Xtant Medical (XTNT) 10-Q/A 30 Mar 18 2017 Q1 Quarterly report (amended) Financial data

Document And Entity Information

Document And Entity Information - shares	3 Months Ended
	Mar. 31, 2017	May 15, 2017
Document Information [Line Items]
Document Type	10-Q
Amendment Flag	true
Document Period End Date	Mar. 31, 2017
Document Fiscal Year Focus	2,017
Document Fiscal Period Focus	Q1
Entity Registrant Name	Xtant Medical Holdings, Inc.
Entity Central Index Key	1,453,593
Current Fiscal Year End Date	--12-31
Entity Filer Category	Smaller Reporting Company
Trading Symbol	XTNT
Entity Common Stock, Shares Outstanding		18,092,603
Amendment Description	We are filing this Amendment No. 1 on Form 10-Q/A to amend and restate in their entirety the following items of our Quarterly Report on Form 10-Q for the quarter ended March 31, 2017 as originally filed with the Securities and Exchange Commission on May 15, 2017 (the “Original Form 10-Q”): (i) Item 1 of Part I “Financial Statements,” (ii) Item 2 of Part I, “Management’s Discussion and Analysis of Financial Condition and Results of Operations,” and (iii) Item 4 of Part I, “Controls and Procedures,” in Exhibits 31.1, 31.2, 32.1 and 32.2, and our financial statements formatted in Extensible Business Reporting Language (XBRL) in Exhibits 101. No other sections were affected, but for the convenience of the reader, this report on Form 10-Q/A restates in its entirety, as amended, our Original Form 10-Q. This report on Form 10-Q/A is presented as of the filing date of the Original Form 10-Q and does not reflect events occurring after that date, or modify or update disclosures in any way other than as required to reflect the restatement described below. We have determined that our previously reported results for the quarter ended March 31, 2017 erroneously recorded accumulated depreciation on surgical instruments. Correcting the error requires a decrease in property and equipment, net, in the amount of $617,627 and a related increase in cost of goods sold. Detection of the error resulted in the restatement of the condensed consolidated balance sheet, condensed consolidated statement of operations, condensed consolidated statement of cash flows and Note 4, property and equipment, net for the quarter ended March 31, 2017 included in this Form 10-Q/A. We have made necessary conforming changes in “Management’s Discussion and Analysis of Financial Condition and Results of Operations” resulting from the correction of this error.

CONDENSED CONSOLIDATED BALANCE

CONDENSED CONSOLIDATED BALANCE SHEETS - USD ($)	Mar. 31, 2017	Dec. 31, 2016
Current Assets:
Cash and cash equivalents	$ 2,486,839	$ 2,578,267
Trade accounts receivable, net of allowance for doubtful accounts of $1,889,854 and $1,653,385, respectively	16,320,038	18,991,872
Current inventories, net	26,359,272	26,266,457
Prepaid and other current assets	1,651,187	1,149,615
Total current assets	46,817,336	48,986,211
Non-current inventories, net	440,853	971,854
Property and equipment, net	14,602,098	15,840,730
Goodwill	41,534,626	41,534,626
Intangible assets, net	34,800,556	35,940,810
Other assets	874,561	827,374
Total Assets	139,070,030	144,101,605
Current Liabilities:
Accounts payable	8,896,188	10,471,944
Accounts payable - related party (Note 13)	472,657	640,442
Revolving line of credit	10,293,706	10,448,283
Accrued liabilities	8,815,400	8,982,187
Warrant derivative liability	163,582	333,613
Current portion of capital lease obligations	259,027	244,847
Total current liabilities	28,900,560	31,121,316
Long-term liabilities:
Capital lease obligation, less current portion	754,994	832,152
Long-term convertible debt, less issuance costs	70,636,665	68,937,247
Long-term debt, less issuance costs	51,069,961	50,284,187
Total Liabilities	151,362,180	151,174,902
Commitments and Contingencies (Note 10)
Stockholders' Deficit
Preferred stock, $0.000001 par value; 5,000,000 shares authorized; no shares issued and outstanding	0	0
Common stock, $0.000001 par value; 95,000,000 shares authorized; 18,092,603 shares issued and outstanding as of March 31, 2017 and 11,897,601 shares issued and outstanding as of December 31, 2016	18	17
Additional paid-in capital	86,026,911	85,461,210
Accumulated deficit	(98,319,079)	(92,534,524)
Total Stockholders’ Deficit	(12,292,150)	(7,073,297)
Total Liabilities and Stockholders’ Deficit	$ 139,070,030	$ 144,101,605

CONDENSED CONSOLIDATED BALANCE3

CONDENSED CONSOLIDATED BALANCE SHEETS [Parenthetical] - USD ($)	Mar. 31, 2017	Dec. 31, 2016
Trade accounts receivable, allowance for doubtful accounts (in dollars)	$ 1,889,854	$ 1,653,385
Preferred stock, par value (in dollars per share)	$ 0.000001	$ 0.000001
Preferred stock, shares authorized	5,000,000	5,000,000
Preferred stock, shares issued	0	0
Preferred stock, shares outstanding	0	0
Common stock, par value (in dollars per share)	$ 0.000001	$ 0.000001
Common stock, shares authorized	95,000,000	95,000,000
Common stock, shares issued	18,092,603	11,897,601
Common Stock, shares outstanding	18,092,603	11,897,601

CONDENSED CONSOLIDATED STATEMEN

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($)	3 Months Ended
	Mar. 31, 2017	Mar. 31, 2016
Revenue
Orthopedic product sales	$ 21,996,315	$ 20,808,035
Other revenue	86,354	169,300
Total Revenue	22,082,669	20,977,335
Cost of sales	7,175,229	6,877,267
Gross Profit	14,907,440	14,100,068
Operating Expenses:
General and administrative	4,128,268	3,484,712
Sales and marketing	10,997,019	10,512,966
Research and development	698,635	899,575
Depreciation and amortization	1,280,965	1,208,334
Acquisition and integration related expenses	0	301,773
Separation related expenses	224,372	0
Non-cash consulting expense	144,723	55,296
Total Operating Expenses	17,473,982	16,462,656
Loss from Operations	(2,566,542)	(2,362,588)
Other Income (Expense):
Interest expense	(3,400,389)	(2,827,174)
Change in warrant derivative liability	170,031	18,690
Other income (expense)	12,344	(425,000)
Total Other Income (Expense)	(3,218,014)	(3,233,484)
Benefit (Provision) for Income Taxes
Net Loss from Operations	$ (5,784,556)	$ (5,596,072)
Net loss per share:
Basic	$ (0.32)	$ (0.47)
Dilutive	$ (0.32)	$ (0.47)
Shares used in the computation:
Basic	17,933,315	11,897,601
Dilutive	17,933,315	11,897,601

CONDENSED CONSOLIDATED STATEME5

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)	3 Months Ended
	Mar. 31, 2017	Mar. 31, 2016
Operating activities:
Net loss	$ (5,784,556)	$ (5,596,072)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation and amortization	2,071,337	1,779,986
Non-cash interest	3,151,227	2,822,980
Loss on impairment and disposal of fixed assets	617,627	0
Non-cash consulting expense/stock option expense	230,424	136,079
Provision for losses on accounts receivable and inventory	312,588	(72,313)
Change in derivative warrant liability	(170,031)	(18,690)
Changes in operating assets and liabilities:
Accounts receivable	2,536,242	328,290
Inventories	261,189	(1,144,652)
Prepaid and other assets	(648,769)	(235,779)
Accounts payable	(1,743,541)	3,734,694
Accrued liabilities	(397,532)	(707,214)
Net cash provided by operating activities	436,205	1,027,309
Investing activities:
Purchases of property and equipment and intangible assets	(310,078)	(2,718,985)
Net cash used in investing activities	(310,078)	(2,718,985)
Financing activities:
Payments on capital leases	(62,978)	(7,985)
Payments on revolving line of credit	(154,577)	0
Net cash used in financing activities	(217,555)	(7,985)
Net change in cash and cash equivalents	(91,428)	(1,699,661)
Cash and cash equivalents at beginning of period	2,578,267	6,368,016
Cash and cash equivalents at end of period	$ 2,486,839	$ 4,668,355

Business Description and Summar

Business Description and Summary of Significant Accounting Policies	3 Months Ended
	Mar. 31, 2017
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Business Description and Summary of Significant Accounting Policies	(1) Business Description and Summary of Significant Accounting Policies The accompanying condensed consolidated financial statements include the accounts of Xtant Medical Holdings, Inc. (“Xtant”), formerly known as Bacterin International Holdings, Inc., a Delaware corporation, and its wholly owned subsidiaries, Xtant Medical, Inc., a Delaware corporation, Bacterin International, Inc., (“Bacterin”) a Nevada corporation and X-Spine Systems, Inc. (“X-spine”), an Ohio corporation, (Xtant, Bacterin and X-spine are jointly referred to herein as the “Company”). All intercompany balances and transactions have been eliminated in consolidation. Xtant develops, manufactures and markets regenerative orthopedic products for domestic and international markets and fixation devices. Xtant products serve the combined specialized needs of orthopedic and neurological surgeons, including orthobiologics for the promotion of bone healing, implants and instrumentation for the treatment of spinal disease, tissue grafts for the treatment of orthopedic disorders to promote healing following spine, cranial and foot surgeries and the development, manufacturing and sale of medical devices for use in orthopedic spinal surgeries. On July 31, 2015, Xtant acquired all of the outstanding capital stock of X-spine for approximately $ 60 13 4,242,655 The markets in which the Company competes are highly competitive and rapidly changing. Significant technological advances, changes in customer requirements, or the emergence of competitive products with new capabilities or technologies could adversely affect the Company’s operating results. The Company’s business could be harmed by a decline in demand for, or in the prices of, its products or as a result of, among other factors, any change in pricing or distribution methods, increased price competition, changes in government regulations or a failure by the Company to keep up with technological change. Further, a decline in available donors could have an adverse impact on our business. The accompanying interim condensed consolidated financial statements of Xtant for the quarters ended March 31, 2017 and 2016 are unaudited and are prepared in accordance with accounting principles generally accepted in the United States of America. They do not include all disclosures required by generally accepted accounting principles for annual financial statements, but in the opinion of management, include all adjustments, consisting only of normal recurring items, necessary for a fair presentation. Interim results are not necessarily indicative of results which may be achieved in the future for the full year ending December 31, 2017. These condensed financial statements should be read in conjunction with the financial statements and notes thereto which are included in Xtant’s Annual Report on Form 10-K for the year ended December 31, 2016. The accounting policies set forth in those annual financial statements are the same as the accounting policies utilized in the preparation of these financial statements, except as modified for appropriate interim financial statement presentation. The Company has incurred losses since its inception. The terms, conditions and amounts outstanding under the Company’s debt agreements (See Note 7, “Debt” below) raise substantial doubt about the Company’s ability to continue as a going concern. The Company has established a special committee of its board of directors to evaluate restructuring alternatives, assist in related negotiations with the Company’s lenders and consider alternatives for raising new capital. The Company also is evaluating various cost-reduction and cash flow improvement measures. However, there can be no assurance that the Company will be successful in these efforts. The accompanying condensed consolidated financial statements have been prepared assuming that the Company will continue as a going concern; however, the above conditions raise substantial doubt about the Company’s ability to do so. The financial statements do not include any adjustments to reflect the possible future effects on the recoverability and classification of assets or the amounts and classifications of liabilities that may result should the Company be unable to continue as a going concern. The Company’s accounts receivable are due from a variety of health care organizations and distributors throughout the world. No single customer accounted for more than 10% of revenue or accounts receivable for the comparable periods. The Company provides for uncollectible amounts when specific credit issues arise. Management’s estimates for uncollectible amounts have been adequate during prior periods, and management believes that all significant credit risks have been identified at March 31, 2017. In the quarter ended March 31, 2017, Xtant purchased from Norwood Medical less than 10 18 The preparation of the financial statements requires management of the Company to make a number of estimates and assumptions relating to the reported amount of assets and liabilities and the disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenue and expenses during the period. Significant estimates include the carrying amount of property and equipment, goodwill, and intangible assets and liabilities; valuation allowances for trade receivables, inventory, and deferred income tax assets and liabilities; valuation of the warrant derivative liability, inventory, and estimates for the fair value of stock options grants and other equity awards upon which the Company determines stock-based compensation expense. Actual results could differ from those estimates. Long-lived assets, including intangible assets, are reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Recoverability of assets to be held and used is measured by a comparison of the carrying amount of an asset to future net cash flows expected to be generated by the asset. If such assets are considered to be impaired, the impairment to be recognized is measured by the amount by which the carrying amount of the assets exceeds the estimated fair value of the assets Goodwill represents the excess of costs over fair value of assets of businesses acquired. Goodwill and intangible assets acquired in a purchase business combination and determined to have indefinite useful lives are not amortized, instead they are tested for impairment at least annually and whenever events or circumstances indicate the carrying amount of such asset may not be recoverable. In its evaluation of goodwill, the Company performs an assessment of qualitative factors to determine if it is more-likely-than-not that goodwill might be impaired and whether it is necessary to perform the two-step goodwill impairment. The Company conducts its annual impairment test on December 31 of each year. Revenue is recognized when all of the following criteria are met: a) the Company has entered into a legally binding agreement with the customer; b) the products or services have been delivered; c) the Company’s fee for providing the products and services is fixed or determinable; and d) collection of the Company’s fee is probable. The Company’s policy is to record revenue net of any applicable sales, use, or excise taxes. If an arrangement includes a right of acceptance or a right to cancel, revenue is recognized when acceptance is received or the right to cancel has expired. The Company ships to certain customers under consignment arrangements whereby the Company’s product is stored by the customer. The customer is required to report the use to the Company and upon such notice, the Company invoices the customer and revenue is recognized when above criteria have been met. Research and development costs, which are principally related to internal costs for the development of new devices and biologics and processes are expensed as incurred. Other income (expense) primarily consists of non-recurring items that are outside of the normal Company’s operations such as other related legal expenses, gain or loss on the sale of fixed assets and miscellaneous minor adjustments to account balances. Basic net income (loss) per share is computed by dividing net income (loss) by the weighted average number of common shares outstanding. Shares issued during the period and shares reacquired during the period are weighted for the portion of the period that they were outstanding. Diluted net income (loss) per share is computed in a manner consistent with that of basic earnings per share while giving effect to all potentially dilutive common shares outstanding during the period, which include the assumed exercise of stock options and warrants using the treasury stock method. Diluted net loss per share was the same as basic net loss per share for the quarters ended March 31, 2017 and 2016, as shares issuable upon the exercise of stock options and warrants were anti-dilutive as a result of the net losses incurred for those periods. Dilutive earnings per share are not reported as their effects of including 7,479,410 1,861,272 The carrying values of financial instruments, including trade accounts receivable, accounts payable, other accrued expenses and long-term debt, approximate their fair values based on terms and related interest rates. The Company follows a framework for measuring fair value. The framework provides a hierarchy that prioritizes the inputs to valuation techniques used to measure fair value. The hierarchy gives the highest priority to unadjusted quoted prices in active markets for identical assets or liabilities (Level 1) and the lowest priority to unobservable inputs (Level 3). The three levels of the fair value hierarchy are described below: Level 1: Inputs to the valuation methodology are unadjusted quoted prices for identical assets or liabilities in active markets. Level 2: Inputs to the valuation methodology include quoted prices for similar assets and liabilities in active markets, and inputs that are observable for the asset or liability, either directly or indirectly, for substantially the full term of the financial instrument. Level 3: Inputs to the valuation methodology are unobservable and significant to the fair value measurement. A financial instrument’s level within the fair value hierarchy is based on the lowest level of any input that is significant to the fair value measurement. During the quarters ended March 31, 2017 and 2016, there was no reclassification in financial assets or liabilities between Level 1, 2 or 3 categories. The following table sets forth by level, within the fair value hierarchy, our liabilities that are measured at fair value on a recurring basis: As of As of March 31, December 31, 2017 2016 Level 1 - - Level 2 - - Level 3 $ 163,582 $ 333,613 The valuation technique used to measure fair value of the warrant liability is based on a lattice valuation model and significant assumptions and inputs determined by us (See Note 9, “Warrants” below). Level 3 Changes The following is a reconciliation of the beginning and ending balances for liabilities measured at fair value on a recurring basis using significant unobservable inputs (Level 3) during the quarter ended March 31, 2017: Balance at January 1, 2016 $ 1,050,351 Gain recognized in earnings (716,738) Balance at January 1, 2017 $ 333,613 Gain recognized in earnings (170,031) Balance at March 31, 2017 $ 163,582 During the quarter ended March 31, 2017, the Company did not change any of the valuation techniques used to measure its liabilities at fair value. In May 2014, the Financial Accounting Standards Board (FASB) issued Accounting Standards Update No. 2014-09, Revenue from Contracts with Customers. The new standard was originally effective for reporting periods beginning after December 15, 2016 and early adoption was not permitted. On August 12, 2015, the FASB approved a one year delay of the effective date to reporting periods beginning after December 15, 2017, while permitting companies to voluntarily adopt the new standard as of the original effective date. The comprehensive new standard will supersede existing revenue recognition guidance and require revenue to be recognized when promised goods or services are transferred to customers in amounts that reflect the consideration to which the company expects to be entitled in exchange for those goods or services. Adoption of the new rules could affect the timing of revenue recognition for certain transactions. The guidance permits two implementation approaches, one requiring retrospective application of the new standard with restatement of prior years and one requiring prospective application of the new standard with disclosure of results under old standards. The Company is currently evaluating the impacts of adoption and the implementation approach to be used. In February 2016, the FASB issued Accounting Standards Update No. 2016-02, Leases (Topic 842) Restatement of Financials Statements Our condensed consolidated balance sheet, condensed consolidated statement of operations, condensed consolidated statement of cash flows, and Note 4, property and equipment, net, for the quarter ended March 31, 2017 have been restated to correct the error recorded for accumulated depreciation on surgical instruments of $ 617,627 First Quarter Ended March 31, 2017: As Reported Restated Balance Sheet: Property and equipment, net $ 15,219,725 $ 14,602,098 Accumulated deficit $ (97,701,452) $ (98,319,079) Income Statement: Cost of sales $ 6,557,602 $ 7,175,229 Net loss from operations $ (5,166,929) $ (5,784,556)

Equity

Equity	3 Months Ended
	Mar. 31, 2017
Equity [Abstract]
Equity	(2) Equity We entered into a purchase agreement on March 16, 2015, as amended and restated on April 17, 2015, with Aspire Capital, which provides that, upon the terms and subject to the conditions and limitations set forth therein, Aspire Capital was committed to purchase up to an aggregate of $ 10 expired in the quarter ending March 31, 2017 In connection with the offering of units pursuant to the subscription rights, referred to as the “Rights Offering.”, the Company distributed to holders of its common stock and to holders of its convertible notes, at no charge, non-transferable subscription rights to purchase units. Each unit consisted of one share of common stock and one tradeable warrant representing the right to purchase one share of common stock (“Tradeable Warrants”). On October 31, 2016, the Company entered into a dealer-manager agreement (the “Dealer-Manager Agreement”) with Maxim Group LLC (“Maxim”), to engage Maxim as dealer-manager for the Rights Offering. In the Rights Offering, holders received two subscription rights for each share of common stock, or each share of common stock underlying our convertible notes owned on the record date, October 21, 2016. Subscribers whose subscriptions otherwise would have resulted in their beneficial ownership of more than 4.99 0.01 The Rights Offering closed on November 14, 2016. The units were priced at $ 0.75 3.8 2.5 0.90 After the one-year anniversary of issuance, we may redeem the Tradeable Warrants for $0.01 per Tradeable Warrant if the volume weighted average price of our common stock is above $2.25 for each of 10 consecutive trading days. In connection with the Rights Offering, the Company paid to Maxim a cash fee equal to 7 75,000 Under the terms and subject to the conditions contained in the Dealer-Manager Agreement, the Company agreed not to issue or announce the issuance of any shares of common stock or common stock equivalents until 90 days after the closing date of the Rights Offering, without the consent of Maxim, subject to certain exceptions including a pre-existing agreement, equity awards, conversion of derivative securities and in connection with any acquisitions, partnerships or strategic transactions.

Inventories, Net

Inventories, Net	3 Months Ended
	Mar. 31, 2017
Inventory Disclosure [Abstract]
Inventories, Net	(3) Inventories, Net March 31, December 31, 2017 2016 Current inventories: Raw materials $ 4,192,054 $ 4,833,403 Work in process 1,523,002 1,891,380 Finished goods 25,002,633 23,878,040 Gross current inventories 30,717,689 30,602,823 Reserve for obsolescence (4,358,417) (4,336,366) Current inventories, net 26,359,272 26,266,457 Non-current inventories: Finished goods 875,425 1,385,017 Reserve for obsolescence (434,572) (413,163) Non-current inventories, net 440,853 971,854 Total inventories, net $ 26,800,125 $ 27,238,311

Property and Equipment, Net

Property and Equipment, Net	3 Months Ended
	Mar. 31, 2017
Property, Plant and Equipment [Abstract]
Property and Equipment, Net	(4) Property and Equipment, Net March 31, December 31, 2017 2016 (restated) Equipment $ 4,568,357 $ 4,629,754 Computer equipment 416,233 416,233 Computer software 529,726 529,726 Furniture and fixtures 181,566 181,566 Leasehold improvements 4,054,864 4,053,837 Vehicles 10,000 10,000 Surgical instruments 13,549,262 13,876,757 Total cost 23,310,008 23,697,873 Less: accumulated depreciation (8,707,910) (7,857,143) Property and equipment, net $ 14,602,098 $ 15,840,730 The Company provides surgical instruments to surgeons to use during surgical procedures. Instruments are classified as non-current assets and are recorded as property and equipment. Instruments are recorded at cost and are carried at book value (cost less accumulated depreciation). Depreciation is calculated using the straight-line method using a five year useful life. Depreciation expense related to property and equipment, including property under capital lease for the first quarter of 2017 and 2016 was $ 910,465 658,176 The Company leases certain equipment under capital leases. For financial reporting purposes, minimum lease payments relating to the assets have been capitalized. As of March 31, 2017, the Company has recorded $ 1,460,625 397,591

Intangible Assets

Intangible Assets	3 Months Ended
	Mar. 31, 2017
Goodwill and Intangible Assets Disclosure [Abstract]
Intangible Assets	(5) Intangible Assets Intangible assets consist of various patents with regard to processes for its products and intangible assets associated with the acquisition of X-spine. March 31, December 31, 2017 2016 Patents 767,867 747,249 Acquisition related intangibles: Technology 28,698,700 28,698,700 Customer relationships 9,911,000 9,911,000 Tradename 4,543,300 4,543,300 Non-compete 40,500 40,500 Accumulated amortization (9,160,811) (7,999,939) Intangible assets, net $ 34,800,556 $ 35,940,810 Aggregate amortization expense: $ 1,160,872 $ 4,479,010 Remainder of 2017 $ 3,484,325 2018 4,660,352 2019 4,550,768 2020 4,468,157 2021 4,210,811 Thereafter 13,426,143 Total $ 34,800,556

Accrued Liabilities

Accrued Liabilities	3 Months Ended
	Mar. 31, 2017
Payables and Accruals [Abstract]
Accrued Liabilities	(6) Accrued Liabilities March 31, December 31, 2017 2016 Accrued stock compensation $ 358,480 $ 213,758 Wages/commissions payable 3,029,440 3,330,578 Accrued integration expense - 73,510 Accrued interest payable 3,176,610 3,090,585 Other accrued expenses 2,250,870 2,273,756 Accrued liabilities $ 8,815,400 $ 8,982,187

Debt

Debt	3 Months Ended
	Mar. 31, 2017
Debt Disclosure [Abstract]
Debt	Debt Indenture On July 31, 2015, we completed an offering of $ 65 6.00 52 3 At any time prior to the close of business on the second business day immediately preceding the maturity date, holders may convert their Notes into shares of Xtant common stock (together with cash in lieu of fractional shares) at an initial conversion rate of 257.5163 1,000 3.88 9.99 We will not adjust the conversion rate for other events, such as for an issuance of our common stock for cash or in connection with an acquisition that may dilute our common stock thereby adversely affecting its market price. In addition, Xtant will, in certain circumstances, increase the conversion rate for holders who convert their Notes in connection with a “make-whole fundamental change” (as defined in the Indenture). No sinking fund is provided for the Notes. Xtant may not redeem the Notes at its option prior to their maturity. If a “fundamental change” (as defined in the Indenture) occurs, holders will have the right, at their option, to require us to repurchase their Notes at a cash price equal to 100 The Notes are Xtant’s senior, unsecured obligations, rank equal in right of payment with its existing and future unsecured indebtedness that is not junior to the Notes, are senior in right of payment to any of its existing and future indebtedness that is expressly subordinated to the Notes, and are effectively subordinated to its existing and future secured indebtedness to the extent of the value of the collateral securing such indebtedness. The Notes are structurally subordinated to all existing and future indebtedness and other liabilities, including trade payables, and (to the extent Xtant is not a holder thereof) preferred equity, if any, of its subsidiaries. On April 14, 2016, we issued $ 2,238,166 Both the Additional Notes and the Notes bear interest at a rate equal to 6.00 The Additional Notes may be converted into shares of our common stock (together with cash in lieu of fractional shares) at an initial conversion rate of 344.8276 1,000 2.90 On January 17, 2017, the Company entered into securities purchase agreements with Bruce Fund, Inc., Park West Partners International, Limited, Park West Investors Master Fund, Limited, and Telemetry Securities, L.L.C., to satisfy interest obligations that we owed to such parties under $ 16,000,000 843,289 0.5692 On January 17, 2017, the Company entered into a securities purchase agreement and certain related documents with the OrbiMed Purchasers, to satisfy interest obligations that the Company owed to them pursuant to $ 52,000,000 6 1,560,000 0.7589 July 15, 2021 On January 17, 2017, the Company also entered into a securities purchase agreement and certain related documents with the OrbiMed Purchasers, to satisfy interest obligations that the Company owed to them pursuant to $ 2,238,166 6 67,145 0.7589 July 15, 2021 Effective March 31, 2017, the Company and the OrbiMed Purchasers entered into a waiver letter (the “ Indenture Waiver The OrbiMed Purchasers also entered into a waiver (the “Notes Waiver”) for defaults that occurred under multiple convertible promissory notes (including the Notes, the Additional Notes, the Indenture Notes and the PIK Notes). Under the Notes Waiver, the OrbiMed Purchasers waived any non-compliance with the covenants set forth in Section 6.01(a)(vii) of their respective notes due to the going concern qualification included in the Company’s audit report for the year ended December 31, 2016. Amended and Restated Credit Agreement On July 31, 2015 the Company recorded $ 42 July 31, 2020 9 14 1 9 12 14 1 12 7.5 Approximately $ 4.9 4.7 We have entered into several amendments to the New Facility, and the material provisions of such amendments that have been subsequently modified or restated are summarized below. On July 29, 2016 we entered into the fourth amendment to the New Facility. The amendment modified the New Facility by including an additional “Tranche A Commitment” in an amount up to $ 1,000,000 43 On September 27, 2016, we entered into the sixth amendment to the New Facility which increased the fee on any amounts paid under the New Facility from 7.5 9.0 9.0 The seventh amendment (effective December 31, 2016), eighth amendment (effective January 13, 2017), ninth amendment (effective January 31, 2017), tenth amendment (effective February 14, 2017), eleventh amendment (effective February 28, 2017) and twelfth amendment (effective March 31, 2017) deferred our accrued interest payment date for the fiscal quarter ended December 31, 2016, until April 30, 2017. The interest due on April 30, 2017 was $1,147,329, plus The twelfth amendment also modified the minimum revenue base covenant for the quarter ending March 31, 2017 to $ 20 25 500,000 5,000,000 Loan and Security Agreement On May 25, 2016, we entered into a Loan and Security Agreement (the “LSA”) with Silicon Valley Bank, a California corporation (the “Bank”), pursuant to which the Bank agreed to provide us with a revolving line of credit in the aggregate principal amount of $ 6,000,000 1.00 As a condition to the extension of credit under the LSA, we agreed to enter into an Intellectual Property Security Agreement with the Bank, dated May 25, 2016, and to take such other actions as the Bank may request in its good faith business judgment to perfect and maintain a perfected security interest in favor of the Bank in our intellectual property. On August 12, 2016, we entered into a First Loan Modification Agreement (the “Modification Agreement”) with the Bank, which amended certain provisions of the LSA. Pursuant to the terms of the Modification Agreement, the Bank increased the aggregate principal amount of the revolving line of credit to $ 11,000,000 4.00 March 31, December 31, 2017 2016 Loan payable to ROS Acquisition Offshore (See details above) $ 43,000,000 $ 43,000,000 PIK Interest payable to ROS 8,408,508 7,648,776 6% convertible senior unsecured notes due 2021 (See details above) 71,865,311 70,238,166 Gross long-term debt 123,273,819 120,886,942 Less: capitalized debt issuance costs (1,567,193) (1,665,508) Long-term debt, less issuance costs $ 121,706,626 $ 119,221,434 Remainder of 2017 $ - 2018 - 2019 - 2020 51,408,508 2021 71,865,311 Thereafter - Total $ 123,273,819

Stock-Based Compensation

Stock-Based Compensation	3 Months Ended
	Mar. 31, 2017
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Stock-Based Compensation	(8) Stock-Based Compensation The Amended and Restated Xtant Medical Equity Incentive Plan (the “Plan”) provides for stock awards, including options and performance stock awards, to be granted to employees, consultants, independent contractors, officers and directors. The purpose of the Plan is to enable us to attract, retain and motivate key employees, directors and, on occasion, independent consultants, by providing them with stock options and restricted stock grants. Stock options granted under the Plan may be either incentive stock options to employees, as defined in Section 422A of the Internal Revenue Code of 1986, or non-qualified stock options. The Plan is administered by the compensation committee of our Board of Directors. Stock options granted under the Plan are generally not transferable, vest in installments over the requisite service period and are exercisable during the stated contractual term of the option only by such optionee. Executives may be awarded an option to purchase common stock outside of the Plan (collectively the “Non-Plan Grants”), as described below. The exercise price of all incentive stock options granted under the Plan must be at least equal to the fair market value of the shares of common stock on the date of the grant. 1,900,000 670,000 Stock compensation expense recognized in the condensed consolidated statements of operations for the quarters ended March 31, 2017 and 2016 is based on awards ultimately expected to vest and reflects an estimate of awards that will be forfeited. ASC 718 requires forfeitures to be estimated at the time of grant and revised, if necessary, in subsequent periods if actual forfeitures differ from those estimates. No stock options were issued in the first quarter of 2017 or 2016. 2017 2016 Weighted Weighted Average Average Weighted Fair Weighted Fair Average Value at Average Value at Exercise Grant Exercise Grant Shares Price Date Shares Price Date Outstanding at January 1 1,205,913 $ 5.21 $ 2.82 664,081 $ 10.64 $ 5.32 Cancelled or expired (17,834) 7.34 4.24 (81,375) 8.93 4.13 Outstanding at March 31 1,188,079 $ 5.18 $ 2.80 582,706 $ 10.88 $ 5.48 Exercisable at March 31 371,646 $ 11.81 $ 5.71 366,003 $ 13.39 $ 6.40 The aggregate intrinsic value of options outstanding as of March 31, 2017 was zero because the closing price of the stock at March 31, 2017 was less than the strike price of all options outstanding. As of March 31, 2017, there were 816,433 1.48 561,491 Total share based compensation recognized for employees, directors and consultants was $ 230,424 161,123 On July 5, 2016, the Company granted 130,804 40,000 1.99 118,000 Effective January 21, 2017, Daniel Goldberger resigned as Chief Executive Officer and a director of the Company and Carl O’Connell was appointed as Interim Chief Executive Officer of the Company. Mr. Goldberger’s Non-plan Grant option to purchase 200,000 6.00 130,000 43,333 Effective February 17, 2017, our board of directors appointed Carl O’Connell to serve as the Chief Executive Officer and a director of the Company after serving as Interim Chief Executive Officer of the Company since January 21, 2017. Mr. O’Connell serves as a Class I Director until the 2018 Annual Meeting of Stockholders and until his successor has been duly elected and qualified. As Mr. O’Connell is an officer of the Company, he does not qualify as an independent director and does not serve on any committees of the Board. On October 6, 2016, we issued an option to purchase 300,000 1.11 10,387

Warrants

Warrants	3 Months Ended
	Mar. 31, 2017
Warrants and Rights Note Disclosure [Abstract]
Warrants	(9) Warrants The following table summarizes our warrant activities for the quarter ended March 31, 2017: Weighted Common Average Stock Exercise Warrants Price Outstanding as of January 1, 2016 1,278,566 $ 8.45 Issued 5,055,345 0.90 Expired (42,580 ) 31.73 Outstanding at January 1, 2017 6,291,331 $ 2.23 Issued - - Expired - - Outstanding at March 31, 2017 6,291,331 $ 2.23 We utilize a lattice valuation model to determine the fair market value of the warrants accounted for as liabilities. The lattice valuation model accommodates the probability of exercise price adjustment features as outlined in the warrant agreements. We recorded an unrealized gain of $170,031 resulting from the change in the fair value of the warrant derivative liability for the first quarter of 2017. Under the terms of some of our warrant agreements, at any time while the warrant is outstanding, the exercise price per share can be reduced to the price per share of future subsequent equity sales of our common stock or a common stock equivalent that is lower than the exercise price per share as stated in the warrant agreement. The estimated fair value was derived using a valuation model with the following weighted-average assumptions: Quarter Ended March 31, 2017 2016 Value of underlying common stock (per share) $ 0.62 $ 2.71 Risk free interest rate 1.9 % 1.0 % Expected term 5 years 4 years Volatility 91 % 76 % Dividend yield 0 % 0 % The following table summarizes our activities related to warrants accounted for as a derivative liability for the quarters ended March 31, 2017 and 2016: 2017 2016 Balance at January 1, 1,125,119 1,125,119 Derivative warrants issued, exercised and expired - - Balance at March 31, 1,125,119 1,125,119

Commitments and Contingencies

Commitments and Contingencies	3 Months Ended
	Mar. 31, 2017
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	(10) Commitments and Contingencies Operating Leases We lease five office facilities under non-cancelable operating lease agreements with expiration dates between 2019 and 2025. We have the option to extend the five leases for up to another ten year term and for one facility, we have the right of first refusal on any sale. Remainder of 2017 $ 596,532 2018 806,747 2019 668,807 2020 396,263 2021 375,289 Thereafter 1,038,417 Total $ 3,882,055 Rent expense was $ 202,649 230,007 Capital Leases Remainder of 2017 $ 346,254 2018 452,756 2019 420,765 2020 162,745 2021 - Thereafter - Total minimum lease payments 1,382,520 Less amount representing interest (368,499) Present value of obligations under capital leases 1,014,021 Less current portion (259,027) Long-term capital lease obligations $ 754,994 Indemnifications Our arrangements generally include limited warranties and certain provisions for indemnifying customers against liabilities if our products or services infringe a third-party’s intellectual property rights. To date, we have not incurred any material costs as a result of such warranties or indemnification provisions and have not accrued any liabilities related to such obligations in the accompanying condensed consolidated financial statements. We have also agreed to indemnify our directors and executive officers for costs associated with any fees, expenses, judgments, fines and settlement amounts incurred by any of these persons in any action or proceeding to which any of those persons is, or is threatened to be, made a party by reason of the person’s service as a director or officer, including any action by us, arising out of that person’s services as our director or officer or that person’s services provided to any other company or enterprise at our request.

Income Taxes

Income Taxes	3 Months Ended
	Mar. 31, 2017
Income Tax Disclosure [Abstract]
Income Taxes	(11) Income Taxes In evaluating the realizability of the net deferred tax assets, we take into account a number of factors, primarily relating to the ability to generate taxable income. Where it is determined that it is likely that we will be unable to realize deferred tax assets, a valuation allowance is established against the portion of the deferred tax asset. Because it cannot be accurately determined when or if we will become profitable, a valuation allowance was provided against the entire deferred income tax asset balance. The Company did not recognize any interest or penalties related to income taxes for the quarters ended March 31, 2017 and 2016.

Supplemental Disclosure of Cash

Supplemental Disclosure of Cash Flow Information	3 Months Ended
	Mar. 31, 2017
Supplemental Cash Flow Elements [Abstract]
Supplemental Disclosure of Cash Flow Information	(12) Supplemental Disclosure of Cash Flow Information Quarter Ended March 31, 2017 2016 Supplemental disclosure of cash flow information Cash paid during the period for: Interest $ 249,162 $ 4,194 Non-cash activity: Interest converted into common stock $ 480,000 $ -

Related Party Transactions

Related Party Transactions	3 Months Ended
	Mar. 31, 2017
Related Party Transactions [Abstract]
Related Party Transactions	(13) Related Party Transactions Darrel Holmes, our former Chief Operating Officer of our Bacterin subsidiary and resigned from the Company on January 20, 2017, continued to serve on the board of American Donor Services Inc. (“ADS”). Mr. Holmes receives $ 5,000 277,825 270,035 Certain of X-spine’s former shareholders own over 10% of our common stock in conjunction with the acquisition, and have owned a controlling interest of X-spine’s largest supplier, Norwood Tool Company d/b/a Norwood Medical. In the first quarter of 2017, Xtant purchased from Norwood Medical less than 10 Unless delegated to the Compensation Committee by the Board of Directors, the Audit Committee or the disinterested members of the full Board of Directors reviews and approves all related party transactions.

Segment and Geographic Informat

Segment and Geographic Information	3 Months Ended
	Mar. 31, 2017
Segment Reporting [Abstract]
Segment and Geographic Information	(14) Segment and Geographic Information The Company’s management reviews financial results and manages the business on an aggregate basis. Therefore, financial results are reported in a single operating segment: the development, manufacture and marketing of orthopedic medical products and devices. The Company attributes revenues to geographic areas based on the location of the customer. Approximately 96 93 Quarter Ended March 31, 2017 2016 United States $ 21,104,489 $ 19,604,142 Rest of world 978,180 1,373,193 Total revenue $ 22,082,669 $ 20,977,335

Subsequent Events

Subsequent Events	3 Months Ended
	Mar. 31, 2017
Subsequent Events [Abstract]
Subsequent Events	(15) Subsequent Events On April 30, 2017, the Company and its wholly owned subsidiaries, entered into a forbearance agreement (the “Forbearance Agreement”) with the Bank. Pursuant to the Forbearance Agreement, the Bank agreed to forbear from exercising its rights and remedies under the LSA, as amended by the Modification Agreement with respect to certain defaults from the date of the Forbearance Agreement until the earliest to occur of (a) the occurrence of any Event of Default (as defined in the LSA), (b) the failure of Borrower to promptly perform under the Forbearance Agreement when required, or (c) May 5, 2017. The defaults consisted of the Company’s failure to comply with the financial covenant that the Company deliver an unqualified opinion from an independent certified public accounting firm on the annual financial statements of the Company for the fiscal year ended December 31, 2016, and the incurrence of cross-defaults under other debt arrangements (all of which have been waived). With the execution of the Fourteen Amendment (see below) and the pay off of the outstanding accounts receivable credit facility balance, the terms of the Forbearance Agreement have been settled and are no longer applicable. Effective April 30, 2017, the Company, as the guarantor, and ROS entered into the thirteenth amendment to the New Facility. Prior amendments to the New Facility deferred our accrued interest payment date for the fiscal quarter ended on December 31, 2016 until April 30, 2017. The thirteenth amendment further defers our accrued interest payment date for the fiscal quarter ended on December 31, 2016 until May 31, 2017, while also deferring our accrued interest payment date for the fiscal quarter ended on March 31, 2017 until May 31, 2017. The interest due on May 31, 2017 for the fiscal quarter ended on December 31, 2016 will be $ 1,147,329 interest accrued on such interest from January 2, 2017 until paid at a rate equal to 14% plus the higher of the LIBO Rate for the fiscal quarter ended on December 31, 2016, or 1%. 1,139,597 interest accrued on such interest from April 1, 2017 until paid at a rate equal to 14% plus the higher of the LIBO Rate for the fiscal quarter ended on March 31, 2017, or 1%. Effective May 11, 2017, Bacterin International, Inc. (“Bacterin”), a Nevada corporation and wholly-owned subsidiary of Xtant Medical Holdings, Inc. (the “Company”), as borrower, the Company, X-Spine Systems, Inc., an Ohio corporation and wholly-owned subsidiary of the Company, and Xtant Medical, Inc., a Delaware corporation and wholly-owned subsidiary of the Company, collectively as the guarantors, ROS Acquisition Offshore LP (“ROS”) and OrbiMed Royalty Opportunities II, LP (“Royalty Opportunities”), entered into the Fourteenth Amendment to Amended and Restated Credit Agreement (the “Amendment”), which amended the existing Amended and Restated Credit Agreement (the “Facility”). Prior amendments to the Facility deferred Bacterin’s accrued interest payment date for the fiscal quarter ended on December 31, 2016 until May 31, 2017. The Amendment further defers Bacterin’s accrued interest payment date for the fiscal quarter ended on December 31, 2016 until June 30, 2017, while also deferring Bacterin’s accrued interest payment date for the fiscal quarter ended on March 31, 2017 until June 30, 2017. The interest due on June 30, 2017 for the fiscal quarter ended on December 31, 2016 will be $1,147,329.47, plus interest accrued on such interest from January 2, 2017 until paid at a rate equal to 14% plus the higher of the LIBO Rate (as defined in the Facility) for the fiscal quarter ended on December 31, 2016, or 1%. The interest due on June 30, 2017 for the fiscal quarter ended on March 31, 2017 will be $1,139,597.47, plus interest accrued on such interest from April 1, 2017 until paid at a rate equal to 14% plus the higher of the LIBO Rate for the fiscal quarter ended on March 31, 2017, or 1%. The Amendment also allows for X-Spine to make addition term loans with ROS and Royalty Opportunities in an aggregate amount of up to $ 15,000,000 Also, on May 8, 2017, the Company entered into an agreement (the “CRO Agreement”) with Aurora Management Partners Inc. (“Aurora”). Pursuant to the CRO Agreement, David Baker will now serve as Chief Restructuring Officer of the Company (the “CRO”) and Wayne Tanner will serve as a Deputy Restructuring Officer of the Company. The CRO and Aurora personnel assisting on this engagement will report to the special restructuring committee of the Board of Directors of the Company and will provide periodic updates on progress made in fulfilling the scope of services. The term of the agreement will begin on May 8, 2017, and the term continues until the engagement is completed or earlier if the engagement is terminated by either party. Aurora will be paid the hourly rates set forth on Schedule A to the CRO Agreement and will reimbursed for its expenses actually incurred in providing the services. The CRO Agreement may be terminated by either party, in its sole discretion, for any reason and the termination is effective immediately upon the other party’s receipt of written notice of the termination.

Business Description and Summ21

Business Description and Summary of Significant Accounting Policies (Policies)	3 Months Ended
	Mar. 31, 2017
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Business Description	Business Description The accompanying condensed consolidated financial statements include the accounts of Xtant Medical Holdings, Inc. (“Xtant”), formerly known as Bacterin International Holdings, Inc., a Delaware corporation, and its wholly owned subsidiaries, Xtant Medical, Inc., a Delaware corporation, Bacterin International, Inc., (“Bacterin”) a Nevada corporation and X-Spine Systems, Inc. (“X-spine”), an Ohio corporation, (Xtant, Bacterin and X-spine are jointly referred to herein as the “Company”). All intercompany balances and transactions have been eliminated in consolidation. Xtant develops, manufactures and markets regenerative orthopedic products for domestic and international markets and fixation devices. Xtant products serve the combined specialized needs of orthopedic and neurological surgeons, including orthobiologics for the promotion of bone healing, implants and instrumentation for the treatment of spinal disease, tissue grafts for the treatment of orthopedic disorders to promote healing following spine, cranial and foot surgeries and the development, manufacturing and sale of medical devices for use in orthopedic spinal surgeries. On July 31, 2015, Xtant acquired all of the outstanding capital stock of X-spine for approximately $ 60 13 4,242,655 The markets in which the Company competes are highly competitive and rapidly changing. Significant technological advances, changes in customer requirements, or the emergence of competitive products with new capabilities or technologies could adversely affect the Company’s operating results. The Company’s business could be harmed by a decline in demand for, or in the prices of, its products or as a result of, among other factors, any change in pricing or distribution methods, increased price competition, changes in government regulations or a failure by the Company to keep up with technological change. Further, a decline in available donors could have an adverse impact on our business. The accompanying interim condensed consolidated financial statements of Xtant for the quarters ended March 31, 2017 and 2016 are unaudited and are prepared in accordance with accounting principles generally accepted in the United States of America. They do not include all disclosures required by generally accepted accounting principles for annual financial statements, but in the opinion of management, include all adjustments, consisting only of normal recurring items, necessary for a fair presentation. Interim results are not necessarily indicative of results which may be achieved in the future for the full year ending December 31, 2017. These condensed financial statements should be read in conjunction with the financial statements and notes thereto which are included in Xtant’s Annual Report on Form 10-K for the year ended December 31, 2016. The accounting policies set forth in those annual financial statements are the same as the accounting policies utilized in the preparation of these financial statements, except as modified for appropriate interim financial statement presentation.
Going Concern	Going Concern The Company has incurred losses since its inception. The terms, conditions and amounts outstanding under the Company’s debt agreements (See Note 7, “Debt” below) raise substantial doubt about the Company’s ability to continue as a going concern. The Company has established a special committee of its board of directors to evaluate restructuring alternatives, assist in related negotiations with the Company’s lenders and consider alternatives for raising new capital. The Company also is evaluating various cost-reduction and cash flow improvement measures. However, there can be no assurance that the Company will be successful in these efforts. The accompanying condensed consolidated financial statements have been prepared assuming that the Company will continue as a going concern; however, the above conditions raise substantial doubt about the Company’s ability to do so. The financial statements do not include any adjustments to reflect the possible future effects on the recoverability and classification of assets or the amounts and classifications of liabilities that may result should the Company be unable to continue as a going concern.
Concentrations and Credit Risk	Concentrations and Credit Risk The Company’s accounts receivable are due from a variety of health care organizations and distributors throughout the world. No single customer accounted for more than 10% of revenue or accounts receivable for the comparable periods. The Company provides for uncollectible amounts when specific credit issues arise. Management’s estimates for uncollectible amounts have been adequate during prior periods, and management believes that all significant credit risks have been identified at March 31, 2017. In the quarter ended March 31, 2017, Xtant purchased from Norwood Medical less than 10 18
Use of Estimates	Use of Estimates The preparation of the financial statements requires management of the Company to make a number of estimates and assumptions relating to the reported amount of assets and liabilities and the disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenue and expenses during the period. Significant estimates include the carrying amount of property and equipment, goodwill, and intangible assets and liabilities; valuation allowances for trade receivables, inventory, and deferred income tax assets and liabilities; valuation of the warrant derivative liability, inventory, and estimates for the fair value of stock options grants and other equity awards upon which the Company determines stock-based compensation expense. Actual results could differ from those estimates.
Long-Lived Assets	Long-Lived Assets Long-lived assets, including intangible assets, are reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Recoverability of assets to be held and used is measured by a comparison of the carrying amount of an asset to future net cash flows expected to be generated by the asset. If such assets are considered to be impaired, the impairment to be recognized is measured by the amount by which the carrying amount of the assets exceeds the estimated fair value of the assets
Goodwill	Goodwill Goodwill represents the excess of costs over fair value of assets of businesses acquired. Goodwill and intangible assets acquired in a purchase business combination and determined to have indefinite useful lives are not amortized, instead they are tested for impairment at least annually and whenever events or circumstances indicate the carrying amount of such asset may not be recoverable. In its evaluation of goodwill, the Company performs an assessment of qualitative factors to determine if it is more-likely-than-not that goodwill might be impaired and whether it is necessary to perform the two-step goodwill impairment. The Company conducts its annual impairment test on December 31 of each year.
Revenue Recognition	Revenue Recognition Revenue is recognized when all of the following criteria are met: a) the Company has entered into a legally binding agreement with the customer; b) the products or services have been delivered; c) the Company’s fee for providing the products and services is fixed or determinable; and d) collection of the Company’s fee is probable. The Company’s policy is to record revenue net of any applicable sales, use, or excise taxes. If an arrangement includes a right of acceptance or a right to cancel, revenue is recognized when acceptance is received or the right to cancel has expired. The Company ships to certain customers under consignment arrangements whereby the Company’s product is stored by the customer. The customer is required to report the use to the Company and upon such notice, the Company invoices the customer and revenue is recognized when above criteria have been met.
Research and Development	Research and Development Research and development costs, which are principally related to internal costs for the development of new devices and biologics and processes are expensed as incurred.
Other Income (Expense)	Other Income (Expense) Other income (expense) primarily consists of non-recurring items that are outside of the normal Company’s operations such as other related legal expenses, gain or loss on the sale of fixed assets and miscellaneous minor adjustments to account balances.
Net Loss Per Share	Net Loss Per Share Basic net income (loss) per share is computed by dividing net income (loss) by the weighted average number of common shares outstanding. Shares issued during the period and shares reacquired during the period are weighted for the portion of the period that they were outstanding. Diluted net income (loss) per share is computed in a manner consistent with that of basic earnings per share while giving effect to all potentially dilutive common shares outstanding during the period, which include the assumed exercise of stock options and warrants using the treasury stock method. Diluted net loss per share was the same as basic net loss per share for the quarters ended March 31, 2017 and 2016, as shares issuable upon the exercise of stock options and warrants were anti-dilutive as a result of the net losses incurred for those periods. Dilutive earnings per share are not reported as their effects of including 7,479,410 1,861,272
Fair Value of Financial Instruments	Fair Value of Financial Instruments The carrying values of financial instruments, including trade accounts receivable, accounts payable, other accrued expenses and long-term debt, approximate their fair values based on terms and related interest rates. The Company follows a framework for measuring fair value. The framework provides a hierarchy that prioritizes the inputs to valuation techniques used to measure fair value. The hierarchy gives the highest priority to unadjusted quoted prices in active markets for identical assets or liabilities (Level 1) and the lowest priority to unobservable inputs (Level 3). The three levels of the fair value hierarchy are described below: Level 1: Inputs to the valuation methodology are unadjusted quoted prices for identical assets or liabilities in active markets. Level 2: Inputs to the valuation methodology include quoted prices for similar assets and liabilities in active markets, and inputs that are observable for the asset or liability, either directly or indirectly, for substantially the full term of the financial instrument. Level 3: Inputs to the valuation methodology are unobservable and significant to the fair value measurement. A financial instrument’s level within the fair value hierarchy is based on the lowest level of any input that is significant to the fair value measurement. During the quarters ended March 31, 2017 and 2016, there was no reclassification in financial assets or liabilities between Level 1, 2 or 3 categories. The following table sets forth by level, within the fair value hierarchy, our liabilities that are measured at fair value on a recurring basis: As of As of March 31, December 31, 2017 2016 Level 1 - - Level 2 - - Level 3 $ 163,582 $ 333,613 The valuation technique used to measure fair value of the warrant liability is based on a lattice valuation model and significant assumptions and inputs determined by us (See Note 9, “Warrants” below). Level 3 Changes The following is a reconciliation of the beginning and ending balances for liabilities measured at fair value on a recurring basis using significant unobservable inputs (Level 3) during the quarter ended March 31, 2017: Balance at January 1, 2016 $ 1,050,351 Gain recognized in earnings (716,738) Balance at January 1, 2017 $ 333,613 Gain recognized in earnings (170,031) Balance at March 31, 2017 $ 163,582 During the quarter ended March 31, 2017, the Company did not change any of the valuation techniques used to measure its liabilities at fair value.
Recent Accounting Pronouncements	Recent Accounting Pronouncements In May 2014, the Financial Accounting Standards Board (FASB) issued Accounting Standards Update No. 2014-09, Revenue from Contracts with Customers. The new standard was originally effective for reporting periods beginning after December 15, 2016 and early adoption was not permitted. On August 12, 2015, the FASB approved a one year delay of the effective date to reporting periods beginning after December 15, 2017, while permitting companies to voluntarily adopt the new standard as of the original effective date. The comprehensive new standard will supersede existing revenue recognition guidance and require revenue to be recognized when promised goods or services are transferred to customers in amounts that reflect the consideration to which the company expects to be entitled in exchange for those goods or services. Adoption of the new rules could affect the timing of revenue recognition for certain transactions. The guidance permits two implementation approaches, one requiring retrospective application of the new standard with restatement of prior years and one requiring prospective application of the new standard with disclosure of results under old standards. The Company is currently evaluating the impacts of adoption and the implementation approach to be used. In February 2016, the FASB issued Accounting Standards Update No. 2016-02, Leases (Topic 842)
Reclassifications	Restatement of Financials Statements Our condensed consolidated balance sheet, condensed consolidated statement of operations, condensed consolidated statement of cash flows, and Note 4, property and equipment, net, for the quarter ended March 31, 2017 have been restated to correct the error recorded for accumulated depreciation on surgical instruments of $ 617,627 First Quarter Ended March 31, 2017: As Reported Restated Balance Sheet: Property and equipment, net $ 15,219,725 $ 14,602,098 Accumulated deficit $ (97,701,452) $ (98,319,079) Income Statement: Cost of sales $ 6,557,602 $ 7,175,229 Net loss from operations $ (5,166,929) $ (5,784,556)

Business Description and Summ22

Business Description and Summary of Significant Accounting Policies (Tables)	3 Months Ended
	Mar. 31, 2017
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Schedule of Assets and Liabilities Measured on Recurring Basis	Warrant derivative liability As of As of March 31, December 31, 2017 2016 Level 1 - - Level 2 - - Level 3 $ 163,582 $ 333,613
Schedule of Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation	Warrant derivative liability Balance at January 1, 2016 $ 1,050,351 Gain recognized in earnings (716,738) Balance at January 1, 2017 $ 333,613 Gain recognized in earnings (170,031) Balance at March 31, 2017 $ 163,582
Schedule of Error Corrections and Prior Period Adjustments	The following table summarizes the effects of our restatement resulting from the correction of this error. First Quarter Ended March 31, 2017: As Reported Restated Balance Sheet: Property and equipment, net $ 15,219,725 $ 14,602,098 Accumulated deficit $ (97,701,452) $ (98,319,079) Income Statement: Cost of sales $ 6,557,602 $ 7,175,229 Net loss from operations $ (5,166,929) $ (5,784,556)

Inventories, Net (Tables)

Inventories, Net (Tables)	3 Months Ended
	Mar. 31, 2017
Inventory Disclosure [Abstract]
Schedule of Inventories	Inventories consist of the following: March 31, December 31, 2017 2016 Current inventories: Raw materials $ 4,192,054 $ 4,833,403 Work in process 1,523,002 1,891,380 Finished goods 25,002,633 23,878,040 Gross current inventories 30,717,689 30,602,823 Reserve for obsolescence (4,358,417) (4,336,366) Current inventories, net 26,359,272 26,266,457 Non-current inventories: Finished goods 875,425 1,385,017 Reserve for obsolescence (434,572) (413,163) Non-current inventories, net 440,853 971,854 Total inventories, net $ 26,800,125 $ 27,238,311

Property and Equipment, Net (Ta

Property and Equipment, Net (Tables)	3 Months Ended
	Mar. 31, 2017
Property, Plant and Equipment [Abstract]
Schedule of Property and Equipment, Net	Property and equipment, net are as follows: March 31, December 31, 2017 2016 (restated) Equipment $ 4,568,357 $ 4,629,754 Computer equipment 416,233 416,233 Computer software 529,726 529,726 Furniture and fixtures 181,566 181,566 Leasehold improvements 4,054,864 4,053,837 Vehicles 10,000 10,000 Surgical instruments 13,549,262 13,876,757 Total cost 23,310,008 23,697,873 Less: accumulated depreciation (8,707,910) (7,857,143) Property and equipment, net $ 14,602,098 $ 15,840,730

Intangible Assets (Tables)

Intangible Assets (Tables)	3 Months Ended
	Mar. 31, 2017
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Intangible Assets	The following table sets forth information regarding intangible assets: March 31, December 31, 2017 2016 Patents 767,867 747,249 Acquisition related intangibles: Technology 28,698,700 28,698,700 Customer relationships 9,911,000 9,911,000 Tradename 4,543,300 4,543,300 Non-compete 40,500 40,500 Accumulated amortization (9,160,811) (7,999,939) Intangible assets, net $ 34,800,556 $ 35,940,810 Aggregate amortization expense: $ 1,160,872 $ 4,479,010
Schedule of Estimated Amortization Expense for Intangible Assets	The following is a summary of estimated future amortization expense for intangible assets as of March 31, 2017: Remainder of 2017 $ 3,484,325 2018 4,660,352 2019 4,550,768 2020 4,468,157 2021 4,210,811 Thereafter 13,426,143 Total $ 34,800,556

Accrued Liabilities (Tables)

Accrued Liabilities (Tables)	3 Months Ended
	Mar. 31, 2017
Payables and Accruals [Abstract]
Schedule of Accrued Liabilities	March 31, December 31, 2017 2016 Accrued stock compensation $ 358,480 $ 213,758 Wages/commissions payable 3,029,440 3,330,578 Accrued integration expense - 73,510 Accrued interest payable 3,176,610 3,090,585 Other accrued expenses 2,250,870 2,273,756 Accrued liabilities $ 8,815,400 $ 8,982,187

Debt (Tables)

Debt (Tables)	3 Months Ended
	Mar. 31, 2017
Debt Disclosure [Abstract]
Schedule of Long-term Debt	Long-term debt consists of the following: March 31, December 31, 2017 2016 Loan payable to ROS Acquisition Offshore (See details above) $ 43,000,000 $ 43,000,000 PIK Interest payable to ROS 8,408,508 7,648,776 6% convertible senior unsecured notes due 2021 (See details above) 71,865,311 70,238,166 Gross long-term debt 123,273,819 120,886,942 Less: capitalized debt issuance costs (1,567,193) (1,665,508) Long-term debt, less issuance costs $ 121,706,626 $ 119,221,434
Schedule of Maturities of Long-term Debt	The following is a summary of maturities due on the debt as of March 31, 2017: Remainder of 2017 $ - 2018 - 2019 - 2020 51,408,508 2021 71,865,311 Thereafter - Total $ 123,273,819

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	3 Months Ended
	Mar. 31, 2017
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Schedule of Share-based Compensation, Stock Options, Activity	Stock option activity, including options granted under the Plan and the Non-Plan Grants, was as follows: 2017 2016 Weighted Weighted Average Average Weighted Fair Weighted Fair Average Value at Average Value at Exercise Grant Exercise Grant Shares Price Date Shares Price Date Outstanding at January 1 1,205,913 $ 5.21 $ 2.82 664,081 $ 10.64 $ 5.32 Cancelled or expired (17,834) 7.34 4.24 (81,375) 8.93 4.13 Outstanding at March 31 1,188,079 $ 5.18 $ 2.80 582,706 $ 10.88 $ 5.48 Exercisable at March 31 371,646 $ 11.81 $ 5.71 366,003 $ 13.39 $ 6.40

Warrants (Tables)

Warrants (Tables)	3 Months Ended
	Mar. 31, 2017
Warrants and Rights Note Disclosure [Abstract]
Schedule of Warrant Activity	The following table summarizes our warrant activities for the quarter ended March 31, 2017: Weighted Common Average Stock Exercise Warrants Price Outstanding as of January 1, 2016 1,278,566 $ 8.45 Issued 5,055,345 0.90 Expired (42,580) 31.73 Outstanding at January 1, 2017 6,291,331 $ 2.23 Issued - - Expired - - Outstanding at March 31, 2017 6,291,331 $ 2.23
Schedule of Warrant Valuation Assumptions	The estimated fair value was derived using a valuation model with the following weighted-average assumptions: Quarter Ended March 31, 2017 2016 Value of underlying common stock (per share) $ 0.62 $ 2.71 Risk free interest rate 1.9 % 1.0 % Expected term 5 years 4 years Volatility 91 % 76 % Dividend yield 0 % 0 %
Schedule of Warrants Activities Used In Derivative Liability	The following table summarizes our activities related to warrants accounted for as a derivative liability for the quarters ended March 31, 2017 and 2016: 2017 2016 Balance at January 1, 1,125,119 1,125,119 Derivative warrants issued, exercised and expired - - Balance at March 31, 1,125,119 1,125,119

Commitments and Contingencies (

Commitments and Contingencies (Tables)	3 Months Ended
	Mar. 31, 2017
Commitments and Contingencies Disclosure [Abstract]
Schedule of Future Minimum Rental Payments for Operating Leases	Future minimum payments for the next five years and thereafter as of March 31, 2017, under these leases, are as follows: Remainder of 2017 $ 596,532 2018 806,747 2019 668,807 2020 396,263 2021 375,289 Thereafter 1,038,417 Total $ 3,882,055
Schedule of Future Minimum Lease Payments for Capital Leases	Future minimum payments for the next five years and thereafter as of March 31, 2017, under these capital leases, are as follows: Remainder of 2017 $ 346,254 2018 452,756 2019 420,765 2020 162,745 2021 - Thereafter - Total minimum lease payments 1,382,520 Less amount representing interest (368,499) Present value of obligations under capital leases 1,014,021 Less current portion (259,027) Long-term capital lease obligations $ 754,994

Supplemental Disclosure of Ca31

Supplemental Disclosure of Cash Flow Information (Tables)	3 Months Ended
	Mar. 31, 2017
Supplemental Cash Flow Elements [Abstract]
Supplemental Disclosure of Cash Flow Information	Supplemental cash flow information is as follows: Quarter Ended March 31, 2017 2016 Supplemental disclosure of cash flow information Cash paid during the period for: Interest $ 249,162 $ 4,194 Non-cash activity: Interest converted into common stock $ 480,000 $ -

Segment and Geographic Inform32

Segment and Geographic Information (Tables)	3 Months Ended
	Mar. 31, 2017
Segment Reporting [Abstract]
Schedule of Revenues by Geographic Region	Total revenue by major geographic area is reported is reported below as follows: Quarter Ended March 31, 2017 2016 United States $ 21,104,489 $ 19,604,142 Rest of world 978,180 1,373,193 Total revenue $ 22,082,669 $ 20,977,335

Business Description and Summ33

Business Description and Summary of Significant Accounting Policies (Details) - USD ($)	Mar. 31, 2017	Dec. 31, 2016
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Warrant derivative liability	$ 163,582	$ 333,613
Fair Value, Inputs, Level 1 [Member] | Fair Value, Measurements, Recurring [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Warrant derivative liability	0	0
Fair Value, Inputs, Level 2 [Member] | Fair Value, Measurements, Recurring [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Warrant derivative liability	0	0
Fair Value, Inputs, Level 3 [Member] | Fair Value, Measurements, Recurring [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Warrant derivative liability	$ 163,582	$ 333,613

Business Description and Summ34

Business Description and Summary of Significant Accounting Policies (Details 1) - USD ($)	3 Months Ended	12 Months Ended
	Mar. 31, 2017	Dec. 31, 2016
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Balance	$ 333,613	$ 1,050,351
Gain recognized in earnings	(170,031)	(716,738)
Balance	$ 163,582	$ 333,613

Business Description and Summ35

Business Description and Summary of Significant Accounting Policies (Details 2) - USD ($)	3 Months Ended
	Mar. 31, 2017	Mar. 31, 2016	Dec. 31, 2016
Balance Sheet:
Property and equipment, net	$ 14,602,098		$ 15,840,730
Accumulated deficit	(98,319,079)		$ (92,534,524)
Income Statement:
Cost of sales	7,175,229	$ 6,877,267
Net loss from operations	(5,784,556)	$ (5,596,072)
Scenario, Previously Reported [Member]
Balance Sheet:
Property and equipment, net	15,219,725
Accumulated deficit	(97,701,452)
Income Statement:
Cost of sales	6,557,602
Net loss from operations	$ (5,166,929)

Business Description and Summ36

Business Description and Summary of Significant Accounting Policies (Details Textual) - USD ($)	1 Months Ended	3 Months Ended
	Jul. 31, 2015	Mar. 31, 2017	Mar. 31, 2016	Dec. 31, 2016
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount		7,479,410	1,861,272
Business Combination, Consideration Transferred	$ 60,000,000
Accumulated Depreciation, Depletion and Amortization, Property, Plant, and Equipment		$ 8,707,910		$ 7,857,143
Restatement Adjustment [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Accumulated Depreciation, Depletion and Amortization, Property, Plant, and Equipment		$ 617,627
Debt [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Other Payments to Acquire Businesses	$ 13,000,000
Common Stock [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Business Acquisition Number Of Shares Acquired	4,242,655
Sales Revenue, Net [Member] | One Vendor [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Concentration Risk, Percentage		10.00%	18.00%

Equity (Details Textual)

Equity (Details Textual) - USD ($) $ / shares in Units, shares in Millions	Nov. 14, 2016	Mar. 31, 2017	Dec. 31, 2016	Dec. 31, 2015	Mar. 16, 2015
Schedule of Equity Method Investments [Line Items]
Class of Warrant or Right, Exercise Price of Warrants or Rights	$ 0.90	$ 2.23	$ 2.23	$ 8.45
Equity Method Investment, Ownership Percentage		4.99%
Rights Offering Offering Price Per Unit	$ 0.75
Gross Proceeds From Issuance Of Rights Shares	$ 3,800,000
Net Proceeds From Issuance Of Rights Shares	$ 2,500,000
Maxim Group LLC [Member]
Schedule of Equity Method Investments [Line Items]
Rights Offering Cash Fee Percentage Paid To Gross Proceeds		7.00%
Rights Offering Cash Fee Reimbursed		$ 75,000
Tradable Warrants [Member]
Schedule of Equity Method Investments [Line Items]
Class Of Warrant Or Right Warrant Redemption Terms		After the one-year anniversary of issuance, we may redeem the Tradeable Warrants for $0.01 per Tradeable Warrant if the volume weighted average price of our common stock is above $2.25 for each of 10 consecutive trading days.
Pre Funded Warrants [Member]
Schedule of Equity Method Investments [Line Items]
Class of Warrant or Right, Exercise Price of Warrants or Rights		$ 0.01
Aspire Capital Fund LLC [Member]
Schedule of Equity Method Investments [Line Items]
Common Stock, Shares Subscribed but Unissued					10

Inventories, Net (Details)

Inventories, Net (Details) - USD ($)	Mar. 31, 2017	Dec. 31, 2016
Current inventories:
Raw materials	$ 4,192,054	$ 4,833,403
Work in process	1,523,002	1,891,380
Finished goods	25,002,633	23,878,040
Gross current inventories	30,717,689	30,602,823
Reserve for obsolescence	(4,358,417)	(4,336,366)
Current inventories, net	26,359,272	26,266,457
Non-current inventories:
Finished goods	875,425	1,385,017
Reserve for obsolescence	(434,572)	(413,163)
Non-current inventories, net	440,853	971,854
Total inventories, net	$ 26,800,125	$ 27,238,311

Property and Equipment, Net (De

Property and Equipment, Net (Details) - USD ($)	Mar. 31, 2017	Dec. 31, 2016
Property, Plant and Equipment [Line Items]
Total cost	$ 23,310,008	$ 23,697,873
Less: accumulated depreciation	(8,707,910)	(7,857,143)
Property and equipment, net	14,602,098	15,840,730
Equipment [Member]
Property, Plant and Equipment [Line Items]
Total cost	4,568,357	4,629,754
Computer equipment [Member]
Property, Plant and Equipment [Line Items]
Total cost	416,233	416,233
Computer software[Member]
Property, Plant and Equipment [Line Items]
Total cost	529,726	529,726
Furniture and fixtures [Member]
Property, Plant and Equipment [Line Items]
Total cost	181,566	181,566
Leasehold improvements [Member]
Property, Plant and Equipment [Line Items]
Total cost	4,054,864	4,053,837
Vehicles [Member]
Property, Plant and Equipment [Line Items]
Total cost	10,000	10,000
Surgical instruments [Member]
Property, Plant and Equipment [Line Items]
Total cost	$ 13,549,262	$ 13,876,757

Property and Equipment, Net (40

Property and Equipment, Net (Details Textual) - USD ($)	3 Months Ended
	Mar. 31, 2017	Mar. 31, 2016
Property, Plant and Equipment [Line Items]
Capital Leased Assets, Gross	$ 1,460,625
Capital Leases, Lessee Balance Sheet, Assets by Major Class, Accumulated Depreciation	397,591
Depreciation	$ 910,465	$ 658,176
Property, Plant and Equipment, Useful Life	5 years

Intangible Assets (Details)

Intangible Assets (Details) - USD ($)	3 Months Ended	12 Months Ended
	Mar. 31, 2017	Dec. 31, 2016
Finite Lived Intangible Assets Future Amortization Expense [Line Items]
Accumulated amortization	$ (9,160,811)	$ (7,999,939)
Intangible assets, net	34,800,556	35,940,810
Aggregate amortization expense:	1,160,872	4,479,010
Patents [Member]
Finite Lived Intangible Assets Future Amortization Expense [Line Items]
Gross carrying value	767,867	747,249
Technology [Member]
Finite Lived Intangible Assets Future Amortization Expense [Line Items]
Gross carrying value	28,698,700	28,698,700
Customer relationships [Member]
Finite Lived Intangible Assets Future Amortization Expense [Line Items]
Gross carrying value	9,911,000	9,911,000
Tradename [Member]
Finite Lived Intangible Assets Future Amortization Expense [Line Items]
Gross carrying value	4,543,300	4,543,300
Non-compete [Member]
Finite Lived Intangible Assets Future Amortization Expense [Line Items]
Gross carrying value	$ 40,500	$ 40,500

Intangible Assets (Details 1)

Intangible Assets (Details 1) - USD ($)	Mar. 31, 2017	Dec. 31, 2016
Estimated amortization expense:
Remainder of 2017	$ 3,484,325
2,018	4,660,352
2,019	4,550,768
2,020	4,468,157
2,021	4,210,811
Thereafter	13,426,143
Total	$ 34,800,556	$ 35,940,810

Accrued Liabilities (Details)

Accrued Liabilities (Details) - USD ($)	Mar. 31, 2017	Dec. 31, 2016
Accrued Liabilities [Line Items]
Accrued stock compensation	$ 358,480	$ 213,758
Wages/commissions payable	3,029,440	3,330,578
Accrued integration expense	0	73,510
Accrued interest payable	3,176,610	3,090,585
Other accrued liabilities	2,250,870	2,273,756
Accrued Liabilities	$ 8,815,400	$ 8,982,187

Debt (Details)

Debt (Details) - USD ($)	Mar. 31, 2017	Dec. 31, 2016
Debt Instrument [Line Items]
Loan payable to ROS Acquisition Offshore	$ 43,000,000	$ 43,000,000
PIK Interest payable to ROS	8,408,508	7,648,776
6% convertible senior unsecured notes due 2021	71,865,311	70,238,166
Total	123,273,819	120,886,942
Less: capitalized debt issuance costs	(1,567,193)	(1,665,508)
Long-term debt, less issuance costs	$ 121,706,626	$ 119,221,434

Debt (Details 1)

Debt (Details 1) - USD ($)	Mar. 31, 2017	Dec. 31, 2016
Schedule of maturities due on debt [Line Items]
Remainder of 2017	$ 0
2,018	0
2,019	0
2,020	51,408,508
2,021	71,865,311
Thereafter	0
Total	$ 123,273,819	$ 120,886,942

Debt (Details Textual)

Debt (Details Textual) - USD ($)

Aug. 12, 2016

Apr. 12, 2016

Aug. 10, 2015

Apr. 30, 2017

Jan. 17, 2017

May 25, 2016

Apr. 14, 2016

Jul. 31, 2015

Jun. 30, 2017

Mar. 31, 2017

Mar. 31, 2016

Dec. 31, 2016

Sep. 27, 2016

Jul. 29, 2016

Debt Instrument [Line Items]

Debt Instrument, Face Amount

$ 65,000,000

Conversion of Stock, Amount Converted

$ 480,000

$ 0

Business Acquisition, Percentage of Voting Interests Acquired

100.00%

Business Combination Conjunction Related Expenses

$ 4,900,000

Payments of Debt Issuance Costs

$ 4,700,000

Debt Instrument Convertible Extent Not Convertible Beneficial Ownership Percentage

9.99%

Interest Payable

$ 8,408,508

$ 7,648,776

PIK Notes SPA [Member]

Debt Instrument [Line Items]

Debt Instrument, Face Amount

$ 67,145

Debt Instrument, Convertible, Conversion Price

$ 0.7589

Debt Instrument, Maturity Date

Jul. 15, 2021

Debt Instrument, Interest Rate, Stated Percentage

0.00%

Indenture Notes SPA [Member]

Debt Instrument [Line Items]

Debt Instrument, Face Amount

$ 1,560,000

Debt Instrument, Convertible, Conversion Price

$ 0.7589

Debt Instrument, Maturity Date

Jul. 15, 2021

Debt Instrument, Interest Rate, Stated Percentage

6.00%

Indenture Common Stock SPA [Member]

Debt Instrument [Line Items]

Debt Conversion, Converted Instrument, Shares Issued

843,289

Debt Instrument, Convertible, Conversion Price

$ 0.5692

Debt Conversion, Converted Instrument, Amount

$ 16,000,000

Xspine [Member]

Debt Instrument [Line Items]

Debt Instrument, Interest Rate During Period

6.00%

New Facility [Member]

Debt Instrument [Line Items]

Line of Credit Facility, Expiration Date

Jul. 31, 2020

Line Of Credit Facility Loans Outstanding Payment Fee

7.50%

New Facility [Member] | First Period [Member]

Debt Instrument [Line Items]

Debt Instrument Interest Rate Portion Payable In Cash

0.00%

Debt Instrument Interest Rate Portion Payable In Kind

14.00%

Debt Instrument Interest Rate Addition To Pik Portion

1.00%

Debt Instrument Interest Rate Pik Portion Subtraction

9.00%

New Facility [Member] | Second Period [Member]

Debt Instrument [Line Items]

Debt Instrument Interest Rate Portion Payable In Cash

12.00%

Debt Instrument Interest Rate Portion Payable In Kind

14.00%

Debt Instrument Interest Rate Addition To Pik Portion

1.00%

Debt Instrument Interest Rate Pik Portion Subtraction

12.00%

Fourth Amendment To Amended And Restated Credit Agreement [Member] | OrbiMed and ROS [Member]

Debt Instrument [Line Items]

Debt Instrument Additional Tranche Commitment

$ 1,000,000

Debt Instrument Additional Tranche Commitment Outstanding

$ 43,000,000

Sixth Amendement To Restated New Credit Faciltiy [Member]

Debt Instrument [Line Items]

Line Of Credit Facility Loans Outstanding Payment Fee Percentage

9.00%

Sixth Amendement To Restated New Credit Faciltiy [Member] | Minimum [Member]

Debt Instrument [Line Items]

Line Of Credit Facility Loans Outstanding Payment Fee Percentage

7.50%

Sixth Amendement To Restated New Credit Faciltiy [Member] | Maximum [Member]

Debt Instrument [Line Items]

Line Of Credit Facility Loans Outstanding Payment Fee Percentage

9.00%

Twelfth Amendement To Restated New Credit Faciltiy [Member]

Debt Instrument [Line Items]

Debt Instrument, Minimum Revenue Base Covenant

$ 20,000,000

Twelfth Amendement To Restated New Credit Faciltiy [Member] | Scenario, Forecast [Member]

Debt Instrument [Line Items]

Debt Instrument, Minimum Revenue Base Covenant

$ 25,000,000

Convertible Notes Payable [Member]

Debt Instrument [Line Items]

Debt Instrument, Face Amount

$ 52,000,000

Debt Instrument Purchase Of Additional Notes

$ 3,000,000

Conversion of Stock, Shares Converted

257.5163

Conversion of Stock, Amount Converted

$ 1,000

Debt Instrument, Convertible, Conversion Price

$ 3.88

Term Loan [Member]

Debt Instrument [Line Items]

Line of Credit Facility, Current Borrowing Capacity

$ 42,000,000

Subsequent Event [Member] | Seventh Amendement To Restated New Credit Faciltiy [Member]

Debt Instrument [Line Items]

Debt Instrument, Description of Variable Rate Basis

interest accrued on such interest from January 2, 2017 until paid at a rate equal to 14% plus the higher of the LIBO Rate (as defined in the New Facility) for the fiscal quarter ended on December 31, 2016, or 1%.

Interest Payable

$ 1,147,329

Line Of Credit Facility Minimum Expected Liquidity

500,000

Subsequent Event [Member] | Seventh Amendement To Restated New Credit Faciltiy [Member] | Xtant Medical Holdings and Subsidiaries [Member]

Debt Instrument [Line Items]

Line Of Credit Facility Minimum Expected Liquidity

$ 5,000,000

Subsequent Event [Member] | Twelfth Amendement To Restated New Credit Faciltiy [Member]

Debt Instrument [Line Items]

Debt Instrument, Description of Variable Rate Basis

interest accrued on such interest from April 1, 2017 until paid at a rate equal to 14% plus the higher of the LIBO Rate for the fiscal quarter ended on March 31, 2017, or 1%.

Interest Payable

$ 1,139,597

Silicon Valley Bank [Member] | Revolving Credit Facility [Member]

Debt Instrument [Line Items]

Line of Credit Facility, Maximum Borrowing Capacity

$ 6,000,000

Debt Instrument, Basis Spread on Variable Rate

1.00%

Silicon Valley Bank [Member] | First Loan Modification Agreement [Member]

Debt Instrument [Line Items]

Line of Credit Facility, Maximum Borrowing Capacity

$ 11,000,000

Debt Instrument, Basis Spread on Variable Rate

4.00%

Line of Credit Facility, Covenant Terms

The terms of the Modification Agreement include standard reporting covenants and a minimum, quarterly revenue covenant of $20 million through June 30, 2017, which increases to $22 million per quarter.

Convertible Senior Unsecured Notes [Member]

Debt Instrument [Line Items]

Debt Instrument, Face Amount

$ 2,238,166

Debt Instrument, Interest Rate During Period

6.00%

Conversion of Stock, Shares Converted

344.8276

Conversion of Stock, Amount Converted

$ 1,000

Debt Instrument, Convertible, Conversion Price

$ 2.90

Convertible Promissory Notes [Member] | PIK Notes SPA [Member]

Debt Instrument [Line Items]

Debt Instrument, Face Amount

2,238,166

Convertible Promissory Notes [Member] | Indenture Notes SPA [Member]

Debt Instrument [Line Items]

Debt Instrument, Face Amount

$ 52,000,000

Stock-Based Compensation (Detai

Stock-Based Compensation (Details) - Stock Option - $ / shares	3 Months Ended
	Mar. 31, 2017	Mar. 31, 2016
Schedule of activity under stock option plans [Line Items]
Outstanding at January 1	1,205,913	664,081
Cancelled or expired, Shares	(17,834)	(81,375)
Outstanding at December 31	1,188,079	582,706
Exercisable at December 31	371,646	366,003
Outstanding at January 1, Weighted Average Exercise Price	$ 5.21	$ 10.64
Cancelled or expired, Weighted Average Exercise Price	7.34	8.93
Outstanding at December 31, Weighted Average Exercise Price	5.18	10.88
Exercisable at December 31, Weighted Average Exercise Price	11.81	13.39
Outstanding at January 1, Weighted Average Fair Value At Grant Date	2.82	5.32
Cancelled or expired, Weighted Average Fair Value At Grant Date	4.24	4.13
Outstanding at December 31, Weighted Average Fair Value At Grant Date	2.8	5.48
Exercisable at December 31, Weighted Average Fair Value At Grant Date	$ 5.71	$ 6.4

Stock-Based Compensation (Det48

Stock-Based Compensation (Details Textual) - USD ($)	Oct. 06, 2016	Mar. 31, 2017	Mar. 31, 2016	Jun. 21, 2017	May 21, 2017	Apr. 21, 2017	Jan. 21, 2017
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Shares authorized under the Plan		1,900,000
Aggregate intrinsic value of options outstanding		670,000
Other Noncash Expense		$ 144,723	$ 55,296
Share-based Compensation, Total		230,424	136,079
President [Member]
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Options granted	300,000
Share Price	$ 1.11
Share-based Compensation, Total		$ 10,387
Interim Chief Executive Officer [Member]
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Share-Based Compensation Arrangement By Share-Based Payment Award, Equity Instruments Other Than Options, Grants In Period		200,000
Share-based Compensation Arrangement by Share-based Payment Award, Equity Instruments Other than Options, Grants in Period Weighted Average Exercise Price		$ 6
Deferred Compensation Cash-based Arrangements, Liability, Current							$ 130,000
Interim Chief Executive Officer [Member] | Third Installment [Member] | Scenario, Forecast [Member]
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Compensation Payable, Monthly Installments				$ 43,333
Interim Chief Executive Officer [Member] | Subsequent Event [Member] | First Installment [Member]
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Compensation Payable, Monthly Installments						$ 43,333
Interim Chief Executive Officer [Member] | Subsequent Event [Member] | Second Installment [Member]
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Compensation Payable, Monthly Installments					$ 43,333
Directors and Consultants [Member]
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Allocated Share-based Compensation Expense		$ 230,424	$ 161,123
Employee Stock Option [Member]
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Employee Service Share-based Compensation, Nonvested Awards, Total Compensation Cost Not yet Recognized, Stock Options		$ 816,433
Share-Based Compensation Arrangement By Share-Based Payment Award, Options, Exercisable, Weighted Average Exercise Price		$ 1.48
Employee Service Share-based Compensation, Tax Benefit from Compensation Expense		$ 561,491
Restricted Stock [Member]
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Employee Service Share-based Compensation, Nonvested Awards, Compensation Not yet Recognized, Share-based Awards Other than Options		$ 40,000
Stock Issued During Period, Shares, Restricted Stock Award, Net of Forfeitures, Total		130,804
Shares Issued, Price Per Share		$ 1.99
Other Noncash Expense		$ 118,000

Warrants (Details)

Warrants (Details) - $ / shares	3 Months Ended	12 Months Ended
	Mar. 31, 2017	Dec. 31, 2016
Warrant activity [Line Items]
Outstanding	6,291,331	1,278,566
Issued	0	5,055,345
Expired	0	(42,580)
Outstanding	6,291,331	6,291,331
Outstanding Weighted Average Exercise Price	$ 2.23	$ 8.45
Issued, Weighted Average Exercise Price	0	0.9
Expired, Weighted Average Exercise Price	0	31.73
Outstanding Weighted Average Exercise Price	$ 2.23	$ 2.23

Warrants (Details 1)

Warrants (Details 1) - Warrant [Member] - $ / shares	3 Months Ended
	Mar. 31, 2017	Mar. 31, 2016
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Value of underlying common stock (per share)	$ 0.62	$ 2.71
Risk free interest rate	1.90%	1.00%
Expected term	5 years	4 years
Volatility	91.00%	76.00%
Dividend yield	0.00%	0.00%

Warrants (Details 2)

Warrants (Details 2) - shares	3 Months Ended
	Mar. 31, 2017	Mar. 31, 2016
Class of Warrant or Right [Line Items]
Outstanding	6,291,331	1,278,566
Derivative warrants issued, exercised and expired	0	0
Outstanding	6,291,331
Warrant [Member]
Class of Warrant or Right [Line Items]
Outstanding	1,125,119	1,125,119
Outstanding	1,125,119	1,125,119

Warrants (Details Textual)

Warrants (Details Textual)	3 Months Ended
	Mar. 31, 2017USD ($)
Class of Warrant or Right [Line Items]
Unrealized Loss On Warranty Derivative Liability	$ 170,031

Commitments and Contingencies53

Commitments and Contingencies (Details)	Mar. 31, 2017USD ($)
Schedule of future minimum payments by operating lease [Line Items]
Remainder of 2017	$ 596,532
2,018	806,747
2,019	668,807
2,020	396,263
2,021	375,289
Thereafter	1,038,417
Total	$ 3,882,055

Commitments and Contingencies54

Commitments and Contingencies (Details 1) - USD ($)	Mar. 31, 2017	Dec. 31, 2016
Remainder of 2017	$ 346,254
2,018	452,756
2,019	420,765
2,020	162,745
2,021	0
Thereafter	0
Total minimum lease payments	1,382,520
Less amount representing interest	(368,499)
Present value of obligations under capital leases	1,014,021
Less current portion	(259,027)	$ (244,847)
Long-term capital lease obligations	$ 754,994	$ 832,152

Commitments and Contingencies55

Commitments and Contingencies (Details Textual)	3 Months Ended
	Mar. 31, 2017USD ($)	Mar. 31, 2016USD ($)
Schedule of commitment and contingencies [Line Items]
Lessee Leasing Arrangements, Operating Leases, Renewal Term	10 years
Lessee Leasing Arrangements Operating Leases Term Of Contract Number Of Options To Extend	1
Sale-leaseback Transaction for the Property Located at 664 Cruiser Lane, Belgrade, Montana [Member]
Schedule of commitment and contingencies [Line Items]
Operating Leases, Rent Expense, Net	$ 202,649	$ 230,007

Supplemental Disclosure of Ca56

Supplemental Disclosure of Cash Flow Information (Details) - USD ($)	3 Months Ended
	Mar. 31, 2017	Mar. 31, 2016
Cash paid during the period for:
Interest	$ 249,162	$ 4,194
Non-cash activity:
Interest converted into common stock	$ 480,000	$ 0

Related Party Transactions (Det

Related Party Transactions (Details Textual) - USD ($)	3 Months Ended
	Mar. 31, 2017	Mar. 31, 2016
One Vendor [Member] | Sales Revenue, Net [Member]
Related Party Transaction [Line Items]
Concentration Risk, Percentage	10.00%	18.00%
Chief Operating Officer [Member]
Related Party Transaction [Line Items]
Amount of related party transaction	$ 5,000
American Donor Services [Member]
Related Party Transaction [Line Items]
Amount of related party transaction	$ 277,825	$ 270,035

Segment and Geographic Inform58

Segment and Geographic Information (Details) - USD ($)	3 Months Ended
	Mar. 31, 2017	Mar. 31, 2016
Segment Reporting Information [Line Items]
Total Revenue	$ 22,082,669	$ 20,977,335
United States [Member]
Segment Reporting Information [Line Items]
Total Revenue	21,104,489	19,604,142
Rest of world [Member]
Segment Reporting Information [Line Items]
Total Revenue	$ 978,180	$ 1,373,193

Segment and Geographic Inform59

Segment and Geographic Information (Details Textual)	3 Months Ended
	Mar. 31, 2017	Mar. 31, 2016
Geographic Concentration Risk [Member] | Sales Revenue, Net [Member] | UNITED STATES
Segment Reporting Information [Line Items]
Concentration Risk, Percentage	96.00%	93.00%

Subsequent Events (Details Text

Subsequent Events (Details Textual) - USD ($)	1 Months Ended
	Apr. 30, 2017	Mar. 31, 2017	Dec. 31, 2016	Jul. 31, 2015
Subsequent Event [Line Items]
Debt Instrument, Face Amount				$ 65,000,000
Interest Payable		$ 8,408,508	$ 7,648,776
Subsequent Event [Member] | ROS And Royalty Opportunities [Member]
Subsequent Event [Line Items]
Debt Instrument, Face Amount	$ 15,000,000
Subsequent Event [Member] | Seventh Amendement To Restated New Credit Faciltiy [Member]
Subsequent Event [Line Items]
Interest Payable	$ 1,147,329
Debt Instrument, Description of Variable Rate Basis	interest accrued on such interest from January 2, 2017 until paid at a rate equal to 14% plus the higher of the LIBO Rate (as defined in the New Facility) for the fiscal quarter ended on December 31, 2016, or 1%.
Subsequent Event [Member] | Seventh Amendement To Restated New Credit Faciltiy [Member] | Interest Due On May 31, 2017 [Member]
Subsequent Event [Line Items]
Interest Payable	$ 1,147,329
Debt Instrument, Description of Variable Rate Basis	interest accrued on such interest from January 2, 2017 until paid at a rate equal to 14% plus the higher of the LIBO Rate for the fiscal quarter ended on December 31, 2016, or 1%.
Subsequent Event [Member] | Seventh Amendement To Restated New Credit Faciltiy [Member] | Interest Due On June 30, 2017 [Member]
Subsequent Event [Line Items]
Interest Payable	$ 1,147,329.47
Debt Instrument, Description of Variable Rate Basis	interest accrued on such interest from January 2, 2017 until paid at a rate equal to 14% plus the higher of the LIBO Rate (as defined in the Facility) for the fiscal quarter ended on December 31, 2016, or 1%.
Subsequent Event [Member] | Twelfth Amendement To Restated New Credit Faciltiy [Member]
Subsequent Event [Line Items]
Interest Payable	$ 1,139,597
Debt Instrument, Description of Variable Rate Basis	interest accrued on such interest from April 1, 2017 until paid at a rate equal to 14% plus the higher of the LIBO Rate for the fiscal quarter ended on March 31, 2017, or 1%.
Subsequent Event [Member] | Twelfth Amendement To Restated New Credit Faciltiy [Member] | Interest Due On May 31, 2017 [Member]
Subsequent Event [Line Items]
Interest Payable	$ 1,139,597
Debt Instrument, Description of Variable Rate Basis	interest accrued on such interest from April 1, 2017 until paid at a rate equal to 14% plus the higher of the LIBO Rate for the fiscal quarter ended on March 31, 2017, or 1%.
Subsequent Event [Member] | Twelfth Amendement To Restated New Credit Faciltiy [Member] | Interest Due On June 30, 2017 [Member]
Subsequent Event [Line Items]
Interest Payable	$ 1,139,597.47
Debt Instrument, Description of Variable Rate Basis	interest accrued on such interest from April 1, 2017 until paid at a rate equal to 14% plus the higher of the LIBO Rate for the fiscal quarter ended on March 31, 2017, or 1%.