,000
Line of credit	$ 11,900,000
Line of credit, expiration month and year	2022-12
Interest rate	7.58%
Revolving credit facility | LIBOR
Line of Credit Facility [Line Items]
Interest rate description	(“LIBOR”) plus 6.0%,
Basis spread	6.00%
Term Loan
Line of Credit Facility [Line Items]
Maximum borrowing capacity	$ 5,000,000

Debt - Squadron Credit Agreemen

Debt - Squadron Credit Agreement (Details) - Squadron Credit Agreement - USD ($)	May 09, 2020	Mar. 27, 2019	Nov. 06, 2018	Mar. 31, 2020	Mar. 31, 2019	Apr. 30, 2020	Apr. 02, 2020
Line of Credit Facility [Line Items]
Current interest rate			10.00%
Debt instrument, aggregate principal to be paid on installments			$ 10,000,000
Debt instrument, frequency of periodic payment		29 equal monthly installments	29 equal monthly installments
Debt instrument, maturity date		Nov. 30, 2023	Nov. 30, 2023
New debt issuance costs					$ 300,000
Additional warrants for future				0
Debt carrying amount, net of issuance cost				$ 39,000,000
Debt issuance costs				$ 6,000,000
Debt issuance cost, amortization period				5 years
Expanded Credit Facility
Line of Credit Facility [Line Items]
Maximum borrowing capacity		$ 30,000,000		$ 45,000,000
Expanded Credit Facility | Subsequent Event
Line of Credit Facility [Line Items]
Debt instrument, maturity date	May 31, 2025
Common Stock
Line of Credit Facility [Line Items]
Number of warrants issued (in shares)		4,838,710	845,000
Exercise price of warrants		$ 2.17	$ 3.15
Warrants term		7 years	7 years
Common Stock | Subsequent Event
Line of Credit Facility [Line Items]
Number of warrants issued (in shares)	1,076,000
Exercise price of warrants	$ 4.88
Minimum
Line of Credit Facility [Line Items]
Current interest rate			10.00%
Maximum
Line of Credit Facility [Line Items]
Current interest rate			13.00%
Line of Credit
Line of Credit Facility [Line Items]
Line of credit				$ 10,000,000
Floor on interest rate		10.00%
Ceiling on interest rate		13.00%
Line of Credit | Subsequent Event
Line of Credit Facility [Line Items]
Line of credit							$ 20,000,000
Line of Credit | LIBOR
Line of Credit Facility [Line Items]
Maturity Term			5 years
Interest rate description			LIBOR plus 8%
Basis spread			8.00%
Term Loan
Line of Credit Facility [Line Items]
Secured debt agreement			$ 35,000,000
Term Loan | Subsequent Event
Line of Credit Facility [Line Items]
Line of credit						$ 20,000,000

Debt - Inventory Financing Agre

Debt - Inventory Financing Agreement (Details) - Inventory Financing Agreement	3 Months Ended
	Mar. 31, 2020USD ($)
Line of Credit Facility [Line Items]
Maximum borrowing capacity	$ 3,000,000
Line of Credit
Line of Credit Facility [Line Items]
Debt instrument, maturity date	Nov. 6, 2023
Debt instrument, frequency of periodic payment	monthly
Obligation outstanding under inventory financing agreement	$ 3,000,000
LIBOR | Line of Credit
Line of Credit Facility [Line Items]
Interest rate description	LIBOR plus 8%
Basis spread	8.00%
Floor on interest rate	10.00%
Ceiling on interest rate	13.00%

Debt - Principal Payments Remai

Debt - Principal Payments Remaining on Debt (Details) $ in Thousands	Mar. 31, 2020USD ($)
Debt Disclosure [Abstract]
Remainder of 2020	$ 885
2021	4,483
2022	19,607
2023	35,820
Total	60,795
Add: capital lease principal payments	92
Less: unamortized debt discount and debt issuance costs	(6,938)
Total	53,949
Less: current portion of long-term debt	(916)
Long-term debt, net of current portion	$ 53,033

Debt - Covenants (Details)

Debt - Covenants (Details) - Line of Credit $ in Millions	3 Months Ended
	Mar. 31, 2020USD ($)
Line of Credit Facility [Line Items]
Minimum liquidity covenant amount	$ 5
Fixed Charge Coverage Ratio	100.00%
Maximum
Line of Credit Facility [Line Items]
Debt default, interest rate increase	5.00%

Commitments and Contingencies -

Commitments and Contingencies - Additional Information (Details)	Dec. 04, 2019ft²	Mar. 31, 2020USD ($)	Mar. 31, 2019USD ($)	Jan. 01, 2019
Loss Contingencies [Line Items]
Remaining operating lease term		1 year 4 months 24 days
Rent expense		$ 300,000	$ 300,000
Payments related to operating lease		400,000	$ 300,000
Liability in connection with lawsuit		0
Alphatec Spine, Inc.
Loss Contingencies [Line Items]
Guaranteed obligated minimum royalty payments through 2024 and beyond		$ 5,100,000
Minimum
Loss Contingencies [Line Items]
Operating lease term		1 year
Maximum
Loss Contingencies [Line Items]
Operating lease term		5 years 6 months
Building lease
Loss Contingencies [Line Items]
Area for facility of office, engineering and research and development space | ft²	121,541
Lease agreement commencement date	Nov. 15, 2020
Lease agreement expiry date	Nov. 30, 2030
Operating lease discount rate				10.50%

Commitments and Contingencies_2

Commitments and Contingencies - Future Minimum Annual Lease Payments (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Commitments And Contingencies Disclosure [Abstract]
Remainder of 2020	$ 1,114
2021	916
2022	39
Total undiscounted lease payments	2,069
Less: present value adjustment	(154)
Operating lease liability	1,915
Less: current portion of operating lease liability	(1,356)	$ (1,314)
Operating lease liability, less current portion	$ 559	$ 925

Orthotec Settlement - Additiona

Orthotec Settlement - Additional Information (Details)	Jul. 01, 2016USD ($)	Oct. 01, 2014USD ($)	Aug. 13, 2014USD ($)installment	Sep. 30, 2014USD ($)	Apr. 30, 2014USD ($)	Mar. 31, 2014USD ($)	Mar. 31, 2020USD ($)	Dec. 31, 2019USD ($)
Loss Contingencies [Line Items]
Settlement amount to be contributed							$ 5,000,000	$ 5,000,000
Litigation settlement, remaining outstanding balance including interest							0
Orthotec LLC, litigation settlement
Loss Contingencies [Line Items]
Judgment assessed by court for (against) company			$ 49,000,000
Payments of settlement					$ 15,750,000	$ 1,750,000	41,700,000
Number of quarterly installments | installment			28
Litigation settlement interest, quarterly installments, amount			$ 1,100,000
Litigation settlement, final installment amount			700,000
Litigation settlement, remaining outstanding balance including interest							16,100,000
Orthotec LLC, litigation settlement | HealthpointCapital, LLC
Loss Contingencies [Line Items]
Judgment assessed by court for (against) company				$ 5,000,000
Payments of settlement	$ 1,000,000						1,100,000
Settlement amount to be contributed							$ 5,000,000
Beginning fourth quarter of 2014 | Orthotec LLC, litigation settlement
Loss Contingencies [Line Items]
Settlement amount, remaining balance		$ 31,500,000
Litigation settlement interest, quarterly installments, amount			$ 1,100,000
Litigation settlement interest rate			7.00%
Litigation settlement payments, quarterly payment amount			$ 1,100,000
Final installment | Orthotec LLC, litigation settlement
Loss Contingencies [Line Items]
Number of quarterly installments | installment			1

Orthotec Settlement - Schedule

Orthotec Settlement - Schedule of Reconciliation of Total Net Settlement Obligation (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Commitments And Contingencies Disclosure [Abstract]
Litigation settlement obligation - short-term portion	$ 4,400	$ 4,400
Litigation settlement obligation - long-term portion	9,865	10,712
Total	14,265	15,112
Future Interest	1,868	2,121
Total settlement obligation, gross	16,133	17,233
Related party receivable - included in stockholders' equity	(5,000)	(5,000)
Total settlement obligation, net	$ 11,133	$ 12,233

Acquisition of SafeOp Surgica_2

Acquisition of SafeOp Surgical, Inc. - Additional Information (Details) - USD ($) $ / shares in Units, $ in Millions	Mar. 08, 2018	Mar. 31, 2018	Mar. 31, 2019	Dec. 31, 2018
Common Stock
Business Acquisition [Line Items]
Stock issued for acquisition			887,000
SafeOp Surgical, Inc.
Business Acquisition [Line Items]
Business acquisition date	Mar. 8, 2018
Convertible notes issued		$ 3
Convertible note convertible to common stock		987,578
Number of warrants issued		2,200,000
Exercise price of warrants per share		$ 3.50
Warrant issued to purchase of common stock and purchase of common stock period		5 years
Convertible note, maturity date		Mar. 9, 2019
SafeOp Surgical, Inc. | Common Stock
Business Acquisition [Line Items]
Stock issued for acquisition			886,843	443,421
SafeOp Surgical, Inc. | Interest Expense
Business Acquisition [Line Items]
Recognition of beneficial conversion feature SafeOp convertible notes			$ 0.2

Net Loss Per Share - Computatio

Net Loss Per Share - Computation of Basic and Diluted Net Loss Per Share for Continuing and Discontinued Operations (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Numerator:
Net loss, basic and diluted	$ (20,722)	$ (12,968)
Denominator:
Weighted average common shares outstanding	62,732	45,310
Weighted average unvested common shares subject to repurchase	(164)	(290)
Weighted average common shares outstanding—basic and diluted	62,568	45,020
Net loss per share, basic and diluted:	$ (0.33)	$ (0.29)

Net Loss Per Share - Anti-Dilut

Net Loss Per Share - Anti-Dilutive Securities Not Included in Diluted Net Loss Per Share (Details) - shares shares in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Anti-dilutive securities not included in diluted net loss per share (in shares)	35,121	30,897
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)	4,195	4,670
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)	6,487	3,761
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)	24,372	22,302
Series A Convertible Preferred 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)	67	164

Stock Benefit Plans and Equit_3

Stock Benefit Plans and Equity Transactions - Additional Information (Details) - USD ($) $ / shares in Units, $ in Thousands	Mar. 08, 2018	Jul. 31, 2019	Mar. 31, 2017	Mar. 31, 2020	Mar. 31, 2019	Dec. 31, 2017	Sep. 30, 2019	Jun. 30, 2019	Dec. 31, 2018	Oct. 25, 2018
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Warrants outstanding				24,324,839
Stock-based compensation				$ 3,568	$ 1,612
2017 Common Stock Warrants
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Exercise price of warrants				$ 2
Proceeds from exercise of warrant				$ 300
Number of warrants exercised				100,000	0
Warrants outstanding				3,107,000
2017 Banker Warrants
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Exercise price of warrants				$ 2.50
Warrants outstanding				148,554
2018 Common Stock Warrants
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of warrants issued (in shares)				1,800,000
Exercise price of warrants				$ 3.50
Number of warrants exercised				525,000
Warrants outstanding				11,663,147
Warrant expiration period				5 years
Squadron Capital
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of warrants issued (in shares)								4,838,710	845,000
Exercise price of warrants								$ 2.17	$ 3.15
Warrants outstanding							5,683,710
Warrant expiration period				7 years
Common Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of preferred shares converted to common stock					1,858,000
Series A Convertible Preferred Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of preferred shares converted				0	3,715
Number of preferred shares outstanding for being conversion				135
Series A Convertible Preferred Stock | Common Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of preferred shares converted to common stock				0	1,857,586
Number of preferred shares outstanding for being conversion to common stock				67,338
2017 Private Placement | 2017 Common Stock Warrants
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Exercise price of warrants				$ 2
2017 Private Placement | 2017 Banker Warrants
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Exercise price of warrants				$ 2.50
2017 Private Placement | Common Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Issuance of common stock upon securities purchase agreement			1,809,628
Common stock purchase price per share			$ 2
2017 Private Placement | Series A Convertible Preferred Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Preferred stock, shares issued			15,245
Shares issued price per share			$ 1,000
2017 Private Placement | Series A Convertible Preferred Stock | Common Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Preferred stock convertible to common stock			7,622,372
2018 Private Placement
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Exercise price of warrants	$ 3.50
Warrant expiration period	5 years
Aggregate gross proceeds for private placement	$ 45,200
2018 Private Placement | 2017 Banker Warrants
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of warrants exercised				0	0
Warrants outstanding				148,554
2018 Private Placement | 2018 Common Stock Warrants
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Proceeds from exercise of warrant				$ 900
Number of warrants exercised				2,100,000	0
Warrants outstanding				11,663,147
2018 Private Placement | Series A Convertible Preferred Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Preferred stock, shares issued	45,200
Shares issued price per share	$ 1,000
2018 Private Placement | Series A Convertible Preferred Stock | Common Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Preferred stock convertible to common stock	14,349,236
Maximum | 2017 Common Stock Warrants
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Beneficial ownership limitation percentage				4.99%
Beneficial ownership, limitation option, percentage				9.99%
Beneficial ownership limitation notification period				61 days
Maximum | 2018 Common Stock Warrants
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Beneficial ownership limitation percentage				4.99%
Beneficial ownership, limitation option, percentage				9.99%
Beneficial ownership limitation notification period				61 days
Maximum | 2017 Private Placement | 2017 Banker Warrants
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of warrants issued (in shares)				471,600
Maximum | 2017 Private Placement | Common Stock | 2017 Common Stock Warrants
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of warrants issued (in shares)				9,432,000
Maximum | 2018 Private Placement | Common Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of warrants issued (in shares)	12,196,851
2016 Equity Incentive Plan | Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares available for grant										500,000
2016 Equity Incentive Plan | Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares available for grant										1,250,000
2017 Distributor Inducement Plan | Restricted Stock Units
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares available for grant						75,000
Number of shares earned and issued						75,000
2017 Distributor Inducement Plan | Common Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of warrants issued (in shares)				260,000
Common stock issued				92,000
Stock-based compensation				$ 100	$ 100
Number of warrants available to be granted						50,000
2017 Distributor Inducement Plan | Common Stock | Board of Directors Chairman
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share authorized grant of warrants						1,000,000
2017 Development Services Plan | Restricted Common Stock | Board of Directors Chairman
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share authorized grant of warrants				2,400,000
2017 Development Services Plan | Common Stock | Board of Directors Chairman
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share authorized grant of warrants						3,000,000
Common stock issued				0
Issuance of shares granted to distributors was vested				0
2019 Management Objective Strategic Incentive Plan | Restricted Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Restricted shares granted under the plan				55,000
2019 Management Objective Strategic Incentive Plan | Common Stock | Board of Directors Chairman
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share authorized grant of warrants		500,000
Maximum grant of shares per participant		50,000

Stock Benefit Plans and Equit_4

Stock Benefit Plans and Equity Transactions - Summary of Total Stock Based Compensation (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total stock-based compensation	$ 3,568	$ 1,612
Cost of revenues
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total stock-based compensation	107	28
Research and development
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total stock-based compensation	291	143
Sales, general and administrative
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Total stock-based compensation	$ 3,170	$ 1,441

Stock Benefit Plans and Equit_5

Stock Benefit Plans and Equity Transactions - Summary Common Stock Reserved for Future Issuance (Details) shares in Thousands	Mar. 31, 2020shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance	40,633
Employee Stock Option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance	4,195
Unvested restricted share awards
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance	6,487
Employee Stock Purchase Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance	114
Series A Convertible Preferred Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance	67
Warrants Outstanding
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance	24,325
Authorized for Future Grant Under the Distributor and Development Services Plans
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance	3,908
Authorized for Future Grant Under the Management Objective Strategic Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance	445
Authorized for Future Grant Under the Company Equity Plans
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance	1,092

Stock Benefit Plans and Equit_6

Stock Benefit Plans and Equity Transactions - Summary of Outstanding Warrants (Details)	Mar. 31, 2020$ / sharesshares
Class Of Warrant Or Right [Line Items]
Number of Warrants	24,324,839
2017 Common Stock Warrants
Class Of Warrant Or Right [Line Items]
Number of Warrants	3,107,000
Strike Price | $ / shares	$ 2
2017 Banker Warrants
Class Of Warrant Or Right [Line Items]
Number of Warrants	148,554
Strike Price | $ / shares	$ 2.50
2018 Common Stock Warrants
Class Of Warrant Or Right [Line Items]
Number of Warrants	11,663,147
Strike Price | $ / shares	$ 3.50
Merger Warrants
Class Of Warrant Or Right [Line Items]
Number of Warrants	2,199,682
Strike Price | $ / shares	$ 3.50
Executive Warrants
Class Of Warrant Or Right [Line Items]
Number of Warrants	1,327,434
Strike Price | $ / shares	$ 5
Squadron Capital Warrant Exercise Price at $3.15
Class Of Warrant Or Right [Line Items]
Number of Warrants	845,000
Strike Price | $ / shares	$ 3.15
Squadron Capital Warrant Exercise Price at $2.17
Class Of Warrant Or Right [Line Items]
Number of Warrants	4,838,710
Strike Price | $ / shares	$ 2.17
Other Warrants
Class Of Warrant Or Right [Line Items]
Number of Warrants	195,312
Strike Price | $ / shares	$ 3.85

Income Taxes - Additional Infor

Income Taxes - Additional Information (Details) - USD ($)	3 Months Ended
	Mar. 31, 2020	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Unrecognized tax benefits	$ 2,500,000	$ 2,500,000
Changes in unrecognized tax benefits	$ 0
Effective income tax rate from continuing operations	0.00%
Federal statutory income tax rate	21.00%

Related Party Transactions - Ad

Related Party Transactions - Additional Information (Details) - USD ($) $ in Thousands	Jul. 01, 2016	Aug. 13, 2014	Sep. 30, 2014	Apr. 30, 2014	Mar. 31, 2014	Mar. 31, 2020	Dec. 31, 2019
Related Party Transaction [Line Items]
Settlement amount to be contributed						$ 5,000	$ 5,000
Orthotec LLC, litigation settlement
Related Party Transaction [Line Items]
Payments of settlement				$ 15,750	$ 1,750	41,700
Judgment assessed by court for (against) company		$ (49,000)
Orthotec LLC, litigation settlement | HealthpointCapital, LLC
Related Party Transaction [Line Items]
Payments of settlement	$ 1,000					1,100
Judgment assessed by court for (against) company			$ (5,000)
Settlement amount to be contributed						$ 5,000

Restructuring - Rollforward of

Restructuring - Rollforward of accrued restructuring liability (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Restructuring And Related Activities [Abstract]
Beginning balance	$ 24
Accrued restructuring charges		$ 60
Payments	(7)
Ending balance	$ 17

Subsequent Event - Additional I

Subsequent Event - Additional Information (Details) - USD ($)	May 09, 2020	Apr. 27, 2020	Apr. 23, 2020	Apr. 05, 2020	Mar. 27, 2019	Nov. 06, 2018
Squadron Credit Agreement
Subsequent Event [Line Items]
Debt instrument, maturity date					Nov. 30, 2023	Nov. 30, 2023
Squadron Credit Agreement | Common Stock
Subsequent Event [Line Items]
Number of warrants issued (in shares)					4,838,710	845,000
Exercise price of warrants					$ 2.17	$ 3.15
Subsequent Event | Squadron Credit Agreement | Common Stock
Subsequent Event [Line Items]
Number of warrants issued (in shares)	1,076,000
Exercise price of warrants	$ 4.88
Subsequent Event | Squadron Credit Agreement | Expanded Credit Facility
Subsequent Event [Line Items]
Debt instrument, maturity date	May 31, 2025
Additional secured financing of commitment letter	$ 35,000,000
Subsequent Event | Tender Offer Agreement | EOS Imaging S.A.
Subsequent Event [Line Items]
Termination date		Apr. 27, 2020
Subsequent Event | Commitment Letter | EOS Imaging S.A.
Subsequent Event [Line Items]
Termination date		Apr. 27, 2020
Subsequent Event | Paycheck Protection Program Loans
Subsequent Event [Line Items]
Proceeds from loan			$ 4,300,000
Debt instrument, maturity date			Apr. 21, 2022
Interest rate			1.00%
Debt instrument, Description			Commencing November 21, 2020, the Company is required to pay the lender equal monthly payments of principal and interest as required to fully amortize by April 21, 2022 the principal amount outstanding on the PPP Loan as of October 21, 2020.
Prepayment penalties			$ 0
Subsequent Event | Salary-to-Equity Conversion Program
Subsequent Event [Line Items]
Vesting date				Jul. 10, 2020
Subsequent Event | Minimum | Salary-to-Equity Conversion Program
Subsequent Event [Line Items]
Eligible employee payroll cost for conversion program				$ 100,000
Employee voluntary election to reduce compensation rate				10.00%
Subsequent Event | Maximum | Salary-to-Equity Conversion Program
Subsequent Event [Line Items]
Employee voluntary election to reduce compensation rate				75.00%