Alphatec (ATEC) 10-K 1 Mar 22 2021 FY Annual report Financial data

Document and Entity Information

Document and Entity Information - USD ($) $ in Billions	12 Months Ended
	Dec. 31, 2021	Feb. 24, 2022	Jun. 30, 2021
Cover [Abstract]
Entity Registrant Name	ALPHATEC HOLDINGS, INC.
Entity Central Index Key	0001350653
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Document Type	10-K
Trading Symbol	ATEC
Document Period End Date	Dec. 31, 2021
Document Fiscal Year Focus	2021
Document Fiscal Period Focus (Q1,Q2,Q3,FY)	FY
Amendment Flag	false
Entity Well-known Seasoned Issuer	No
Entity Current Reporting Status	Yes
Entity Voluntary Filers	No
Entity Common Stock, Shares Outstanding		99,786,612
Entity Public Float			$ 1
Entity Emerging Growth Company	false
Entity Small Business	true
Entity Shell Company	false
ICFR Auditor Attestation Flag	true
Entity File Number	000-52024
Entity Tax Identification Number	20-2463898
Entity Address, Address Line One	1950 Camino Vida Roble
Entity Address, City or Town	Carlsbad
Entity Address, State or Province	CA
Entity Address, Postal Zip Code	92008
City Area Code	760
Local Phone Number	431-9286
Document Annual Report	true
Document Transition Report	false
Entity Incorporation, State or Country Code	DE
Entity Interactive Data Current	Yes
Title of 12(b) Security	Common Stock, par value $0.0001 per share
Security Exchange Name	NASDAQ
Auditor Firm ID	34
Auditor Name	Deloitte & Touche LLP
Auditor Location	New York, New York, United States
Documents Incorporated by Reference	DOCUMENTS INCORPORATED BY REFERENCE The following documents (or parts thereof) are incorporated by reference into the following parts of this Form 10-K: Certain information required in Part III of this Annual Report on Form 10-K is incorporated from the Registrant’s Proxy Statement for the 2022 Annual Meeting of Stockholders.

CONSOLIDATED BALANCE SHEETS

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Current assets:
Cash and cash equivalents	$ 187,248	$ 107,765
Accounts receivable, net	41,893	23,527
Inventories	91,703	46,001
Prepaid expenses and other current assets	10,313	5,439
Withholding tax receivable from Officer		1,076
Current assets of discontinued operations		352
Total current assets	331,157	184,160
Property and equipment, net	87,401	36,670
Right-of-use assets	25,283	1,177
Goodwill	39,689	13,897
Intangible assets, net	85,274	24,720
Other assets	3,249	541
Noncurrent assets of discontinued operations		58
Total assets	572,053	261,223
Current liabilities:
Accounts payable	25,737	17,599
Accrued expenses and other current liabilities	55,549	35,264
Contract liability	15,255
Short-term debt	342	4,167
Current portion of operating lease liability	4,212	885
Current liabilities of discontinued operations		397
Total current liabilities	101,095	58,312
Long-term debt	326,489	37,999
Operating lease liability, less current portion	24,383	41
Other long-term liabilities	17,061	11,388
Redeemable preferred stock, $0.0001 par value; 20,000 shares authorized, and 3,319 shares issued and outstanding at December 31, 2021 and 2020	23,603	23,603
Commitments and contingencies (Note 7)
Stockholders’ equity:
Common stock, $0.0001 par value; 200,000 authorized; 99,627 shares issued and 99,537 outstanding at December 31, 2021, and 82,294 shares issued and 82,104 shares outstanding at December 31, 2020	10	8
Treasury stock, 1,808 shares at December 31, 2021 and 2 shares at December 31, 2020	(25,097)	(97)
Additional paid-in capital	892,828	770,764
Shareholder note receivable		(4,000)
Accumulated other comprehensive (deficit) income	(5,994)	1,204
Accumulated deficit	(782,325)	(637,999)
Total stockholders’ equity	79,422	129,880
Total liabilities and stockholders’ equity	572,053	261,223
Series A Convertible Preferred Stock
Stockholders’ equity:
Series A convertible preferred stock, $0.0001 par value; 15 shares authorized, and 0 shares issued and outstanding at December 31, 2021 and 2020

CONSOLIDATED BALANCE SHEETS (Pa

CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares	Dec. 31, 2021	Dec. 31, 2020
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	99,627,000	82,294,000
Common stock, shares outstanding	99,537,000	82,104,000
Treasury stock, shares	1,808,000	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

CONSOLIDATED STATEMENTS OF OPER

CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Revenue:
Revenues	$ 243,212	$ 144,861
Cost of sales	85,450	42,360
Gross profit	157,762	102,501
Operating expenses:
Research and development	32,015	18,745
Sales, general and administrative	229,271	129,156
Litigation-related expenses	11,123	8,552
Amortization of acquired intangible assets	5,348	688
Transaction-related expenses	6,365	4,223
Restructuring expenses	1,697
Total operating expenses	285,819	161,364
Operating loss	(128,057)	(58,863)
Interest and other expense, net:
Interest expense, net	(7,108)	(12,374)
Loss on debt extinguishment, net	(7,434)	(7,612)
Other expense, net	(1,563)
Total interest and other expense, net	(16,105)	(19,986)
Net loss before taxes	(144,162)	(78,849)
Income tax provision	164	145
Net loss	$ (144,326)	$ (78,994)
Net loss per share, basic and diluted	$ (1.50)	$ (1.18)
Weighted average shares outstanding, basic and diluted	96,197	67,020
Products and Services
Revenue:
Revenues	$ 242,258	$ 141,079
International Supply Agreement
Revenue:
Revenues	$ 954	$ 3,782

CONSOLIDATED STATEMENTS OF COMP

CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Statement Of Income And Comprehensive Income [Abstract]
Net loss	$ (144,326)	$ (78,994)
Foreign currency translation adjustments	(7,198)	116
Comprehensive loss	$ (151,524)	$ (78,878)

CONSOLIDATED STATEMENTS OF STOC

CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY - USD ($) shares in Thousands, $ in Thousands	Total	Private Placement	Public Offering	Cumulative Effect, Period of Adoption, Adjustment	Additional paid-in capital	Additional paid-in capitalPrivate Placement	Additional paid-in capitalPublic Offering	Shareholder note receivable	Treasury stock	Accumulated other comprehensive income	Accumulated deficit	Accumulated deficitCumulative Effect, Period of Adoption, Adjustment	Common Stock	Common StockPrivate Placement	Common StockPublic Offering
Balance at Dec. 31, 2019	$ 43,631			$ (81)	$ 606,558			$ (5,000)	$ (97)	$ 1,088	$ (558,924)	$ (81)	$ 6
Balance, shares at Dec. 31, 2019													61,400
Accounting Standards Update Description	ASU 2019-08
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock-based compensation	$ 15,730				15,730
Common stock issued for conversion of Series A preferred stock, shares													39
Distributor equity incentives	521				521
Common stock issued for warrant exercises	2,368				2,368
Common stock issued for warrant exercises, shares													1,907
Common stock issued for employee stock purchase plan and stock option exercises	1,970				1,970
Common stock issued for employee stock purchase plan and stock option exercises, shares													665
Common stock issued for vesting of restricted stock units, net of shares withheld for tax liability	(983)				(983)
Common stock issued for vesting of restricted stock units, net of shares withheld for tax liability, shares													2,238
Issuance of common stock warrants, net	2,974				2,974
Issuance of common stock, net of offering costs			$ 107,698				$ 107,696								$ 2
Issuance of common stock, net of offering costs, shares															13,143
Shareholder note receivable	1,000							1,000
Issuance of common stock for other services	123				123
Issuance of common stock for other services, shares													12
Issuance of common stock for prepayment of debt	33,807				33,807
Issuance of common stock for prepayment of debt, shares													2,700
Foreign currency translation adjustments	116									116
Net loss	(78,994)										(78,994)
Balance at Dec. 31, 2020	129,880				770,764			(4,000)	(97)	1,204	(637,999)		$ 8
Balance, shares at Dec. 31, 2020													82,104
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Stock-based compensation	34,728				34,728
Distributor equity incentives	1,339				1,339
Distributor equity incentives, shares													164
Common stock issued for warrant exercises	3,254				3,254
Common stock issued for warrant exercises, shares													3,943
Common stock issued for employee stock purchase plan and stock option exercises	3,584				3,584
Common stock issued for employee stock purchase plan and stock option exercises, shares													796
Common stock issued for vesting of restricted stock units, net of shares withheld for tax liability	(12,801)				(12,801)
Common stock issued for vesting of restricted stock units, net of shares withheld for tax liability, shares													1,915
Issuance of common stock, net of offering costs		$ 131,828				$ 131,826								$ 2
Issuance of common stock, net of offering costs, shares														12,421
Shareholder note receivable	4,000							$ 4,000
Repurchase of common stock	(25,000)								(25,000)
Repurchase of common stock, shares													(1,806)
Purchase of capped calls	(39,866)				(39,866)
Foreign currency translation adjustments	(7,198)									(7,198)
Net loss	(144,326)										(144,326)
Balance at Dec. 31, 2021	$ 79,422				$ 892,828				$ (25,097)	$ (5,994)	$ (782,325)		$ 10
Balance, shares at Dec. 31, 2021													99,537

CONSOLIDATED STATEMENTS OF ST_2

CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY (Parenthetical) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Private Placement
Common stock, offering costs	$ 6,200
Public Offering
Common stock, offering costs		$ 7,300

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Operating activities:
Net loss	$ (144,326)	$ (78,994)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation and amortization	26,756	10,949
Stock-based compensation	36,450	17,659
Amortization of debt discount and debt issuance costs	1,868	3,974
Amortization of right-of-use assets	3,418	683
Write-down for excess and obsolete inventories	11,147	7,044
Loss on disposal of assets	1,976	498
Loss on debt extinguishment, net	7,434	7,612
Impairment of investment	3,000
Other	2,721	116
Changes in operating assets and liabilities:
Accounts receivable	(10,141)	(7,484)
Inventories	(27,746)	(18,192)
Prepaid expenses and other current assets	1,258	(2,930)
Other assets	11	(51)
Accounts payable	757	7,130
Accrued expenses and other current liabilities	6,983	8,812
Lease liability	150	(1,312)
Other long-term liabilities	4,852	(1,926)
Net cash used in operating activities	(73,432)	(46,412)
Investing activities:
Purchases of property and equipment	(68,544)	(23,131)
Acquisition of business, net of cash acquired	(62,133)
Purchase of OCEANE	(21,097)
Cash paid for investments	(3,000)
Cash paid for acquisition of intangible assets		(755)
Cash received from sale of assets		27
Settlement of forward contract	(2,988)
Net cash used in investing activities	(157,762)	(23,859)
Financing activities:
Proceeds from common stock offering, net	131,828	107,698
Proceeds from issuance of convertible notes	316,250
Payment of debt issuance costs	(10,028)
Net cash (paid) received from common stock exercises	(5,963)	3,341
Borrowings under lines of credit		42,455
Repayments under lines of credit		(56,615)
Purchase of capped calls	(39,866)
Repurchase of common stock	(25,000)
Proceeds from issuance of term debt, net		34,008
Repayment of Squadron Medical Term Loan	(45,000)
Repayment of Inventory Financing Agreement	(8,088)
Other	(2,167)	(58)
Net cash provided by financing activities	311,966	130,829
Effect of exchange rate changes on cash	(1,289)	94
Net increase in cash and cash equivalents	79,483	60,652
Cash and cash equivalents at beginning of year	107,765	47,113
Cash and cash equivalents at end of year	187,248	107,765
Supplemental disclosure of cash flow information:
Cash paid for interest	5,027	6,330
Cash paid for income taxes	223	190
Supplemental disclosure of noncash investing and financing activities:
Common stock warrants issued with term loan draw		2,974
Common stock issued for partial extinguishment of debt		33,807
PPP Loan Forgiveness	4,271
Common stock issued for development of intangible assets		123
Purchases of property and equipment in accounts payable	2,577	$ 3,527
Financed inventory	4,015
Recognition of lease liability	$ 23,403

The Company and Basis of Presen

The Company and Basis of Presentation	12 Months Ended
	Dec. 31, 2021
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”), SafeOp Surgical, Inc. (“SafeOp”), and EOS imaging S.A. (“EOS”), is a medical technology company that designs, develops, and markets technology for the treatment of spinal disorders associated with disease and degeneration, congenital deformities, and trauma. The Company markets its products in the U.S. and internationally via a network of independent distributors and direct sales representatives. Basis of Presentation The consolidated financial statements have been prepared in accordance with generally accepted accounting principles in the United States of America ("U.S. GAAP") and include the accounts of the Company and its wholly owned subsidiaries. The Company translates the financial statements of its foreign subsidiaries using end-of-period exchange rates for assets and liabilities and average exchange rates during each reporting period for results of operations. All intercompany balances and transactions have been eliminated in consolidation. The Company operates in one reportable business segment. Reclassification Certain amounts in the consolidated financial statements for the year ended December 31, 2020 have been reclassified to conform to the current year’s presentation. These reclassifications were immaterial and have no impact on previously reported results of operations or accumulated deficit. Recent Developments 0.75% Senior Convertible Notes due 2026 In August 2021, the Company issued $316.3 million principal amount of unsecured senior convertible notes (the “2026 Notes”) with a stated interest rate of 0.75% and a maturity date of August 1, 2026. See Note 6 for additional information on the 2026 Notes. Acquisition of EOS On May 13, 2021, the Company acquired a controlling interest in EOS, pursuant to the Tender Offer Agreement (the “Tender Offer Agreement”) it entered into on December 16, 2020, and in June 2021 purchased the remaining issued and outstanding ordinary shares for a 100% interest in EOS. is a global medical device company that designs, develops and markets innovative, low dose 2D/3D full body and weight-bearing imaging, rapid 3D modeling of EOS patient X-ray images, web-based patient-specific surgical planning, and integration of surgical plan into the operating room that collectively bridge the entire spectrum of care from imaging to post-operative assessment capabilities for orthopedic surgery. COVID-19 Pandemic In 2020, a novel strain of Coronavirus, which causes COVID-19, was identified and declared by the World Health Organization to be a pandemic. The virus causing COVID-19 has since rapidly spread across the globe to all countries, including to the United States. To slow the spread of COVID-19, governments have implemented measures, which include the mandatory closure of businesses, and restrictions on travel. In addition, many government agencies in conjunction with hospitals and healthcare systems have, to varying degrees, deferred or suspended elective surgical procedures. While certain spine surgeries are deemed essential and certain surgeries cannot be delayed, the Company has seen and may continue to see a reduction in procedural volumes as hospital systems and/or patients elect to defer spine surgery procedures and hospital systems experience staffing shortages. The cumulative effect of these disruptions had an impact on the Company’s business during the years ended December 31, 2021 and 2020. The COVID-19 pandemic continues to evolve and its full impact on the Company’s business will depend on several factors that are uncertain and unpredictable, including, the efficacy and adoption of vaccines, future resurgences of the virus and its variants, the speed at which government restrictions are lifted or enacted, and patient capacity at hospitals and healthcare systems.

Summary of Significant Accounti

Summary of Significant Accounting Policies	12 Months Ended
	Dec. 31, 2021
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	2. Summary of Significant Accounting Policies Use of Estimates The preparation of consolidated financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities, the disclosure of contingent assets and liabilities, and the reported amounts of revenues and expenses. Actual results could differ from those estimates. Significant items subject to such estimates and assumptions include the useful lives of property and equipment, goodwill, intangible assets, allowances for doubtful accounts, the valuation of share-based liabilities, deferred tax assets, inventory, stock-based compensation, revenues, restructuring liabilities, income tax uncertainties, and other contingencies. Concentrations of Credit Risk and Significant Customers Financial instruments, which potentially subject the Company to concentrations of credit risk, consist primarily of cash, cash equivalents, and accounts receivable. The Company limits its exposure to credit loss by depositing its cash and investments with established financial institutions. As of December 31, 2021, a substantial portion of the Company’s available cash funds is held in business accounts. Although the Company deposits its cash with multiple financial institutions, its deposits, at times, may exceed federally insured limits. The Company’s customers are primarily hospitals, surgical centers, and distributors. No one single customer represented greater than 10 percent of consolidated revenues and accounts receivable for the years presented. Credit to customers is granted based on an analysis of the customers’ credit worthiness. Credit losses have not been significant. Cash and Cash Equivalents The company considers all highly liquid investments that are readily convertible into cash and have an original maturity of three months or less at the time of purchase to be cash equivalents. Accounts Receivable, net Accounts receivable are presented net of allowance for doubtful accounts. The Company makes judgments as to its ability to collect outstanding receivables and provides allowances for a portion of receivables when collection becomes doubtful. Provisions are made based upon a specific review of all significant outstanding invoices. In determining the provision for invoices not specifically reviewed, the Company analyzes historical collection experience. If the historical data used to calculate the allowance provided for doubtful accounts does not reflect the Company’s future ability to collect outstanding receivables or if the financial condition of customers were to deteriorate, resulting in impairment of their ability to make payments, an increase in the provision for doubtful accounts may be required. The Company’s accounts Inventories Most of the Company’s inventory is comprised of finished goods, which is primarily produced by third-party suppliers. Specialized implants, fixation products, biologics, and disposables are determined by utilizing a standard cost method that includes capitalized variances which approximates the weighted average cost. Imaging equipment and related parts are valued at weighted average cost. Inventories are stated at the lower of cost or net realizable value. The Company reviews the components of its inventory on a periodic basis for excess and obsolescence and adjusts inventory to its net realizable value as necessary. The Company records a lower of cost or net realizable value inventory reserve (“LCNRV”) for estimated excess and obsolete inventory based upon its expected use of inventory on hand. The Company’s inventory, which consists primarily of specialized implants, fixation products, biologics, and disposables is at risk of obsolescence due to the need to maintain substantial levels of inventory. In order to market its products effectively and meet the demands of interoperative product placement, the Company maintains and provides surgeons and hospitals with a variety of inventory products and sizes. For each surgery, fewer than all components will be consumed. The need to maintain and provide such a variety of inventory causes inventory to be held that is not likely to be used. The Company’s estimates and assumptions for excess and obsolete inventory are reviewed and updated on a quarterly basis. The estimates and assumptions are determined primarily based on current usage of inventory and the age of inventory quantities on hand. Additionally, the Company considers recent experience to develop assumptions about future demand for its products, while considering market conditions, product life cycles and new product launches. Increases in the LCNRV reserve for excess and obsolete inventory result in a corresponding charge to cost of sales. For the years ended December 31, 2021 and 2020, the Company recorded a write-down for excess and obsolete inventory of $11.1 million and $7.0 million, respectively. Property and Equipment, net Property and equipment are stated at cost, net of accumulated depreciation. Depreciation is computed using the straight-line method over the estimated useful lives of the related assets, generally ranging from three to seven years. Leasehold improvements and assets acquired under capital leases are amortized over the shorter of their useful lives or the remaining terms of the related leases. Operating Lease The Company determines whether a contract is a lease or contains a lease at inception by assessing whether there is an identified asset and whether the contract conveys the right to control the use of the identified asset in exchange for consideration over a period of time. If both criteria are met, the Company determines the initial classification and measurement of its right-of-use (“ROU”) asset and lease liabilities at the lease commencement date and thereafter, if modified. The Company recognizes a ROU asset and lease liability for its operating leases with lease terms greater than 12 months. The lease term includes any renewal options and termination options that the Company is reasonably assured to exercise. ROU assets and lease liabilities are based on the present value of lease payments over the lease term. The present value of operating lease payments is determined by using the incremental borrowing rate of interest that the Company would borrow on a collateralized basis for an amount equal to the lease payments in a similar economic environment. Rent expense for operating leases is recognized on a straight-line basis over the reasonably assured lease term based on the total lease payments and is included in cost of sales, research and development, and sales, general and administrative expenses in the consolidated statements of operations. The Company aggregates all lease and non-lease components for each class of underlying assets into a single lease component and variable charges for common area maintenance and other variable costs are recognized as expense as incurred. Total variable costs associated with leases for the year s ended December 31, 2021 and 2020 were immaterial. The Company had an immaterial amount of financing leases as of December 31, 2021 and 2020 , which is included in property and equipment, net, accrued expenses and other current liabilities , and other long-term liabilities on the consolidated balance sheets . Valuation of Goodwill Goodwill represents the excess of the cost over the fair value of net assets acquired from the Company’s business combinations. The determination of the value of goodwill and intangible assets arising from business combinations and asset acquisitions requires extensive use of accounting estimates and judgments to allocate the purchase price to the fair value of the net tangible and intangible assets acquired. Goodwill is assessed for impairment using fair value measurement techniques on an annual basis or more frequently if facts and circumstance warrant such a review. Goodwill is considered to be impaired if the Company determines that the carrying value of the reporting unit exceeds its respective fair value. The Company’s annual evaluation for impairment of goodwill consists of one reporting unit. The Company completed its most recent annual evaluation for impairment of goodwill as of October 1, 2021 and determined that no impairment existed. In addition, no indicators of impairment were noted through December 31, 2021, and consequently no impairment charge was recorded during the years ended December 31, 2021 and 2020. Valuation of Intangible Assets Intangible assets are comprised primarily of purchased technology, customer relationships, trade name, trademarks, and in-process research and development. The Company makes significant judgments in relation to the valuation of intangible assets resulting from business combinations and asset acquisitions. Intangible assets are generally amortized on a straight-line basis over their estimated useful lives of 2 to 12 years. The Company bases the useful lives and related amortization expense on the period of time it estimates the assets will generate net sales or otherwise be used. The Company also periodically reviews the lives assigned to its intangible assets to ensure that its initial estimates do not exceed any revised estimated periods from which the Company expects to realize cash flows. If a change were to occur in any of the above-mentioned factors or estimates, the likelihood of a material change in the Company’s reported results would increase. The Company evaluates its intangible assets with finite lives for indications of impairment whenever events or changes in circumstances indicate that the carrying value may not be recoverable. Factors that could trigger an impairment review include significant under-performance relative to expected historical or projected future operating results, significant changes in the manner of the Company’s use of the acquired assets or the strategy for its overall business or significant negative industry or economic trends. If this evaluation indicates that the value of the intangible asset may be impaired, the Company makes an assessment of the recoverability of the net carrying value of the asset over its remaining useful life. If this assessment indicates that the intangible asset is not recoverable, based on the estimated undiscounted future cash flows of the asset over the remaining amortization period, the Company reduces the net carrying value of the related intangible asset to fair value and may adjust the remaining amortization period. Significant judgment is required in the forecasts of future operating results that are used in the discounted cash flow valuation models. It is possible that plans may change and estimates used may prove to be inaccurate. If actual results, or the plans and estimates used in future impairment analyses, are lower than the original estimates used to assess the recoverability of these assets, the Company could incur additional impairment charges. There were no impairment charges during the years ended December 31, 2021 or 2020. Impairment of Long-Lived Assets The Company assesses potential impairment to its long-lived assets when there is evidence that events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. An impairment loss is recognized when estimated future undiscounted cash flows related to the asset are less than its carrying amount. Any required impairment loss is measured as the amount by which the carrying amount of a long-lived asset exceeds its fair value and is recorded as a reduction in the carrying value of the related asset and a charge to operating results. There were no material impairment charges during the years ended December 31, 2021 or 2020. Warrants to Purchase Common Stock Warrants are accounted for in accordance with the applicable accounting guidance as either derivative liabilities or as equity instruments depending on the specific terms of the agreements. All warrants issued during the year ended December 31, 2020 qualified for classification within stockholders’ equity. There were no warrants issued during the year ended December 31, 2021. Fair Value Measurements The carrying amount of financial instruments consisting of cash and cash equivalents, accounts receivable, prepaid expenses and other current assets, accounts payable, accrued expenses, and short-term debt included in the Company’s consolidated financial statements are reasonable estimates of fair value due to their short maturities. Authoritative guidance establishes a three-tier fair value hierarchy, which prioritizes the inputs used in measuring fair value as follows: Level 1: Level 2: Inputs other than Level 1 that are observable, either directly or indirectly, such as quoted prices for similar assets or liabilities, quoted prices in markets that are not active; or other inputs that can be corroborated by observable market data for substantially the full term of the assets or liabilities. Level 3: The following table presents information related to the Company’s assets measured at fair value on a recurring basis as of December 31, 2021 (in thousands): December 31, 2021 Level 1 Level 2 Level 3 Total Cash equivalents: Money market funds $ 140,010 — — $ 140,010 Total cash equivalents $ 140,010 — — $ 140,010 There were no assets measured at fair value on a recurring basis as of December 31, 2020. The following table presents information related to the Company’s liabilities measured at fair value on a recurring basis as of December 31, 2021 and December 31, 2020 (in thousands): December 31, 2021 Level 1 Level 2 Level 3 Total Liability classified equity award $ — — 2,052 $ 2,052 December 31, 2020 Level 1 Level 2 Level 3 Total Liability classified equity award (1) $ — — 4,108 $ 4,108 Foreign currency forward contract — 878 — 878 Total $ — 878 4,108 $ 4,986 (1) A portion of this award is being accreted over the requisite service period. The amount in the above table includes the fair value of the vested and unvested portion of the award. The Company did not have any transfers of assets and liabilities between the levels of the fair value measurement hierarchy during the periods presented. On March 16, 2021, the Company entered into two foreign currency forward contracts, with a notional amount of $8.0 million total, $4.0 million each (€6.7 million total and €3.3 million each), to mitigate the foreign currency exchange risk related to its EOS subsidiary. The contracts are not designated as hedging instruments. The Company classified the derivative liabilities within Level 2 of the fair value hierarchy as observable inputs are available for the full term of the derivative instruments. The fair value of the forward contracts was developed using a market approach based on publicly available market yield curves and the term of the contracts. During the year ended December 31, 2021, the foreign currency forward contracts were settled for $7.6 million (€6.7 million). The Company recognized a nominal loss from the change in fair value of the contracts during the year ended December 31, 2021. The loss on the contract settlement was recorded within other expense, net on the consolidated statements of operations and the cash settlement is included in investing activities in the consolidated statements of cash flows for the year ended December 31, 2021. On December 18, 2020, the Company entered into a foreign currency forward contract, with a notional amount of $117.9 million (€95.6 million) to mitigate the foreign currency exchange risk related to the Tender Offer Agreement, denominated in Euros. The contract was not designated as a hedging instrument. The Company classified the derivative liability within Level 2 of the fair value hierarchy as observable inputs were available for the full term of the derivative instrument. The fair value of the forward contract was developed using a market approach based on publicly available market yield curves and the term of the contract. On March 2, 2021, the foreign currency forward contract was settled for $115.3 million (€95.6 million). The Company recognized a $1.7 million loss from the change in fair value of the contract during the year ended December 31, 2021. The loss on the contract settlement was recorded as other expense on the consolidated statement of operations and the cash settlement is included in investing activities in the consolidated statements of cash flows for the year ended December 31, 2021. The Company issued a liability classified equity award to one of its executive officers. The award vests in 2023 subject to continued service and a specific market condition. As the award will be settled in cash, 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 specific market condition with the valuation updated at each reporting period. The full fair value of the award was $3.1 million as of December 31, 2021 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) as of December 31, 2021 and 2020 Level 3 Liabilities Balance at December 31, 2019 $ 266 Straight-line recognition of liability classified equity award 371 Change in fair value measurement 1,031 Balance at December 31, 2020 $ 1,668 Straight-line recognition of liability classified equity award 1,028 Change in fair value measurement (644 ) Balance at December 31, 2021 $ 2,052 Fair Value of Long-term Debt The fair value, based on a quoted market price (Level 1), of the Company’s 2026 Notes at December 31, 2021 was approximately $308.1 million. The fair value based on a quoted market price (Level 1), of the Company’s outstanding OCEANEs at December 31, 2021 was approximately $14.1 million. See Note 6 for further information. Revenue Recognition The Company recognizes revenue from product sales in accordance with Financial Accounting Standards Board (“FASB”) Accounting Standards Codification (“ASC”) Revenue from Contracts with Customers Sales are derived primarily from the sale of spinal implant products to hospitals and medical centers through direct sales representatives and independent distributor agents, and with the acquisition of EOS, includes imaging equipment and related services. Revenue is recognized when obligations under the terms of a contract with customers are satisfied, which occurs with the transfer of control of products to customers, either upon shipment of the product or delivery of the product to the customer depending on the shipping terms, or when the products are used in a surgical procedure (implanted in a patient). Revenue from the sale of imaging equipment is recognized as each distinct performance obligation is fulfilled and control transfers to the customer, beginning with shipment or delivery, depending on the terms. Revenue from other distinct performance obligations, such as maintenance on imaging equipment and other imaging related services, is recognized in the period the service is performed, and makes up less than 10% of the Company’s total revenue. Revenue is measured based on the amount of consideration expected to be received in exchange for the transfer of the goods or services specified in the contract with each customer. In certain cases, the Company does offer the ability for customers to lease its imaging equipment primarily on a non-sales type basis, but such arrangements are immaterial to total revenue in the periods presented. The Company generally does not allow returns of products that have been delivered. Costs incurred by the Company associated with sales contracts with customers are deferred over the performance obligation period and recognized in the same period as the related revenue, except for contracts that complete within one year or less, in which case the associated costs are expensed as incurred. Payment terms for sales to customers may vary but are commensurate with the general business practices in the country of sale. To the extent that the transaction price includes variable consideration, such as discounts, rebates, and customer payment penalties, the Company estimates the amount of variable consideration that should be included in the transaction price utilizing either the expected value method or the most likely amount method depending on the nature of the variable consideration. Variable consideration is included in the transaction price if, in the Company’s judgment, it is probable that a significant future reversal of cumulative revenue under the contract will not occur. Estimates of variable consideration and determination of whether to include estimated amounts in the transaction price are based largely on an assessment of the Company’s anticipated performance and all information that is reasonably available, including historical, current, and forecasted information. The Company records a contract liability, or deferred revenue, when it has an obligation to provide a product or service to the customer and payment is received in advance of its performance. When the Company sells a product or service with a future performance obligation, revenue is deferred on the unfulfilled performance obligation and recognized over the related performance period. Generally, the Company does not have observable evidence of the standalone selling price related to its future service obligations; therefore, the Company estimates the selling price using an expected cost plus a margin approach. The transaction price is allocated using the relative standalone selling price method. The use of alternative estimates could result in a different amount of revenue deferral. The Company had current and non-current contract liability balances totaling $15.3 million and $2.9 million, respectively, as of December 31, 2021. The Company had no contract liability balances as of December 31, 2020. The non-current contract liability balance is included in other long-term liabilities on the consolidated balance sheets. The Company recognized $14.6 million of revenue from its contract liabilities during the year ended December 31, 2021. The Company did not recognize revenue related to contract liabilities during the year ended December 31, 2020. The opening and closing balances of the Company’s contract liability are as follows: Balance at January 1, 2021 $ — Contract liability assumed in acquisition of EOS 21,196 Payments received 11,590 Revenue recognized (14,635 ) Balance at December 31, 2021 $ 18,151 Research and Development Expenses Research and development expenses consist of costs associated with the design, development, testing, and enhancement of the Company’s products and technologies. Research and development costs also include salaries and related employee benefits, research-related overhead expenses, and fees paid to external service providers. Research and development costs are expensed as incurred. Litigation-related Expenses Litigation-related expenses are costs incurred for the ongoing litigation, primarily with NuVasive, Inc . See Note 7 for additional information on ongoing litigation. Transaction-related Expenses The Company expensed certain costs incurred throughout the year related primarily to the acquisition and integration of EOS. . Product Shipment Cost Product shipment costs for surgical sets are included in sales, general and administrative expenses in the accompanying consolidated statements of operations. Product shipment costs totaled $8.3 million and $5.3 million for the years ended December 31, 2021 and 2020, respectively. Stock-Based Compensation Stock-based compensation expense for equity-classified awards, principally related to restricted stock units, or RSUs, and performance restricted stock units, or PRSUs, is measured at the grant date based on the estimated fair value of the award. The fair value of equity instruments that are expected to vest is recognized and amortized over the requisite service period. The Company has granted awards with up to four year graded or cliff vesting terms. No exercise price or other monetary payment is required for receipt of the shares issued in settlement of the respective award; instead, consideration is furnished in the form of the participant’s service. The fair value of RSUs including PRSUs with pre-defined performance criteria is based on the stock price on the date of grant whereas the expense for PRSUs with pre-defined performance criteria is adjusted with the probability of achievement of such performance criteria at each period end. The fair value of the PRSUs that are earned based on the achievement of pre-defined market conditions, is estimated on the date of grant using a Monte Carlo valuation model. The key assumptions in applying this model are an expected volatility and a risk-free interest rate. Stock-based compensation recorded in the Company’s consolidated statements of operations is based on awards expected to ultimately vest and has been reduced for estimated forfeitures. The Company’s estimated forfeiture rates may differ from its actual forfeitures. The Company considers its historical experience of pre-vesting forfeitures on awards by each homogenous group of employees as the basis to arrive at its estimated annual pre-vesting forfeiture rates. The Company estimate s the fair value of stock options issued under the Company’s equity incentive plans and shares issued to employees under the Company’s employee stock purchase plan (“ ESPP ”) using a Black-Scholes option-pricing model on the date of grant. The Black-Scholes option-pricing model incorporates various assumptions including expected volatility, expected term and risk-free interest rates. The expected volatility is based on the historical volatility of the Company’s common stock over the most recent period commensurate with the estimated expected term of the Company’s stock options and ESPP offering period which is derived from historical experience. The risk-free interest rate for periods within the contractual life of the option is based on the U.S. Treasury yield in effect at the time of grant. The Company has never declared or paid dividends and have no plans to do so in the foreseeable future. The Company accounts for stock option grants to non-employees in accordance with provisions which require that the fair value of these instruments be recognized as an expense over the period in which the related services are rendered. Income Taxes The Company accounts for income taxes in accordance with provisions which set forth an asset and liability approach that requires the recognition of deferred tax assets and deferred tax liabilities for the expected future tax consequences of temporary differences between the carrying amounts and the tax bases of assets and liabilities. Valuation allowances are established when necessary to reduce deferred tax assets to the amount expected to be realized. In making such determination, a review of all available positive and negative evidence must be considered, including scheduled reversal of deferred tax liabilities, projected future taxable income, tax planning strategies, and recent financial performance. The Company recognizes interest and penalties related to uncertain tax positions as a component of the income tax provision. Net Loss per Share Basic earnings per share (“EPS”) is calculated by dividing the net loss available to common stockholders by the weighted average number of shares of common stock issued and outstanding for the period. Diluted EPS is computed by dividing the net loss available to common stockholders by the weighted average number of shares of common stock outstanding for the period and the weighted average number of dilutive common stock equivalents outstanding for the period determined using the treasury-stock method and the if-converted method for convertible debt. For purposes of this calculation, common stock subject to repurchase by the Company, common stock issuable upon conversion of convertible notes, preferred shares, options, and warrants are considered to be common stock equivalents and are only included in the calculation of diluted earnings per share when their effect is dilutive. Due to the Company’s net loss position, the effect of including common stock equivalents in the EPS calculation is anti-dilutive, and therefore not included. The following table sets forth the computation of basic and diluted loss per share (in thousands, except per share data): Year Ended December 31, 2021 2020 Numerator: Net loss $ (144,326 ) $ (78,994 ) Denominator: Weighted average common shares outstanding 96,197 67,020 Net loss per share, basic and diluted $ (1.50 ) $ (1.18 ) The following potentially dilutive shares of common stock were excluded from the calculation of diluted net loss per share because their effect would have been anti-dilutive for the years presented (in thousands): Year Ended December 31, 2021 2020 Series A convertible preferred stock 29 29 Options to purchase common stock and employee stock purchase plan 3,416 3,951 Unvested restricted stock units 8,703 8,216 Warrants to purchase common stock 20,184 24,881 Senior convertible notes 17,246 — 49,578 37,077 Recent Accounting Pronouncements Recently Adopted Accounting Pronouncements In May 2021, the FASB issued Accounting Standard Update (“ASU”) No. 2021-04, Earnings Per Share (Topic 260), Debt—Modifications and Extinguishments (Subtopic 470-50), Compensation—Stock Compensation (Topic 718), and Derivatives and Hedging—Contracts in Entity’s Own Equity (Subtopic 815-40): Issuer’s Accounting for Certain Modifications or Exchanges of Freestanding Equity-Classified Written Call Options In August 2020, the FASB issued ASU No. 2020-06, Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging-Contracts in Entity’s Own Equity (Subtopic 815-40) (“ ”) Recently Issued Accounting Pronouncements In August 2021, the FASB issued ASU No. 2021-08, Business Combinations (Topic 805): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers

Business Combination

Business Combination	12 Months Ended
	Dec. 31, 2021
Business Combinations [Abstract]
Business Combination	3. Business Combination The Company recognizes assets acquired, liabilities assumed, and any noncontrolling interest at fair value at the date of acquisition. On December 16, 2020, the Company entered into the Tender Offer Agreement with EOS, pursuant to which the Company agreed to commence a public tender offer (the “Offer”) to purchase all of the issued and outstanding ordinary shares, nominal value €0.01 per share (collectively, the “EOS Shares”) for a cash offer of €2.45 per EOS Share, and outstanding convertible bonds of EOS (“OCEANEs”) for a cash offer of €7.01 per OCEANE, which included accrued but unpaid interest. On May 13, 2021 (the “Change in Control Date”), the Company substantially completed the Offer, pursuant to which the Company purchased 59% of the issued and outstanding EOS Shares and 53% of the OCEANEs for $66.5 million in cash pursuant to the Offer. In addition, prior to the Change in Control Date, the Company had also acquired 30% of the issued and outstanding EOS Shares and 4% of the OCEANEs on the open market for $25.0 million in cash. After the Change in Control Date, the Company held a controlling financial interest in EOS representing 89% of issued and outstanding EOS Shares and 57% of OCEANEs, equal to approximately 80% of the capital and voting rights of EOS on a fully diluted basis. The Offer was reopened on May 17, 2021 to purchase the remaining EOS Shares for $8.5 million, ultimately resulting in the acquisition of 100% of EOS Shares and 57% of the OCEANEs as of June 2, 2021. As of June 2, 2021, the total cash paid to acquire 100% of the EOS Shares and 57% of the OCEANEs was $100.0 million. EOS, which now operates as a wholly owned subsidiary of the Company, is a global medical device company that designs, develops and markets innovative, low dose 2D/3D full body and biplanar weight-bearing imaging, rapid 3D modeling of EOS patient X-ray images, web-based patient-specific surgical planning, and integration of surgical plan into the operating room that collectively bridge the entire spectrum of care from imaging to post-operative assessment capabilities for orthopedic surgery. The Company plans to integrate this technology into its procedural approach to spine surgery to better inform and better achieve spinal alignment objectives in surgery. The Company is still in the process of finalizing the purchase price allocation given the timing of the acquisition and the size and scope of the assets and liabilities subject to valuation. While the Company does not expect material changes in the outcome of the valuation, certain assumptions and findings that were in place at the date of acquisition may result in changes in the purchase price allocation. The allocation of the purchase price to the assets acquired and liabilities assumed based on their fair values were as follows: (in thousands) As of May 13, 2021 Cash paid for purchase of EOS shares at Change in Control Date $ 46,908 Cash paid for purchase of OCEANEs at Change in Control Date 19,620 Total cash paid at Change in Control Date 66,528 Fair value of investment in EOS Shares held prior to Change in Control Date 23,549 Fair value of investment in OCEANEs held prior to Change in Control Date 1,477 Total fair value of investment in EOS held prior to Change in Control Date 25,026 Fair value of noncontrolling interest acquired after Change in Control Date 8,454 $ 100,008 Cash and cash equivalents $ 16,778 Accounts receivable 9,083 Inventory 26,531 Other current assets 4,422 Property, plant and equipment, net 1,650 Deferred tax assets 2,314 Right-of-use asset 4,341 Goodwill 27,841 Definite-lived intangible assets: Developed technology 56,000 Customer relationships 9,500 Trade names 6,000 Other noncurrent assets 395 Contract liabilities 21,196 Long-term debt 15,297 Other liabilities assumed 28,354 Total identifiable net assets $ 100,008 The purchase price, including cash paid at the Change in Control Date, the fair value of the investment held prior to the Change in Control Date, and the fair value of the noncontrolling interest acquired, exceeded the fair value of the net tangible and identifiable intangible assets acquired as part of the acquisition. As a result, the Company recorded goodwill in connection with the acquisition. Goodwill primarily consists of expected revenue synergies resulting from the combination of product portfolios and cost synergies related to elimination of redundant facilities and functions associated with the combined entity. Goodwill recognized in this transaction is not deductible for tax purposes. The intangible assets acquired will be amortized on a straight-line basis over useful lives of ten years, seven years and ten years for technology-based, customer-related, and trade name related intangible assets, respectively. The estimated fair values of the intangible assets acquired were primarily determined using the income approach based on significant inputs that were not observable in the market. Acquisition related costs of $5.8 million were recognized during the year ended December 31, 2021, as transaction-related expenses on the consolidated statements of operations. The Company’s results of operations for the year ended December 31, 2021 included the operating results of EOS of $30.0 million of revenue and a net loss of $17.6 million in the consolidated statement of operations. The following table presents the unaudited pro forma results for the year s ended December 31, 2021 and 2020, which combines the historical results of operations of the Company and its wholly owned subsidiaries as though the companies had been combined as of January 1, 2020. The pro forma information is presented for informational purposes only and is not indicative of the results of operations that may have been achieved if the acquisition had taken place at such time. The unaudited pro forma results presented include non-recurring adjustments directly attributable to the business combination, including $ million in amortization charges for acquired intangible assets, a $ 2.0 million adjustment related to the increased fair value of acquired inventory and $ 14.1 million in acquisition related expenses. The unaudited pro forma results include IFRS to U.S. GAAP adjustments for EOS historical results and adjustments for accounting policy alignment, which were materially similar to the Company. Any differences in accounting policies were adjusted to reflect the accounting policies of the Company in the unaudited pro forma results presented . December 31, (in thousands, except per share amounts) 2021 2020 Total revenue $ 251,906 $ 172,052 Net loss (140,441 ) (111,967 ) Net loss per share, basic and diluted $ (1.46 ) $ (1.17 )

Balance Sheets Details

Balance Sheets Details	12 Months Ended
	Dec. 31, 2021
Balance Sheet Related Disclosures [Abstract]
Balance Sheets Details	4. Balance Sheet Details Accounts Receivable, net Accounts receivable, net consist of the following (in thousands): December 31, 2021 2020 Accounts receivable $ 44,200 $ 23,887 Allowance for doubtful accounts (2,307 ) (360 ) Accounts receivable, net $ 41,893 $ 23,527 Inventories Inventories consist of the following (in thousands): December 31, 2021 2020 Raw materials $ 14,671 $ 6,064 Work-in-process 5,712 1,982 Finished goods 71,320 37,955 Inventories $ 91,703 $ 46,001 Property and Equipment, net Property and equipment, net consist of the following (in thousands, except as indicated): Useful lives December 31, (in years) 2021 2020 Surgical instruments 4 $ 130,432 $ 76,669 Machinery and equipment 7 11,092 6,562 Computer equipment 3 5,694 4,206 Office furniture and equipment 5 3,861 1,380 Leasehold improvements various 1,754 1,761 Construction in progress n/a 7,292 2,738 160,125 93,316 Less: accumulated depreciation (72,724 ) (56,646 ) Property and equipment, net $ 87,401 $ 36,670 Total depreciation expense was $20.3 million and $9.2 million for the years ended December 31, 2021 and 2020, respectively. At December 31, 2021 and 2020, assets recorded under capital leases of $0.4 million and $0.1 million, respectively, 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 Gross Accumulated Intangible December 31, 2021: (in years) Amount Amortization Assets, net Developed product technology 12 $ 74,543 $ (5,768 ) $ 68,775 Trademarks and trade names 10 5,732 (477 ) 5,255 Customer relationships 5 14,732 (5,264 ) 9,468 Distribution network 3 2,413 (1,840 ) 573 In-process research and development n/a 1,203 — 1,203 Total $ 98,623 $ (13,349 ) $ 85,274 Remaining Avg. Useful lives Gross Accumulated Intangible December 31, 2020: (in years) Amount Amortization Assets, net Developed product technology 12 $ 35,376 $ (23,056 ) $ 12,320 License agreements 1 5,536 (965 ) 4,571 Trademarks and trade names — 792 (119 ) 673 Customer relationships 3 7,458 (3,968 ) 3,490 Distribution network 2 4,027 (1,639 ) 2,388 In-process research and development n/a 1,278 — 1,278 Total $ 54,467 $ (29,747 ) $ 24,720 During the year ended December 31, 2021, in connection with the expiration and termination of the Supply Agreement with Globus Medical, defined below, the Company wrote off $32.6 million in fully amortized intangible assets. During the year ended December 31, 2021, in connection with the Company’s acquisition of EOS, as further described in Note 3, the Company recorded additions to definite-lived intangible assets in the amount of $71.5 million. Total expense related to amortization of intangible assets was $6.4 million and $1.8 million for the years ended December 31, 2021 and 2020, respectively. In-process research and development intangibles begin amortizing when the relevant products reach full commercial launch. Future amortization expense related to intangible assets as of December 31, 2021 is as follows (in thousands): Year Ending December 31, 2022 $ 9,436 2023 9,436 2024 9,333 2025 8,748 2026 8,748 Thereafter 39,573 Total $ 85,274 Goodwill The change in the carrying amount of goodwill during the year ended December 31, 2021 included the following (in thousands): December 31, 2020 $ 13,897 Additions 27,841 Foreign currency fluctuation (2,049 ) December 31, 2021 $ 39,689 There were no changes in the carrying amount of goodwill during the year ended December 31, 2020. Accrued Expenses and Other Current Liabilities Accrued expenses and other current liabilities consist of the following (in thousands): December 31, 2021 2020 Payroll and payroll related $ 18,449 $ 13,552 Commissions and sales milestones 12,420 7,038 Professional fees 4,684 3,551 Litigation settlement obligation 4,400 4,000 Royalties 3,466 2,293 Other taxes payable 3,004 248 Inventory in-transit 2,089 1,771 Administration fees 1,698 442 Interest 1,045 619 Other 4,294 1,750 Total accrued expenses and other current liabilities $ 55,549 $ 35,264 Other Long-Term Liabilities Other long-term liabilities consist of the following (in thousands): December 31, 2021 2020 Royalties $ 5,833 $ 1,678 Litigation settlement obligation - long-term portion 3,587 7,634 Income tax-related liabilities 1,522 373 Contract liability 2,897 — Other 3,222 1,703 Other long-term liabilities $ 17,061 $ 11,388

Discontinued Operations

Discontinued Operations	12 Months Ended
	Dec. 31, 2021
Discontinued Operations And Disposal Groups [Abstract]
Discontinued Operations	5. Discontinued Operations 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 Medical”). As a result of this transaction, the International Business has been excluded from continuing operations for all periods presented in the consolidated financial statements and is reported as 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 Medical, pursuant to which the Company supplied to Globus Medical certain of its implants and instruments, previously offered for sale by the Company in international markets at agreed-upon prices. The Supply Agreement expired and terminated on August 31, 2021 and all associated discontinued operations balances were removed from the consolidated balance sheets for the year ended December 31, 2021. In accordance with authoritative guidance, sales to Globus Medical were reported under continuing operations as the Company had continuing involvement under the Supply Agreement. The Company recorded $1.0 million in revenue and $1.1 million in cost of sales from the Supply Agreement in continuing operations for year ended December 31, 2021. The Company recorded $3.8 million in revenue and $3.5 million in cost of sales from the Supply Agreement in continuing operations for the year ended December 31, 2020.

Debt

Debt	12 Months Ended
	Dec. 31, 2021
Debt Disclosure [Abstract]
Debt	6. Debt 0.75% Senior Convertible Notes due 2026 In August 2021, the Company issued $316.3 million aggregate principal amount of unsecured Senior Convertible Senior Notes with a stated interest rate of 0.75% and a maturity date of August 1, 2026 Interest on payable semi-annually in arrears on February 1 and August 1 of each year, beginning on February 1, 2022. and the repayment of the outstanding unsecured term loan (the “Term Loan”) with Squadron Medical Finance Solutions, LLC (“Squadron Medical”) and outstanding obligation under the Inventory Financing Agreement, as below. The 2026 Notes are convertible into shares of the Company’s common stock based upon an initial conversion rate of 54.5316 shares of the Company’s common stock per $1,000 principal amount of 2026 Notes (equivalent to an initial conversion price of approximately $18.34 per share). The conversion rate will be subject to adjustment upon the occurrence of certain specified events, including certain distributions and dividends to all or substantially all of the holders of the Company’s common stock. Based on the terms of the 2026 Notes, when a conversion notice is received, the Company has the option to pay or deliver cash, shares of the Company’s common stock, or a combination thereof. Holders of the 2026 Notes have the right to convert their notes in certain circumstances and during specified periods. Prior to the close of business on the business day immediately preceding February 2, 2026, holders may convert all or a portion of their 2026 Notes only under the following circumstances: (1) during any calendar quarter (and only during such calendar quarter) commencing after the calendar quarter ending on September 30, 2021, if the last reported sale price of the Company’s common stock for at least 20 trading days (whether or not consecutive) during a period of 30 consecutive trading days ending on, and including, the last trading day of the immediately preceding calendar quarter is greater than or equal to 130% of the conversion price on each applicable trading day; (2) during the 5 consecutive business days immediately after any 10 consecutive trading day period (the “measurement period”) in which the trading price per $1,000 principal amount of 2026 Notes for each trading day of the measurement period was less than 98% of the product of the last reported sale price of the Company’s common stock and the conversion rate on each such trading day; or (3) upon the occurrence of specified corporate events. As of December 31, 2021, none of the conditions permitting the holders of the 2026 Notes to convert have been met. The 2026 Notes are classified as long-term debt on the consolidated balance sheets as of December 31, 2021. The 2026 Notes are redeemable, in whole or in part, at the Company’s option at any time, and from time to time, on or after August 6, 2024 and on or before the 40th scheduled trading day immediately before the maturity date, at a cash redemption price equal to the principal amount of the 2026 Notes to be redeemed, plus accrued and unpaid interest, if any, but only if the last reported sale price per share of the Company’s common stock exceeds 130% of the conversion price for a specified period of time. In addition, calling any of the 2026 Notes for redemption will constitute a “make-whole fundamental change” with respect to that note, in which case the conversion rate applicable to the conversion of that note will be increased in certain circumstances if such note is converted after it is called for redemption. If a fundamental change occurs prior to the maturity date, holders may require the Company to repurchase all or a portion of their 2026 Notes for cash at a price equal to 100% of the principal amount of the 2026 Notes plus accrued and unpaid interest. No principal payments are otherwise due on the 2026 Notes prior to maturity. The Company recorded the full principal amount of the 2026 Notes as a long-term liability net of deferred issuance costs. The annual effective interest rate for the 2026 Notes is 1.4%. Total interest expense for the 2026 Notes was $1.7 million during the year ended December 31, 2021. The Company uses the if-converted method for assumed conversion of the 2026 Notes to compute the weighted average shares of common stock outstanding for diluted earnings per share, if applicable. The outstanding principal amount and carrying value of the 2026 Notes consist of the following (in thousands): December 31, 2021 Principal $ 316,250 Unamortized debt issuance costs (9,259 ) Net carrying value $ 306,991 Capped Call Transactions In connection with the offering of the 2026 Notes, the Company entered into privately negotiated capped call transactions (the “Capped Call Transactions”) with certain financial institutions. The Capped Call Transactions are expected generally to reduce the potential dilution and/or offset the cash payments the Company is required to make in excess of the principal amount of the 2026 Notes upon conversion of the 2026 Notes in the event that the market price per share of the Company’s common stock is greater than the strike price of the Capped Call Transactions with such reduction and/or offset subject to a cap. The Capped Call Transactions have an initial cap price of $27.68 per share of the Company’s common stock, which represents a premium of 100% over the last reported sale price of the Company’s common stock on August 5, 2021, and is subject to certain adjustments under the terms of the Capped Call Transactions. Collectively, the Capped Call Transactions cover, initially, the number of shares of the Company’s common stock underlying the 2026 Notes, subject to anti-dilution adjustments substantially similar to those applicable to the 2026 Notes. The Capped Call Transactions are separate transactions and are not part of the terms of the 2026 Notes and will not affect any holder’s rights under the 2026 Notes. Holders of the 2026 Notes will not have any rights with respect to the Capped Call Transactions. The Capped Call Transactions meet all of the applicable criteria for equity classification and, as a result, the related $39.9 million cost was recorded as a reduction to additional paid-in capital on the Company’s consolidated statements of shareholders’ equity. OCEANE Convertible Bonds On May 31, 2018, EOS issued 4,344,651 OCEANE convertible bonds, denominated in Euros, due May 2023 for aggregate gross proceeds of $34.3 million (€29.5 million). The OCEANEs are unsecured obligations of EOS, rank equally with all other unsecured and unsubordinated obligations of EOS, and pay interest at a rate equal to 6% per year, payable semiannually in arrears on May 31 and November 30 of each year, beginning November 30, 2018. Unless either earlier converted or repurchased, the OCEANEs will mature on May 31, 2023. Interest expense was $0.7 million for the period from May 13, 2021 to December 31, 2021. As discussed in Note 3, in connection with the Offer to acquire EOS, the Company purchased 2,486,135 OCEANEs, and as such, 1,858,516 OCEANEs with a principal amount of $15.3 million (€12.6 million) remained outstanding at the time of acquisition. The OCEANEs are convertible by their holders into new EOS Shares or exchangeable for existing EOS Shares, at the Company’s option, at an initial conversion rate of one share per OCEANE, and the initial conversion rate is subject to customary anti-dilution adjustments. The OCEANEs are convertible at any time until the seventh business day prior to maturity or seventh business day prior to an earlier redemption of the OCEANE. If the number of shares calculated is not a whole number, the holder may request allocation of either the whole number of shares immediately below the number and receive an amount in cash equal to the remaining fractional share value, or the whole number of shares immediately above the number and pay an amount in cash equal to the remaining fractional share value. Holders of the OCEANEs have the option to convert all or any portion of such OCEANEs, regardless of any conditions, at any time until the close of seventh business day immediately preceding the maturity date. EOS has a right to redeem all of the OCEANEs at its option any time after June 20, 2021 at a cash redemption price equal to the par value of the OCEANEs plus accrued and unpaid interest if the product of the volume-weighted-average price of the shares and the conversion ratio as specified in the agreement in effect on each trading day exceeds 150% of the par value of each OCEANE on each of at least twenty consecutive trading days during any forty consecutive trading days, if EOS redeems the OCEANEs when the number of OCEANEs outstanding is 15% or less of the number of OCEANEs originally issued, or the occurrence of a tender or exchange offer. As a result of the Company’s acquisition of EOS, the OCEANEs are now convertible into new shares of EOS, as a wholly-owned subsidiary of the Company. OCEANE holders can redeem the notes upon the occurrence of an event of default or upon the occurrence of a change of control. In July 2021, in connection with the change of control, holders of 25,971 OCEANEs chose to redeem their bonds for approximately $0.2 million (€0.2 million). The carrying value of the outstanding OCEANEs was $14.1 million (€12.5 million) as of December 31, 2021 . Other Debt Agreements In January and April 2021, prior to the acquisition, EOS obtained two loan agreements, denominated in Euros, under French government sponsored COVID-19 relief initiatives (pret garanti par l’etat or “PGE” loans). Each loan contains a 12-month term and 90% of the principal balance of each loan is state guaranteed. The cost of the state guaranty is 0.25% of the loan amounts. The loans carry an interest-free rate from the commercial banks (€3.3 million) and a 1.75% interest from the lender (€1.5 million). The loan capital and loan guaranty costs are payable in full at the end of the 12-month term or the loan may be extended up to 5 additional years. If the Company chooses to extend the debt, the election must be made by the Company between months 8 and 11 of the 12-month term. The extension will carry an interest rate at the banks’ refinancing cost, to be applied from year 2 to year 6 and an increased state guaranty cost (50 to 200 bps, as per a scale with company size and extension year). In February 2022, the Company extended the maturity for each loan agreement to 2027. Each loan shall have a 12-month period from the applicable extension date where interest only payments will occur (the “Interest Only Period”). Following the Interest Only Period, monthly and quarterly installments of principal and interest under each loan agreement will be due until the original principal amounts and applicable interest is fully repaid in 2027. The Company has recorded the debt as long-term debt on the consolidated balance sheets as of December 31, 2021. The outstanding obligation under each loan as of December 31, 2021 was $3.7 million and $1.6 million (€3.3 million and €1.5 million) at weighted average interest rates of 0.69% and 1.25%, respectively, and weighted average costs of the state guaranty of 0.69% and 1.00%, respectively. Debt consists of the following (in thousands): December 31, 2021 2020 2026 Notes $ 316,250 $ — OCEANEs 14,113 — Other notes payable 386 1,887 EOS PGE Loans 5,341 — Squadron Medical Term Loan — 45,000 Inventory Financing — 3,821 PPP Loan — 4,271 Total 336,090 54,979 Less: debt discount (9,259 ) (12,813 ) Total 326,831 42,166 Less: current portion of long-term debt (342 ) (4,167 ) Total long-term debt, net of current portion $ 326,489 $ 37,999 Principal payments on debt are as follows as of December 31, 2021 (in thousands): 2022 $ 342 2023 14,834 2024 1,353 2025 1,335 2026 317,586 Thereafter 640 Total 336,090 Less: debt discount (9,259 ) Total 326,831 Less: current portion of long-term debt (342 ) Long-term debt, net of current portion $ 326,489 Paycheck Protection Loan On April 23, 2020, the Company received the proceeds from a loan in the amount of $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 August 21, 2021, the Company was required to pay the lender equal monthly payments of principal and interest as required to fully amortize the principal amount outstanding on the PPP Loan by April 21, 2022, the date prescribed by guidance issued by U.S. Small Business Administration (“ 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 twenty-four-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. The Company used all of the proceeds from the PPP Loan to retain employees and maintain payroll. In July 2021, the Company received confirmation from the SBA that the entire PPP Loan was forgiven and recorded a gain on debt extinguishment of $4.3 million, which is included in loss on debt extinguishment, net, on the consolidated statements of operations Squadron Medical Credit Agreement On November 6, 2018, the Company entered into a Term Loan (the “Term Loan”) with Squadron Medical Finance Solutions, LLC, a provider of debt financing to growing companies in the orthopedic industry. The Term Loan was subsequently amended March 2019, May 29, 2020 and December 16, 2020 to expand the availability of additional term loans, extend the maturity, remove all financial covenant requirements and, in the December 2020 amendment, to incorporate a debt exchange. On December 16, 2020, the Company amended the Term Loan to expand the credit facility by an additional $15.0 million and to extend the maturity of the Term Loan to June 30, 2026. In conjunction with the Term Loan amendment on December 16, 2020, the Company entered into a debt exchange agreement whereby the Company exchanged $30.0 million of the Company’s outstanding debt obligations pursuant to the Term Loan dated as of November 6, 2018, as amended, for the issuance of 2,700,270 shares of the Company’s Common Stock to Squadron Capital LLC and a participant lender, based on a price of $11.11 per share. The debt exchange resulted in additional debt issuance costs of $3.8 million calculated as the difference between the Company’s stock price on the date of issuance and the issuance price. The Company accounted for the March 2019, May 2020, and December 2020 amendments of the Term Loan as debt modifications with continued amortization of the existing and inclusion of the new debt issuance costs amortized into interest expense utilizing the effective interest rate method. The Company determined that the $30.0 million pre-payment associated with the December 16, 2020 amendment should be accounted for as a partial extinguishment of the November 6, 2018 Term Loan, as amended. As a result of the partial extinguishment the Company elected, as an accounting policy in accordance with ASC 470-50-40-2, to write off a proportionate amount of the unamortized fees at the time that the financing was partially settled in accordance with the terms of the Term Loan dated November 6, 2018, as amended. The unamortized debt issuance costs were allocated between the remaining original loan balance and the portion of the loan paid down on a pro-rata basis. At the time of prepayment, the Company recorded a loss on extinguishment of $6.1 million, for the year ended December 31, 2020 and capitalized $3.8 million in non-cash debt issuance closing costs. On August 10, 2021, the Company terminated and repaid all obligations under the Term Loan, which consisted of the $45.0 million outstanding principal and $0.2 million accrued interest. As a result of the early termination of the Term Loan, the Company recorded a loss on debt extinguishment associated with the unamortized debt issuance costs of $11.7 million, for the year ended December 31, 2021. In connection with the initial 2018 Term Loan and subsequent amendments, the Company issued an aggregate of 6,759,530 warrants to Squadron Medical and a participant lender. See Note 9 for further information on the warrants issued. Inventory Financing In November 2018, the Company entered into an Inventory Financing Agreement with an inventory supplier whereby the Company was originally permitted to draw up to $3.0 million for the purchase of inventory. In November 2020 and May 2021, the Company amended the Inventory Financing Agreement with the supplier to increase the available draw to $6.0 million and then to $9.0 million for the purchase of inventory. On August 10, 2021, the Company terminated and repaid all obligations under the Inventory Financing Agreement, which consisted of $8.1 million outstanding principal and $0.1 million accrued interest. MidCap Facility Agreement On May 29, 2020, the Company repaid in full all amounts outstanding under the Amended Credit Facility with MidCap Funding IV, LLC (“MidCap”), including the outstanding balance of $9.6 million, which consisted of outstanding principal and accrued interest. As a result of the early termination of the Credit Facility with MidCap, the Company recorded a loss on debt extinguishment in its consolidated statements of operations for the year ended December 31, 2020.

Commitments and Contingencies

Commitments and Contingencies	12 Months Ended
	Dec. 31, 2021
Commitments And Contingencies Disclosure [Abstract]
Commitments and Contingencies	7. Commitments and Contingencies Leases The Company determines if an arrangement is a lease at inception by assessing whether there is an identified asset and whether the contract conveys the right to control the use of the identified asset in exchange for consideration over a period of time. The Company recognizes ROU assets and lease liabilities for office buildings and certain equipment with lease terms of 1 year to 10 years, some of which include options to extend and/or terminate the leases. Any short-term leases defined as twelve months or less or month-to-month leases were excluded and continue to be expensed each month. Total costs associated with these short-term leases is immaterial to all periods presented. The Company aggregates all lease and non-lease components for each class of underlying assets into a single lease component and variable charges for common area maintenance and other variable costs are recognized as expense as incurred. Total variable costs associated with leases for the year ended December 31, 2021 were immaterial. The Company had an immaterial amount of financing leases as of December 31, 2021, which is included in property and equipment, net, accrued expenses and other current liabilities, and other long-term liabilities, on the consolidated balance sheets. Operating Lease The Company occupies approximately 121,541 square feet of office, engineering, and research and development space in Carlsbad, California. On December 4, 2019, the Company entered into a 10-year operating lease that commenced on February 1, 2021 and will terminate on January 31, 2031, subject to two sixty-month options to renew which are not reasonably certain to be exercised. The Company recognized a $21.1 million ROU asset and $21.5 million lease liability on the consolidated balance sheet upon taking control of the premises on the lease commencement date. Base rent under the building lease for the first twelve months of the term will be $0.2 million per month subject to full abatement during months two through ten, and thereafter will increase annually by 3.0% throughout the remainder of the lease. On April 9, 2021, the Company entered into a 7-year operating lease agreement for a new distribution center which consists of approximately 75,643 square feet of office and warehouse space in Memphis, Tennessee. The term of the lease commenced on May 1, 2021 and will terminate on May 1, 2028, subject to two thirty-six-month options to renew which are not reasonably certain to be exercised. The Company recognized a $1.7 million ROU asset and $1.6 million lease liability upon taking control of the premises on the lease commencement date. Base rent under the new building lease will be commensurate with the Company’s proportionate share of occupancy of the new building and will increase annually by 3.0% throughout the remainder of the lease. With the acquisition of EOS, the Company assumed its ROU assets and lease liabilities in the amount of $4.3 million. EOS occupies its main office in Paris, France. The EOS office in Paris, France is a 10-year operating lease that commenced in 2019 and will terminate in September 2028. Base rent under the lease is approximately $0.6 million per year. Future minimum annual lease payments for all operating leases of the Company are as follows (in thousands): 2022 $ 4,405 2023 4,609 2024 4,620 2025 4,590 2026 4,694 Thereafter 17,846 Total undiscounted lease payments 40,764 Less: imputed interest (12,169 ) Operating lease liability 28,595 Less: current portion of operating lease liability (4,212 ) Operating lease liability, less current portion $ 24,383 The Company’s weighted average remaining lease term and weighted average discount rate as of December 31, 2021 and December 31, 2020 are as follows: December 31, 2021 December 31, 2020 Weighted average remaining lease term (years) 8.6 0.7 Weighted average discount rate 8.5 % 10.5 % Information related to the Company’s operating lease is as follows (in thousands): December 31, 2021 2020 Rent expense $ 4,482 $ 1,300 Cash paid for amounts included in measurement of lease liabilities $ 1,795 $ 1,400 Purchase Commitments With the acquisition of EOS, the Company assumed its inventory purchase commitment agreement with a third-party supplier. The Company is obligated to certain minimum purchase commitment requirements through December 2025. As of December 31, 2021, the remaining minimum purchase commitment under the agreement was $33.5 million. Litigation The Company is and may become involved in various legal proceedings arising from its business activities. While management is not aware of any litigation matter that in and of itself would have a material adverse impact on the Company’s consolidated results of operations, cash flows or financial position, litigation is inherently unpredictable, and depending on the nature and timing of a proceeding, an unfavorable resolution could materially affect the Company’s future consolidated results of operations, cash flows or financial position in a particular period. The Company assesses contingencies to determine the degree of probability and range of possible loss for potential accrual or disclosure in the Company’s consolidated financial statements. An estimated loss contingency is accrued in the Company’s consolidated financial statements if it is probable that a liability has been incurred and the amount of the loss can be reasonably estimated. Because litigation is inherently unpredictable and unfavorable resolutions could occur, assessing contingencies is highly subjective and requires judgments about future events. When evaluating contingencies, the Company may be unable to provide a meaningful estimate due to a number of factors, including the procedural status of the matter in question, the presence of complex or novel legal theories, and/or the ongoing discovery and development of information important to the matters. In addition, damage amounts claimed in litigation against the Company may be unsupported, exaggerated or unrelated to reasonably possible outcomes, and as such are not meaningful indicators of the Company’s potential liability. 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 or that it would suffer irreparable harm absent 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 claims in October 2018. Also in October 2018, NuVasive moved to dismiss the Company’s counterclaims that . In January 2019, the Court denied NuVasive’s motion as to all but one counterclaim, but granted the Company leave to amend that counterclaim to cure 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 July 2019, PTAB instituted inter partes review (“IPR”) of the validity of asserted claims of the two patents at issue. 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. In July 2020, the PTAB ruled that all challenged claims of the ‘156 Patent were valid (not unpatentable) and ruled that several challenged claims of the ‘334 Patent were invalid, while finding that other challenged claims of the ‘334 Patent valid. NuVasive and the Company both appealed the PTAB’s written decision on the matter. In February 2022, the U.S. Court of Appeals for the Federal Circuit affirmed the PTAB’s ruling without opinion. 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. In April 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. Also, in April 2020, 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. In November 2020, NuVasive filed a Motion to Strike the Company’s Invalidity Contentions concerning the ’156 and ’334 Implant Patents. In April 2021, the Court denied NuVasive’s motion. In January 2021, NuVasive filed a Motion for Partial Summary Judgment of infringement and validity of the ’156 and ’334 Implant Patents and the Company filed a Motion for Summary Judgment of invalidity of those same patents. These motions were argued to the Court on June 29, 2021. In August 2021, the Court denied NuVasive’s motion and granted the Company’s motion for summary judgment of invalidity of the ’156 Patent. In September 2021, NuVasive elected not to proceed with its remaining claims for the ’334 Patent, ’780 Patent, ’270 Patent, ’227 Patent, and ’859 Patent. Trial on the remaining patents (’801 Patent, ’832 Patent, and ’531 Patent) has been rescheduled several times due to the COVID-19 pandemic and is now set to begin March 1, 2022. 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 December 31, 2021, the Company has not recorded any liability on the consolidated balance sheet related to this matter. On October 12, 2018, the Delaware Court ordered that NuVasive begin advancing legal fees for Mr. Miles’ defense in the lawsuit, as well as Mr. Miles’ legal fees incurred in pursuing advancement of his fees, pursuant to an indemnification agreement between NuVasive and Mr. Miles. As of December 31, 2021, the Company has not recorded any liability on the consolidated balance sheet related to this matter. Royalties The Company has entered into various intellectual property agreements requiring the payment of royalties based on the sale of products that utilize such intellectual property. These royalties are based on fixed fees or calculated either as a percentage of net sales or on a per-unit sold basis. Royalties are included on the accompanying consolidated statements of operations as a component of cost of sales.

Orthotec Settlement

Orthotec Settlement	12 Months Ended
	Dec. 31, 2021
Commitments And Contingencies Disclosure [Abstract]
Orthotec Settlement	8. Orthotec Settlement On September 26, 2014, the Company entered into a Settlement and Release Agreement, dated 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 unpaid amounts due accrue interest at the rate of 7.0% 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. 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 $5.0 million to the $49.0 million settlement amount. In October 2020, made its first $1.0 million payment. See Note 12 for further information regarding HealthpointCapital. As of December 31, 2021, the Company has made payments in the aggregate of $49.0 million, with a remaining outstanding balance of $8.5 million (including imputed interest) A reconciliation of the total net settlement obligation is as follows (in thousands): December 31, 2021 December 31, 2020 Litigation settlement obligation - short-term portion $ 4,400 $ 4,000 Litigation settlement obligation - long-term portion 3,587 7,634 Total 7,987 11,634 Future imputed interest 478 1,199 Total settlement obligation, gross 8,465 12,833 Related party receivable - included in stockholders' equity — (4,000 ) Total settlement obligation, net $ 8,465 $ 8,833

Equity

Equity	12 Months Ended
	Dec. 31, 2021
Equity [Abstract]
Equity	9. Equity Common Stock There were 200,000,000 shares of common stock authorized at December 31, 2021 and 2020. On March 1, 2021 the Company completed the sale of 12,421,242 shares of common stock for gross proceeds of $138.0 million, and net proceeds of approximately $131.8 million, net of $6.2 million in fees. On October 16, 2020 the Company completed the sale of 13,142,855 shares of common stock for gross proceeds of $115.0 million, resulting in net proceeds of approximately $107.7 million, net of $7.3 million in fees. On August 3, 2021, the Company’s Board of Directors authorized the Company to repurchase an aggregate of up to $25.0 million of shares of the Company’s common stock. On August 10, 2021, The Company repurchased Redeemable Preferred Stock The Company issued shares of redeemable preferred stock in connection with its initial public offering in June 2006. As of December 31, 2021, and 2020, the redeemable preferred stock carrying value was $23.6 million and there were 20 million shares of redeemable preferred stock authorized. The redeemable preferred stock is not convertible into common stock but is redeemable at $9.00 per share, (i) upon the Company’s liquidation, dissolution or winding up, or the occurrence of certain mergers, consolidations or sales of all or substantially all of the Company’s assets, before any payment to the holders of the Company’s common stock, or (ii) at the Company’s option at any time. Holders of redeemable preferred stock are generally not entitled to vote on matters submitted to the stockholders, except with respect to certain matters that will affect them adversely as a class and are not entitled to receive dividends. The carrying value of the redeemable preferred stock was $7.11 per share at December 31, 2021 and 2020. The redeemable preferred stock is presented separately from stockholders’ equity in the consolidated balance sheets and any adjustments to its carrying value up to its redemption value of $9.00 per share are reported as a dividend. 2017 PIPE Warrants The 2017 Common Stock Warrants (the “2017 PIPE Warrants”) have a five-year there were 273,554 2017 PIPE Warrant exercises, for total cash proceeds of $0.6 million. 2018 PIPE Warrants The 2018 Common Stock Warrants (the “2018 PIPE Warrants”) have a five-year year ended December 31, 2021, there were 2,900,660 2018 PIPE Warrant exercises for total cash proceeds of $1.5 million. During the year ended , there were 2,342,986 2018 PIPE Warrant exercises for total cash proceeds of $1.3 million. December 31, 2021 SafeOp Surgical Merger Warrants In conjunction with the Company’s 2018 acquisition of SafeOp, the Company issued warrants to purchase 2,200,000 shares of common stock at an exercise price of $3.50 per share and contain a five-year Squadron Medical Warrants During the year ended December 31, 2018, in connection with the Term Loan with Squadron Medical and a participant lender, 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. In May 2020, an additional 1,075,820 warrants were issued at an exercise price of $4.88 per share in conjunction with the Company’s second amendment to the Term Loan for total warrants outstanding to Squadron Medical and the participant lender of 6,759,530. In conjunction with the second amendment, the expiration dates for all existing warrants were extended to May 29, 2027 to align all outstanding warrant expiration dates. In accordance with authoritative accounting guidance, the warrants qualified for equity treatment upon issuance and 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. The fair value assigned to the warrant amendment was also allocated as a debt issuance cost and amortized into interest expense. 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. No Squadron Medical Warrants have been exercised as of December 31, 2021. Executive Warrants In December 2017 the Company issued warrants to Mr. Patrick S. Miles, the Company’s Chairman and Chief Executive Officer, to purchase 1,327,434 shares of the Company’s common stock for $5.00 per share (the “Executive Warrants”). The warrants have a five-year A summary of all outstanding warrants is as follows (in thousands): Number of Warrants Strike Price Expiration 2017 PIPE Warrants 2,312 $ 2.00 June 2022 2018 PIPE Warrants 8,479 $ 3.50 May 2023 SafeOp Surgical Merger Warrants 1,195 $ 3.50 May 2023 2018 Squadron Medical Warrants 845 $ 3.15 May 2027 2019 Squadron Medical Warrants 4,839 $ 2.17 May 2027 2020 Squadron Medical Warrants 1,076 $ 4.88 May 2027 Executive Warrants 1,327 $ 5.00 December 2022 Other* 111 $ 5.40 Various through December 2024 Total 20,184 *Represents weighted average strike price

Stock Benefit Plans and Stock-B

Stock Benefit Plans and Stock-Based Compensation	12 Months Ended
	Dec. 31, 2021
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Stock Benefit Plans and Stock-Based Compensation	10. Stock Benefit Plans and Stock-Based Compensation 2016 Equity Incentive Plan In 2016 the Company adopted its 2016 Equity Incentive Plan (the “2016 Plan”), which replaced the Company’s 2005 Employee, Director and Consultant Stock Plan. On October 25, 2018, the Company’s Board of Directors adopted an amendment to the Company’s 2016 Equity Incentive Award Plan. The 2016 Plan allows for the grant of options, restricted stock, restricted stock unit awards and performance unit awards to employees, directors, and consultants of the Company. Upon its adoption, the 2016 Plan had 1,083,333 shares of common stock reserved for issuance. The Board of Directors determines the terms of the grants made under the 2016 Plan. Options granted under the 2016 Plan expire no later than ten years from the date of grant (five years for incentive stock options granted to holders of more than 10% of the Company’s voting stock). Options generally vest over a four-year Salary-to-Equity Conversion Program On 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 permitted 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 was granted a restricted stock unit from the Company’s 2016 Equity Incentive Plan, 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 fully vested on July 10, 2020. 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. As the plan allows for a cash payment of the deferred amount in the event the employee separated from the Company prior to the completion date of the program, the amounts were recorded as a liability instrument through its settlement date with a corresponding fair value adjustment at each reporting period. In 2020, the full fair value of $0.9 million was reclassified into equity upon settlement of the program and issuance of the common stock. A stock compensation charge of $0.9 million related to the program was recorded during the year ended December 31, 2020. 2016 Employment Inducement Award Plan On October 4, 2016, the Company’s Board of Directors adopted the 2016 Employment Inducement Award Plan (the “Inducement Plan”). The Inducement Plan allows for the grant of options, restricted stock, restricted stock unit awards and performance unit awards to new employees of the Company by granting an award to such new employee as an inducement for the employee to begin employment with the Company. As of December 31, 2021 the Inducement Plan had 535,125 shares of common stock reserved for issuance, which may only be granted to an employee who has not previously been an employee or member of the board of directors of the Company. The terms of the Inducement Plan are substantially similar to the terms of the Company’s 2016 Plan with two principal exceptions: (i) incentive stock options may not be granted under the Inducement Plan; and (ii) the annual compensation paid by the Company to specified executives will be deductible only to the extent that it does not exceed $1.0 million. 2019 Management Objective Strategic Incentive Plan Under the 2019 Management Objective Strategic Incentive Plan, the Company is authorized to grant up to 500,000 shares of common stock to third-party individuals or entities that do not qualify under the Company’s other existing equity plans, with a maximum grant of 50,000 shares per participant. As of December 31, 2021, 122,500 restricted shares and a warrant to purchase up to 12,500 restricted common stock shares have been granted under the 2019 Management Objective Strategic Incentive Plan. 2017 Distributor Inducement Plan Under the 2017 Distributor Inducement Plan, the Company is authorized to grant up to 1,000,000 shares of common stock to third-party distributors whereby, upon the achievement of certain Company sales and/or distribution milestones the Company may grant to a distributor shares of common stock or warrants to purchase shares of common stock. The warrants and restricted stock units issued under the plan are subject to time based or net sales-based vesting conditions. As of December 31, 2021, 325,000 warrants and 229,900 shares of restricted common stock were granted under the 2017 Distributor Inducement Plan. As of December 31, 2021, 205,000 warrants and 146,100 shares of common stock were earned or issued. 2017 Development Services Plan Under the 2017 Development Services Plan, the Company is authorized to issue up to 7,000,000 shares of common stock to third-parties upon the achievement of certain revenue milestones associated with certain developed royalty-bearing products. Future royalty payments for product and/or intellectual property development work may be paid in either cash or restricted shares of the Company’s common stock at the election of the developer, depending on the terms of the agreement. Each common stock issuance is contingent on net sales-based criteria and other provisions, including the satisfaction of applicable laws and market regulations regarding the issuance of restricted shares to such developers. The Company has entered into Development Services Agreements for development of a wide variety of potential products and intellectual property, with the possibility of issuing shares of common stock. As of December 31, 2021, no shares have been issued and the majority of the agreements are not deemed probable of common stock issuance at this time. The Company recognizes stock-based compensation once the achievement of the performance criteria and vesting conditions are deemed probable. Stock-Based Compensation Costs The compensation cost that has been included in the Company’s consolidated statements of operations for all stock-based compensation arrangements is detailed as follows (in thousands): Year Ended December 31, 2021 2020 Cost of sales $ 737 $ 512 Research and development 4,056 2,114 Sales, general and administrative 31,657 15,033 Total $ 36,450 $ 17,659 Stock Options A summary of the Company’s stock option activity under the Plans and related information is as follows (in thousands, except as indicated and per share data): Shares Weighted average exercise price Weighted average remaining contractual term (in years) Aggregate intrinsic value Outstanding at December 31, 2020 3,951 $ 3.21 Granted 85 13.62 Exercised (569 ) 2.63 Forfeited (116 ) 5.28 Outstanding at December 31, 2021 3,351 $ 3.50 6.03 $ 27,619 Options vested and exercisable at December 31, 2021 2,973 $ 3.24 5.86 $ 25,162 Options vested and expected to vest at December 31, 2021 3,351 $ 3.50 6.03 $ 27,619 The weighted-average grant-date fair value per share of stock options granted during the years ended December 31, 2021 and 2020 was $9.88 and $4.71, respectively. The total intrinsic value of stock options exercised was $6.8 million and $2.3 million for the years ended December 31, 2021 and 2020, respectively. The aggregate intrinsic value of options at December 31, 2021 is based on the Company’s closing stock price on the last business day of 2021 of $11.43 per share. The weighted average assumptions used to compute the stock-based compensation costs for the stock options granted during the years ended December 31, 2021 and 2020 are as follows: Year Ended December 31, 2021 2020 Risk-free interest rate 0.84 % 1.03 % Expected dividend yield — — Weighted average expected life (years) 6.07 6.08 Volatility 87.38 % 84.00 % As of December 31, 2021, there was $1.3 million of unrecognized compensation expense for stock options which is expected to be recognized on a straight-line basis over a weighted average period of approximately 1.40 years. Restricted Stock Awards and Units The following table summarizes information about the restricted stock awards, restricted stock units and performance-based restricted units activity (in thousands, except as indicated and per share data): Shares Weighted average grant date fair value Weighted average remaining recognition period (in years) Unvested at December 31, 2020 8,216 $ 3.13 Awarded 3,980 12.79 Vested (2,824 ) 3.88 Forfeited (669 ) 4.01 Unvested at December 31, 2021 8,703 $ 6.34 1.66 The weighted average fair value per share of awards granted during the years ended December 31, 2021 and 2020 was $12.79 and $4.87, respectively. The total fair value of RSUs that vested during the years ended December 31, 2021 and 2020 was $43.9 million and $13.1 million, respectively. As of December 31, 2021, there was $42.0 million of unrecognized compensation expense for restricted stock awards, restricted stock units, and performance-based restricted units which is expected to be recognized on a straight-line basis over a weighted average period of approximately 1.66 years. Employee Stock Purchase Plan In 2007 the Company adopted the Alphatec Holdings, Inc. 2007 Amended and Restated Employee Stock Purchase Plan (the “ESPP”), which was first amended in May 2017. On June 16, 2021, the Company’s shareholders approved a second amendment to the ESPP which increased the amount of shares of common stock available for purchase under the ESPP by 500,000 shares. The ESPP provides eligible employees with a means of acquiring equity in the Company at a discounted purchase price using their own accumulated payroll deductions. Under the terms of the ESPP, employees can elect to have up to 20% of their annual compensation, up to a maximum of $21,250 per year, withheld to purchase shares of Company common stock for a purchase price equal to 85% of the lower of the fair market value per share (at closing) of Company common stock on (i) the commencement date of the six-month During the years ended December 31, 2021 and 2020, there were 227,245 and 379,166 shares of common stock, respectively, purchased under the ESPP. The Company recognized $1.1 million and $1.0 million in expense related to the ESPP for the years ended December 31, 2021 and 2020, respectively. As of December 31, 2021, 547,170 shares were available under the ESPP for future issuance. The Company estimates the fair value of shares issued to employees under the ESPP using the Black-Scholes option-pricing model Year Ended December 31, 2021 2020 Risk-free interest rate 0.04% - 0.12% 0.12% - 1.58% Expected dividend yield — — Expected term (years) 0.50 0.50 Volatility 49.98% - 78.37% 54.96% - 102.5% Common Stock Reserved for Future Issuance Common stock reserved for future issuance consists of the following (in thousands): December 31, 2021 Stock options outstanding 3,351 Unvested restricted stock units 8,703 Employee stock purchase plan 547 Series A convertible preferred stock 29 Senior convertible notes 17,246 Warrants outstanding 20,184 Authorized for future grant under the Distributor and Development Services plans 445 Authorized for future grant under the Management Objective Strategic Incentive Plan 365 Authorized for future grant under the Company Equity plans 4,025 54,895

Income Taxes

Income Taxes	12 Months Ended
	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Income Taxes	11. Income Taxes The components of the pretax income (loss) are presented in the following table (in thousands): Year Ended December 31, 2021 2020 U.S. Domestic $ (127,943 ) $ (78,849 ) Foreign (16,219 ) — Net loss before taxes $ (144,162 ) $ (78,849 ) The components of the provision for income taxes from continuing operations are presented in the following table (in thousands): Year Ended December 31, 2021 2020 Current income tax provision: Federal $ 123 $ — State 166 100 Foreign 66 35 Total current 355 135 Deferred income tax provision: Federal (159 ) (2 ) State (32 ) 12 Total deferred (191 ) 10 Total income tax provision $ 164 $ 145 The provision for income taxes differs from the amount of income tax determined by applying the applicable U.S. statutory federal income tax rate to pretax loss from continuing operations as a result of the following differences: December 31, 2021 2020 Federal statutory rate 21.00 % 21.00 % Adjustments for tax effects of: State taxes, net (0.07 ) (0.11 ) Stock-based compensation (0.48 ) (0.93 ) Foreign rate differential 0.43 0.00 Foreign taxes (0.05 ) (0.04 ) Other permanent adjustments 0.08 (1.70 ) Federal uncertain tax positions (0.08 ) 0.00 Other (0.13 ) (0.15 ) Valuation allowance (20.81 ) (18.25 ) Effective income tax rate (0.11 )% (0.18 )% Significant components of the Company’s deferred tax assets and liabilities as of December 31, 2021 and 2020 are as follows (in thousands): December 31, 2021 2020 Deferred tax assets: Net operating losses $ 131,734 $ 70,220 Interest 11,095 8,193 Inventory 8,784 8,117 Accruals and reserves 7,145 3,437 Lease liability 6,216 228 Stock-based compensation 4,318 2,464 Legal settlement 1,998 2,875 Income tax credit carryforwards 1,574 1,582 Total deferred tax assets 172,864 97,116 Valuation allowance (127,209 ) (87,489 ) Total deferred tax assets, net of valuation allowance 45,655 9,627 Deferred tax liabilities: Goodwill and intangibles (18,439 ) (2,483 ) Property and equipment (18,404 ) (6,803 ) Right-of-use assets (6,256 ) (291 ) Total deferred tax liabilities (43,099 ) (9,577 ) Net deferred tax assets $ 2,556 $ 50 The realization of deferred tax assets is dependent on the Company’s ability to generate sufficient taxable income in future years in the associated jurisdiction to which the deferred tax assets relate. As of December 31, 2021, a valuation allowance of $127.2 million has been established against the deferred tax assets, as the Company has determined that it is currently not likely that these assets will be realized. During the year ended December 31, 2021, the valuation allowance increased by $39.7 million. In determining the need for a valuation allowance, the Company considers all available positive and negative evidence, including scheduled reversals of deferred tax liabilities, projected future taxable income, tax planning strategies, and recent financial performance. Based on the review of all positive and negative evidence, including a three-year The following table summarizes the changes to unrecognized tax benefits (in thousands): Year ended December 31, 2021 2020 Unrecognized tax benefit at the beginning of the year $ 2,452 $ 2,452 Increases in tax positions for current year relating to acquisitions 12,713 — Unrecognized tax benefits at the end of the year $ 15,165 $ 2,452 At December 31, 2021 and 2020, $14.5 million and $2.0 million, respectively, of the Company’s total unrecognized tax benefits, if recognized, would impact the effective income tax rate. In accordance with the disclosure requirements as described in ASC Topic 740, Income Taxes The Company and its subsidiaries are subject to federal income tax as well as income tax of multiple state and foreign jurisdictions. With few exceptions, the Company is no longer subject to income tax examination by tax authorities in major jurisdictions for years prior to 2016. However, to the extent allowed by law, the taxing authorities may have the right to examine prior periods where net operating losses and tax credits were generated and carried forward and make adjustments up to the amount of the carryforwards. The Company is not currently under examination by the Internal Revenue Service, foreign or state and local tax authorities. At December 31, 2021, the Company had federal, state, and foreign net operating loss carryforwards of $448.8 million, $316.9 million and $122.4 million, respectively. Federal and state begin expiring at various dates beginning in 2022 through 2042, while foreign net operating losses in France carryforward indefinitely. Federal and some state net operating losses generated in years ending after December 31, 2017 can be carried forward indefinitely. At December 31, 2021, the Company had state research and development tax credit carryforwards of $3.2 million. The state research and development tax credits do not have an expiration date and may be carried forward indefinitely. Utilization of the net operating loss and tax credit carryforwards may become subject to annual limitations due to ownership change limitations that could occur in the future as provided by Section 382 and 383 of the Internal Revenue Code of 1986, as amended (the “Internal Revenue Code”), as well as similar state provisions. These ownership changes may limit the amount of the net operating loss and tax credit carryforwards that can be utilized annually to offset future taxable income if the Company experiences a cumulative change in ownership of more than 50% within a three-year

Related Party Transactions

Related Party Transactions	12 Months Ended
	Dec. 31, 2021
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 $5.0 million to the $49.0 million Orthotec settlement amount. In October 2020, made its first quarterly $1.0 million payment. In November 2018, the Company entered into the Term Loan and Inventory Financing Agreement with certain affiliates of Squadron Capital, LLC (“Squadron”), including an inventory supplier (the” Squadron Supplier Affiliate”). The Term Loan was amended in March 2019, May 2020, and December 2020. On August 10, 2021, the Company terminated and repaid all obligations under the Term Loan and the Inventory Financing Agreement. See Note 6 for further details regarding the Term Loan and Inventory Financing Agreement. For the years ended December 31, 2021 and 2020, the Company purchased inventory in the amounts of $7.7 million and $4.0 million, respectively, from the Squadron Supplier Affiliate. As of December 31, 2021 and 2020, the company had $0.8 million and $4.0 million, respectively, due to the Squadron Supplier Affiliate. Squadron was a lead investor in the Private Placement that was closed on March 1, 2021. David Pelizzon, President and Director of Squadron, currently serves on the Company’s Board of Directors.

Business Segment and Geographic

Business Segment and Geographic Information	12 Months Ended
	Dec. 31, 2021
Segment Reporting [Abstract]
Business Segment and Geographic Information	13. Business Segment and Geographic Information The Company operates in one segment based upon the Company’s organizational structure, the way in which the operations and investments are managed and evaluated by the chief operating decision maker (“CODM”) as well as the lack of available discrete financial information at a level lower than the consolidated level. The Company shares common, centralized support functions which report directly to the CODM and decision-making regarding the Company’s overall operating performance and allocation of Company resources is assessed on a consolidated basis . Revenue Property and equipment, net December 31, December 31, (in thousands) 2021 2020 2021 2020 United States $ 223,911 $ 141,079 $ 85,320 $ 36,670 International 19,301 3,782 2,081 — Total $ 243,212 $ 144,861 $ 87,401 $ 36,670

Subsequent Events

Subsequent Events	12 Months Ended
	Dec. 31, 2021
Subsequent Events [Abstract]
Subsequent Events	14. Subsequent Events In February 2022, the Company extended the maturity for its outstanding PGE loans from 2022 to 2027. See Note 6 for further details regarding the PGE loans

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2021
Accounting Policies [Abstract]
Use of Estimates	Use of Estimates The preparation of consolidated financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities, the disclosure of contingent assets and liabilities, and the reported amounts of revenues and expenses. Actual results could differ from those estimates. Significant items subject to such estimates and assumptions include the useful lives of property and equipment, goodwill, intangible assets, allowances for doubtful accounts, the valuation of share-based liabilities, deferred tax assets, inventory, stock-based compensation, revenues, restructuring liabilities, income tax uncertainties, and other contingencies.
Concentrations of Credit Risk and Significant Customers	Concentrations of Credit Risk and Significant Customers Financial instruments, which potentially subject the Company to concentrations of credit risk, consist primarily of cash, cash equivalents, and accounts receivable. The Company limits its exposure to credit loss by depositing its cash and investments with established financial institutions. As of December 31, 2021, a substantial portion of the Company’s available cash funds is held in business accounts. Although the Company deposits its cash with multiple financial institutions, its deposits, at times, may exceed federally insured limits. The Company’s customers are primarily hospitals, surgical centers, and distributors. No one single customer represented greater than 10 percent of consolidated revenues and accounts receivable for the years presented. Credit to customers is granted based on an analysis of the customers’ credit worthiness. Credit losses have not been significant.
Cash and Cash Equivalents	Cash and Cash Equivalents The company considers all highly liquid investments that are readily convertible into cash and have an original maturity of three months or less at the time of purchase to be cash equivalents.
Accounts Receivable, net	Accounts Receivable, net Accounts receivable are presented net of allowance for doubtful accounts. The Company makes judgments as to its ability to collect outstanding receivables and provides allowances for a portion of receivables when collection becomes doubtful. Provisions are made based upon a specific review of all significant outstanding invoices. In determining the provision for invoices not specifically reviewed, the Company analyzes historical collection experience. If the historical data used to calculate the allowance provided for doubtful accounts does not reflect the Company’s future ability to collect outstanding receivables or if the financial condition of customers were to deteriorate, resulting in impairment of their ability to make payments, an increase in the provision for doubtful accounts may be required. The Company’s accounts
Inventories	Inventories Most of the Company’s inventory is comprised of finished goods, which is primarily produced by third-party suppliers. Specialized implants, fixation products, biologics, and disposables are determined by utilizing a standard cost method that includes capitalized variances which approximates the weighted average cost. Imaging equipment and related parts are valued at weighted average cost. Inventories are stated at the lower of cost or net realizable value. The Company reviews the components of its inventory on a periodic basis for excess and obsolescence and adjusts inventory to its net realizable value as necessary. The Company records a lower of cost or net realizable value inventory reserve (“LCNRV”) for estimated excess and obsolete inventory based upon its expected use of inventory on hand. The Company’s inventory, which consists primarily of specialized implants, fixation products, biologics, and disposables is at risk of obsolescence due to the need to maintain substantial levels of inventory. In order to market its products effectively and meet the demands of interoperative product placement, the Company maintains and provides surgeons and hospitals with a variety of inventory products and sizes. For each surgery, fewer than all components will be consumed. The need to maintain and provide such a variety of inventory causes inventory to be held that is not likely to be used. The Company’s estimates and assumptions for excess and obsolete inventory are reviewed and updated on a quarterly basis. The estimates and assumptions are determined primarily based on current usage of inventory and the age of inventory quantities on hand. Additionally, the Company considers recent experience to develop assumptions about future demand for its products, while considering market conditions, product life cycles and new product launches. Increases in the LCNRV reserve for excess and obsolete inventory result in a corresponding charge to cost of sales. For the years ended December 31, 2021 and 2020, the Company recorded a write-down for excess and obsolete inventory of $11.1 million and $7.0 million, respectively.
Property and Equipment, net	Property and Equipment, net Property and equipment are stated at cost, net of accumulated depreciation. Depreciation is computed using the straight-line method over the estimated useful lives of the related assets, generally ranging from three to seven years. Leasehold improvements and assets acquired under capital leases are amortized over the shorter of their useful lives or the remaining terms of the related leases.
Operating Lease	Operating Lease The Company determines whether a contract is a lease or contains a lease at inception by assessing whether there is an identified asset and whether the contract conveys the right to control the use of the identified asset in exchange for consideration over a period of time. If both criteria are met, the Company determines the initial classification and measurement of its right-of-use (“ROU”) asset and lease liabilities at the lease commencement date and thereafter, if modified. The Company recognizes a ROU asset and lease liability for its operating leases with lease terms greater than 12 months. The lease term includes any renewal options and termination options that the Company is reasonably assured to exercise. ROU assets and lease liabilities are based on the present value of lease payments over the lease term. The present value of operating lease payments is determined by using the incremental borrowing rate of interest that the Company would borrow on a collateralized basis for an amount equal to the lease payments in a similar economic environment. Rent expense for operating leases is recognized on a straight-line basis over the reasonably assured lease term based on the total lease payments and is included in cost of sales, research and development, and sales, general and administrative expenses in the consolidated statements of operations. The Company aggregates all lease and non-lease components for each class of underlying assets into a single lease component and variable charges for common area maintenance and other variable costs are recognized as expense as incurred. Total variable costs associated with leases for the year s ended December 31, 2021 and 2020 were immaterial. The Company had an immaterial amount of financing leases as of December 31, 2021 and 2020 , which is included in property and equipment, net, accrued expenses and other current liabilities , and other long-term liabilities on the consolidated balance sheets .
Valuation of Goodwill	Valuation of Goodwill Goodwill represents the excess of the cost over the fair value of net assets acquired from the Company’s business combinations. The determination of the value of goodwill and intangible assets arising from business combinations and asset acquisitions requires extensive use of accounting estimates and judgments to allocate the purchase price to the fair value of the net tangible and intangible assets acquired. Goodwill is assessed for impairment using fair value measurement techniques on an annual basis or more frequently if facts and circumstance warrant such a review. Goodwill is considered to be impaired if the Company determines that the carrying value of the reporting unit exceeds its respective fair value. The Company’s annual evaluation for impairment of goodwill consists of one reporting unit. The Company completed its most recent annual evaluation for impairment of goodwill as of October 1, 2021 and determined that no impairment existed. In addition, no indicators of impairment were noted through December 31, 2021, and consequently no impairment charge was recorded during the years ended December 31, 2021 and 2020.
Valuation of Intangible Assets	Valuation of Intangible Assets Intangible assets are comprised primarily of purchased technology, customer relationships, trade name, trademarks, and in-process research and development. The Company makes significant judgments in relation to the valuation of intangible assets resulting from business combinations and asset acquisitions. Intangible assets are generally amortized on a straight-line basis over their estimated useful lives of 2 to 12 years. The Company bases the useful lives and related amortization expense on the period of time it estimates the assets will generate net sales or otherwise be used. The Company also periodically reviews the lives assigned to its intangible assets to ensure that its initial estimates do not exceed any revised estimated periods from which the Company expects to realize cash flows. If a change were to occur in any of the above-mentioned factors or estimates, the likelihood of a material change in the Company’s reported results would increase. The Company evaluates its intangible assets with finite lives for indications of impairment whenever events or changes in circumstances indicate that the carrying value may not be recoverable. Factors that could trigger an impairment review include significant under-performance relative to expected historical or projected future operating results, significant changes in the manner of the Company’s use of the acquired assets or the strategy for its overall business or significant negative industry or economic trends. If this evaluation indicates that the value of the intangible asset may be impaired, the Company makes an assessment of the recoverability of the net carrying value of the asset over its remaining useful life. If this assessment indicates that the intangible asset is not recoverable, based on the estimated undiscounted future cash flows of the asset over the remaining amortization period, the Company reduces the net carrying value of the related intangible asset to fair value and may adjust the remaining amortization period. Significant judgment is required in the forecasts of future operating results that are used in the discounted cash flow valuation models. It is possible that plans may change and estimates used may prove to be inaccurate. If actual results, or the plans and estimates used in future impairment analyses, are lower than the original estimates used to assess the recoverability of these assets, the Company could incur additional impairment charges. There were no impairment charges during the years ended December 31, 2021 or 2020.
Impairment of Long-Lived Assets	Impairment of Long-Lived Assets The Company assesses potential impairment to its long-lived assets when there is evidence that events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. An impairment loss is recognized when estimated future undiscounted cash flows related to the asset are less than its carrying amount. Any required impairment loss is measured as the amount by which the carrying amount of a long-lived asset exceeds its fair value and is recorded as a reduction in the carrying value of the related asset and a charge to operating results. There were no material impairment charges during the years ended December 31, 2021 or 2020.
Warrants to Purchase Common Stock	Warrants to Purchase Common Stock Warrants are accounted for in accordance with the applicable accounting guidance as either derivative liabilities or as equity instruments depending on the specific terms of the agreements. All warrants issued during the year ended December 31, 2020 qualified for classification within stockholders’ equity. There were no warrants issued during the year ended December 31, 2021.
Fair Value Measurements	Fair Value Measurements The carrying amount of financial instruments consisting of cash and cash equivalents, accounts receivable, prepaid expenses and other current assets, accounts payable, accrued expenses, and short-term debt included in the Company’s consolidated financial statements are reasonable estimates of fair value due to their short maturities. Authoritative guidance establishes a three-tier fair value hierarchy, which prioritizes the inputs used in measuring fair value as follows: Level 1: Level 2: Inputs other than Level 1 that are observable, either directly or indirectly, such as quoted prices for similar assets or liabilities, quoted prices in markets that are not active; or other inputs that can be corroborated by observable market data for substantially the full term of the assets or liabilities. Level 3: The following table presents information related to the Company’s assets measured at fair value on a recurring basis as of December 31, 2021 (in thousands): December 31, 2021 Level 1 Level 2 Level 3 Total Cash equivalents: Money market funds $ 140,010 — — $ 140,010 Total cash equivalents $ 140,010 — — $ 140,010 There were no assets measured at fair value on a recurring basis as of December 31, 2020. The following table presents information related to the Company’s liabilities measured at fair value on a recurring basis as of December 31, 2021 and December 31, 2020 (in thousands): December 31, 2021 Level 1 Level 2 Level 3 Total Liability classified equity award $ — — 2,052 $ 2,052 December 31, 2020 Level 1 Level 2 Level 3 Total Liability classified equity award (1) $ — — 4,108 $ 4,108 Foreign currency forward contract — 878 — 878 Total $ — 878 4,108 $ 4,986 (1) A portion of this award is being accreted over the requisite service period. The amount in the above table includes the fair value of the vested and unvested portion of the award. The Company did not have any transfers of assets and liabilities between the levels of the fair value measurement hierarchy during the periods presented. On March 16, 2021, the Company entered into two foreign currency forward contracts, with a notional amount of $8.0 million total, $4.0 million each (€6.7 million total and €3.3 million each), to mitigate the foreign currency exchange risk related to its EOS subsidiary. The contracts are not designated as hedging instruments. The Company classified the derivative liabilities within Level 2 of the fair value hierarchy as observable inputs are available for the full term of the derivative instruments. The fair value of the forward contracts was developed using a market approach based on publicly available market yield curves and the term of the contracts. During the year ended December 31, 2021, the foreign currency forward contracts were settled for $7.6 million (€6.7 million). The Company recognized a nominal loss from the change in fair value of the contracts during the year ended December 31, 2021. The loss on the contract settlement was recorded within other expense, net on the consolidated statements of operations and the cash settlement is included in investing activities in the consolidated statements of cash flows for the year ended December 31, 2021. On December 18, 2020, the Company entered into a foreign currency forward contract, with a notional amount of $117.9 million (€95.6 million) to mitigate the foreign currency exchange risk related to the Tender Offer Agreement, denominated in Euros. The contract was not designated as a hedging instrument. The Company classified the derivative liability within Level 2 of the fair value hierarchy as observable inputs were available for the full term of the derivative instrument. The fair value of the forward contract was developed using a market approach based on publicly available market yield curves and the term of the contract. On March 2, 2021, the foreign currency forward contract was settled for $115.3 million (€95.6 million). The Company recognized a $1.7 million loss from the change in fair value of the contract during the year ended December 31, 2021. The loss on the contract settlement was recorded as other expense on the consolidated statement of operations and the cash settlement is included in investing activities in the consolidated statements of cash flows for the year ended December 31, 2021. The Company issued a liability classified equity award to one of its executive officers. The award vests in 2023 subject to continued service and a specific market condition. As the award will be settled in cash, 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 specific market condition with the valuation updated at each reporting period. The full fair value of the award was $3.1 million as of December 31, 2021 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) as of December 31, 2021 and 2020 Level 3 Liabilities Balance at December 31, 2019 $ 266 Straight-line recognition of liability classified equity award 371 Change in fair value measurement 1,031 Balance at December 31, 2020 $ 1,668 Straight-line recognition of liability classified equity award 1,028 Change in fair value measurement (644 ) Balance at December 31, 2021 $ 2,052 Fair Value of Long-term Debt The fair value, based on a quoted market price (Level 1), of the Company’s 2026 Notes at December 31, 2021 was approximately $308.1 million. The fair value based on a quoted market price (Level 1), of the Company’s outstanding OCEANEs at December 31, 2021 was approximately $14.1 million. See Note 6 for further information.
Revenue Recognition	Revenue Recognition The Company recognizes revenue from product sales in accordance with Financial Accounting Standards Board (“FASB”) Accounting Standards Codification (“ASC”) Revenue from Contracts with Customers Sales are derived primarily from the sale of spinal implant products to hospitals and medical centers through direct sales representatives and independent distributor agents, and with the acquisition of EOS, includes imaging equipment and related services. Revenue is recognized when obligations under the terms of a contract with customers are satisfied, which occurs with the transfer of control of products to customers, either upon shipment of the product or delivery of the product to the customer depending on the shipping terms, or when the products are used in a surgical procedure (implanted in a patient). Revenue from the sale of imaging equipment is recognized as each distinct performance obligation is fulfilled and control transfers to the customer, beginning with shipment or delivery, depending on the terms. Revenue from other distinct performance obligations, such as maintenance on imaging equipment and other imaging related services, is recognized in the period the service is performed, and makes up less than 10% of the Company’s total revenue. Revenue is measured based on the amount of consideration expected to be received in exchange for the transfer of the goods or services specified in the contract with each customer. In certain cases, the Company does offer the ability for customers to lease its imaging equipment primarily on a non-sales type basis, but such arrangements are immaterial to total revenue in the periods presented. The Company generally does not allow returns of products that have been delivered. Costs incurred by the Company associated with sales contracts with customers are deferred over the performance obligation period and recognized in the same period as the related revenue, except for contracts that complete within one year or less, in which case the associated costs are expensed as incurred. Payment terms for sales to customers may vary but are commensurate with the general business practices in the country of sale. To the extent that the transaction price includes variable consideration, such as discounts, rebates, and customer payment penalties, the Company estimates the amount of variable consideration that should be included in the transaction price utilizing either the expected value method or the most likely amount method depending on the nature of the variable consideration. Variable consideration is included in the transaction price if, in the Company’s judgment, it is probable that a significant future reversal of cumulative revenue under the contract will not occur. Estimates of variable consideration and determination of whether to include estimated amounts in the transaction price are based largely on an assessment of the Company’s anticipated performance and all information that is reasonably available, including historical, current, and forecasted information. The Company records a contract liability, or deferred revenue, when it has an obligation to provide a product or service to the customer and payment is received in advance of its performance. When the Company sells a product or service with a future performance obligation, revenue is deferred on the unfulfilled performance obligation and recognized over the related performance period. Generally, the Company does not have observable evidence of the standalone selling price related to its future service obligations; therefore, the Company estimates the selling price using an expected cost plus a margin approach. The transaction price is allocated using the relative standalone selling price method. The use of alternative estimates could result in a different amount of revenue deferral. The Company had current and non-current contract liability balances totaling $15.3 million and $2.9 million, respectively, as of December 31, 2021. The Company had no contract liability balances as of December 31, 2020. The non-current contract liability balance is included in other long-term liabilities on the consolidated balance sheets. The Company recognized $14.6 million of revenue from its contract liabilities during the year ended December 31, 2021. The Company did not recognize revenue related to contract liabilities during the year ended December 31, 2020. The opening and closing balances of the Company’s contract liability are as follows: Balance at January 1, 2021 $ — Contract liability assumed in acquisition of EOS 21,196 Payments received 11,590 Revenue recognized (14,635 ) Balance at December 31, 2021 $ 18,151
Research and Development Expenses	Research and Development Expenses Research and development expenses consist of costs associated with the design, development, testing, and enhancement of the Company’s products and technologies. Research and development costs also include salaries and related employee benefits, research-related overhead expenses, and fees paid to external service providers. Research and development costs are expensed as incurred.
Litigation-related Expenses	Litigation-related Expenses Litigation-related expenses are costs incurred for the ongoing litigation, primarily with NuVasive, Inc . See Note 7 for additional information on ongoing litigation.
Transaction-related Expenses	Transaction-related Expenses The Company expensed certain costs incurred throughout the year related primarily to the acquisition and integration of EOS. .
Product Shipment Cost	Product Shipment Cost Product shipment costs for surgical sets are included in sales, general and administrative expenses in the accompanying consolidated statements of operations. Product shipment costs totaled $8.3 million and $5.3 million for the years ended December 31, 2021 and 2020, respectively.
Stock-Based Compensation	Stock-Based Compensation Stock-based compensation expense for equity-classified awards, principally related to restricted stock units, or RSUs, and performance restricted stock units, or PRSUs, is measured at the grant date based on the estimated fair value of the award. The fair value of equity instruments that are expected to vest is recognized and amortized over the requisite service period. The Company has granted awards with up to four year graded or cliff vesting terms. No exercise price or other monetary payment is required for receipt of the shares issued in settlement of the respective award; instead, consideration is furnished in the form of the participant’s service. The fair value of RSUs including PRSUs with pre-defined performance criteria is based on the stock price on the date of grant whereas the expense for PRSUs with pre-defined performance criteria is adjusted with the probability of achievement of such performance criteria at each period end. The fair value of the PRSUs that are earned based on the achievement of pre-defined market conditions, is estimated on the date of grant using a Monte Carlo valuation model. The key assumptions in applying this model are an expected volatility and a risk-free interest rate. Stock-based compensation recorded in the Company’s consolidated statements of operations is based on awards expected to ultimately vest and has been reduced for estimated forfeitures. The Company’s estimated forfeiture rates may differ from its actual forfeitures. The Company considers its historical experience of pre-vesting forfeitures on awards by each homogenous group of employees as the basis to arrive at its estimated annual pre-vesting forfeiture rates. The Company estimate s the fair value of stock options issued under the Company’s equity incentive plans and shares issued to employees under the Company’s employee stock purchase plan (“ ESPP ”) using a Black-Scholes option-pricing model on the date of grant. The Black-Scholes option-pricing model incorporates various assumptions including expected volatility, expected term and risk-free interest rates. The expected volatility is based on the historical volatility of the Company’s common stock over the most recent period commensurate with the estimated expected term of the Company’s stock options and ESPP offering period which is derived from historical experience. The risk-free interest rate for periods within the contractual life of the option is based on the U.S. Treasury yield in effect at the time of grant. The Company has never declared or paid dividends and have no plans to do so in the foreseeable future. The Company accounts for stock option grants to non-employees in accordance with provisions which require that the fair value of these instruments be recognized as an expense over the period in which the related services are rendered.
Income Taxes	Income Taxes The Company accounts for income taxes in accordance with provisions which set forth an asset and liability approach that requires the recognition of deferred tax assets and deferred tax liabilities for the expected future tax consequences of temporary differences between the carrying amounts and the tax bases of assets and liabilities. Valuation allowances are established when necessary to reduce deferred tax assets to the amount expected to be realized. In making such determination, a review of all available positive and negative evidence must be considered, including scheduled reversal of deferred tax liabilities, projected future taxable income, tax planning strategies, and recent financial performance. The Company recognizes interest and penalties related to uncertain tax positions as a component of the income tax provision.
Net Loss per Share	Net Loss per Share Basic earnings per share (“EPS”) is calculated by dividing the net loss available to common stockholders by the weighted average number of shares of common stock issued and outstanding for the period. Diluted EPS is computed by dividing the net loss available to common stockholders by the weighted average number of shares of common stock outstanding for the period and the weighted average number of dilutive common stock equivalents outstanding for the period determined using the treasury-stock method and the if-converted method for convertible debt. For purposes of this calculation, common stock subject to repurchase by the Company, common stock issuable upon conversion of convertible notes, preferred shares, options, and warrants are considered to be common stock equivalents and are only included in the calculation of diluted earnings per share when their effect is dilutive. Due to the Company’s net loss position, the effect of including common stock equivalents in the EPS calculation is anti-dilutive, and therefore not included. The following table sets forth the computation of basic and diluted loss per share (in thousands, except per share data): Year Ended December 31, 2021 2020 Numerator: Net loss $ (144,326 ) $ (78,994 ) Denominator: Weighted average common shares outstanding 96,197 67,020 Net loss per share, basic and diluted $ (1.50 ) $ (1.18 ) The following potentially dilutive shares of common stock were excluded from the calculation of diluted net loss per share because their effect would have been anti-dilutive for the years presented (in thousands): Year Ended December 31, 2021 2020 Series A convertible preferred stock 29 29 Options to purchase common stock and employee stock purchase plan 3,416 3,951 Unvested restricted stock units 8,703 8,216 Warrants to purchase common stock 20,184 24,881 Senior convertible notes 17,246 — 49,578 37,077
Recent Accounting Pronouncements	Recent Accounting Pronouncements Recently Adopted Accounting Pronouncements In May 2021, the FASB issued Accounting Standard Update (“ASU”) No. 2021-04, Earnings Per Share (Topic 260), Debt—Modifications and Extinguishments (Subtopic 470-50), Compensation—Stock Compensation (Topic 718), and Derivatives and Hedging—Contracts in Entity’s Own Equity (Subtopic 815-40): Issuer’s Accounting for Certain Modifications or Exchanges of Freestanding Equity-Classified Written Call Options In August 2020, the FASB issued ASU No. 2020-06, Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging-Contracts in Entity’s Own Equity (Subtopic 815-40) (“ ”) Recently Issued Accounting Pronouncements In August 2021, the FASB issued ASU No. 2021-08, Business Combinations (Topic 805): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Tables)	12 Months Ended
	Dec. 31, 2021
Accounting Policies [Abstract]
Assets and Liabilities Measured at Fair Value on Recurring Basis	The following table presents information related to the Company’s assets measured at fair value on a recurring basis as of December 31, 2021 (in thousands): December 31, 2021 Level 1 Level 2 Level 3 Total Cash equivalents: Money market funds $ 140,010 — — $ 140,010 Total cash equivalents $ 140,010 — — $ 140,010 There were no assets measured at fair value on a recurring basis as of December 31, 2020. The following table presents information related to the Company’s liabilities measured at fair value on a recurring basis as of December 31, 2021 and December 31, 2020 (in thousands): December 31, 2021 Level 1 Level 2 Level 3 Total Liability classified equity award $ — — 2,052 $ 2,052 December 31, 2020 Level 1 Level 2 Level 3 Total Liability classified equity award (1) $ — — 4,108 $ 4,108 Foreign currency forward contract — 878 — 878 Total $ — 878 4,108 $ 4,986 (1) A portion of this award is being accreted over the requisite service period. The amount in the above table includes the fair value of the vested and unvested portion of the award.
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) as of December 31, 2021 and 2020 Level 3 Liabilities Balance at December 31, 2019 $ 266 Straight-line recognition of liability classified equity award 371 Change in fair value measurement 1,031 Balance at December 31, 2020 $ 1,668 Straight-line recognition of liability classified equity award 1,028 Change in fair value measurement (644 ) Balance at December 31, 2021 $ 2,052
Opening and Closing Balances of Company's Contract Liability	The opening and closing balances of the Company’s contract liability are as follows: Balance at January 1, 2021 $ — Contract liability assumed in acquisition of EOS 21,196 Payments received 11,590 Revenue recognized (14,635 ) Balance at December 31, 2021 $ 18,151
Computation of Basic and Diluted Loss Per Share	The following table sets forth the computation of basic and diluted loss per share (in thousands, except per share data): Year Ended December 31, 2021 2020 Numerator: Net loss $ (144,326 ) $ (78,994 ) Denominator: Weighted average common shares outstanding 96,197 67,020 Net loss per share, basic and diluted $ (1.50 ) $ (1.18 )
Anti-Dilutive Securities of Common Stock Excluded from Calculation of Diluted Net Loss Per Share	The following potentially dilutive shares of common stock were excluded from the calculation of diluted net loss per share because their effect would have been anti-dilutive for the years presented (in thousands): Year Ended December 31, 2021 2020 Series A convertible preferred stock 29 29 Options to purchase common stock and employee stock purchase plan 3,416 3,951 Unvested restricted stock units 8,703 8,216 Warrants to purchase common stock 20,184 24,881 Senior convertible notes 17,246 — 49,578 37,077

Business Combination (Tables)

Business Combination (Tables)	12 Months Ended
	Dec. 31, 2021
Business Combinations [Abstract]
Schedule of Allocation of Purchase Price to Assets Acquired and Liabilities Assumed Based on Fair Values	The allocation of the purchase price to the assets acquired and liabilities assumed based on their fair values were as follows: (in thousands) As of May 13, 2021 Cash paid for purchase of EOS shares at Change in Control Date $ 46,908 Cash paid for purchase of OCEANEs at Change in Control Date 19,620 Total cash paid at Change in Control Date 66,528 Fair value of investment in EOS Shares held prior to Change in Control Date 23,549 Fair value of investment in OCEANEs held prior to Change in Control Date 1,477 Total fair value of investment in EOS held prior to Change in Control Date 25,026 Fair value of noncontrolling interest acquired after Change in Control Date 8,454 $ 100,008 Cash and cash equivalents $ 16,778 Accounts receivable 9,083 Inventory 26,531 Other current assets 4,422 Property, plant and equipment, net 1,650 Deferred tax assets 2,314 Right-of-use asset 4,341 Goodwill 27,841 Definite-lived intangible assets: Developed technology 56,000 Customer relationships 9,500 Trade names 6,000 Other noncurrent assets 395 Contract liabilities 21,196 Long-term debt 15,297 Other liabilities assumed 28,354 Total identifiable net assets $ 100,008
Schedule of Unaudited Pro Forma Results	The unaudited pro forma results include IFRS to U.S. GAAP adjustments for EOS historical results and adjustments for accounting policy alignment, which were materially similar to the Company. Any differences in accounting policies were adjusted to reflect the accounting policies of the Company in the unaudited pro forma results presented . December 31, (in thousands, except per share amounts) 2021 2020 Total revenue $ 251,906 $ 172,052 Net loss (140,441 ) (111,967 ) Net loss per share, basic and diluted $ (1.46 ) $ (1.17 )

Balance Sheets Details (Tables)

Balance Sheets Details (Tables)	12 Months Ended
	Dec. 31, 2021
Balance Sheet Related Disclosures [Abstract]
Accounts receivable, net	Accounts receivable, net consist of the following (in thousands): December 31, 2021 2020 Accounts receivable $ 44,200 $ 23,887 Allowance for doubtful accounts (2,307 ) (360 ) Accounts receivable, net $ 41,893 $ 23,527
Inventories	Inventories consist of the following (in thousands): December 31, 2021 2020 Raw materials $ 14,671 $ 6,064 Work-in-process 5,712 1,982 Finished goods 71,320 37,955 Inventories $ 91,703 $ 46,001
Property and equipment, net	Property and equipment, net consist of the following (in thousands, except as indicated): Useful lives December 31, (in years) 2021 2020 Surgical instruments 4 $ 130,432 $ 76,669 Machinery and equipment 7 11,092 6,562 Computer equipment 3 5,694 4,206 Office furniture and equipment 5 3,861 1,380 Leasehold improvements various 1,754 1,761 Construction in progress n/a 7,292 2,738 160,125 93,316 Less: accumulated depreciation (72,724 ) (56,646 ) Property and equipment, net $ 87,401 $ 36,670
Intangible assets, net	Intangible assets, net consist of the following (in thousands, except as indicated): Remaining Avg. Useful lives Gross Accumulated Intangible December 31, 2021: (in years) Amount Amortization Assets, net Developed product technology 12 $ 74,543 $ (5,768 ) $ 68,775 Trademarks and trade names 10 5,732 (477 ) 5,255 Customer relationships 5 14,732 (5,264 ) 9,468 Distribution network 3 2,413 (1,840 ) 573 In-process research and development n/a 1,203 — 1,203 Total $ 98,623 $ (13,349 ) $ 85,274 Remaining Avg. Useful lives Gross Accumulated Intangible December 31, 2020: (in years) Amount Amortization Assets, net Developed product technology 12 $ 35,376 $ (23,056 ) $ 12,320 License agreements 1 5,536 (965 ) 4,571 Trademarks and trade names — 792 (119 ) 673 Customer relationships 3 7,458 (3,968 ) 3,490 Distribution network 2 4,027 (1,639 ) 2,388 In-process research and development n/a 1,278 — 1,278 Total $ 54,467 $ (29,747 ) $ 24,720
Schedule of intangible assets, future expected amortization expense	Future amortization expense related to intangible assets as of December 31, 2021 is as follows (in thousands): Year Ending December 31, 2022 $ 9,436 2023 9,436 2024 9,333 2025 8,748 2026 8,748 Thereafter 39,573 Total $ 85,274
Schedule of Goodwill	The change in the carrying amount of goodwill during the year ended December 31, 2021 included the following (in thousands): December 31, 2020 $ 13,897 Additions 27,841 Foreign currency fluctuation (2,049 ) December 31, 2021 $ 39,689
Accrued expenses and other current liabilities	Accrued expenses and other current liabilities consist of the following (in thousands): December 31, 2021 2020 Payroll and payroll related $ 18,449 $ 13,552 Commissions and sales milestones 12,420 7,038 Professional fees 4,684 3,551 Litigation settlement obligation 4,400 4,000 Royalties 3,466 2,293 Other taxes payable 3,004 248 Inventory in-transit 2,089 1,771 Administration fees 1,698 442 Interest 1,045 619 Other 4,294 1,750 Total accrued expenses and other current liabilities $ 55,549 $ 35,264
Schedule of Other Long-Term Liabilities	Other long-term liabilities consist of the following (in thousands): December 31, 2021 2020 Royalties $ 5,833 $ 1,678 Litigation settlement obligation - long-term portion 3,587 7,634 Income tax-related liabilities 1,522 373 Contract liability 2,897 — Other 3,222 1,703 Other long-term liabilities $ 17,061 $ 11,388

Debt (Tables)

Debt (Tables)	12 Months Ended
	Dec. 31, 2021
Debt Disclosure [Abstract]
Outstanding Principal Amount and Carrying Value of Notes	The outstanding principal amount and carrying value of the 2026 Notes consist of the following (in thousands): December 31, 2021 Principal $ 316,250 Unamortized debt issuance costs (9,259 ) Net carrying value $ 306,991
Debt	Debt consists of the following (in thousands): December 31, 2021 2020 2026 Notes $ 316,250 $ — OCEANEs 14,113 — Other notes payable 386 1,887 EOS PGE Loans 5,341 — Squadron Medical Term Loan — 45,000 Inventory Financing — 3,821 PPP Loan — 4,271 Total 336,090 54,979 Less: debt discount (9,259 ) (12,813 ) Total 326,831 42,166 Less: current portion of long-term debt (342 ) (4,167 ) Total long-term debt, net of current portion $ 326,489 $ 37,999
Principal Payments on Debt	Principal payments on debt are as follows as of December 31, 2021 (in thousands): 2022 $ 342 2023 14,834 2024 1,353 2025 1,335 2026 317,586 Thereafter 640 Total 336,090 Less: debt discount (9,259 ) Total 326,831 Less: current portion of long-term debt (342 ) Long-term debt, net of current portion $ 326,489

Commitments and Contingencies (

Commitments and Contingencies (Tables)	12 Months Ended
	Dec. 31, 2021
Commitments And Contingencies Disclosure [Abstract]
Future minimum annual lease payments	Future minimum annual lease payments for all operating leases of the Company are as follows (in thousands): 2022 $ 4,405 2023 4,609 2024 4,620 2025 4,590 2026 4,694 Thereafter 17,846 Total undiscounted lease payments 40,764 Less: imputed interest (12,169 ) Operating lease liability 28,595 Less: current portion of operating lease liability (4,212 ) Operating lease liability, less current portion $ 24,383
Summary of Weighted-Average Remaining Lease Term and Discount Rate	The Company’s weighted average remaining lease term and weighted average discount rate as of December 31, 2021 and December 31, 2020 are as follows: December 31, 2021 December 31, 2020 Weighted average remaining lease term (years) 8.6 0.7 Weighted average discount rate 8.5 % 10.5 %
Summary of Operating Leases	Information related to the Company’s operating lease is as follows (in thousands): December 31, 2021 2020 Rent expense $ 4,482 $ 1,300 Cash paid for amounts included in measurement of lease liabilities $ 1,795 $ 1,400

Orthotec Settlement (Tables)

Orthotec Settlement (Tables)	12 Months Ended
	Dec. 31, 2021
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): December 31, 2021 December 31, 2020 Litigation settlement obligation - short-term portion $ 4,400 $ 4,000 Litigation settlement obligation - long-term portion 3,587 7,634 Total 7,987 11,634 Future imputed interest 478 1,199 Total settlement obligation, gross 8,465 12,833 Related party receivable - included in stockholders' equity — (4,000 ) Total settlement obligation, net $ 8,465 $ 8,833

Equity (Tables)

Equity (Tables)	12 Months Ended
	Dec. 31, 2021
Equity [Abstract]
Summary of Outstanding Warrants	A summary of all outstanding warrants is as follows (in thousands): Number of Warrants Strike Price Expiration 2017 PIPE Warrants 2,312 $ 2.00 June 2022 2018 PIPE Warrants 8,479 $ 3.50 May 2023 SafeOp Surgical Merger Warrants 1,195 $ 3.50 May 2023 2018 Squadron Medical Warrants 845 $ 3.15 May 2027 2019 Squadron Medical Warrants 4,839 $ 2.17 May 2027 2020 Squadron Medical Warrants 1,076 $ 4.88 May 2027 Executive Warrants 1,327 $ 5.00 December 2022 Other* 111 $ 5.40 Various through December 2024 Total 20,184 *Represents weighted average strike price

Stock Benefit Plans and Stock_2

Stock Benefit Plans and Stock-Based Compensation (Tables)	12 Months Ended
	Dec. 31, 2021
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Summary of Stock Option Activity	A summary of the Company’s stock option activity under the Plans and related information is as follows (in thousands, except as indicated and per share data): Shares Weighted average exercise price Weighted average remaining contractual term (in years) Aggregate intrinsic value Outstanding at December 31, 2020 3,951 $ 3.21 Granted 85 13.62 Exercised (569 ) 2.63 Forfeited (116 ) 5.28 Outstanding at December 31, 2021 3,351 $ 3.50 6.03 $ 27,619 Options vested and exercisable at December 31, 2021 2,973 $ 3.24 5.86 $ 25,162 Options vested and expected to vest at December 31, 2021 3,351 $ 3.50 6.03 $ 27,619
Summary of Information about Restricted Stock Awards, Restricted Stock Units and Performance-Based Restricted Units Activity	The following table summarizes information about the restricted stock awards, restricted stock units and performance-based restricted units activity (in thousands, except as indicated and per share data): Shares Weighted average grant date fair value Weighted average remaining recognition period (in years) Unvested at December 31, 2020 8,216 $ 3.13 Awarded 3,980 12.79 Vested (2,824 ) 3.88 Forfeited (669 ) 4.01 Unvested at December 31, 2021 8,703 $ 6.34 1.66
Schedule of Assumptions used to Estimate Fair Value of Stock Options Granted and Stock Purchase Rights under ESPP	The Company estimates the fair value of shares issued to employees under the ESPP using the Black-Scholes option-pricing model Year Ended December 31, 2021 2020 Risk-free interest rate 0.04% - 0.12% 0.12% - 1.58% Expected dividend yield — — Expected term (years) 0.50 0.50 Volatility 49.98% - 78.37% 54.96% - 102.5%
Summary of Common Stock Reserved for Future Issuance	Common stock reserved for future issuance consists of the following (in thousands): December 31, 2021 Stock options outstanding 3,351 Unvested restricted stock units 8,703 Employee stock purchase plan 547 Series A convertible preferred stock 29 Senior convertible notes 17,246 Warrants outstanding 20,184 Authorized for future grant under the Distributor and Development Services plans 445 Authorized for future grant under the Management Objective Strategic Incentive Plan 365 Authorized for future grant under the Company Equity plans 4,025 54,895

Income Taxes (Tables)

Income Taxes (Tables)	12 Months Ended
	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Components of Pretax Income (Loss)	The components of the pretax income (loss) are presented in the following table (in thousands): Year Ended December 31, 2021 2020 U.S. Domestic $ (127,943 ) $ (78,849 ) Foreign (16,219 ) — Net loss before taxes $ (144,162 ) $ (78,849 )
Components of Provision for Income Taxes from Continuing Operations	The components of the provision for income taxes from continuing operations are presented in the following table (in thousands): Year Ended December 31, 2021 2020 Current income tax provision: Federal $ 123 $ — State 166 100 Foreign 66 35 Total current 355 135 Deferred income tax provision: Federal (159 ) (2 ) State (32 ) 12 Total deferred (191 ) 10 Total income tax provision $ 164 $ 145
Schedule of Effective Income Tax Rate Reconciliation	The provision for income taxes differs from the amount of income tax determined by applying the applicable U.S. statutory federal income tax rate to pretax loss from continuing operations as a result of the following differences: December 31, 2021 2020 Federal statutory rate 21.00 % 21.00 % Adjustments for tax effects of: State taxes, net (0.07 ) (0.11 ) Stock-based compensation (0.48 ) (0.93 ) Foreign rate differential 0.43 0.00 Foreign taxes (0.05 ) (0.04 ) Other permanent adjustments 0.08 (1.70 ) Federal uncertain tax positions (0.08 ) 0.00 Other (0.13 ) (0.15 ) Valuation allowance (20.81 ) (18.25 ) Effective income tax rate (0.11 )% (0.18 )%
Significant Components of Company's Deferred Tax Assets and Liabilities	Significant components of the Company’s deferred tax assets and liabilities as of December 31, 2021 and 2020 are as follows (in thousands): December 31, 2021 2020 Deferred tax assets: Net operating losses $ 131,734 $ 70,220 Interest 11,095 8,193 Inventory 8,784 8,117 Accruals and reserves 7,145 3,437 Lease liability 6,216 228 Stock-based compensation 4,318 2,464 Legal settlement 1,998 2,875 Income tax credit carryforwards 1,574 1,582 Total deferred tax assets 172,864 97,116 Valuation allowance (127,209 ) (87,489 ) Total deferred tax assets, net of valuation allowance 45,655 9,627 Deferred tax liabilities: Goodwill and intangibles (18,439 ) (2,483 ) Property and equipment (18,404 ) (6,803 ) Right-of-use assets (6,256 ) (291 ) Total deferred tax liabilities (43,099 ) (9,577 ) Net deferred tax assets $ 2,556 $ 50
Summary of Changes to Unrecognized Tax Benefits	The following table summarizes the changes to unrecognized tax benefits (in thousands): Year ended December 31, 2021 2020 Unrecognized tax benefit at the beginning of the year $ 2,452 $ 2,452 Increases in tax positions for current year relating to acquisitions 12,713 — Unrecognized tax benefits at the end of the year $ 15,165 $ 2,452

Business Segment and Geograph_2

Business Segment and Geographic Information (Tables)	12 Months Ended
	Dec. 31, 2021
Segment Reporting [Abstract]
Schedule of Net Revenue and Property, Plant and Equipment, Net, by Geographic Region	Revenue Property and equipment, net December 31, December 31, (in thousands) 2021 2020 2021 2020 United States $ 223,911 $ 141,079 $ 85,320 $ 36,670 International 19,301 3,782 2,081 — Total $ 243,212 $ 144,861 $ 87,401 $ 36,670

The Company and Basis of Pres_2

The Company and Basis of Presentation - Additional Information (Details)	1 Months Ended	12 Months Ended
	Aug. 31, 2021USD ($)	Dec. 31, 2021segment	Jun. 02, 2021
Company And Basis Of Presentation [Line Items]
Number of Reportable Segments | segment		1
Tender Offer Agreement | EOS Imaging S.A.
Company And Basis Of Presentation [Line Items]
Percentage of interest acquired			100.00%
0.75% Senior Convertible Notes due 2026
Company And Basis Of Presentation [Line Items]
Debt Instrument Face Amount	$ 316,300,000
Interest rate	0.75%
Debt instrument, maturity date	Aug. 1, 2026
Net proceeds	$ 306,200,000

Summary of Significant Accoun_4

Summary of Significant Accounting Policies - Additional Information (Details) € in Millions	Mar. 02, 2021USD ($)	Mar. 02, 2021EUR (€)	Dec. 31, 2021USD ($)customershares	Dec. 31, 2021EUR (€)customer	Dec. 31, 2020USD ($)customer	Mar. 16, 2021USD ($)Contract	Mar. 16, 2021EUR (€)Contract	Dec. 18, 2020USD ($)	Dec. 18, 2020EUR (€)
Significant Accounting Policies [Line Items]
Accounts receivable payment terms			30 days	30 days
Write-down for excess and obsolete inventories			$ 11,147,000		$ 7,044,000
Goodwill impairment charge			0		0
Intangible asset impairment charge			0		0
Impairment charges of Long-lived assets disposition			0		0
Impairment charges of Long-lived assets held for use			$ 0		0
Number of warrants issued (in shares) | shares			0
Contract liability, current			$ 15,255,000
Contract liability, non-current			2,897,000
Revenue from contract liabilities			14,635,000
Sales, general and administrative			$ 229,271,000		129,156,000
ASU No. 2021-04
Significant Accounting Policies [Line Items]
Change in accounting principle, Accounting standards update, Adopted [true false]			true
Change in accounting principle, Accounting standards update, Adoption date			Jan. 1, 2021
Change in accounting principle, Accounting standards update, Immaterial effect [true false]			true
ASU No. 2020-06
Significant Accounting Policies [Line Items]
Change in accounting principle, Accounting standards update, Adopted [true false]			true
Change in accounting principle, Accounting standards update, Adoption date			Jan. 1, 2021
Change in accounting principle, Accounting standards update, Immaterial effect [true false]			true
Product Shipment
Significant Accounting Policies [Line Items]
Sales, general and administrative			$ 8,300,000		$ 5,300,000
Fair value, inputs, level 2
Significant Accounting Policies [Line Items]
Number of foreign currency forward contracts entered | Contract						2	2
Notional amount of foreign currency forward contracts						$ 8,000,000	€ 6.7	$ 117,900,000	€ 95.6
Notional amount of each foreign currency forward contract						$ 4,000,000	€ 3.3
Foreign currency forward contract settled	$ 115,300,000	€ 95.6	7,600,000	€ 6.7
Foreign currency forward contract loss recognized			1,700,000
Fair value, inputs, level 3
Significant Accounting Policies [Line Items]
Fair value of the cash settled award			3,100,000
Fair Value, Inputs, Level 1 | OCEANE Convertible Bonds
Significant Accounting Policies [Line Items]
Fair value of long-term debt			14,100,000
Fair Value, Inputs, Level 1 | 2026 Notes
Significant Accounting Policies [Line Items]
Fair value of long-term debt			$ 308,100,000
Debt maturity year			2026	2026
Minimum
Significant Accounting Policies [Line Items]
Estimated useful lives of property and equipment			3 years	3 years
Intangible assets, amortization period			2 years	2 years
Maximum
Significant Accounting Policies [Line Items]
Estimated useful lives of property and equipment			7 years	7 years
Intangible assets, amortization period			12 years	12 years
Vesting period			4 years	4 years
Percentage of revenue from other distinct performance obligations of total revenue			10.00%	10.00%
Sales | Customer Concentration Risk
Significant Accounting Policies [Line Items]
Concentration risk, number of customers | customer			0	0	0
Accounts Receivable | Customer Concentration Risk
Significant Accounting Policies [Line Items]
Concentration risk, number of customers | customer			0	0	0

Summary of Significant Accoun_5

Summary of Significant Accounting Policies - Assets and Liabilities Measured at Fair Value on Recurring Basis (Details) - Recurring - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets measured at fair value on a recurring basis	$ 140,010
Liabilities measured at fair value on a recurring basis		$ 4,986
Liability Classified Equity Award
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Liabilities measured at fair value on a recurring basis	2,052	4,108
Foreign Currency Forward Contract
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Liabilities measured at fair value on a recurring basis		878
Money Market Funds
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets measured at fair value on a recurring basis	140,010
Fair Value, Inputs, Level 1
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets measured at fair value on a recurring basis	140,010
Fair Value, Inputs, Level 1 | Money Market Funds
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets measured at fair value on a recurring basis	140,010
Level 2
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Liabilities measured at fair value on a recurring basis		878
Level 2 | Foreign Currency Forward Contract
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Liabilities measured at fair value on a recurring basis		878
Fair value, inputs, level 3
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Liabilities measured at fair value on a recurring basis		4,108
Fair value, inputs, level 3 | Liability Classified Equity Award
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Liabilities measured at fair value on a recurring basis	$ 2,052	$ 4,108

Summary of Significant Accoun_6

Summary of Significant Accounting Policies - Reconciliation of Liabilities Measured at Fair Value Using Significant Unobservable Inputs (Details) - Fair value, inputs, level 3 - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Roll Forward]
Beginning balance	$ 1,668	$ 266
Straight-line recognition of liability classified equity award	1,028	371
Change in fair value measurement	(644)	1,031
Ending balance	$ 2,052	$ 1,668

Summary of Significant Accoun_7

Summary of Significant Accounting Policies - Opening and Closing Balances of Company's Contract Liability (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2021USD ($)
Accounting Policies [Abstract]
Contract liability assumed in acquisition of EOS	$ 21,196
Payments received	11,590
Revenue recognized	(14,635)
Balance at December 31, 2021	$ 18,151

Summary of Significant Accoun_8

Summary of Significant Accounting Policies - Computation of Basic and Diluted Loss Per Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Numerator:
Net loss	$ (144,326)	$ (78,994)
Denominator:
Weighted average common shares outstanding	96,197	67,020
Net loss per share, basic and diluted	$ (1.50)	$ (1.18)

Summary of Significant Accoun_9

Summary of Significant Accounting Policies - Anti-Dilutive Securities of Common Stock Excluded from Calculation of Diluted Net Loss Per Share (Details) - shares shares in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Anti-dilutive securities not included in diluted net loss per share (in shares)	49,578	37,077
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)	29	29
Options to purchase common stock and employee stock purchase plan
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Anti-dilutive securities not included in diluted net loss per share (in shares)	3,416	3,951
Unvested restricted stock units
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Anti-dilutive securities not included in diluted net loss per share (in shares)	8,703	8,216
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)	20,184	24,881
Senior Convertible Notes
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Anti-dilutive securities not included in diluted net loss per share (in shares)	17,246

Business Combination - Addition

Business Combination - Additional Information (Details) $ in Thousands	Jun. 02, 2021USD ($)	May 17, 2021USD ($)	May 13, 2021USD ($)	May 12, 2021USD ($)	Dec. 31, 2021USD ($)	Dec. 31, 2020USD ($)	Dec. 16, 2020€ / shares
Business Acquisition [Line Items]
Transaction-related expenses					$ 6,365	$ 4,223
Net loss					144,326	78,994
Amortization of acquired intangible assets					5,348	$ 688
EOS Imaging S.A.
Business Acquisition [Line Items]
Purchase price			$ 100,008
Purchase price in cash			66,528
Transaction-related expenses					14,100
Revenue					30,000
Net loss					17,600
Amortization of acquired intangible assets					3,100
Adjustment related to increased fair value of acquired inventory					2,000
EOS Imaging S.A. | Transaction Related Expenses
Business Acquisition [Line Items]
Transaction-related expenses					$ 5,800
EOS Imaging S.A. | Technology-Based Intangible Assets
Business Acquisition [Line Items]
Intangible assets acquired amortized on a straight-line basis over useful lives					10 years
EOS Imaging S.A. | Customer Related Intangible Assets
Business Acquisition [Line Items]
Intangible assets acquired amortized on a straight-line basis over useful lives					7 years
EOS Imaging S.A. | Trade Name Related Intangible Assets
Business Acquisition [Line Items]
Intangible assets acquired amortized on a straight-line basis over useful lives					10 years
EOS Imaging S.A. | EOS Share
Business Acquisition [Line Items]
Purchase price in cash			46,908
EOS Imaging S.A. | OCEANEs
Business Acquisition [Line Items]
Purchase price in cash			19,620
Tender Offer Agreement | EOS Imaging S.A.
Business Acquisition [Line Items]
Share price | € / shares							€ 0.01
Business acquisition ownership percentage acquired	100.00%
Purchase price	$ 100,000	$ 8,500	$ 66,500
Purchase price in cash				$ 25,000
Ownership percentage on share capital and voting rights			80.00%
Tender Offer Agreement | EOS Imaging S.A. | EOS Share
Business Acquisition [Line Items]
Tender offer price | € / shares							2.45
Business acquisition ownership percentage acquired	100.00%		59.00%
Ownership percentage on share capital prior to change in control period				30.00%
Ownership percentage on share capital after change in control date			89.00%
Tender Offer Agreement | EOS Imaging S.A. | OCEANEs
Business Acquisition [Line Items]
Tender offer price | € / shares							€ 7.01
Business acquisition ownership percentage acquired	57.00%		53.00%
Ownership percentage on share capital prior to change in control period				4.00%
Ownership percentage on share capital after change in control date			57.00%

Business Combination - Schedule

Business Combination - Schedule of Allocation of Purchase Price to Assets Acquired and Liabilities Assumed Based on Fair Values (Details) - USD ($) $ in Thousands	May 13, 2021	Dec. 31, 2021	Dec. 31, 2020
Business Acquisition [Line Items]
Goodwill		$ 39,689	$ 13,897
EOS Imaging S.A.
Business Acquisition [Line Items]
Total cash paid at Change in Control Date	$ 66,528
Total fair value of investment in EOS held prior to Change in Control Date	25,026
Fair value of noncontrolling interest acquired after Change in Control Date	8,454
Purchase price	100,008
Cash and cash equivalents	16,778
Accounts receivable	9,083
Inventory	26,531
Other current assets	4,422
Property, plant and equipment, net	1,650
Deferred tax assets	2,314
Right-of-use asset	4,341
Goodwill	27,841
Definite-lived intangible assets:
Other noncurrent assets	395
Contract liabilities	21,196
Long-term debt	15,297
Other liabilities assumed	28,354
Total identifiable net assets	100,008
EOS Imaging S.A. | Developed Technology
Definite-lived intangible assets:
Definite-lived intangible assets:	56,000
EOS Imaging S.A. | Customer Relationships
Definite-lived intangible assets:
Definite-lived intangible assets:	9,500
EOS Imaging S.A. | Trade Names
Definite-lived intangible assets:
Definite-lived intangible assets:	6,000
EOS Imaging S.A. | EOS Share
Business Acquisition [Line Items]
Total cash paid at Change in Control Date	46,908
Total fair value of investment in EOS held prior to Change in Control Date	23,549
EOS Imaging S.A. | OCEANEs
Business Acquisition [Line Items]
Total cash paid at Change in Control Date	19,620
Total fair value of investment in EOS held prior to Change in Control Date	$ 1,477

Business Combination - Summary

Business Combination - Summary of Unaudited Proforma Results (Details) - EOS Imaging S.A. - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Business Acquisition [Line Items]
Total revenue	$ 251,906	$ 172,052
Net loss	$ (140,441)	$ (111,967)
Net loss per share, basic and diluted	$ (1.46)	$ (1.17)

Balance Sheet Details - Account

Balance Sheet Details - Accounts Receivable, Net (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Balance Sheet Related Disclosures [Abstract]
Accounts receivable	$ 44,200	$ 23,887
Allowance for doubtful accounts	(2,307)	(360)
Accounts receivable, net	$ 41,893	$ 23,527

Balance Sheet Details - Invento

Balance Sheet Details - Inventories (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Balance Sheet Related Disclosures [Abstract]
Raw materials	$ 14,671	$ 6,064
Work-in-process	5,712	1,982
Finished goods	71,320	37,955
Inventories	$ 91,703	$ 46,001

Balance Sheet Details - Propert

Balance Sheet Details - Property and Equipment, Net (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 160,125	$ 93,316
Less: accumulated depreciation	(72,724)	(56,646)
Property and equipment, net	$ 87,401	36,670
Surgical instruments
Property, Plant and Equipment [Line Items]
Useful lives	4 years
Property and equipment, gross	$ 130,432	76,669
Machinery and equipment
Property, Plant and Equipment [Line Items]
Useful lives	7 years
Property and equipment, gross	$ 11,092	6,562
Computer equipment
Property, Plant and Equipment [Line Items]
Useful lives	3 years
Property and equipment, gross	$ 5,694	4,206
Office furniture and equipment
Property, Plant and Equipment [Line Items]
Useful lives	5 years
Property and equipment, gross	$ 3,861	1,380
Leasehold improvements
Property, Plant and Equipment [Line Items]
Various useful lives of leasehold improvements	various
Property and equipment, gross	$ 1,754	1,761
Construction in progress
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 7,292	$ 2,738

Balance Sheet Details - Additio

Balance Sheet Details - Additional Information (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Balance Sheet Related Disclosures [Line Items]
Depreciation	$ 20.3	$ 9.2
Amortization of intangible assets	6.4	1.8
Additions to definite-lived intangible assets	71.5
Changes in goodwill		0
Globus
Balance Sheet Related Disclosures [Line Items]
Amortization of intangible assets	32.6
Machinery and equipment
Balance Sheet Related Disclosures [Line Items]
Capital leased assets, gross	$ 0.4	$ 0.1

Balance Sheet Details - Intangi

Balance Sheet Details - Intangible Assets, Net (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Finite Lived Intangible Assets [Line Items]
Gross Amount	$ 98,623	$ 54,467
Accumulated Amortization	(13,349)	(29,747)
Intangible Assets, net	$ 85,274	$ 24,720
Developed Technology
Finite Lived Intangible Assets [Line Items]
Intangible assets acquired amortized on a straight-line basis over useful lives	12 years	12 years
Gross Amount	$ 74,543	$ 35,376
Accumulated Amortization	(5,768)	(23,056)
Intangible Assets, net	$ 68,775	$ 12,320
Licensing Agreements
Finite Lived Intangible Assets [Line Items]
Intangible assets acquired amortized on a straight-line basis over useful lives		1 year
Gross Amount		$ 5,536
Accumulated Amortization		(965)
Intangible Assets, net		4,571
Trademarks and trade names
Finite Lived Intangible Assets [Line Items]
Intangible assets acquired amortized on a straight-line basis over useful lives	10 years
Gross Amount	$ 5,732	792
Accumulated Amortization	(477)	(119)
Intangible Assets, net	$ 5,255	$ 673
Customer Relationships
Finite Lived Intangible Assets [Line Items]
Intangible assets acquired amortized on a straight-line basis over useful lives	5 years	3 years
Gross Amount	$ 14,732	$ 7,458
Accumulated Amortization	(5,264)	(3,968)
Intangible Assets, net	$ 9,468	$ 3,490
Distribution network
Finite Lived Intangible Assets [Line Items]
Intangible assets acquired amortized on a straight-line basis over useful lives	3 years	2 years
Gross Amount	$ 2,413	$ 4,027
Accumulated Amortization	(1,840)	(1,639)
Intangible Assets, net	573	2,388
In process research and development
Finite Lived Intangible Assets [Line Items]
Gross Amount	1,203	1,278
Intangible Assets, net	$ 1,203	$ 1,278

Balance Sheet Details - Schedul

Balance Sheet Details - Schedule of Intangible Assets, Future Expected Amortization Expense (Details) $ in Thousands	Dec. 31, 2021USD ($)
Balance Sheet Related Disclosures [Abstract]
2022	$ 9,436
2023	9,436
2024	9,333
2025	8,748
2026	8,748
Thereafter	39,573
Total	$ 85,274

Balance Sheet Details - Sched_2

Balance Sheet Details - Schedule of Goodwill (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2021USD ($)
Balance Sheet Related Disclosures [Abstract]
December 31, 2020	$ 13,897
Additions	27,841
Foreign currency fluctuation	(2,049)
December 31, 2021	$ 39,689

Balance Sheet Details - Accrued

Balance Sheet Details - Accrued Expenses and Other Current Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Balance Sheet Related Disclosures [Abstract]
Payroll and payroll related	$ 18,449	$ 13,552
Commissions and sales milestones	12,420	7,038
Professional fees	4,684	3,551
Litigation settlement obligation	4,400	4,000
Royalties	3,466	2,293
Other taxes payable	3,004	248
Inventory in-transit	2,089	1,771
Administration fees	1,698	442
Interest	1,045	619
Other	4,294	1,750
Total accrued expenses and other current liabilities	$ 55,549	$ 35,264

Balance Sheet Details - Sched_3

Balance Sheet Details - Schedule of Other Long-Term Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Balance Sheet Related Disclosures [Abstract]
Royalties	$ 5,833	$ 1,678
Litigation settlement obligation - long-term portion	3,587	7,634
Income tax-related liabilities	1,522	373
Contract liability, non-current	2,897
Other	3,222	1,703
Other long-term liabilities	$ 17,061	$ 11,388

Discontinued Operations - Addit

Discontinued Operations - Additional Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Contracts revenue	$ 243,212	$ 144,861
Cost of sales	85,450	42,360
Supply agreement
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Contracts revenue	1,000	3,800
Cost of sales	$ 1,100	$ 3,500
Discontinued Operations, Disposed of by Sale | International Operations
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Supply agreement, expired and terminated date	Aug. 31, 2021

Debt - 0.75% Senior Convertible

Debt - 0.75% Senior Convertible Notes due 2026 (Details) - 0.75% Senior Convertible Notes due 2026	1 Months Ended	3 Months Ended	12 Months Ended
	Aug. 31, 2021USD ($)$ / sharesshares	Dec. 31, 2021Day	Dec. 31, 2021USD ($)Day
Line Of Credit Facility [Line Items]
Debt Instrument Face Amount	$ 316,300,000
Interest rate	0.75%
Debt instrument, maturity date	Aug. 1, 2026
Debt instrument, frequency of periodic payment	semi-annually
Debt instrument, Date of first payment	Feb. 1, 2022
Net proceeds	$ 306,200,000
Payment terms			Interest on the 2026 Notes is payable semi-annually in arrears on February 1 and August 1 of each year, beginning on February 1, 2022.
Debt instrument covenant description			The 2026 Notes do not contain any financial covenants
Initial conversion rate | shares	54.5316
Debt instrument converted principal amount	$ 1,000
Conversion price per share | $ / shares	$ 18.34
Consecutive trading days | Day		30	10
Threshold percentage of par value trigger	130.00%		98.00%
Number of conversion price, consecutive business days | Day			5
Debt instrument converted principal amount			$ 1,000
Debt conversion start date			Feb. 2, 2026
Convertible notes redemption start date	Aug. 6, 2024
Convertible notes, redemption price percentage	100.00%
Principal payments due	$ 0
Effective interest rate		1.40%	1.40%
Total interest expenses			$ 1,700,000
Minimum
Line Of Credit Facility [Line Items]
Threshold trading days | Day		20
Maximum
Line Of Credit Facility [Line Items]
Threshold percentage of par value trigger		130.00%

Debt - Outstanding Principal Am

Debt - Outstanding Principal Amount and Carrying Value of Notes (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Line Of Credit Facility [Line Items]
Principal	$ 336,090	$ 54,979
Net carrying value	326,831	$ 42,166
2026 Notes
Line Of Credit Facility [Line Items]
Principal	316,250
Unamortized debt issuance costs	(9,259)
Net carrying value	$ 306,991

Debt - Capped Call Transactions

Debt - Capped Call Transactions (Details) - 0.75% Senior Convertible Notes due 2026 - Capped Call Transactions $ in Millions	Aug. 05, 2021USD ($)$ / shares
Debt Instrument [Line Items]
Initial cap price | $ / shares	27.68
Percentage of premium over last reported sale price of common stock	100.00%
Cost of capped call transactions	$ 39.9
Reduction to additional paid-in capital	$ 39.9

Debt - OCEANE Convertible Bonds

Debt - OCEANE Convertible Bonds (Details) $ in Thousands, € in Millions	Jun. 20, 2021Day	May 31, 2018USD ($)ConvertibleBondshares	May 31, 2018EUR (€)ConvertibleBondshares	Jul. 31, 2021USD ($)shares	Jul. 31, 2021EUR (€)shares	Dec. 31, 2021USD ($)	Dec. 31, 2021USD ($)	Dec. 31, 2021EUR (€)	Dec. 31, 2020USD ($)	May 31, 2018EUR (€)shares
Debt Instrument [Line Items]
Carrying value of OCEANEs | $						$ 336,090	$ 336,090		$ 54,979
OCEANE Convertible Bonds
Debt Instrument [Line Items]
Debt instrument redemption				25,971	25,971
Debt instrument redemption amount				$ 200	€ 0.2
Carrying value of OCEANEs						14,100	$ 14,100	€ 12.5
OCEANE Convertible Bonds | EOS Imaging S.A.
Debt Instrument [Line Items]
Number of OCEANE convertible bonds issued | ConvertibleBond		4,344,651	4,344,651
Aggregate gross proceeds		$ 34,300	€ 29.5
Interest rate		6.00%								6.00%
Payment terms							The OCEANEs are unsecured obligations of EOS, rank equally with all other unsecured and unsubordinated obligations of EOS, and pay interest at a rate equal to 6% per year, payable semiannually in arrears on May 31 and November 30 of each year, beginning November 30, 2018.
Debt instrument, frequency of periodic payment		semiannually	semiannually
Debt instrument, Date of first payment		Nov. 30, 2018	Nov. 30, 2018
Debt instrument, maturity date		May 31, 2023	May 31, 2023
Interest expense | $						$ 700
Debt instrument purchased		2,486,135	2,486,135
Debt instrument outstanding		1,858,516								1,858,516
Debt Instrument Face Amount		$ 15,300								€ 12.6
Initial conversion rate		1	1
Threshold percentage of par value trigger	150.00%
Consecutive trading days | Day	40
Threshold percentage of debt instrument outstanding	15.00%
OCEANE Convertible Bonds | EOS Imaging S.A. | Minimum
Debt Instrument [Line Items]
Consecutive trading days | Day	20

Debt - Other Debt Agreements (D

Debt - Other Debt Agreements (Details) - EOS Imaging S.A. $ in Millions	1 Months Ended	4 Months Ended	12 Months Ended
	Feb. 28, 2022	Apr. 30, 2021EUR (€)Agreement	Dec. 31, 2021USD ($)	Dec. 31, 2021EUR (€)
Line Of Credit Facility [Line Items]
Number of loan agreements | Agreement		2
Debt instrument term		12 months
Percentage of principal state guaranteed		90.00%
Percentage of cost of state guaranty		0.25%
Debt instrument interest-free rate amount		€ 3,300,000
Effective interest rate		1.75%
Debt instrument interest rate amount		€ 1,500,000
Line of credit facility description			The loan capital and loan guaranty costs are payable in full at the end of the 12-month term or the loan may be extended up to 5 additional years. If the Company chooses to extend the debt, the election must be made by the Company between months 8 and 11 of the 12-month term.
Line of credit facility extension description			The extension will carry an interest rate at the banks’ refinancing cost, to be applied from year 2 to year 6 and an increased state guaranty cost (50 to 200 bps, as per a scale with company size and extension year).
Subsequent Event
Line Of Credit Facility [Line Items]
Debt instrument term	12 months
Debt instrument, extended maturity year	2027
Loan One
Line Of Credit Facility [Line Items]
Outstanding loan obligation			$ 3.7	€ 3,300,000
Weighted average interest rate on loan			0.69%	0.69%
Percentage of weighted average cost of state guaranty			0.69%
Loan Two
Line Of Credit Facility [Line Items]
Outstanding loan obligation			$ 1.6	€ 1,500,000
Weighted average interest rate on loan			1.25%	1.25%
Percentage of weighted average cost of state guaranty			1.00%
Maximum
Line Of Credit Facility [Line Items]
Debt instrument loan extended additional period		5 years

Debt - Debt (Details)

Debt - Debt (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Debt Instrument [Line Items]
Total	$ 336,090	$ 54,979
Less: debt discount	(9,259)	(12,813)
Net carrying value	326,831	42,166
Less: current portion of long-term debt	(342)	(4,167)
Total long-term debt, net of current portion	326,489	37,999
Other Notes Payable
Debt Instrument [Line Items]
Total	386	1,887
2026 Notes
Debt Instrument [Line Items]
Total	316,250
Net carrying value	306,991
OCEANE Convertible Bonds
Debt Instrument [Line Items]
Total	14,113
EOS PGE Loans
Debt Instrument [Line Items]
Total	$ 5,341
Squadron Medical Term Loan
Debt Instrument [Line Items]
Total		45,000
Inventory Financing
Debt Instrument [Line Items]
Total		3,821
PPP Loan
Debt Instrument [Line Items]
Total		$ 4,271

Debt - Principal Payments on De

Debt - Principal Payments on Debt (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Debt Disclosure [Abstract]
2022	$ 342
2023	14,834
2024	1,353
2025	1,335
2026	317,586
Thereafter	640
Total	336,090	$ 54,979
Less: debt discount	(9,259)	(12,813)
Net carrying value	326,831	42,166
Less: current portion of long-term debt	(342)	(4,167)
Total long-term debt, net of current portion	$ 326,489	$ 37,999

Debt - Paycheck Protection Loan

Debt - Paycheck Protection Loan (Details) - USD ($)	Apr. 23, 2020	Dec. 31, 2021	Dec. 31, 2020
Line Of Credit Facility [Line Items]
Gain (loss) on debt extinguishment		$ (7,434,000)	$ (7,612,000)
Paycheck Protection Program Loans
Line Of Credit Facility [Line Items]
Proceeds from loan	$ 4,300,000
Debt instrument, maturity date	Apr. 21, 2022
Interest rate	1.00%
Debt instrument, Description	Commencing August 21, 2021, the Company was required to pay the lender equal monthly payments of principal and interest as required to fully amortize the principal amount outstanding on the PPP Loan by April 21, 2022, the date prescribed by guidance issued by U.S. Small Business Administration (“SBA”).
Amount of compensation excluded for payroll costs	$ 100,000
Maximum percentage forgiven for non-payroll costs.	25.00%
Maximum amount of compensation to reduce the forgiveness	$ 100,000
Debt forgiveness	4,300,000
Gain (loss) on debt extinguishment	$ 4,300,000

Debt - Squadron Medical Credit

Debt - Squadron Medical Credit Agreement (Details) - USD ($) $ / shares in Units, $ in Thousands	Aug. 10, 2021	Dec. 16, 2020	Nov. 06, 2018	Dec. 31, 2021	Dec. 31, 2020
Line Of Credit Facility [Line Items]
Issuance of common stock				99,627,000	82,294,000
Gain (loss) on debt extinguishment				$ (7,434)	$ (7,612)
Number of warrants outstanding				20,184,000
Squadron Medical Term Loan
Line Of Credit Facility [Line Items]
Issuance of common stock		2,700,270
Common stock price per share		$ 11.11
Additional debt issuance costs		$ 3,800
New debt issuance costs		30,000
Gain (loss) on debt extinguishment			$ (6,100)	$ (11,700)
Debt instrument capitalized non-cash costs			$ 3,800
Repaid of outstanding principal	$ 45,000
Accrued interest	$ 200
Squadron Medical Term Loan | Common Stock | Participant Lender
Line Of Credit Facility [Line Items]
Number of warrants outstanding				6,759,530
Squadron Medical Term Loan | Term Loan
Line Of Credit Facility [Line Items]
Additional line of credit		$ 15,000
Debt instrument, maturity date		Jun. 30, 2026
Secured debt agreement		$ 30,000

Debt - Inventory Financing Agre

Debt - Inventory Financing Agreement (Details) - Inventory Financing Agreement - USD ($)	Aug. 10, 2021	Dec. 31, 2021	May 31, 2021	Nov. 30, 2020	Nov. 30, 2018
Line Of Credit Facility [Line Items]
Maximum borrowing capacity			$ 6,000,000	$ 6,000,000	$ 3,000,000
Current availability		$ 9,000,000
Repaid of outstanding principal	$ 8,100,000
Accrued interest	$ 100,000

Debt - MidCap Facility Agreemen

Debt - MidCap Facility Agreement (Details) - USD ($) $ in Thousands	May 29, 2020	Dec. 31, 2020
Debt Disclosure [Abstract]
Final settlement under agreement	$ 9,600	$ 56,615

Commitments and Contingencies -

Commitments and Contingencies - Additional Information (Details)	May 13, 2021USD ($)	Apr. 09, 2021USD ($)ft²	Dec. 04, 2019USD ($)ft²	Dec. 31, 2021USD ($)	Dec. 31, 2020USD ($)
Loss Contingencies [Line Items]
Lessee operating lease, description				The Company recognizes ROU assets and lease liabilities for office buildings and certain equipment with lease terms of 1 year to 10 years, some of which include options to extend and/or terminate the leases. Any short-term leases defined as twelve months or less or month-to-month leases were excluded and continue to be expensed each month. Total costs associated with these short-term leases is immaterial to all periods presented.
Right-of-use assets				$ 25,283,000	$ 1,177,000
Lease liability				28,595,000
Liability in connection with lawsuit				0	$ 0
EOS Imaging S.A.
Loss Contingencies [Line Items]
Operating lease term	10 years
Lease liability	$ 4,300,000
Lease commencement year	2019
Lease termination date	2028-09
Base rent	$ 600,000
EOS Imaging S.A. | Inventory Purchase | Third-party Supplier
Loss Contingencies [Line Items]
Remaining minimum purchase commitment required				$ 33,500,000
Building Lease
Loss Contingencies [Line Items]
Operating lease term		7 years	10 years
Area for facility of office, engineering and research and development space | ft²		75,643	121,541
Lease agreement commencement date		May 1, 2021	Feb. 1, 2021
Lease agreement expiry date		May 1, 2028	Jan. 31, 2031
Lease renewal term		236 months	260 months
Right-of-use assets		$ 1,700,000	$ 21,100,000
Lease liability		$ 1,600,000	$ 21,500,000
Beginning and end of abatement period			full abatement during months two through ten
Annual increase in base rent		3.00%	3.00%
First year | Building Lease
Loss Contingencies [Line Items]
Lease base rent payment per month			$ 200,000
Minimum
Loss Contingencies [Line Items]
Operating lease term				1 year
Minimum | First year | Building Lease
Loss Contingencies [Line Items]
Abatement period			2 months
Maximum
Loss Contingencies [Line Items]
Operating lease term				10 years
Maximum | First year | Building Lease
Loss Contingencies [Line Items]
Abatement period			10 months

Commitments and Contingencies_2

Commitments and Contingencies - Future Minimum Annual Lease Payments (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Commitments And Contingencies Disclosure [Abstract]
2022	$ 4,405
2023	4,609
2024	4,620
2025	4,590
2026	4,694
Thereafter	17,846
Total undiscounted lease payments	40,764
Less: imputed interest	(12,169)
Operating lease liability	28,595
Less: current portion of operating lease liability	(4,212)	$ (885)
Operating lease liability, less current portion	$ 24,383	$ 41

Commitments and Contingencies_3

Commitments and Contingencies - Summary of Weighted-Average Remaining Lease Term and Discount Rate (Details)	Dec. 31, 2021	Dec. 31, 2020
Commitments And Contingencies Disclosure [Abstract]
Weighted average remaining lease term (years)	8 years 7 months 6 days	8 months 12 days
Weighted average discount rate	8.50%	10.50%

Commitments and Contingencies_4

Commitments and Contingencies - Summary of Operating Leases (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Commitments And Contingencies Disclosure [Abstract]
Rent expense	$ 4,482	$ 1,300
Cash paid for amounts included in measurement of lease liabilities	$ 1,795	$ 1,400

Orthotec Settlement - Additiona

Orthotec Settlement - Additional Information (Details)	Jul. 01, 2016USD ($)	Oct. 01, 2014USD ($)	Aug. 13, 2014USD ($)installment	Oct. 31, 2020USD ($)	Sep. 30, 2014USD ($)	Apr. 30, 2014USD ($)	Mar. 31, 2014USD ($)	Dec. 31, 2021USD ($)	Dec. 31, 2020USD ($)
Loss Contingencies [Line Items]
Litigation settlement, remaining outstanding balance								$ 0	$ 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	49,000,000
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								8,500,000
Orthotec LLC, litigation settlement | HealthpointCapital, LLC
Loss Contingencies [Line Items]
Judgment assessed by court for (against) company				$ 1,000,000	$ 5,000,000			4,000,000
Payments of settlement	$ 1,000,000							1,100,000
Contribution amount to be paid by other party				$ 1,000,000	$ 5,000,000			4,000,000
Amounts receivable								$ 0
Beginning Fourth Quarter of 2014 | Orthotec LLC, litigation settlement
Loss Contingencies [Line Items]
Litigation settlement, full amount to be paid in quarterly installments		$ 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	Dec. 31, 2021	Dec. 31, 2020
Commitments And Contingencies Disclosure [Abstract]
Litigation settlement obligation - short-term portion	$ 4,400	$ 4,000
Litigation settlement obligation - long-term portion	3,587	7,634
Total	7,987	11,634
Future imputed interest	478	1,199
Total settlement obligation, gross	8,465	12,833
Related party receivable - included in stockholders' equity		(4,000)
Total settlement obligation, net	$ 8,465	$ 8,833

Equity - Additional Information

Equity - Additional Information (Details) - USD ($)	Aug. 03, 2021	Mar. 01, 2021	Oct. 16, 2020	Dec. 31, 2017	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2017	May 31, 2020	Jun. 30, 2019	Dec. 31, 2018
Subsidiary Sale Of Stock [Line Items]
Common stock, shares authorized					200,000,000	200,000,000
Redeemable preferred stock carrying value					$ 23,603,000	$ 23,603,000
Redeemable preferred stock authorized					20,000,000	20,000,000
Redeemable preferred stock, price per share					$ 0.0001	$ 0.0001
Number of warrants outstanding					20,184,000
Number of warrants issued (in shares)					0
Stock-based compensation					$ 36,450,000	$ 17,659,000
Patrick S. Miles
Subsidiary Sale Of Stock [Line Items]
Warrant expiration period				5 years
Number of warrants issued (in shares)				1,327,434	0		1,327,434
Exercise price of warrants				$ 5			$ 5
Stock-based compensation							$ 1,400,000
SafeOp Surgical, Inc.
Subsidiary Sale Of Stock [Line Items]
Warrant expiration period					5 years
Proceeds from exercise of warrant					$ 100,000	$ 0
Number of warrants exercised					969,932	34,807
Number of warrants outstanding					1,194,943
Number of warrants issued (in shares)					2,200,000
Exercise price of warrants					$ 3.50
Squadron Medical | Participant Lender
Subsidiary Sale Of Stock [Line Items]
Number of warrants outstanding						6,759,530
Number of warrants issued (in shares)					0			1,075,820	4,838,710	845,000
Exercise price of warrants								$ 4.88	$ 2.17	$ 3.15
Warrants And Rights Outstanding Maturity Date								May 29, 2027
2017 PIPE Warrants
Subsidiary Sale Of Stock [Line Items]
Warrant expiration period					5 years
Proceeds from exercise of warrant					$ 1,600,000	$ 600,000
Number of warrants exercised					795,000	273,554
Number of warrants outstanding					2,312,000
Exercise price of warrants					$ 2
2018 Common Stock Warrants
Subsidiary Sale Of Stock [Line Items]
Warrant expiration period					5 years
Proceeds from exercise of warrant					$ 1,500,000	$ 1,300,000
Number of warrants exercised					2,900,660	2,342,986
Number of warrants outstanding					8,479,025
Exercise price of warrants					$ 3.50
Redeemable Preferred Stock
Subsidiary Sale Of Stock [Line Items]
Redeemable preferred stock carrying value					$ 23,600,000	$ 23,600,000
Redeemable preferred stock authorized					20,000,000	20,000,000
Redeemable preferred stock redemption, price per share					$ 9	$ 9
Redeemable preferred stock, price per share					$ 7.11	$ 7.11
Private Placement
Subsidiary Sale Of Stock [Line Items]
Common stock issued		12,421,242,000
Net proceeds from private placement		$ 131,800,000
Gross proceeds from private placement		138,000
Private placement fee net		$ 6,200
Private Placement | Common Stock
Subsidiary Sale Of Stock [Line Items]
Common stock issued					12,421,000
Underwritten Public Offering | Common Stock
Subsidiary Sale Of Stock [Line Items]
Common stock issued			13,142,855,000
Net proceeds from offering			$ 107,700,000
Gross proceeds from offering			115,000
Common stock fee net			$ 7,300
0.75% Convertible Senior Notes
Subsidiary Sale Of Stock [Line Items]
Share repurchase, authorized amount	$ 25,000
Number of shares repurchased	1,806,358,000					0
Aggregate price of repurchased shares	$ 25,000

Equity - Summary of Outstanding

Equity - Summary of Outstanding Warrants (Details)	12 Months Ended
	Dec. 31, 2021$ / sharesshares
Class Of Warrant Or Right [Line Items]
Number of Warrants	20,184,000
2017 PIPE Warrants
Class Of Warrant Or Right [Line Items]
Number of Warrants	2,312,000
Strike Price | $ / shares	$ 2
Expiration	June 2022
2018 PIPE Warrants
Class Of Warrant Or Right [Line Items]
Number of Warrants	8,479,025
Strike Price | $ / shares	$ 3.50
Expiration	May 2023
SafeOp Surgical Merger Warrants
Class Of Warrant Or Right [Line Items]
Number of Warrants	1,195,000
Strike Price | $ / shares	$ 3.50
Expiration	May 2023
2018 Squadron Medical Warrants
Class Of Warrant Or Right [Line Items]
Number of Warrants	845,000
Strike Price | $ / shares	$ 3.15
Expiration	May 2027
2019 Squadron Medical Warrants
Class Of Warrant Or Right [Line Items]
Number of Warrants	4,839,000
Strike Price | $ / shares	$ 2.17
Expiration	May 2027
2020 Squadron Medical Warrants
Class Of Warrant Or Right [Line Items]
Number of Warrants	1,076,000
Strike Price | $ / shares	$ 4.88
Expiration	May 2027
Executive Warrants
Class Of Warrant Or Right [Line Items]
Number of Warrants	1,327,000
Strike Price | $ / shares	$ 5
Expiration	December 2022
Other Warrants
Class Of Warrant Or Right [Line Items]
Number of Warrants	111,000
Strike Price | $ / shares	$ 5.40
Expiration	Various through December 2024

Stock Benefit Plans and Stock_3

Stock Benefit Plans and Stock-Based Compensation - Additional Information (Details) - USD ($)	Jun. 16, 2021	Apr. 05, 2020	Jul. 31, 2019	Sep. 30, 2016	Dec. 31, 2021	Dec. 31, 2020	Jun. 17, 2020	Apr. 08, 2020	Dec. 31, 2017
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance					54,895,000
Stock compensation charge						$ 900,000
Stock-based compensation					$ 36,450,000	$ 17,659,000
Common Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of warrants available to be granted					205,000
Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period					4 years
Employee Stock Option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance					3,351,000
Weighted-average grant-date fair value of stock options granted					$ 9.88	$ 4.71
Total intrinsic value of stock options exercised					$ 6,800	$ 2,300
Share price					$ 11.43
Unrecognized compensation expense for stock options and awards expected to be recognized					$ 1,300,000
Straight-line basis over a weighted average period						1 year 4 months 24 days
Unvested Restricted Stock Award
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Restricted shares granted under the plan					3,980,000
Straight-line basis over a weighted average period					1 year 7 months 28 days
Weighted average fair value of awards granted					$ 12.79	$ 4.87
Unrecognized compensation expense for restricted stock awards, restricted stock units and performance-based restricted units expected to be recognized					$ 42,000,000
Total fair value of awards vested					$ 43,900,000	$ 13,100,000
ESPP
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance					547,170
Number of shares available for grant	500,000,000
Employee stock purchase plan, maximum annual compensation percentage	20.00%
Employee stock purchase plan, maximum annual compensation amount	$ 21,250
Purchase price equal to the lower of the fair market value per share (at closing) of Company common stock	85.00%
Employee stock purchase plan, offering period	6 months
Shares of common stock purchased under the ESPP					227,245	379,166
Stock-based compensation					$ 1,100,000	$ 1,000,000
2016 Equity Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance				1,083,333
Number of shares available for grant					3,329,247		7,000,000
2016 Equity Incentive Plan | Employee Stock Option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expiration period				10 years
Award vesting period				4 years
Exercise price minimum percentage of market price on grant date				100.00%
2016 Equity Incentive Plan | Employee Stock Option | 10 Percent Stockholder
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expiration period				5 years
Exercise price minimum percentage of market price on grant date				110.00%
Salary-to-Equity Conversion Program
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting date		Jul. 10, 2020
Deferred compensation liability						$ 900,000
Salary-to-Equity Conversion Program | Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Eligible employee payroll cost for conversion program		$ 100,000
Employee voluntary election to reduce compensation rate		10.00%
Salary-to-Equity Conversion Program | Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Employee voluntary election to reduce compensation rate		75.00%
Inducement Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance					535,125
Maximum award to be deductible other than options					$ 1,000,000
2019 Management Objective Strategic Incentive Plan | Board of Directors Chairman | Common Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share authorized grant of warrants			500,000
Maximum grant of shares per participant			50,000
2019 Management Objective Strategic Incentive Plan | Unvested Restricted Stock Award
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Maximum grant of shares per participant					12,500
Restricted shares granted under the plan					122,500
2017 Distributor Inducement Plan | Common Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock issued					146,100
Number of warrants available to be granted					325,000
2017 Distributor Inducement Plan | Board of Directors Chairman | Common Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share authorized grant of warrants									1,000,000
2017 Distributor Inducement Plan | Restricted Common Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Restricted shares granted under the plan					229,900
Two Thousand Seventeen Development Services Plan | Board of Directors Chairman | Common Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares available for grant					0			7,000,000

Stock Benefit Plans and Stock_4

Stock Benefit Plans and Stock-Based Compensation - Summary of Compensation Cost for Stock-Based Compensation Arrangements (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation expense	$ 36,450	$ 17,659
Cost of sales
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation expense	737	512
Research and development
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation expense	4,056	2,114
Sales, General and Administrative
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation expense	$ 31,657	$ 15,033

Stock Benefit Plans and Stock_5

Stock Benefit Plans and Stock-Based Compensation - Summary of Stock Option Activity (Details) $ / shares in Units, shares in Thousands, $ in Thousands	12 Months Ended
	Dec. 31, 2021USD ($)$ / sharesshares
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding [Roll Forward]
Shares Outstanding, Beginning balance | shares	3,951
Shares, Granted | shares	85
Shares, Exercised | shares	(569)
Shares, Forfeited | shares	(116)
Shares Outstanding, Ending balance | shares	3,351
Shares, Options vested and exercisable | shares	2,973
Shares, Options vested and expected to vest | shares	3,351
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding, Weighted Average Exercise Price [Abstract]
Weighted average exercise price, Outstanding, Beginning balance | $ / shares	$ 3.21
Weighted average exercise price, Granted | $ / shares	13.62
Weighted average exercise price,Exercised | $ / shares	2.63
Weighted average exercise price, Forfeited | $ / shares	5.28
Weighted average exercise price, Outstanding, Ending balance | $ / shares	3.50
Weighted average exercise price, Options vested and exercisable | $ / shares	3.24
Weighted average exercise price, Options vested and expected to vest | $ / shares	$ 3.50
Share-based Compensation Arrangement by Share-based Payment Award, Options, Additional Disclosures [Abstract]
Weighted average remaining contractual term, Outstanding, balance	6 years 10 days
Weighted average remaining contractual term, Options vested and exercisable	5 years 10 months 9 days
Weighted average remaining contractual term, Options vested and expected to vest	6 years 10 days
Aggregate intrinsic value, Outstanding | $	$ 27,619
Aggregate intrinsic value, Options vested and exercisable | $	25,162
Aggregate intrinsic value, Options vested and expected to vest | $	$ 27,619

Stock Benefit Plans and Stock_6

Stock Benefit Plans and Stock-Based Compensation - Summary of Weighted Average Assumptions Used to Compute Stock-Based Compensation Costs for Stock Options Granted (Details) - Share-based Payment Arrangement, Option	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk-free interest rate	0.84%	1.03%
Weighted average expected life (years)	6 years 25 days	6 years 29 days
Volatility	87.38%	84.00%

Stock Benefit Plans and Stock_7

Stock Benefit Plans and Stock-Based Compensation - Summary of Information about Restricted Stock Awards, Restricted Stock Units and Performance-Based Restricted Units Activity (Details) - Unvested restricted stock units - $ / shares shares in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Number of Shares [Roll Forward]
Shares, Unvested beginning balance	8,216
Shares, Awarded	3,980
Shares, Vested	(2,824)
Shares, Forfeited	(669)
Shares, Unvested ending balance	8,703	8,216
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Nonvested, Weighted Average Grant Date Fair Value [Abstract]
Weighted average grant date fair value, Unvested beginning balance	$ 3.13
Weighted average grant date fair value, Awarded	12.79	$ 4.87
Weighted average grant date fair value, Vested	3.88
Weighted average grant date fair value, Forfeited	4.01
Weighted average grant date fair value, Unvested ending balance	$ 6.34	$ 3.13
Weighted average remaining recognition period (in years)	1 year 7 months 28 days

Stock Benefit Plans and Stock_8

Stock Benefit Plans and Stock-Based Compensation - Schedule of Assumptions used to Estimate Fair Value of Stock Options Granted and Stock Purchase Rights under ESPP (Details) - ESPP	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Risk-free interest rate, minimum	0.04%	0.12%
Risk-free interest rate, maximum	0.12%	1.58%
Weighted average expected life (years)	6 months	6 months
Volatility, minimum	49.98%	54.96%
Volatility, maximum	78.37%	102.50%

Stock Benefit Plans and Stock_9

Stock Benefit Plans and Stock-Based Compensation - Summary Common Stock Reserved for Future Issuance (Details) shares in Thousands	Dec. 31, 2021shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance	54,895
Unvested Restricted Stock Award
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance	8,703
Senior Convertible Notes
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance	17,246
Warrants Outstanding
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance	20,184
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	445
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	365
Authorized for Future Grant Under the Company Equity Plans
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance	4,025
Employee Stock Option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance	3,351
Employee Stock Purchase Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance	547
Series A Convertible Preferred Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock reserved for future issuance	29

Income Taxes - Components of Pr

Income Taxes - Components of Pretax Income (Loss) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Income Tax Disclosure [Abstract]
U.S. Domestic	$ (127,943)	$ (78,849)
Foreign	(16,219)
Net loss before taxes	$ (144,162)	$ (78,849)

Income Taxes - Components of _2

Income Taxes - Components of Provision for Income Taxes from Continuing Operations (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Current income tax provision:
Federal	$ 123
State	166	$ 100
Foreign	66	35
Total current	355	135
Deferred income tax provision:
Federal	(159)	(2)
State	(32)	12
Total deferred	(191)	10
Total income tax provision	$ 164	$ 145

Income Taxes - Schedule of Effe

Income Taxes - Schedule of Effective Income Tax Rate Reconciliation (Details)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Income Tax Disclosure [Abstract]
Federal statutory rate	21.00%	21.00%
Adjustments for tax effects of:
State taxes, net	(0.07%)	(0.11%)
Stock-based compensation	(0.48%)	(0.93%)
Foreign rate differential	0.43%	0.00%
Foreign taxes	(0.05%)	(0.04%)
Other permanent adjustments	0.08%	(1.70%)
Federal uncertain tax positions	(0.08%)	0.00%
Other	(0.13%)	(0.15%)
Valuation allowance	(20.81%)	(18.25%)
Effective income tax rate	(0.11%)	(0.18%)

Income Taxes - Significant Comp

Income Taxes - Significant Components of Company's Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Deferred tax assets:
Net operating losses	$ 131,734	$ 70,220
Interest	11,095	8,193
Inventory	8,784	8,117
Accruals and reserves	7,145	3,437
Lease liability	6,216	228
Stock-based compensation	4,318	2,464
Legal settlement	1,998	2,875
Income tax credit carryforwards	1,574	1,582
Total deferred tax assets	172,864	97,116
Valuation allowance	(127,209)	(87,489)
Total deferred tax assets, net of valuation allowance	45,655	9,627
Deferred tax liabilities:
Goodwill and intangibles	(18,439)	(2,483)
Property and equipment	(18,404)	(6,803)
Right-of-use assets	(6,256)	(291)
Total deferred tax liabilities	(43,099)	(9,577)
Net deferred tax assets	$ 2,556	$ 50

Income Taxes - Additional Infor

Income Taxes - Additional Information (Details) - USD ($)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2018	Dec. 31, 2020
Income Tax Disclosure [Abstract]
Deferred tax asset, valuation allowance	$ 127,209,000		$ 87,489,000
Deferred tax asset, valuation allowance increase (decrease)	$ 39,700,000
Number of years cumulative pretax loss	3 years
Indefinite lived assets	$ 0
Unrecognized tax benefits, if recognized, would impact the effective income tax rate	14,500,000		2,000,000
Accrued interest and penalties	200,000		$ 0
Operating loss carryforwards state	316,900,000
Operating loss carryforwards federal	448,800,000
Operating loss carryforwards foreign	122,400
Federal and state net operating loss carryforwards, expiring year		2042
State research and development tax credit carryforwards	$ 3,200,000
Cumulative change in ownership percentage	50.00%
Period for cumulative change in ownership	3 years

Income Taxes - Summary of Chang

Income Taxes - Summary of Changes to Unrecognized Tax Benefits (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns [Roll Forward]
Unrecognized tax benefit at the beginning of the year	$ 2,452	$ 2,452
Increases in tax positions for current year relating to acquisitions	12,713	0
Unrecognized tax benefits at the end of the year	$ 15,165	$ 2,452

Related Party Transactions - Ad

Related Party Transactions - Additional Information (Details) - USD ($)	Jul. 01, 2016	Aug. 13, 2014	Oct. 31, 2020	Sep. 30, 2014	Apr. 30, 2014	Mar. 31, 2014	Dec. 31, 2021	Dec. 31, 2020
Squadron Supplier Affiliate | Inventory Financing Agreement
Related Party Transaction [Line Items]
Purchased inventory from related party							$ 7,700	$ 4,000
Due to affiliate							800	$ 4,000
Orthotec LLC, litigation settlement
Related Party Transaction [Line Items]
Payments of settlement					$ 15,750,000	$ 1,750,000	49,000,000
Judgment assessed by court for (against) company		$ (49,000,000)
Orthotec LLC, litigation settlement | HealthpointCapital, LLC
Related Party Transaction [Line Items]
Payments of settlement	$ 1,000,000						1,100,000
Judgment assessed by court for (against) company			$ (1,000,000)	$ (5,000,000)			(4,000,000)
Litigation settlement amount awarded due to other party							$ 0

Business Segment and Geograph_3

Business Segment and Geographic Information - Additional Information (Details)	12 Months Ended
	Dec. 31, 2021segment
Segment Reporting [Abstract]
Number of operating segments	1

Business Segment and Geograph_4

Business Segment and Geographic Information - Schedule of Net Revenue and Property, Plant and Equipment, Net, by Geographic Region (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Revenues From External Customers And Long Lived Assets [Line Items]
Revenues	$ 243,212	$ 144,861
Property and equipment, net	87,401	36,670
United States
Revenues From External Customers And Long Lived Assets [Line Items]
Revenues	223,911	141,079
Property and equipment, net	85,320	36,670
International
Revenues From External Customers And Long Lived Assets [Line Items]
Revenues	19,301	$ 3,782
Property and equipment, net	$ 2,081

Subsequent Events - Additional

Subsequent Events - Additional Information (Details) - EOS Imaging S.A.	1 Months Ended	12 Months Ended
	Feb. 28, 2022	Dec. 31, 2021
Subsequent Event [Line Items]
Debt instrument, maturity year		2022
Subsequent Event
Subsequent Event [Line Items]
Debt instrument, extended maturity year	2027