Xtant Medical (XTNT) 10-K/A 5 Apr 18 2017 FY Annual report (amended) Financial data

Document And Entity Information

Document And Entity Information - USD ($)	12 Months Ended
	Dec. 31, 2017	Apr. 02, 2018	Jun. 30, 2017
Document Information [Line Items]
Document Type	10-K
Amendment Flag	false
Document Period End Date	Dec. 31, 2017
Document Fiscal Year Focus	2,017
Document Fiscal Period Focus	FY
Entity Registrant Name	Xtant Medical Holdings, Inc.
Entity Central Index Key	1,453,593
Current Fiscal Year End Date	--12-31
Entity Well-known Seasoned Issuer	No
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Filer Category	Smaller Reporting Company
Entity Public Float			$ 5,163,275
Trading Symbol	XTNT
Entity Common Stock, Shares Outstanding		13,077,468

Consolidated Statements of Oper

Consolidated Statements of Operations - USD ($)	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Revenue
Orthopedic product sales	$ 82,513,128	$ 89,388,145
Other revenue	98,973	614,591
Total Revenue	82,612,101	90,002,736
Cost of Sales	32,511,120	27,710,014
Gross Profit	50,100,981	62,292,722
Operating Expenses
General and administrative	15,245,926	15,762,531
Sales and marketing	40,511,434	44,055,813
Research and development	2,441,062	3,410,600
Depreciation and amortization	5,485,280	4,940,955
Acquisition and integration related expenses	0	1,401,366
Impairment intangible assets	17,586,071	0
Restructuring expenses	4,679,645	0
Separation related expenses	1,901,187	0
Non-cash consulting expense	84,697	266,721
Total Operating Expenses	87,935,302	69,837,986
Loss from Operations	(37,834,321)	(7,545,264)
Other Income (Expense)
Interest expense	(14,704,751)	(12,262,750)
Change in warrant derivative liability	202,519	716,738
Other expense	(74,709)	(351,914)
Total Other Expense	(14,576,941)	(11,897,926)
Net Loss from Operations Before Provision for Income Taxes	(52,411,262)	(19,443,190)
Provision for Income Taxes
Current and Deferred	0	(50,362)
Net Loss	$ (52,411,262)	$ (19,493,552)
Net loss per share:
Basic	$ (34.76)	$ (18.46)
Dilutive	$ (34.76)	$ (18.46)
Shares used in the computation:
Basic	1,507,769	1,055,937
Dilutive	1,507,769	1,055,937

CONSOLIDATED BALANCE SHEETS

CONSOLIDATED BALANCE SHEETS - USD ($)	Dec. 31, 2017	Dec. 31, 2016
Current Assets:
Cash and cash equivalents	$ 2,855,959	$ 2,578,267
Trade accounts receivable, net of allowance for doubtful accounts of $2,135,339 and $1,653,385, respectively	12,714,386	18,991,872
Current inventories, net	22,228,587	26,266,457
Prepaid and other current assets	1,705,963	1,149,615
Total current assets	39,504,895	48,986,211
Non-current inventories, net	194,061	971,854
Property and equipment, net	9,913,439	15,840,730
Goodwill	41,534,626	41,534,626
Intangible assets, net	13,826,373	35,940,810
Other assets	731,189	827,374
Total Assets	105,704,583	144,101,605
Current Liabilities:
Accounts payable	9,315,424	10,471,944
Accounts payable - related party (note 14)	160,381	640,442
Revolving line of credit	0	10,448,283
Accrued liabilities	15,845,421	8,982,187
Warrant derivative liability	131,094	333,613
Current portion of capital lease obligations	365,476	244,847
Total current liabilities	25,817,796	31,121,316
Long-term Liabilities:
Capital lease obligation, less current portion	623,297	832,152
Long-term convertible debt, less issuance costs	70,853,485	68,937,247
Long-term debt, less issuance costs	67,108,997	50,284,187
Total Liabilities	164,403,575	151,174,902
Commitments and Contingencies (note 9)
Stockholders’ Equity (Deficit):
Preferred stock, $0.000001 par value; 10,000,000 shares authorized; no shares issued and Outstanding	0	0
Common stock, $0.000001 par value; 50,000,000 shares authorized; 1,514,899 shares issued and outstanding as of December 31, 2017 and 1,437,442 shares issued and outstanding as of December 31, 2016	2	1
Additional paid-in capital	86,246,792	85,461,226
Accumulated deficit	(144,945,786)	(92,534,524)
Total Stockholders’ Equity (Deficit)	(58,698,992)	(7,073,297)
Total Liabilities & Stockholders’ Equity (Deficit)	$ 105,704,583	$ 144,101,605

CONSOLIDATED BALANCE SHEETS _Pa

CONSOLIDATED BALANCE SHEETS [Parenthetical] - USD ($)	Dec. 31, 2017	Dec. 31, 2016
Trade accounts receivable, allowance for doubtful accounts (in dollars)	$ 2,135,339	$ 1,653,385
Preferred stock, par value (in dollars per share)	$ 0.000001	$ 0.000001
Preferred stock, shares authorized	10,000,000	10,000,000
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	50,000,000	50,000,000
Common stock, shares issued	1,514,899	1,437,442
Common Stock, shares outstanding	1,514,899	1,437,442

Consolidated Statements of Chan

Consolidated Statements of Changes in Stockholders' Equity (Deficit) - USD ($)	Total	Common Stock [Member]	Additional Paid-in Capital [Member]	Retained Earnings [Member]
Balance at Dec. 31, 2015	$ 8,876,527	$ 1	$ 81,917,498	$ (73,040,972)
Balance (in shares) at Dec. 31, 2015		991,466
Stock-based compensation	256,266	$ 0	256,266	0
Issuance of restricted stock	200,000	$ 0	200,000	0
Issuance of restricted stock (in shares)		4,901
Issuance of common stock	225,000	$ 0	225,000	0
Issuance of common stock (in shares)		7,295
Net proceed from the rights issuance	2,562,462	$ 0	2,562,462	0
Net proceed from the rights issuance (in shares)		421,280
Issuance of stock to Aspire Capital	300,000	$ 0	300,000	0
Issuance of stock to Aspire Capital (in shares)		12,500
Net loss	(19,493,552)	$ 0		(19,493,552)
Balance at Dec. 31, 2016	(7,073,297)	$ 1	85,461,226	(92,534,524)
Balance (in shares) at Dec. 31, 2016		1,437,442
Stock-based compensation	127,112	$ 0	127,112	0
Issuance of restricted stock	178,455	$ 0	178,455	0
Issuance of restricted stock (in shares)		7,183
Issuance of common stock	480,000	$ 1	479,999	0
Issuance of common stock (in shares)		70,274
Net loss	(52,411,262)	$ 0		(52,411,262)
Balance at Dec. 31, 2017	$ (58,698,992)	$ 2	$ 86,246,792	$ (144,945,786)
Balance (in shares) at Dec. 31, 2017		1,514,899

CONSOLIDATED STATEMENTS OF CASH

CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Operating activities:
Net loss	$ (52,411,262)	$ (19,493,552)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation and amortization	8,408,594	7,241,870
Loss on intangible impairment and disposal of fixed assets	21,242,247	0
Non-cash interest	14,684,712	6,784,785
Loss on sale of fixed assets	10,469	25,458
Non-cash consulting expense/stock option expense	211,809	522,987
Provision for losses on accounts receivable and inventory	4,212,582	223,538
Change in derivative warrant liability	(202,519)	(716,738)
Changes in operating assets and liabilities:
Trade accounts receivable	4,746,876	(2,680,405)
Inventories	2,122,274	(4,074,086)
Prepaid and other assets	(460,162)	(484,061)
Accounts payable	(1,636,580)	319,091
Accrued liabilities	(1,472,220)	(2,076,183)
Net cash used in operating activities	(543,180)	(14,407,296)
Investing activities:
Purchases of property and equipment and intangible assets	(1,640,666)	(5,832,690)
Proceeds from sale of fixed assets	32,500	16,400
Net cash used in investing activities	(1,608,166)	(5,816,290)
Financing activities:
Proceeds from long-term and convertible debt, net of deferred and financing costs	12,787,094	3,238,166
Payments on capital leases	(88,228)	(144,600)
Net proceeds from the revolving line of credit	(10,448,283)	10,252,809
Net proceeds from issuance of stock and warrants	178,455	3,087,462
Net cash provided by financing activities	2,429,038	16,433,837
Net change in cash and cash equivalents	277,692	(3,789,749)
Cash and cash equivalents at beginning of year	2,578,267	6,368,016
Cash and cash equivalents at end of year	$ 2,855,959	$ 2,578,267

Business Description and Summar

Business Description and Summary of Significant Accounting Policies	12 Months Ended
	Dec. 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 consolidated financial statements include the accounts of Xtant Medical Holdings, Inc., 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 Medical Inc., Bacterin and X-spine are jointly referred to herein as “Xtant” or the “Company”). All intercompany balances and transactions have been eliminated in consolidation. 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. 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 Company completed a 1:12 reverse split of its common stock, effective at the open of business on Wednesday, February 14, 2018. The reverse stock split was approved by the Company’s shareholders at the Special Meeting of Shareholders on February 13, 2018. All references to common shares, stock option, restricted stock units, warrants, and per share amounts have been retroactively adjusted to reflect the reverse stock split for all periods presented. The Company’s accounts receivables are 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 in the fiscal years 2017 or 2016. The Company provides for uncollectible amounts when specific credit issues arise. Management believes that all significant credit risks have been identified at December 31, 2017. In the years ended December 31, 2017 and 2016, Xtant purchased from Norwood Medical less than 10% of its operating products (See Note 14, “Related Party Transactions” below). 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 (including surgical instruments), goodwill, and intangible assets and liabilities; valuation allowances for trade receivables, inventory valuation, 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. The Company considers all highly liquid investments purchased with an original maturity date of three months or less to be cash equivalents. Cash equivalents are recorded at cost, which approximates market value. At times the Company maintains deposits in financial institutions in excess of federally insured limits. Accounts receivable represents amounts due from customers for which revenue has been recognized. Normal terms on trade accounts receivable are net 30 days and some customers are offered discounts for early pay. The Company performs credit evaluations when considered necessary, but generally does not require collateral to extend credit. The allowance for doubtful accounts is the Company’s best estimate of the amount of probable credit losses in the Company’s existing receivables. The Company determines the allowance based on factors such as historical collection experience, customer’s current creditworthiness, customer concentration, age of accounts receivable balance, general economic conditions that may affect a customer’s ability to pay, and management judgment. Actual customer collections could differ from estimates. Account balances are charged to the allowance after all means of collection have been exhausted and the potential for recovery is considered remote. Provisions to the allowance for doubtful accounts are charged to expense. The Company does not have any off-balance sheet credit exposure related to its customers. Inventories are stated at the lower of cost or net realizable value. Cost is determined using the specific identification method and includes materials, labor and overhead. The Company calculates an inventory reserve for estimated obsolescence and excess inventory based on historical usage and sales, as well as assumptions about future demand for its products. These estimates for excess and obsolete inventory are reviewed and updated on a quarterly basis. Increases in the inventory reserves result in a corresponding expense, which is recorded to cost of sales. Inventories where the sales cycle is estimated to be beyond twenty-four months at the balance sheet date are classified as Non-current inventories. Property and equipment are stated at cost less accumulated depreciation. Depreciation is computed using the straight-line method over the estimated useful lives of the assets, generally three to seven years for computers and equipment and five years for surgical instruments. Leasehold improvements are depreciated over the shorter of their estimated useful life or the remaining term of the lease. Repairs and maintenance are expensed as incurred. Intangible assets with estimable useful lives are amortized over their respective estimated useful lives to their estimated residual values, and reviewed for impairment whenever events or circumstances indicate their carrying amount may not be recoverable. Intangible assets include trademarks and patents and include costs to acquire and protect Company patents. Intangible assets are carried at cost less accumulated amortization. The Company amortizes these assets on a straight-line basis over their estimated useful lives. In 2015 with the acquisition of X-spine, the Company established a fair value for the technology, tradenames and intangible assets which was determined based upon a “relief from royalty” approach. The amortization of these assets is consistent with the valuation method used to establish their fair value which in turn was based on the assets’ future cash flow. Other Assets consist of the short-term and the long-term portion of prepaid expenses and security deposits. 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 the 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. The results from the assessment and a step 1 analysis allowed the Company to conclude that goodwill was not impaired as of December 31, 2017. The Company conducts its impairment test on an annual basis and will review the analysis assumptions on a quarterly basis. 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 the above criteria have been met. Research and development costs, which are principally related to internal costs for the development of new products are expensed as incurred. Other income (expense) primarily consists of non Basic net loss per share is computed by dividing net 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 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 years ended December 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 loss per share are not reported as their effects of including 587,382 and 624,769 outstanding stock options and warrants for the years ended December 31, 2017 and 2016, respectively, are anti-dilutive. The carrying values of financial instruments, including trade accounts receivable, accounts payable, accrued liabilities 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 fair value 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 years ended December 31, 2017 and 2016, there was no reclassification in financial assets or liabilities between Level 1, 2 or 3 categories. Warrant derivative liability As of As of Level 1 - - Level 2 - - Level 3 $ 131,094 $ 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 8, “Warrants” below). Level 3 Changes 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 (202,519 ) Balance at December 31, 2017 $ 131,094 During the year ended December 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 (ASU) 2014-09, Revenue from Contracts with Customers In February 2016, the FASB issued Accounting Standards Update No. 2016-02, Leases (Topic 842) In June 2016, the FASB issued ASU 2016-13 Financial Instruments - Credit losses: Measurement of Credit Losses on Financial Instruments Financial Instruments-Credit Loss In November 2016, the FASB issued ASU 2016-18, Statement of Cash Flow -Restricted Cash

Inventories

Inventories	12 Months Ended
	Dec. 31, 2017
Inventory Disclosure [Abstract]
Inventories	(2) Inventories December 31, December 31, 2017 2016 Current inventories Raw materials $ 4,276,773 $ 4,833,403 Work in process 1,515,085 1,891,380 Finished goods 23,269,805 23,878,040 Gross current inventories 29,061,663 30,602,823 Reserve for obsolescence (6,833,076) (4,336,366) Current inventories, total 22,228,587 26,266,457 Non-current inventories Finished goods 1,071,956 1,385,017 Reserve for obsolescence (877,895) (413,163) Non-current inventories, total 194,061 971,854 Total inventories $ 22,422,648 $ 27,238,311 The Company provides implants and biologic inventory on consignment through its various sales channels to logistically place the inventory near the anticipated surgical location. Consigned inventory was approximately $ 12.0 11.2

Property and Equipment, Net

Property and Equipment, Net	12 Months Ended
	Dec. 31, 2017
Property, Plant and Equipment [Abstract]
Property and Equipment, Net	(3 ) Property and Equipment, Net December 31, December 31, 2017 2016 Equipment $ 4,471,198 $ 4,629,754 Computer equipment 489,718 416,233 Computer software 523,526 529,726 Furniture and fixtures 214,770 181,566 Leasehold improvements 4,030,010 4,053,837 Vehicles 10,000 10,000 Surgical instruments 11,461,798 13,876,757 Total cost 21,201,020 23,697,873 Less: accumulated depreciation (11,287,581) (7,857,143) $ 9,913,439 $ 15,840,730 The Company deploys certain surgical instruments through its various sales channels for use with purchased implants during surgical procedures. The instruments are classified as non-current assets within property and equipment and depreciated using the straight-line method over a five-year useful life. The net book value of consigned surgical instruments was approximately $ 6.6 8.2 1,614,793 Depreciation expense related to property and equipment, including property under capital lease, for the year ending 2017 and 2016 was $ 3,765,314 2,431,619 The Company leases certain equipment under capital leases. For financial reporting purposes, minimum lease payments relating to the assets have been capitalized. As of December 31, 2017, the Company has recorded $ 1,585,366 500,092

Intangible Assets

Intangible Assets	12 Months Ended
	Dec. 31, 2017
Goodwill and Intangible Assets Disclosure [Abstract]
Intangible Assets	(4) Intangible Assets Intangible assets consist of various patents with regards to processes for our products and intangible assets associated with the acquisition of X-spine. December 31, December 31, Patents $ 847,436 $ 747,249 Acquisition related intangibles: Technology 13,788,617 28,698,700 Customer relationships 9,911,000 9,911,000 Tradename 1,867,312 4,543,300 Non-compete 40,500 40,500 Accumulated amortization (12,628,492) (7,999,939) Net carrying value $ 13,826,373 $ 35,940,810 Aggregate amortization expense: $ 4,628,558 $ 4,479,010 2018 $ 2,053,485 2019 2,005,419 2020 1,969,073 2021 1,855,794 2022 1,758,531 Thereafter 4,184,071 Total $ 13,826,373 The Company recorded an impairment charge in 2017 of $ 14,910,083 2,675,988

Accrued Liabilities

Accrued Liabilities	12 Months Ended
	Dec. 31, 2017
Payables and Accruals [Abstract]
Accrued Liabilities	(5) Accrued Liabilities December 31, December 31, 2017 2016 Accrued interest payable $ 10,834,641 $ 3,090,585 Wages/commissions payable 2,830,946 3,330,578 Accrued stock compensation 120,000 213,758 Other accrued liabilities 2,059,834 2,347,266 Accrued Liabilities $ 15,845,421 $ 8,982,187

Debt

Debt	12 Months Ended
	Dec. 31, 2017
Debt Disclosure [Abstract]
Debt	(6) Debt Convertible Note Indenture In connection with the Restructuring (defined below), effective on February 14, 2018, all of the Notes (defined below) and the Additional Notes (defined below) were converted or exchanged into shares of our common stock and the Indenture (defined below) was discharged. Please see Note 16, “Subsequent Events” below for a further description of such conversions and exchanges of the Notes and the Additional Notes. On July 31, 2015, we completed an offering of $ 65 6.00 49 16 3 52 On April 14, 2016, we entered into a securities purchase agreement with ROS and Royalty Opportunities and issued $ 2,238,166 34.80 On January 17, 2017, the Company entered into securities purchase agreements with Bruce Fund, PWPI, PWIMF and Telemetry, to satisfy interest obligations that were owed to such parties under the Notes issued to them under the Indenture. Pursuant to such agreements, the parties agreed to purchase from the Company a total of 70,274 6.83 On January 17, 2017, the Company entered into securities purchase agreements and certain related documents with ROS and Royalty Opportunities to satisfy interest obligations that the Company owed to them pursuant to the Notes and the 2016 Notes. Pursuant to such agreements, ROS and Royalty Opportunities agreed to purchase from the Company a new series of 6 1,560,000 67,145 9.11 The Additional Notes and the Notes bear interest at a rate equal to 6.00 Effective March 31, 2017, the Company, ROS and Royalty Opportunities entered into a waiver letter (the “Indenture Waiver”) of the Indenture. Under the Indenture Waiver, ROS and Royalty Opportunities waived any non-compliance with the covenant set forth in Section 6.01(a)(vii) of the Indenture due to the going concern qualification included in the Company’s audit report for the year ended December 31, 2016. ROS and Royalty Opportunities also entered into a waiver (the “Notes Waiver”) for defaults that occurred under multiple convertible promissory notes (including the Notes and the Additional Notes). Under the Notes Waiver, ROS and Royalty Opportunities 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. Effective July 15, 2017, the Holders entered into an omnibus waiver which deferred interest accrued on the Notes (the “Omnibus Waiver”). Under the Omnibus Waiver and pursuant to Section 9.02 of the Indenture and Section 10.13 of the Notes, the interest due July 15, 2017 on the Notes was deferred until August 15, 2017, to be paid in cash together with interest accrued on such interest from July 15, 2017 to the date of the payment thereof at a rate equal to 6.00% per annum plus 100 basis points. Effective August 15, 2017, September 29, 2017, October 31, 2017, November 30, 2017 and December 28, 2017, the Company, ROS and Royalty Opportunities entered into the Amendment and Waiver, and the Second, Third, Fourth and Fifth Amendment and Waiver, respectively, which amended the Additional Notes by moving the payment date of interest accrued on the Additional Notes as follows: (a) for interest accrued on the Additional Notes that was originally required to be paid on July 15, 2017, from July 15, 2017 to January 31, 2018, and (b) for interest accrued on the Additional Notes that is required to be paid on January 15, 2018, from January 15, 2018 to January 31, 2018. The amendment also waived any event of default that may have occurred as a result of the non-payment of interest on July 15, 2017 or January 15, 2018. The interest payment due on January 31, 2018 includes interest accrued on such interest from July 15, 2017 and January 15, 2018, respectively, to the date of payment thereof at a rate equal to 6.00% per annum plus 100 basis points. Effective August 16, 2017, October 2, 2017, October 31, 2017, December 1, 2017 and December 29, 2017, the Company and Wilmington Trust, National Association, entered into the Amendment Numbers 1, 2, 3, 4 and 5 to the Indenture, respectively, which amended the existing Indenture. The amendments amended the Indenture by moving the payment date of interest accrued on the Notes issued under the Indenture as follows: (a) for interest accrued on the Notes that was originally required to be paid on July 15, 2017, from July 15, 2017 to January 31, 2018, and (b) for interest accrued on the Notes that is required to be paid on January 15, 2018, from January 15, 2018 to January 31, 2018. Amendment Number 5 to the Indenture also set the record dates for the January 31, 2018 interest payments at June 30, 2017 and December 31, 2017, respectively, and waived any event of default that may have occurred as a result of the non-payment of interest on July 15, 2017 or January 15, 2018. The interest payments due on January 31, 2018 includes interest accrued on such interest from July 15, 2017 and January 15, 2018, respectively, to the date of payment thereof at a rate equal to 6.00% per annum plus 100 basis points. Amended and Restated Credit Agreement In connection with the Restructuring, effective February 14, 2018, a substantial amendment was made to the Amended and Restated Credit Agreement (the “Credit Facility”). Please see Note 16, “Subsequent Events” below for a further description of such amendment to the Credit Facility. On July 31, 2015 the Company recorded $ 42 July 31, 2020 9 14 1 9 12 14 1 12 7.5 The Credit Facility contains financial and other covenant requirements, including, but not limited to, financial covenants that require the Company to maintain revenue and liquidity at levels set forth in the Credit Facility and ensure that the Company’s senior consolidated leverage ratio does not exceed levels set forth in the Credit Facility. The Credit Facility also restricts us from making any payment or distribution with respect to, or purchasing, redeeming, defeasing, retiring or acquiring, the Notes other than payments of scheduled interest on the Notes, issuance of shares of our common stock upon conversion of the Notes, and payment of cash in lieu of fractional shares. The loans under the Credit Facility are guaranteed by the Company and its current and future subsidiaries and are secured by substantially all of the current and future assets of the Company and its subsidiaries. Approximately $ 4.9 4.7 We have entered into several amendments to the Credit 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 Credit Facility which provided for 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 Credit Facility which increased the fee on any amounts paid under the Credit Facility from 7.5 9.0 9.00 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), twelfth amendment (effective March 31, 2017), thirteenth amendment (effective April 30, 2017), fourteenth amendment (effective May 11, 2017), fifteenth amendment (effective June 30, 2017), sixteenth amendment (effective July 15, 2017), seventeenth amendment (effective August 11, 2017), eighteenth amendment (effective September 29, 2017), nineteenth amendment (effective October 31, 2017), twentieth amendment (effective November 30, 2017), and twenty-first amendment (effective December 28, 2017) deferred our accrued interest payment date for the fiscal quarters ended on December 31, 2016, March 31, 2017, June 30, 2017, September 30, 2017 and December 31, 2017 until January 31, 2018. The interest due on January 31, 2018 for the fiscal quarter ended on December 31, 2016 is $ 1,147,329 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 Credit Facility) for the fiscal quarter ended on December 31, 2016, or 1%. 1,139,597 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%. 1,303,935 plus interest accrued on such interest from July 1, 2017 until paid at a rate equal to 14% plus the higher of the LIBO Rate for the fiscal quarter ended on June 30, 2017, or 1%. 1,482,406 plus interest accrued on such interest from October 2, 2017 until paid at a rate equal to 14% plus the higher of the LIBO Rate for the fiscal quarter ended on September 30, 2017, or 1%. 1,521,262 plus interest accrued on such interest from January 2, 2018 until paid at a rate equal to 14% plus the higher of the LIBO Rate for the fiscal quarter ended on December 31, 2017, or 1%. The twelfth amendment waived any non-compliance with the covenant set forth in Section 7.1(c) of the Credit Facility due to the going concern qualification included in the Company’s audit report for the year ended December 31, 2016. The fourteenth amendment to the Credit Facility amended the guarantors to the Company, X-Spine and Xtant Medical, collectively, and listed X-Spine as the Additional Delayed Draw Borrower of new term loans. The fourteenth amendment allowed for X-Spine to make additional term loans with ROS and Royalty Opportunities in an aggregate amount of up to $ 15,000,000 12,787,094 2,212,906 The twentieth amendment modified the consolidated senior leverage ratio financial covenant of the Credit Facility by moving the commencement date of the covenant from the most recent four fiscal quarters ended December 31, 2017, to the most recent four fiscal quarters ended March 31, 2018. The twentieth amendment waived any non-compliance with the covenant set forth in Section 7.1(b) of the Credit Facility with respect to the timely filing of the Company’s quarterly report on Form 10-Q for the quarterly period ended September 30, 2017. Effective November 14, 2017, Bacterin, the Company, X-Spine, Xtant Medical, ROS and Royalty Opportunities, entered into a Waiver to Amended and Restated Credit Agreement, which waived any non-compliance with the minimum revenue base covenant for the quarter ending September 30, 2017. The twenty-first amendment modified the minimum liquidity financial covenant of the Credit Facility by allowing the Company and its subsidiaries to maintain a liquidity amount of not less than $ 100,000 5,000,000 Revolving Credit Line 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 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 On May 12, 2017, we paid off all obligations under the LSA with funds from the Credit Facility and terminated the LSA with Silicon Valley Bank. December 31, December 31, Loan payable to ROS Acquisition Offshore (See details above) $ 55,787,094 $ 43,000,000 PIK Interest payable to ROS 11,582,306 7,648,776 6% convertible senior unsecured notes due 2021 (See details above) 71,865,311 70,238,166 Gross long-term debt 139,234,711 120,886,942 Less: capitalized debt issuance costs (1,272,229) (1,665,508) Long-term debt, less issuance costs $ 137,962,482 $ 119,221,434 2018 $ - 2019 - 2020 67,369,400 2021 71,865,311 2022 - Thereafter - Total $ 139,234,711

Stock-Based Compensation

Stock-Based Compensation	12 Months Ended
	Dec. 31, 2017
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Stock-Based Compensation	(7) 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 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. 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. 158,333 64,000 Stock compensation expense recognized in the statement of operations for the year ended December 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 or exercised in 2017 or 2016. 2017 2016 Weighted Weighted Weighted Average Weighted Average Average Value at Average Value at Shares Price Date Shares Price Date Outstanding at January 1 100,492 $ 62.52 $ 33.84 55,340 $ 127.64 $ 63.84 Granted - - - 59,040 19.44 14.04 Cancelled or expired (33,027) 45.13 30.74 (13,888) 138.48 68.64 Outstanding at December 31 67,465 $ 71.03 $ 36.85 100,492 $ 62.52 $ 33.84 Exercisable at December 31 32,750 $ 128.39 $ 62.23 31,258 $ 141.96 $ 68.76 The aggregate intrinsic value of options outstanding as of December 31, 2017 was zero because the closing price of the stock at year end was less than the strike price of all options outstanding. As of December 31, 2017, there were 34,714 22.92 224,000 From time to time we may grant stock options and restricted stock unit grants to directors and consultants. We account for consultant stock options in accordance with ASC 505-50. Consulting expense for the grant of stock options to consultants is determined based on the estimated fair value of the stock options at the measurement date as defined in ASC 505-50 and is recognized over the vesting period. The Company recognized restricted stock unit expense for the year ended December 31, 2017 and 2016 of $ 84,697 266,721 Total option activity expense recognized in 2017 was $ 127,112 221,261 211,809 487,982 On July 25, 2017, the Company granted 25,974 9.24 On October 6, 2016, we issued an option to purchase 25,000 13.32 On July 5, 2016, the Company granted 6,700 23.88 160,000 52,000 On July 5, 2016, the Company granted 4,950 23.88 32,444 10,000

Warrants

Warrants	12 Months Ended
	Dec. 31, 2017
Warrants and Rights Note Disclosure [Abstract]
Warrants	(8) Warrants Weighted Common Average Stock Exercise Warrants Price Outstanding as of January 1, 2016 106,547 $ 101.40 Issued 421,278 10.80 Expired (3,548) 380.76 Outstanding at January 1, 2017 524,277 $ 26.76 Expired (4,360) 135.36 Outstanding at December 31, 2017 519,917 $ 25.68 We utilize a lattice model to determine the fair market value of the warrants accounted for as liabilities. The valuation model accommodates the probability of exercise price adjustment features as outlined in the warrant agreements. We recorded an unrealized gain of $ 202,519 Year Ended December 31, 2017 2016 Value of underlying common stock (per share) $ 6.84 $ 6.60 Risk free interest rate 2.12 % 1.93 % Expected term 4.6 years 5.6 years Volatility 92 % 84 % Dividend yield 0 % 0 % 2017 2016 Balance at January 1 1,125,119 1,125,119 Derivative warrants issued - - Derivative warrants exercised - - Expired - - Balance at December 31 1,125,119 1,125,119

Commitments and Contingencies

Commitments and Contingencies	12 Months Ended
	Dec. 31, 2017
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	(9) 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 we have the right of first refusal on any sale. 2018 $ 806,747 2019 668,807 2020 396,263 2021 375,289 2022 354,003 Thereafter 684,413 Total $ 3,285,522 Rent expense was $ 795,321 845,845 Capital Leases 2018 $ 522,869 2019 462,544 2020 181,714 2021 - 2022 - Thereafter - Total minimum lease payments 1,167,127 Less amount representing interest (178,354) Present value of obligations under capital leases 988,773 Less current portion (365,476) Long-term capital lease obligations $ 623,297 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 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. Litigation On August 10, 2017, a civil suit complaint was filed against Xtant in the United States District Court, District of Nevada by Axis Spine NV, LLC (“Axis”), Case No. 2:17-CV-02147-APG-VCF. The complaint alleges breach of contract, breach of the implied covenant of good faith and fair dealing, and tortious interference with prospective economic advantage with respect to an alleged medical device distribution relationship between the parties. Specifically, Axis alleges that Xtant owes payments to Axis for its medical device distributions. Axis seeks relief in the form of damages in an amount in excess of $ 972,283 1,342,049

Income Taxes

Income Taxes	12 Months Ended
	Dec. 31, 2017
Income Tax Disclosure [Abstract]
Income Taxes	(10) Income Taxes The Company’s provision for income taxes differs from applying the statutory U.S. Federal income tax rate to income before taxes. The primary difference results from providing for state income taxes and from deducting certain expenses for financial statement purposes but not for federal income tax purposes. Year Ended December 31, 2017 2016 United States $ (52,411,262) $ (19,443,552) Total $ (52,411,262) $ (19,443,552) Year Ended December 31, 2017 2016 Current: Federal $ - $ - State - 50,362 Total current - 50,362 Deferred: Federal - - State - - Total deferred - - Total Provision for Income Taxes $ - $ 50,362 35 Year Ended December 31, 2017 2016 Statutory Federal tax rate $ (18,314,681) $ (6,822,743) Valuation allowance 6,390,359 3,133,196 State income taxes, net of Federal benefit (2,817,493) (721,362) Change in state income tax rate 755,459 267,836 Change in warrant derivative liability (70,882) (277,381) Stock compensation adjustment and other reconciling items (189,834) 2,470,052 Tax Cuts and Jobs Act 11,771,772 - Nondeductible interest 1,472,784 1,915,018 Restructuring expenses 950,857 - Other - (1,038) Nondeductible meals and entertainment expense 51,659 86,784 Total Provision for Income Taxes $ - $ 50,362 Deferred tax components are as follows: At December 31, 2017 2016 Deferred tax assets: Accrued liability for vacation $ 81,076 $ 132,646 Accrued commissions and bonuses / compensation 59,722 43,538 Accrued contingencies 68,344 135,452 Bad debt reserve 579,844 639,868 Charitable contributions carryforward 7,656 10,673 Inventory reserve 2,075,107 1,760,691 Net operating loss carryovers 23,173,536 27,863,368 Stock warrants - 132,543 Stock option compensation 559,868 899,990 Other 42,266 57,435 Total deferred tax assets 26,647,419 31,676,204 Valuation allowance (22,588,729) (16,198,372) Total net deferred tax assets 4,058,690 15,477,832 Deferred tax liabilities: Depreciation (703,666) (2,046,350) Amortization (3,355,024) (13,431,482) Total deferred tax liabilities (4,058,690) (15,477,832) Net deferred tax assets $ - $ - The ultimate realization of deferred tax assets is dependent upon the existence, or generation, of taxable income in the periods when those temporary differences and net operating loss carryovers are deductible. Management considers the scheduled reversal of deferred tax liabilities, taxes paid in carryover years, projected future taxable income, available tax planning strategies, and other factors in making this assessment. Based on available evidence, management does not believe it is more likely than not that all of the deferred tax assets will be realized. Accordingly, the Company has established a valuation allowance equal to the net realizable deferred tax assets. The valuation allowance increased by $ 6,390,357 3,133,196 At December 31, 2017 and 2016, the Company had total domestic Federal and state net operating loss carryovers of approximately $ 164,847,000 136,630,000 Under the Tax Reform Act of 1986, as amended, the amounts of and benefits from net operating loss carryovers and research and development credits may be impaired or limited in certain circumstances. Events which cause limitations in the amount of net operating losses that the Company may utilize in any one year include, but are not limited to, a cumulative ownership change of more than 50%, as defined, over a three-year period. In March 2016, the FASB issued ASU No. 2016-09, Improvements to Employee Share-Based Payment Accounting On December 22, 2017, the Tax Cuts and Jobs Act (the “Act”) was signed into legislation. At December 31, 2017, the Company has not yet completed its accounting assessment for the tax effects of the enactment of the Act; however, as described below, the Company has made a reasonable estimate of the effects on the existing deferred tax balances. As a result of the lower enacted corporate tax rate, the Company has remeasured certain deferred tax assets and liabilities based on the rates at which they are expected to reverse in the future, which is generally 21%. The provisional amount recorded related to the remeasurement of the Company’s deferred tax balance was $11.8 million, that is fully offset by a corresponding decrease to the valuation allowance. On December 22, 2017, Staff Accounting Bulletin No. 118 (“SAB 118”) was issued to address the application of U.S. GAAP in situations when a registrant does not have the necessary information available, prepared, or analyzed (including computations) in reasonable detail to complete the accounting for certain income tax effects of the Act. In accordance with SAB 118, the Company has provisionally determined that there is no tax deferred tax benefit or expense with respect to the remeasurement of certain deferred tax assets and liabilities due to the full valuation allowance against net deferred tax assets. The Company is still analyzing certain aspects of the Act and refining its calculations, which could potentially affect the measurement of these balances or potentially give rise to new deferred tax amounts. Additional analysis of the law and the impact to the Company will be performed and any impact will be recorded in the respective quarter in 2018. The 2014 through 2016 tax years remain open to examination by the Internal Revenue Service and various other state tax agencies. These taxing authorities have the authority to examine those tax years until the applicable statute of limitations expire. The Company did not recognize any material interest or penalties related to income taxes for the years ended December 31, 2017 and 2016.

Equity

Equity	12 Months Ended
	Dec. 31, 2017
Equity [Abstract]
Equity	(11) Equity We entered into the Purchase Agreement on March 16, 2015, as amended and restated on April 17, 2015, with Aspire Capital, which provided that, upon the terms and subject to the conditions and limitations set forth therein. In 2016, we issued 12,500 shares of our common stock to Aspire Capital for $300,000 in aggregate proceeds. The Purchase Agreement has expired with no further purchases in 2017. Related to the acquisition, on October 8, 2015 the Company granted 6,542 restricted stock units to five X-spine employees at $38.28 a share for a total cost of $250,447 to be expensed ratably over twelve months in Acquisition and integration related expenses from the acquisition date. Effective October 6, 2016, our board of directors appointed Carl O’Connell to serve as the President of the Company. In connection with the hiring of Mr. O’Connell, we issued him an option to purchase 25,000 shares of our common stock at $13.32 per share which start vesting 5,000 shares on October 6, 2017 and then vest 1,250 shares per quarter on January 6, 2018 until October 6, 2021. On October 31, 2016, 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”). The offering of units pursuant to the subscription rights is referred to as the “Rights Offering.” 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% of the Company’s Common Stock could elect to receive, in lieu of shares of Common Stock in excess of that threshold, pre-funded warrants to purchase the same number of shares of Common Stock for $0.12 (“Pre-Funded Warrants”), and the subscription price per unit consisting of a Pre-Funded Warrant in lieu of a share of Common Stock was reduced by the $0.12 exercise price but no Pre-Funded Warrants were sold. The Rights Offering closed on November 14, 2016. The units were priced at $9.00 per unit with gross proceeds from the Rights Offering of approximately $3.8 million and the net proceeds from the Rights Offering of approximately $2.5 million after deducting fees and expenses payable, and after deducting other expenses payable by us and excluding any proceeds received upon exercise of any Tradeable Warrants issued in the offering. The Tradeable Warrants are exercisable for a period of five years for one share of Common Stock at an exercise price of $10.80 per share. The Tradeable Warrants associated with the equity raised was subject to an analysis that resulted in the Tradeable Warrants being recorded as equity with the Common Stock in stockholder’s equity. 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 $27.00 for each of 10 consecutive trading days. In connection with the Rights Offering, the Company paid to Maxim a cash fee equal to 7% of the gross proceeds received by us directly from exercises of Subscription Rights. We also reimbursed Maxim $75,000 for expenses incurred in connection with the Rights Offering.

Employee Benefit Plans

Employee Benefit Plans	12 Months Ended
	Dec. 31, 2017
Retirement Benefits [Abstract]
Employee Benefit Plans	(12) Employee Benefit Plans Discretionary Match: 3 Contribution Limit: $18,000 or the statutorily prescribed limit Enrollment Period: Begins at time of employment

Supplemental Disclosure of Cash

Supplemental Disclosure of Cash Flow Information	12 Months Ended
	Dec. 31, 2017
Supplemental Cash Flow Elements [Abstract]
Supplemental Disclosure of Cash Flow Information	(13) Supplemental Disclosure of Cash Flow Information Year Ended December 31, 2017 2016 Cash paid during the period for: Interest $ 627,213 $ 5,477,965 Non-cash activities: Issuance of capital leases $ 173,227 $ 1,178,660 Issuance of shares associated with legal settlement $ - $ 225,000 Interest converted into common stock $ 480,000 $ -

Related Party Transactions

Related Party Transactions	12 Months Ended
	Dec. 31, 2017
Related Party Transactions [Abstract]
Related Party Transactions	(14) Related Party Transactions As discussed in Note 16 below, the Company entered into the Restructuring Agreement with the Holders. Other than as described above with respect to (i) ROS and OrbiMed and (ii) PWPI and PWIMF, the Holders do not constitute a “group” as such term is defined in Section 13(d) of the Exchange Act. Furthermore, as discussed in Note 16 below, the Company entered into the Support Agreement with the Holders, the Company’s executive officers and directors and certain of the Company’s stockholders. Certain of X-spine’s former shareholders, who own over 10 10 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	12 Months Ended
	Dec. 31, 2017
Segment Reporting [Abstract]
Segment and Geographic Information	(15) 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 97% and 95% of sales were in the United States, respectively, for the years ended December 31, 2017 and 2016. Year Ended 2017 2016 United States $ 79,738,169 $ 85,618,087 Rest of World 2,873,932 4,384,649 Total $ 82,612,101 $ 90,002,736

Subsequent Events

Subsequent Events	12 Months Ended
	Dec. 31, 2017
Subsequent Events [Abstract]
Subsequent Events	(16) Subsequent Events Restructuring Agreement On January 11, 2018, we entered into a Restructuring and Exchange Agreement (the “Restructuring Agreement”) with the Holders. The Restructuring Agreement set forth several obligations and approvals that we needed to complete in order to close the Restructuring Agreement and the transaction contemplated thereby (the “Restructuring”), which are described throughout this Note 16. Under the Restructuring Agreement, we agreed to several standard representations, warranties and covenants. Further, we agreed to indemnify certain of our officers and representatives and certain affiliates and representatives of the Holders for all damages arising from any losses based upon any act related to us, the Restructuring, the Restructuring Agreement or any related documents. Pursuant to the Restructuring Agreement, and following the execution of the Sixth Amendment to the 2017 Notes, described below, on January 17, 2018, ROS and Royalty Opportunities converted the 2017 Notes, plus accrued and unpaid interest, at the $ 9.11 189,645 121,045 68,600 In connection with the Restructuring Agreement, we also set a special meeting of the stockholders (the “Special Meeting”), to approve certain items related to the Restructuring Agreement and the Restructuring. We held the Special Meeting on February 13, 2018, and at such meeting our stockholders approved all three proposals related to the Restructuring, which were as follows: ⋅ Approval of the issuance of shares of common stock for purposes of Sections 713(a) and 713(b) of the NYSE American Company Guide. ⋅ Approval of an amendment to our certificate of incorporation (“Charter”) to affect a Reverse Stock Split (defined below), to change the number of authorized shares of common stock and preferred stock available for issuance and to make such other changes as are described below. ⋅ Approval of John Bakewell, Michael Eggenberg, Michael Mainelli, Robert McNamara, Jeffrey Peters and Matthew Rizzo as the new directors to the Board to serve until the 2018 Annual Meeting of Stockholders and until they or respective successors have been duly elected and qualified. After giving effect to the Reverse Stock Split and upon approval of the stockholders at the Special Meeting, on February 14, 2018, the remaining $ 70.238 6.00 138.8889 1,000 7.20 10,401,309 Holder Common Stock issued in Notes Exchange ROS 5,126,534 Royalty Opportunities 2,905,396 Bruce Fund 296,172 PWPI 153,828 PWIMF 1,104,905 Telemetry 814,474 Upon the completion of the Notes Exchange, all outstanding obligations under the Remaining Notes were satisfied in full and the Indenture and the 2016 Notes were discharged. Support Agreement On January 11, 2018, the Holders, our executive officers and directors and certain of our stockholders (collectively the “Support Equityholders”), entered into a support agreement (the “Support Agreement”) simultaneously with the execution of the Restructuring Agreement. Under the Support Agreement, the Support Equityholders agreed to vote their shares of common stock in favor of the approval of: (i) the amendment to our Charter and the issuance of common stock pursuant to the Notes Exchange, (ii) any proposal to adjourn or postpone the meeting to a later date, if there were not sufficient votes for the approval of the such proposals on the date on which such meeting is held, and (iii) any other proposal included in the proxy statement for the Special Meeting that relates to the consummation of the Restructuring that the Board recommended our stockholders approve. The Support Equityholders also appointed ROS and Royalty Opportunities as attorney-in-fact and proxy to vote all applicable shares of the Support Equityholders consistent with the provisions of the Support Agreement. The Support Equityholders made standard representations and warranties related to their ownership of common stock. Sixth Amendment to the 2017 Notes Effective January 17, 2018, we entered into the Sixth Amendment with ROS and Royalty Opportunities, which amended the 2017 Notes. The amendment amended the 2017 Notes by removing the limitations on stock ownership that prevented ROS, Royalty Opportunities or any of their affiliates from effecting a conversion of the 2017 Notes if such conversion would result in the holder or any of its affiliates beneficially owning in excess of 9.99 Twenty-Second Amendment to Amended and Restated Credit Agreement Effective January 30, 2018, Bacterin, the Company, X-Spine, Xtant Medical, ROS and Royalty Opportunities, entered into the Twenty-Second Amendment to Amended and Restated Credit Agreement, which amended the Credit Facility. The amendment further deferred Bacterin’s accrued interest payment date for the fiscal quarters ended on December 31, 2016, March 31, 2017, June 30, 2017, September 30, 2017 and December 31, 2017 until February 28, 2018. The interest due on February 28, 2018 for the fiscal quarter ended on December 31, 2016, is $ 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 (as defined in the Credit Facility) 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% 1,303,935 interest accrued on such interest from July 1, 2017 until paid at a rate equal to 14% plus the higher of the LIBO Rate for the fiscal quarter ended on June 30, 2017, or 1% 1,482,406 interest accrued on such interest from October 2, 2017 until paid at a rate equal to 14% plus the higher of the LIBO Rate for the fiscal quarter ended on September 30, 2017, or 1% 1,521,262 interest accrued on such interest from January 2, 2018 until paid at a rate equal to 14% plus the higher of the LIBO Rate for the fiscal quarter ended on December 31, 2017, or 1%. The amendment also modified the minimum liquidity financial covenant of the Credit Facility by allowing the Company and its subsidiaries to maintain a liquidity amount of not less than $ 100,000 5,000,000 Amendment Number 6 to Indenture Effective January 30, 2018, we entered into the Amendment Number 6 to Indenture with Wilmington Trust, National Association, which amended the Indenture. The amendment amended the Indenture by moving the payment date of interest accrued on the Notes issued under the Indenture as follows: (a) for interest accrued on the such Notes that was originally required to be paid on July 15, 2017, from January 31, 2018 to February 28, 2018, and (b) for interest accrued on the such Notes that is required to be paid on January 15, 2018, from January 31, 2018 to February 28, 2018. The Indenture Amendment also set the record dates for the February 28, 2018 interest payments at June 30, 2017 and December 31, 2017, respectively, and waived any event of default that may have occurred as a result of the non-payment of interest on July 15, 2017 or January 15, 2018. The interest payments due on February 28, 2018 includes interest accrued on such interest from July 15, 2017 and January 15, 2018, respectively, to the date of payment thereof at a rate equal to 6.00 Sixth Amendment and Waiver to the 2016 Notes Effective January 30, 2018, we entered into the Sixth Amendment and Waiver with ROS and Royalty Opportunities, which amended the 2016 Notes. The amendment amended the 2016 Notes by moving the payment date of interest accrued on the 2016 Notes as follows: (a) for interest accrued on the 2016 Notes that was originally required to be paid on July 15, 2017, from January 31, 2018 to February 28, 2018, and (b) for interest accrued on the 2016 Notes that is required to be paid on January 15, 2018, from January 31, 2018 to February 28, 2018. The amendment also waived any event of default that may have occurred as a result of the non-payment of interest on July 15, 2017 or January 15, 2018. The interest payment due on February 28, 2018 includes interest accrued on such interest from July 15, 2017 and January 15, 2018, respectively, to the date of payment thereof at a rate equal to 6.00% per annum plus 100 basis points. Amended and Restated Certificate of Incorporation On February 13, 2018, following the Special Meeting, we filed with the Secretary of State of the State of Delaware a Certificate of Amendment to our Charter (the “Certificate Amendment”) to affect the Reverse Stock Split. The Certificate Amendment amended and restated our Charter, to, among other things: ⋅ effect a reverse stock split at a ratio of 1-for-12 (the “Reverse Stock Split”); ⋅ after giving effect to the Reverse Stock Split, decrease the number of authorized shares of common stock available for issuance from 95,000,000 50,000,000 5,000,000 10,000,000 ⋅ authorize the Board to increase or decrease the number of shares of any series of our capital stock, provided that such increase or decrease does not exceed the number of authorized shares or be less than the number of shares then outstanding; ⋅ authorize the Board to issue new series of preferred stock without approval of the holders of common stock or other series of preferred stock, with such powers, preferences and rights as may be determined by the Board; ⋅ authorize a majority of the Board to fix the number of our directors; ⋅ indemnify the members of the Board to the fullest extent permitted by law; ⋅ remove the classification of the Board to require all directors to be elected annually; ⋅ provide that special meetings of our stockholders may only be called by the Board, the chairman of the Board or our chief executive officer; ⋅ provide that no stockholder will be permitted to cumulative voting at any election of directors; ⋅ elect not to be governed by Section 203 of the Delaware General Corporation Law (the “DGCL”); ⋅ elect the Court of Chancery of the State of Delaware to be the exclusive forum for any derivative action or proceeding brought on our behalf, any action asserting a breach of a fiduciary duty owed by any of our directors, officers or other employees, any action under the DGCL, our Charter or bylaws or any actions governed by the internal affairs doctrine; and ⋅ require the vote of at least two-thirds of the voting power of the then outstanding shares of our capital stock to amend or repeal certain provisions of our Charter. The Reverse Stock Split became effective as of 5:00 p.m. Eastern Time on February 13, 2018, and our common stock began trading on a split-adjusted basis when the market opened on February 14, 2018. Upon the effectiveness of the Reverse Stock Split, every 12 shares of our issued and outstanding common stock automatically converted into one share of common stock, without any change in the par value per share. In addition, a proportionate adjustment was made to the per share exercise price and the number of shares issuable upon the exercise of all of our outstanding convertible securities to purchase shares of common stock and the number of shares reserved for issuance pursuant to our equity incentive compensation plan. Any fraction of a share of common stock that would otherwise have resulted from the Reverse Stock Split was rounded down to the nearest whole share. Twenty-Third Amendment to Amended and Restated Credit Agreement Effective February 14, 2018, Bacterin, the Company, X-Spine, Xtant Medical, ROS and Royalty Opportunities, entered into the Twenty-Third Amendment to Amended and Restated Credit Agreement, which amended the Credit Facility. As of this Amendment, the interest payable has been carried forward at the modified interest rate options within the Credit Facility as follows: (a) through December 31, 2018, we will have the option at our sole discretion (i) to pay PIK Interest at LIBOR (as defined in the Credit Facility) plus 12 10 15 10 10 1 The amendment also made the following modifications to the financial covenants of the Credit Facility: ⋅ The minimum revenue base covenant was removed in its entirety. ⋅ The minimum liquidity financial covenant of the Credit Facility was revised to allow the Company and its subsidiaries to maintain a liquidity amount of not less than $ 500,000 ⋅ The maximum consolidated senior leverage ratio covenant was modified as follows: Four Fiscal Quarters Ended Consolidated Senior Leverage Ratio June 30, 2019 10.00:1.00 September 30, 2019 10.00:1.00 December 31, 2019 8.00:1.00 March 31, 2020 7.00:1.00 June 30, 2020 7.00:1.00 ⋅ A new minimum Consolidated EDITDA covenant was added as follows: Testing Period Minimum Consolidated EBITDA Three quarter period ended September 30, 2018 $2.2 million Four quarter period ended December 31, 2018 $4.0 million Four quarter period ended March 31, 2019 $5.5 million Four quarter period ended June 30, 2019 $7.0 million Four quarter period ended September 30, 2019 $8.5 million Four quarter period ended December 31, 2019 $10 million Four quarter period ended March 31, 2020 The greater of (a) $10 million or (b) 75% of projected Adjusted EBITDA for such period pursuant to projections, based on good faith estimates and assumptions believed to be reasonable at the time made, delivered to ROS no later than December 31, 2019 Four quarter period ended June 30, 2020 The greater of (a) $10 million or (b) 75% of projected Adjusted EBITDA for such period pursuant to projections, based on good faith estimates and assumptions believed to be reasonable at the time made, delivered to ROS no later than December 31, 2019 Private Placement SPA On February 14, 2018, we entered into a Securities Purchase Agreement (the “Private Placement SPA”) with ROS and Royalty Opportunities. Pursuant to the Private Placement SPA, on February 14, 2018, ROS and Royalty Opportunities purchased from us a total of 945,819 7.20 6,809,896 603,687 342,132 Investor Rights Agreement Effective February 14, 2018, we entered into an Investor Rights Agreement (the “Investor Rights Agreement”) with Royalty Opportunities, ROS, PWPI, and PWIMF. Under the Investor Rights Agreement, ROS and Royalty Opportunities are permitted to nominate a majority of our directors and designate the chairperson of the Board at subsequent annual meetings, as long as they maintain an ownership threshold in the Company of at least 40 For so long as the Ownership Threshold is met, we must obtain the approval of ROS and Royalty Opportunities to proceed with the following actions: (i) issue new securities; (ii) incur over $250,000 of debt in a fiscal year; (iii) sell or transfer over $250,000 of our assets or businesses or our subsidiaries in a fiscal year; (iv) acquire over $250,000 of assets or properties in a fiscal year; (v) make capital expenditures over $125,000 individually, or $1,500,000 in the aggregate during a fiscal year; (vi) approve our annual budget; (vii) hire or terminate our chief executive officer; (viii) appoint or remove the chairperson of the Board; and (ix) make, loans to, investments in, or purchase, or permit any subsidiary to purchase, any stock or other securities in another entity in excess of $250,000 in a fiscal year. As long as the Ownership Threshold is met, we may not increase the size of the Board beyond seven directors without the approval of a majority of the directors nominated by ROS and Royalty Opportunities. The Investor Rights Agreement Grants Royalty Opportunities, ROS, PWPI and PWIMF the right to purchase from us a pro rata amount of any new securities that we may propose to issue and sell. The Investor Rights Agreement may be terminated (a) upon the mutual written agreement of all the parties, (b) upon written notice of the Company, ROS or Royalty Opportunities, if ROS and Royalty Opportunities’ ownership percentage of our then outstanding common stock is less than 10%, or (c) upon written notice of ROS and Royalty Opportunities. Registration Rights Agreement Effective February 14, 2018, we entered into a Registration Rights Agreement (the “Registration Rights Agreement”) with the Holders. The Registration Rights Agreement requires us to, among other things, file with the SEC a shelf registration statement (which, initially, will be on Form S-1 and, as soon as we are eligible, will be on Form S-3) covering the resale, from time to time, of our common stock issued: (i) under the Tier 1 Transaction, (ii) upon the Notes Exchange, or (iii) under the Private Placement SPA, within 90 days of the date of the Registration Rights Agreement. We agree to use our best efforts to cause the shelf registration statement to become effective under the Securities Act no later than the 180th day after such demand; provided, that if the SEC notifies us that it will not review or has no comments to such initial registration statement within 110 days after the date of the Registration Rights Agreement, we will use our best efforts to cause such registration statement to become effective under the Securities Act no later than the 120th day after the date of the Registration Rights Agreement. Second Amended and Restated Bylaws On February 14, 2018, we amended and restated our current bylaws by adopting the Second Amended and Restated Bylaws of the Company (the “Amended Bylaws”). The Amended Bylaws amended our existing bylaws to, among other things: ⋅ provide for annual and special meetings of stockholders to be held through remote communications; ⋅ provide for the election of any directors not elected at an annual meeting of stockholders to be elected at a special meeting of stockholders; ⋅ declassify the Board into one group of directors that will hold office until the subsequent annual meeting of stockholders and until the election and qualification of such directors’ respective successors; ⋅ provide for the filling of a new directorship or director vacancy by the affirmative vote of the holders of a majority of the voting power of our shares of stock; ⋅ allow for a majority of the Board present to adjourn a Board meeting if a quorum is not met; ⋅ unless otherwise restricted in the Amended Bylaws or our Charter, provide the Board with the authority to fix the compensation of directors, including without limitation, compensation for services as members of Board committees; ⋅ allow us to enter into an agreement with a stockholder to restrict the transfer of shares held by such stockholder in any manner not prohibited by the DGCL); ⋅ allow the Board to declare dividends on our capital stock, subject to any provisions of our Charter and applicable law; ⋅ allow us to maintain insurance on behalf of any of our directors or officers; and ⋅ allow us to provide electronic notice to our stockholders, if consented to by such stockholder in accordance with Section 232 of the DGCL. Compliance with NYSE American Continued Listing Standards On February 15, 2018, we filed a Current Report on Form 8-K with the SEC to disclose our unaudited pro forma stockholders’ equity of approximately $ 47,362,434

Business Description and Summ23

Business Description and Summary of Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2017
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Business Description	Business Description The accompanying consolidated financial statements include the accounts of Xtant Medical Holdings, Inc., 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 Medical Inc., Bacterin and X-spine are jointly referred to herein as “Xtant” or the “Company”). All intercompany balances and transactions have been eliminated in consolidation. 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. 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.
Reverse Stock Split	Reverse Stock Split The Company completed a 1:12 reverse split of its common stock, effective at the open of business on Wednesday, February 14, 2018. The reverse stock split was approved by the Company’s shareholders at the Special Meeting of Shareholders on February 13, 2018. All references to common shares, stock option, restricted stock units, warrants, and per share amounts have been retroactively adjusted to reflect the reverse stock split for all periods presented.
Concentrations and Credit Risk	Concentrations and Credit Risk The Company’s accounts receivables are 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 in the fiscal years 2017 or 2016. The Company provides for uncollectible amounts when specific credit issues arise. Management believes that all significant credit risks have been identified at December 31, 2017. In the years ended December 31, 2017 and 2016, Xtant purchased from Norwood Medical less than 10% of its operating products (See Note 14, “Related Party Transactions” below).
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 (including surgical instruments), goodwill, and intangible assets and liabilities; valuation allowances for trade receivables, inventory valuation, 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.
Cash and Cash Equivalents	Cash and Cash Equivalents The Company considers all highly liquid investments purchased with an original maturity date of three months or less to be cash equivalents. Cash equivalents are recorded at cost, which approximates market value. At times the Company maintains deposits in financial institutions in excess of federally insured limits.
Trade Accounts Receivable	Trade Accounts Receivable Accounts receivable represents amounts due from customers for which revenue has been recognized. Normal terms on trade accounts receivable are net 30 days and some customers are offered discounts for early pay. The Company performs credit evaluations when considered necessary, but generally does not require collateral to extend credit. The allowance for doubtful accounts is the Company’s best estimate of the amount of probable credit losses in the Company’s existing receivables. The Company determines the allowance based on factors such as historical collection experience, customer’s current creditworthiness, customer concentration, age of accounts receivable balance, general economic conditions that may affect a customer’s ability to pay, and management judgment. Actual customer collections could differ from estimates. Account balances are charged to the allowance after all means of collection have been exhausted and the potential for recovery is considered remote. Provisions to the allowance for doubtful accounts are charged to expense. The Company does not have any off-balance sheet credit exposure related to its customers.
Inventories	Inventories Inventories are stated at the lower of cost or net realizable value. Cost is determined using the specific identification method and includes materials, labor and overhead. The Company calculates an inventory reserve for estimated obsolescence and excess inventory based on historical usage and sales, as well as assumptions about future demand for its products. These estimates for excess and obsolete inventory are reviewed and updated on a quarterly basis. Increases in the inventory reserves result in a corresponding expense, which is recorded to cost of sales. Inventories where the sales cycle is estimated to be beyond twenty-four months at the balance sheet date are classified as Non-current inventories.
Property and Equipment	Property and Equipment Property and equipment are stated at cost less accumulated depreciation. Depreciation is computed using the straight-line method over the estimated useful lives of the assets, generally three to seven years for computers and equipment and five years for surgical instruments. Leasehold improvements are depreciated over the shorter of their estimated useful life or the remaining term of the lease. Repairs and maintenance are expensed as incurred.
Intangible Assets	Intangible Assets Intangible assets with estimable useful lives are amortized over their respective estimated useful lives to their estimated residual values, and reviewed for impairment whenever events or circumstances indicate their carrying amount may not be recoverable. Intangible assets include trademarks and patents and include costs to acquire and protect Company patents. Intangible assets are carried at cost less accumulated amortization. The Company amortizes these assets on a straight-line basis over their estimated useful lives. In 2015 with the acquisition of X-spine, the Company established a fair value for the technology, tradenames and intangible assets which was determined based upon a “relief from royalty” approach. The amortization of these assets is consistent with the valuation method used to establish their fair value which in turn was based on the assets’ future cash flow.
Other Assets	Other Assets Other Assets consist of the short-term and the long-term portion of prepaid expenses and security deposits.
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 the 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. The results from the assessment and a step 1 analysis allowed the Company to conclude that goodwill was not impaired as of December 31, 2017. The Company conducts its impairment test on an annual basis and will review the analysis assumptions on a quarterly basis.
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 the 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 products are expensed as incurred.
Other Expense	Other Expense Other income (expense) primarily consists of non
Net Loss Per Share	Net Loss Per Share Basic net loss per share is computed by dividing net 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 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 years ended December 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 loss per share are not reported as their effects of including 587,382 and 624,769 outstanding stock options and warrants for the years ended December 31, 2017 and 2016, respectively, are anti-dilutive.
Fair Value of Financial Instruments	Fair Value of Financial Instruments The carrying values of financial instruments, including trade accounts receivable, accounts payable, accrued liabilities 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 fair value 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 years ended December 31, 2017 and 2016, there was no reclassification in financial assets or liabilities between Level 1, 2 or 3 categories. Warrant derivative liability As of As of Level 1 - - Level 2 - - Level 3 $ 131,094 $ 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 8, “Warrants” below). Level 3 Changes 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 (202,519 ) Balance at December 31, 2017 $ 131,094 During the year ended December 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 (ASU) 2014-09, Revenue from Contracts with Customers In February 2016, the FASB issued Accounting Standards Update No. 2016-02, Leases (Topic 842) In June 2016, the FASB issued ASU 2016-13 Financial Instruments - Credit losses: Measurement of Credit Losses on Financial Instruments Financial Instruments-Credit Loss In November 2016, the FASB issued ASU 2016-18, Statement of Cash Flow -Restricted Cash

Business Description and Summ24

Business Description and Summary of Significant Accounting Policies (Tables)	12 Months Ended
	Dec. 31, 2017
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Schedule of Assets and Liabilities Measured on Recurring Basis	The following table sets forth by level, within the fair value hierarchy, our liabilities as of December 31, 2017 and 2016 that are measured at fair value on a recurring basis: Warrant derivative liability As of As of Level 1 - - Level 2 - - Level 3 $ 131,094 $ 333,613
Schedule of Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation	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 years ended December 31, 2017 and 2016: 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 (202,519 ) Balance at December 31, 2017 $ 131,094

Inventories (Tables)

Inventories (Tables)	12 Months Ended
	Dec. 31, 2017
Inventory Disclosure [Abstract]
Schedule of Inventories	Inventories consist of the following: December 31, December 31, 2017 2016 Current inventories Raw materials $ 4,276,773 $ 4,833,403 Work in process 1,515,085 1,891,380 Finished goods 23,269,805 23,878,040 Gross current inventories 29,061,663 30,602,823 Reserve for obsolescence (6,833,076) (4,336,366) Current inventories, total 22,228,587 26,266,457 Non-current inventories Finished goods 1,071,956 1,385,017 Reserve for obsolescence (877,895) (413,163) Non-current inventories, total 194,061 971,854 Total inventories $ 22,422,648 $ 27,238,311

Property and Equipment, Net (Ta

Property and Equipment, Net (Tables)	12 Months Ended
	Dec. 31, 2017
Property, Plant and Equipment [Abstract]
Schedule of Property and Equipment, Net	December 31, December 31, 2017 2016 Equipment $ 4,471,198 $ 4,629,754 Computer equipment 489,718 416,233 Computer software 523,526 529,726 Furniture and fixtures 214,770 181,566 Leasehold improvements 4,030,010 4,053,837 Vehicles 10,000 10,000 Surgical instruments 11,461,798 13,876,757 Total cost 21,201,020 23,697,873 Less: accumulated depreciation (11,287,581) (7,857,143) $ 9,913,439 $ 15,840,730

Intangible Assets (Tables)

Intangible Assets (Tables)	12 Months Ended
	Dec. 31, 2017
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Intangible Assets	December 31, December 31, Patents $ 847,436 $ 747,249 Acquisition related intangibles: Technology 13,788,617 28,698,700 Customer relationships 9,911,000 9,911,000 Tradename 1,867,312 4,543,300 Non-compete 40,500 40,500 Accumulated amortization (12,628,492) (7,999,939) Net carrying value $ 13,826,373 $ 35,940,810 Aggregate amortization expense: $ 4,628,558 $ 4,479,010
Schedule of Estimated Amortization Expense for Intangible Assets	2018 $ 2,053,485 2019 2,005,419 2020 1,969,073 2021 1,855,794 2022 1,758,531 Thereafter 4,184,071 Total $ 13,826,373

Accrued Liabilities (Tables)

Accrued Liabilities (Tables)	12 Months Ended
	Dec. 31, 2017
Payables and Accruals [Abstract]
Schedule of Accrued Liabilities	December 31, December 31, 2017 2016 Accrued interest payable $ 10,834,641 $ 3,090,585 Wages/commissions payable 2,830,946 3,330,578 Accrued stock compensation 120,000 213,758 Other accrued liabilities 2,059,834 2,347,266 Accrued Liabilities $ 15,845,421 $ 8,982,187

Debt (Tables)

Debt (Tables)	12 Months Ended
	Dec. 31, 2017
Debt Disclosure [Abstract]
Schedule of Long-term Debt	Long-term debt consists of the following: December 31, December 31, Loan payable to ROS Acquisition Offshore (See details above) $ 55,787,094 $ 43,000,000 PIK Interest payable to ROS 11,582,306 7,648,776 6% convertible senior unsecured notes due 2021 (See details above) 71,865,311 70,238,166 Gross long-term debt 139,234,711 120,886,942 Less: capitalized debt issuance costs (1,272,229) (1,665,508) Long-term debt, less issuance costs $ 137,962,482 $ 119,221,434
Schedule of Maturities of Long-term Debt	The following is a summary of maturities due on the debt as of December 31, 2017: 2018 $ - 2019 - 2020 67,369,400 2021 71,865,311 2022 - Thereafter - Total $ 139,234,711

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	12 Months Ended
	Dec. 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 Weighted Average Weighted Average Average Value at Average Value at Shares Price Date Shares Price Date Outstanding at January 1 100,492 $ 62.52 $ 33.84 55,340 $ 127.64 $ 63.84 Granted - - - 59,040 19.44 14.04 Cancelled or expired (33,027) 45.13 30.74 (13,888) 138.48 68.64 Outstanding at December 31 67,465 $ 71.03 $ 36.85 100,492 $ 62.52 $ 33.84 Exercisable at December 31 32,750 $ 128.39 $ 62.23 31,258 $ 141.96 $ 68.76

Warrants (Tables)

Warrants (Tables)	12 Months Ended
	Dec. 31, 2017
Warrants and Rights Note Disclosure [Abstract]
Schedule of Warrant Activity	The following table summarizes our warrant activities for the period ended December 31, 2017: Weighted Common Average Stock Exercise Warrants Price Outstanding as of January 1, 2016 106,547 $ 101.40 Issued 421,278 10.80 Expired (3,548) 380.76 Outstanding at January 1, 2017 524,277 $ 26.76 Expired (4,360) 135.36 Outstanding at December 31, 2017 519,917 $ 25.68
Schedule of Warrant Valuation Assumptions	The estimated fair value was derived using the lattice model with the following weighted-average assumptions: Year Ended December 31, 2017 2016 Value of underlying common stock (per share) $ 6.84 $ 6.60 Risk free interest rate 2.12 % 1.93 % Expected term 4.6 years 5.6 years Volatility 92 % 84 % 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 years ended December 31, 2017 and 2016: 2017 2016 Balance at January 1 1,125,119 1,125,119 Derivative warrants issued - - Derivative warrants exercised - - Expired - - Balance at December 31 1,125,119 1,125,119

Commitments and Contingencies (

Commitments and Contingencies (Tables)	12 Months Ended
	Dec. 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 December 31, 2017, under these operating leases, are as follows: 2018 $ 806,747 2019 668,807 2020 396,263 2021 375,289 2022 354,003 Thereafter 684,413 Total $ 3,285,522
Schedule of Future Minimum Lease Payments for Capital Leases	Future minimum payments for the next five years and thereafter as of December 31, 2017, under these capital leases, are as follows: 2018 $ 522,869 2019 462,544 2020 181,714 2021 - 2022 - Thereafter - Total minimum lease payments 1,167,127 Less amount representing interest (178,354) Present value of obligations under capital leases 988,773 Less current portion (365,476) Long-term capital lease obligations $ 623,297

Income Taxes (Tables)

Income Taxes (Tables)	12 Months Ended
	Dec. 31, 2017
Income Tax Disclosure [Abstract]
Income Loss Before Provision For Income Taxes	The components of income loss before provision for income taxes consist of the following: Year Ended December 31, 2017 2016 United States $ (52,411,262) $ (19,443,552) Total $ (52,411,262) $ (19,443,552)
Schedule of Components of Income Tax Expense (Benefit)	The components of the income tax provision are as follows: Year Ended December 31, 2017 2016 Current: Federal $ - $ - State - 50,362 Total current - 50,362 Deferred: Federal - - State - - Total deferred - - Total Provision for Income Taxes $ - $ 50,362
Schedule of Effective Income Tax Rate Reconciliation	The reconciliation of income tax attributable to operations computed at the U.S. Federal statutory income tax rate of 35 Year Ended December 31, 2017 2016 Statutory Federal tax rate $ (18,314,681) $ (6,822,743) Valuation allowance 6,390,359 3,133,196 State income taxes, net of Federal benefit (2,817,493) (721,362) Change in state income tax rate 755,459 267,836 Change in warrant derivative liability (70,882) (277,381) Stock compensation adjustment and other reconciling items (189,834) 2,470,052 Tax Cuts and Jobs Act 11,771,772 - Nondeductible interest 1,472,784 1,915,018 Restructuring expenses 950,857 - Other - (1,038) Nondeductible meals and entertainment expense 51,659 86,784 Total Provision for Income Taxes $ - $ 50,362
Schedule of Deferred Tax Assets and Liabilities	Deferred tax components are as follows: At December 31, 2017 2016 Deferred tax assets: Accrued liability for vacation $ 81,076 $ 132,646 Accrued commissions and bonuses / compensation 59,722 43,538 Accrued contingencies 68,344 135,452 Bad debt reserve 579,844 639,868 Charitable contributions carryforward 7,656 10,673 Inventory reserve 2,075,107 1,760,691 Net operating loss carryovers 23,173,536 27,863,368 Stock warrants - 132,543 Stock option compensation 559,868 899,990 Other 42,266 57,435 Total deferred tax assets 26,647,419 31,676,204 Valuation allowance (22,588,729) (16,198,372) Total net deferred tax assets 4,058,690 15,477,832 Deferred tax liabilities: Depreciation (703,666) (2,046,350) Amortization (3,355,024) (13,431,482) Total deferred tax liabilities (4,058,690) (15,477,832) Net deferred tax assets $ - $ -

Employee Benefit Plans (Tables)

Employee Benefit Plans (Tables)	12 Months Ended
	Dec. 31, 2017
Retirement Benefits [Abstract]
Schedule of Defined Benefit Plans Disclosures	The Company combined the previous two plans for Bacterin and X-spine in 2017. Under the combined plan, the employee becomes qualified upon starting employment. Terms for the plan are as follows: Discretionary Match: 3 Contribution Limit: $18,000 or the statutorily prescribed limit Enrollment Period: Begins at time of employment

Supplemental Disclosure of Ca35

Supplemental Disclosure of Cash Flow Information (Tables)	12 Months Ended
	Dec. 31, 2017
Supplemental Cash Flow Elements [Abstract]
Supplemental Disclosure of Cash Flow Information	Supplemental cash flow information is as follows: Year Ended December 31, 2017 2016 Cash paid during the period for: Interest $ 627,213 $ 5,477,965 Non-cash activities: Issuance of capital leases $ 173,227 $ 1,178,660 Issuance of shares associated with legal settlement $ - $ 225,000 Interest converted into common stock $ 480,000 $ -

Segment and Geographic Inform36

Segment and Geographic Information (Tables)	12 Months Ended
	Dec. 31, 2017
Segment Reporting [Abstract]
Schedule of Revenues by Geographic Region	Total revenue by major geographic area is as follows: Year Ended 2017 2016 United States $ 79,738,169 $ 85,618,087 Rest of World 2,873,932 4,384,649 Total $ 82,612,101 $ 90,002,736

Subsequent Events (Tables)

Subsequent Events (Tables)	12 Months Ended
	Dec. 31, 2017
Subsequent Events [Abstract]
Schedule of Debt Conversions [Table Text Block]	This resulted in the issuance of 10,401,309 Holder Common Stock issued in Notes Exchange ROS 5,126,534 Royalty Opportunities 2,905,396 Bruce Fund 296,172 PWPI 153,828 PWIMF 1,104,905 Telemetry 814,474
Debt Instrument, Covenant Description [Table Text Block]	⋅ The maximum consolidated senior leverage ratio covenant was modified as follows: Four Fiscal Quarters Ended Consolidated Senior Leverage Ratio June 30, 2019 10.00:1.00 September 30, 2019 10.00:1.00 December 31, 2019 8.00:1.00 March 31, 2020 7.00:1.00 June 30, 2020 7.00:1.00 ⋅ A new minimum Consolidated EDITDA covenant was added as follows: Testing Period Minimum Consolidated EBITDA Three quarter period ended September 30, 2018 $2.2 million Four quarter period ended December 31, 2018 $4.0 million Four quarter period ended March 31, 2019 $5.5 million Four quarter period ended June 30, 2019 $7.0 million Four quarter period ended September 30, 2019 $8.5 million Four quarter period ended December 31, 2019 $10 million Four quarter period ended March 31, 2020 The greater of (a) $10 million or (b) 75% of projected Adjusted EBITDA for such period pursuant to projections, based on good faith estimates and assumptions believed to be reasonable at the time made, delivered to ROS no later than December 31, 2019 Four quarter period ended June 30, 2020 The greater of (a) $10 million or (b) 75% of projected Adjusted EBITDA for such period pursuant to projections, based on good faith estimates and assumptions believed to be reasonable at the time made, delivered to ROS no later than December 31, 2019

Business Description and Summ38

Business Description and Summary of Significant Accounting Policies (Details) - USD ($)	Dec. 31, 2017	Dec. 31, 2016
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Warrant derivative liability	$ 131,094	$ 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	$ 131,094	$ 333,613

Business Description and Summ39

Business Description and Summary of Significant Accounting Policies (Details 1) - USD ($)	12 Months Ended
	Dec. 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	(202,519)	(716,738)
Balance	$ 131,094	$ 333,613

Business Description and Summ40

Business Description and Summary of Significant Accounting Policies (Details Textual) - shares	12 Months Ended
	Dec. 31, 2017	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	587,382	624,769
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%	10.00%

Inventories (Details)

Inventories (Details) - USD ($)	Dec. 31, 2017	Dec. 31, 2016
Current inventories
Raw materials	$ 4,276,773	$ 4,833,403
Work in process	1,515,085	1,891,380
Finished goods	23,269,805	23,878,040
Gross current inventories	29,061,663	30,602,823
Reserve for obsolescence	(6,833,076)	(4,336,366)
Current inventories, total	22,228,587	26,266,457
Non-current inventories
Finished goods	1,071,956	1,385,017
Reserve for obsolescence	(877,895)	(413,163)
Non-current inventories, total	194,061	971,854
Total inventories	$ 22,422,648	$ 27,238,311

Inventories (Details Textual)

Inventories (Details Textual) - USD ($) $ in Millions	Dec. 31, 2017	Dec. 31, 2016
Consigned Inventory [Member]
Other Inventory, Inventory at off Site Premises, Gross	$ 12	$ 11.2

Property and Equipment, Net (De

Property and Equipment, Net (Details) - USD ($)	Dec. 31, 2017	Dec. 31, 2016
Property, Plant and Equipment [Line Items]
Total cost	$ 21,201,020	$ 23,697,873
Less: accumulated depreciation	(11,287,581)	(7,857,143)
Property and equipment, net	9,913,439	15,840,730
Equipment
Property, Plant and Equipment [Line Items]
Total cost	4,471,198	4,629,754
Computer equipment
Property, Plant and Equipment [Line Items]
Total cost	489,718	416,233
Computer software
Property, Plant and Equipment [Line Items]
Total cost	523,526	529,726
Furniture and fixtures
Property, Plant and Equipment [Line Items]
Total cost	214,770	181,566
Leasehold improvements
Property, Plant and Equipment [Line Items]
Total cost	4,030,010	4,053,837
Vehicles
Property, Plant and Equipment [Line Items]
Total cost	10,000	10,000
Surgical instruments
Property, Plant and Equipment [Line Items]
Total cost	$ 11,461,798	$ 13,876,757

Property and Equipment, Net (44

Property and Equipment, Net (Details Textual) - USD ($)	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Property, Plant and Equipment [Line Items]
Capital Leased Assets, Gross	$ 1,585,366
Capital Leases, Lessee Balance Sheet, Assets by Major Class, Accumulated Depreciation	500,092
Depreciation	$ 3,765,314	$ 2,431,619
Property Plant And Equipment Useful Life	5 years
Property, Plant and Equipment, Net	$ 9,913,439	15,840,730
Impairment of Long-Lived Assets to be Disposed of	1,614,793
Surgical Instruments Property Equipment [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Net	$ 6,600,000	$ 8,200,000

Intangible Assets (Details)

Intangible Assets (Details) - USD ($)	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Finite Lived Intangible Assets Future Amortization Expense [Line Items]
Accumulated amortization	$ (12,628,492)	$ (7,999,939)
Net carrying value	13,826,373	35,940,810
Aggregate amortization expense:	4,628,558	4,479,010
Patents [Member]
Finite Lived Intangible Assets Future Amortization Expense [Line Items]
Gross carrying value	847,436	747,249
Technology [Member]
Finite Lived Intangible Assets Future Amortization Expense [Line Items]
Gross carrying value	13,788,617	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	1,867,312	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 ($)	Dec. 31, 2017	Dec. 31, 2016
Estimated amortization expense:
2,018	$ 2,053,485
2,019	2,005,419
2,020	1,969,073
2,021	1,855,794
2,022	1,758,531
Thereafter	4,184,071
Total	$ 13,826,373	$ 35,940,810

Intangible Assets (Details Text

Intangible Assets (Details Textual)	12 Months Ended
	Dec. 31, 2017USD ($)
Technology-Based Intangible Assets [Member]
Impairment of Intangible Assets (Excluding Goodwill)	$ 14,910,083
Trade Names [Member]
Impairment of Intangible Assets (Excluding Goodwill)	$ 2,675,988

Accrued Liabilities (Details)

Accrued Liabilities (Details) - USD ($)	Dec. 31, 2017	Dec. 31, 2016
Accrued Liabilities [Line Items]
Accrued interest payable	$ 10,834,641	$ 3,090,585
Wages/commissions payable	2,830,946	3,330,578
Accrued stock compensation	120,000	213,758
Other accrued liabilities	2,059,834	2,347,266
Accrued Liabilities	$ 15,845,421	$ 8,982,187

Debt (Details)

Debt (Details) - USD ($)	Dec. 31, 2017	Dec. 31, 2016
Debt Instrument [Line Items]
Loan payable to ROS Acquisition Offshore (See details above)	$ 55,787,094	$ 43,000,000
PIK Interest payable to ROS	11,582,306	7,648,776
6% convertible senior unsecured notes due 2021 (See details above)	71,865,311	70,238,166
Total	139,234,711	120,886,942
Less: capitalized debt issuance costs	(1,272,229)	(1,665,508)
Long-term debt, less issuance costs	$ 137,962,482	$ 119,221,434

Debt (Details 1)

Debt (Details 1) - USD ($)	Dec. 31, 2017	Dec. 31, 2016
Schedule of maturities due on debt [Line Items]
2,018	$ 0
2,019	0
2,020	67,369,400
2,021	71,865,311
2,022	0
Thereafter	0
Total	$ 139,234,711	$ 120,886,942

Debt (Details Textual)

Debt (Details Textual) - USD ($)

Aug. 10, 2015

Jan. 17, 2017

Jul. 31, 2015

Dec. 31, 2017

Sep. 30, 2017

Jun. 30, 2017

Mar. 31, 2017

Dec. 31, 2016

Jan. 15, 2018

Dec. 31, 2017

Feb. 28, 2018

Jan. 31, 2018

Sep. 27, 2016

Aug. 12, 2016

Jul. 29, 2016

May 25, 2016

Apr. 14, 2016

Jan. 17, 2016

Debt Instrument [Line Items]

Debt Instrument, Description of Variable Rate Basis

6.00% per annum plus 100 basis points.

Debt Instrument, Face Amount

$ 65,000,000

Business Combination Conjunction Related Expenses

4,900,000

Payments of Debt Issuance Costs

$ 4,700,000

Interest Payable

$ 11,582,306

$ 7,648,776

$ 11,582,306

Line of Credit Facility, Maximum Borrowing Capacity

15,000,000

15,000,000

Proceeds from Convertible Debt

12,787,094

Line of Credit Facility, Remaining Borrowing Capacity

2,212,906

$ 2,212,906

Indenture Common Stock SPA [Member]

Debt Instrument [Line Items]

Debt Conversion, Converted Instrument, Shares Issued

70,274

Debt Instrument, Convertible, Conversion Price

$ 6.83

Indenture Notes SPA [Member]

Debt Instrument [Line Items]

Debt Instrument, Face Amount

$ 1,560,000

$ 67,145

Debt Instrument, Convertible, Conversion Price

$ 9.11

Debt Instrument, Interest Rate, Stated Percentage

6.00%

Xspine [Member]

Debt Instrument [Line Items]

Debt Instrument, Interest Rate During Period

6.00%

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

9.00%

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%

Seventh Amendement To Restated New Credit Faciltiy [Member] | Fiscal Quarter Ended on March 31, 2017 [Member]

Debt Instrument [Line Items]

Debt Instrument, Description of Variable Rate Basis

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%.

Interest Payable

1,139,597

$ 1,139,597

Seventh Amendement To Restated New Credit Faciltiy [Member] | Fiscal Quarter Ended on June 30, 2017 [Member]

Debt Instrument [Line Items]

Debt Instrument, Description of Variable Rate Basis

plus interest accrued on such interest from July 1, 2017 until paid at a rate equal to 14% plus the higher of the LIBO Rate for the fiscal quarter ended on June 30, 2017, or 1%.

Interest Payable

1,303,935

1,303,935

Seventh Amendement To Restated New Credit Faciltiy [Member] | Fiscal Quarter Ended on December 31, 2016 [Member]

Debt Instrument [Line Items]

Debt Instrument, Description of Variable Rate Basis

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 Credit Facility) for the fiscal quarter ended on December 31, 2016, or 1%.

Interest Payable

1,147,329

1,147,329

Seventh Amendement To Restated New Credit Faciltiy [Member] | Fiscal Quarter Ended on September 31, 2017 [Member]

Debt Instrument [Line Items]

Debt Instrument, Description of Variable Rate Basis

plus interest accrued on such interest from October 2, 2017 until paid at a rate equal to 14% plus the higher of the LIBO Rate for the fiscal quarter ended on September 30, 2017, or 1%.

Interest Payable

$ 1,482,406

1,482,406

Seventh Amendement To Restated New Credit Faciltiy [Member] | Fiscal Quarter Ended on December 31, 2017 [Member]

Debt Instrument [Line Items]

Debt Instrument, Description of Variable Rate Basis

plus interest accrued on such interest from January 2, 2018 until paid at a rate equal to 14% plus the higher of the LIBO Rate for the fiscal quarter ended on December 31, 2017, or 1%.

Interest Payable

$ 1,521,262

$ 1,521,262

Amendment Number 1 To Indenture [Member]

Debt Instrument [Line Items]

Debt Instrument, Description of Variable Rate Basis

6.00% per annum plus 100 basis points.

Twenty First Amendement To Restated New Credit Faciltiy [Member]

Debt Instrument [Line Items]

Line Of Credit Facility Minimum Expected Liquidity

$ 100,000

$ 100,000

Convertible Notes Payable [Member]

Debt Instrument [Line Items]

Debt Instrument, Face Amount

$ 52,000,000

$ 49,000,000

Debt Instrument Purchase Of Additional Notes

$ 3,000,000

Proceeds from Convertible Debt

16,000,000

Term Loan [Member]

Debt Instrument [Line Items]

Line of Credit Facility, Current Borrowing Capacity

$ 42,000,000

Subsequent Event [Member]

Debt Instrument [Line Items]

Line Of Credit Facility Minimum Expected Liquidity

$ 100,000

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

Debt Instrument [Line Items]

Line Of Credit Facility Minimum Expected Liquidity

$ 5,000,000

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

Debt Instrument [Line Items]

Line of Credit Facility, Maximum Borrowing Capacity

$ 6,000,000

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

Debt Instrument [Line Items]

Line of Credit Facility, Maximum Borrowing Capacity

$ 11,000,000

Convertible Senior Unsecured Notes [Member]

Debt Instrument [Line Items]

Debt Instrument, Face Amount

$ 2,238,166

Debt Instrument, Convertible, Conversion Price

$ 34.80

Convertible Senior Unsecured Notes [Member] | Subsequent Event [Member]

Debt Instrument [Line Items]

Debt Instrument, Description of Variable Rate Basis

6.00% per annum plus 100 basis points.

Stock-Based Compensation (Detai

Stock-Based Compensation (Details) - Stock Option - $ / shares	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Schedule of activity under stock option plans [Line Items]
Outstanding at January 1	100,492	55,340
Granted, Shares	0	59,040
Cancelled or expired, Shares	(33,027)	(13,888)
Outstanding at December 31	67,465	100,492
Exercisable at December 31	32,750	31,258
Outstanding at January 1, Weighted Average Exercise Price	$ 62.52	$ 127.64
Granted, Weighted Average Exercise Price	0	19.44
Cancelled or expired, Weighted Average Exercise Price	45.13	138.48
Outstanding at December 31, Weighted Average Exercise Price	71.03	62.52
Exercisable at December 31, Weighted Average Exercise Price	128.39	141.96
Outstanding at January 1, Weighted Average Fair Value At Grant Date	33.84	63.84
Granted, Weighted Average Fair Value At Grant Date	0	14.04
Cancelled or expired, Weighted Average Fair Value At Grant Date	30.74	68.64
Outstanding at December 31, Weighted Average Fair Value At Grant Date	36.85	33.84
Exercisable at December 31, Weighted Average Fair Value At Grant Date	$ 62.23	$ 68.76

Stock-Based Compensation (Det53

Stock-Based Compensation (Details Textual) - USD ($)	Oct. 06, 2016	Jul. 05, 2016	Jul. 25, 2017	Dec. 31, 2017	Dec. 31, 2016
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Shares authorized under the Plan				158,333
Aggregate intrinsic value of options outstanding				64,000
Allocated Share-based Compensation Expense				$ 211,809	$ 487,982
Other Noncash Expense				84,697	266,721
Stock or Unit Option Plan Expense				127,112	221,261
Chief Executive Officer [Member]
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Options granted	25,000
Share Price	$ 13.32
Messrs Lopach, Swanson Deedrick And Buckman [Member]
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Allocated Share-based Compensation Expense		$ 160,000
Share-Based Compensation Arrangement By Share-Based Payment Award, Equity Instruments Other Than Options, Grants In Period		6,700
Share Price		$ 23.88
Other Noncash Expense					52,000
Messrs Mazzocchi And Timko [Member]
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Allocated Share-based Compensation Expense		$ 32,444
Options granted		4,950
Share-Based Compensation Arrangement By Share-Based Payment Award, Options, Exercisable, Weighted Average Exercise Price		$ 23.88
Other Noncash Expense					10,000
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				$ 34,714
Share-Based Compensation Arrangement By Share-Based Payment Award, Options, Exercisable, Weighted Average Exercise Price				$ 22.92
Employee Service Share-based Compensation, Tax Benefit from Compensation Expense				$ 224,000
Restricted Stock [Member]
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Allocated Share-based Compensation Expense				$ 84,697	$ 266,721
Restricted Stock [Member] | Director [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			25,974
Shares Issued, Price Per Share			$ 9.24

Warrants (Details)

Warrants (Details) - $ / shares	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Warrant activity [Line Items]
Outstanding	524,277	106,547
Issued		421,278
Expired	(4,360)	(3,548)
Outstanding	519,917	524,277
Outstanding Weighted Average Exercise Price	$ 26.76	$ 101.4
Issued, Weighted Average Exercise Price		10.8
Expired, Weighted Average Exercise Price	135.36	380.76
Outstanding Weighted Average Exercise Price	$ 25.68	$ 26.76

Warrants (Details 1)

Warrants (Details 1) - Warrant [Member] - $ / shares	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Value of underlying common stock (per share)	$ 6.84	$ 6.6
Risk free interest rate	2.12%	1.93%
Expected term	4 years 7 months 6 days	5 years 7 months 6 days
Volatility	92.00%	84.00%
Dividend yield	0.00%	0.00%

Warrants (Details 2)

Warrants (Details 2) - shares	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Class of Warrant or Right [Line Items]
Outstanding	524,277	106,547
Derivative warrants issued		421,278
Outstanding	519,917	524,277
Warrant [Member]
Class of Warrant or Right [Line Items]
Outstanding	1,125,119	1,125,119
Derivative warrants issued	0	0
Derivative warrants exercised	0	0
Expired	0	0
Outstanding	1,125,119	1,125,119

Warrants (Details Textual)

Warrants (Details Textual)	12 Months Ended
	Dec. 31, 2017USD ($)
Class of Warrant or Right [Line Items]
Unrealized Loss On Warranty Derivative Liability	$ 202,519

Commitments and Contingencies58

Commitments and Contingencies (Details)	Dec. 31, 2017USD ($)
Schedule of future minimum payments by operating lease [Line Items]
2,018	$ 806,747
2,019	668,807
2,020	396,263
2,021	375,289
2,022	354,003
Thereafter	684,413
Total	$ 3,285,522

Commitments and Contingencies59

Commitments and Contingencies (Details 1) - USD ($)	Dec. 31, 2017	Dec. 31, 2016
2,018	$ 522,869
2,019	462,544
2,020	181,714
2,021	0
2,022	0
Thereafter	0
Total minimum lease payments	1,167,127
Less amount representing interest	(178,354)
Present value of obligations under capital leases	988,773
Less current portion	(365,476)	$ (244,847)
Long-term capital lease obligations	$ 623,297	$ 832,152

Commitments and Contingencies60

Commitments and Contingencies (Details Textual) - USD ($)	Aug. 10, 2017	Dec. 31, 2017	Dec. 31, 2016	Sep. 30, 2017
Schedule of commitment and contingencies [Line Items]
Loss Contingency, Damages Sought, Value	$ 972,283
Loss Contingency, Receivable				$ 1,342,049
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		$ 795,321	$ 845,845
Lessee Leasing Arrangements Operating Leases Term Of Each Option To Extend		5 years

Income Taxes (Details)

Income Taxes (Details) - USD ($)	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Income Tax Disclosure [Line Items]
Income (loss) Before Provision for Income Taxes	$ (52,411,262)	$ (19,443,552)
UNITED STATES
Income Tax Disclosure [Line Items]
Income (loss) Before Provision for Income Taxes	$ (52,411,262)	$ (19,443,552)

Income Taxes (Details 1)

Income Taxes (Details 1) - USD ($)	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Current:
Federal	$ 0	$ 0
State	0	50,362
Total current	0	50,362
Deferred:
Federal	0	0
State	0	0
Total deferred	0	0
Total Provision for Income Taxes	$ 0	$ 50,362

Income Taxes (Details 2)

Income Taxes (Details 2) - USD ($)	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Income Tax Disclosure [Line Items]
Statutory Federal tax rate	$ (18,314,681)	$ (6,822,743)
Valuation allowance	6,390,359	3,133,196
State income taxes, net of Federal benefit	(2,817,493)	(721,362)
Change in state income tax rate	755,459	267,836
Change in warrant derivative liability	(70,882)	(277,381)
Stock compensation adjustment and other reconciling items	(189,834)	2,470,052
Tax Cuts and Jobs Act	11,771,772
Nondeductible interest	1,472,784	1,915,018
Restructuring expenses	950,857
Other	0	(1,038)
Nondeductible meals and entertainment expense	51,659	86,784
Total Provision for Income Taxes	$ 0	$ 50,362

Income Taxes (Details 3)

Income Taxes (Details 3) - USD ($)	Dec. 31, 2017	Dec. 31, 2016
Deferred tax assets:
Accrued liability for vacation	$ 81,076	$ 132,646
Accrued commissions and bonuses / compensation	59,722	43,538
Accrued contingencies	68,344	135,452
Bad debt reserve	579,844	639,868
Charitable contributions carryforward	7,656	10,673
Inventory reserve	2,075,107	1,760,691
Net operating loss carryovers	23,173,536	27,863,368
Stock warrants	0	132,543
Stock option compensation	559,868	899,990
Other	42,266	57,435
Total deferred tax assets	26,647,419	31,676,204
Valuation allowance	(22,588,729)	(16,198,372)
Total net deferred tax assets	4,058,690	15,477,832
Deferred tax liabilities:
Depreciation	(703,666)	(2,046,350)
Amortization	(3,355,024)	(13,431,482)
Total deferred tax liabilities	(4,058,690)	(15,477,832)
Net deferred tax assets	$ 0	$ 0

Income Taxes (Details Textual)

Income Taxes (Details Textual) - USD ($)	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Income Tax Disclosure [Line Items]
Valuation Allowance, Deferred Tax Asset, Change in Amount		$ 6,390,357	$ 3,133,196
Operating Loss Carryforwards		$ 164,847,000	$ 136,630,000
Effective Income Tax Rate Reconciliation, at Federal Statutory Income Tax Rate, Percent		35.00%
Operating Loss Carryforwards, Limitations on Use		Events which cause limitations in the amount of net operating losses that the Company may utilize in any one year include, but are not limited to, a cumulative ownership change of more than 50%, as defined, over a three-year period.
Increase (Decrease) in Deferred Income Taxes		$ 11,800,000
Scenario, Plan [Member]
Income Tax Disclosure [Line Items]
Effective Income Tax Rate Reconciliation, at Federal Statutory Income Tax Rate, Percent	21.00%

Equity (Details Textual)

Equity (Details Textual) - USD ($)	Nov. 14, 2016	Oct. 08, 2015	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Schedule of Equity Method Investments [Line Items]
Class of Warrant or Right, Exercise Price of Warrants or Rights	$ 10.80		$ 25.68	$ 26.76	$ 101.4
Stock Issued During Period, Value, New Issues				$ 2,562,462
Share-based Compensation Arrangement by Share-based Payment Award, Award Vesting Rights			In connection with the hiring of Mr. O’Connell, we issued him an option to purchase 25,000 shares of our common stock at $13.32 per share which start vesting 5,000 shares on October 6, 2017 and then vest 1,250 shares per quarter on January 6, 2018 until October 6, 2021.
Equity Method Investment, Ownership Percentage			4.99%
Rights Offering Price Per Unit	$ 9
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
Restricted Stock [Member]
Schedule of Equity Method Investments [Line Items]
Stock issued (in shares)		6,542
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 $27.00 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			$ 0.12
Aspire Capital Fund LLC [Member]
Schedule of Equity Method Investments [Line Items]
Stock issued (in shares)				12,500
Stock Issued During Period, Value, New Issues				$ 300,000
X-Spine [Member] | Restricted Stock [Member]
Schedule of Equity Method Investments [Line Items]
Stock Issued During Period, Price Per Share		$ 38.28
Stock Issued During Period, Value, New Issues		$ 250,447

Employee Benefit Plans (Details

Employee Benefit Plans (Details)	12 Months Ended
	Dec. 31, 2017
Bacterin Employee [Member]
Defined Benefit Plans and Other Postretirement Benefit Plans Table Text Block [Line Items]
Defined Contribution Plan, Maximum Annual Contributions Per Employee, Percent	3.00%
Defined Benefit Plan Contributions Contribution Limit	$18,000 or the statutorily prescribed limit
Defined Benefit Plan Contributions Enrollment Period	Begins at time of employment
X-Spine Employee [Member]
Defined Benefit Plans and Other Postretirement Benefit Plans Table Text Block [Line Items]
Defined Contribution Plan, Maximum Annual Contributions Per Employee, Percent	3.00%
Defined Benefit Plan Contributions Contribution Limit	$18,000 or the statutorily prescribed limit
Defined Benefit Plan Contributions Enrollment Period	Begins at time of employment

Supplemental Disclosure of Ca68

Supplemental Disclosure of Cash Flow Information (Details) - USD ($)	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Cash paid during the period for:
Interest	$ 627,213	$ 5,477,965
Non-cash activities:
Issuance of capital leases	173,227	1,178,660
Issuance of shares associated with legal settlement	0	225,000
Interest converted into common stock	$ 480,000	$ 0

Related Party Transactions (Det

Related Party Transactions (Details Textual) - USD ($)	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Related Party Transaction [Line Items]
Equity Method Investment, Ownership Percentage	4.99%
Due to Related Parties, Current	$ 160,381	$ 640,442
One Vendor [Member] | Sales Revenue, Net [Member]
Related Party Transaction [Line Items]
Concentration Risk, Percentage	10.00%	10.00%
Xspine [Member] | Common Stock [Member]
Related Party Transaction [Line Items]
Equity Method Investment, Ownership Percentage	10.00%

Segment and Geographic Inform70

Segment and Geographic Information (Details) - USD ($)	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016
Revenue, Net, Total	$ 82,612,101	$ 90,002,736
United States [Member]
Revenue, Net, Total	79,738,169	85,618,087
Rest Of World [Member]
Revenue, Net, Total	$ 2,873,932	$ 4,384,649

Subsequent Events (Details)

Subsequent Events (Details) - Subsequent Event [Member]	1 Months Ended
	Feb. 14, 2018shares
ROS [Member]
Debt Conversion, Converted Instrument, Shares Issued	5,126,534
Royalty Opportunities [Member]
Debt Conversion, Converted Instrument, Shares Issued	2,905,396
Bruce Fund [Member]
Debt Conversion, Converted Instrument, Shares Issued	296,172
PWPI [Member]
Debt Conversion, Converted Instrument, Shares Issued	153,828
PWIMF [Member]
Debt Conversion, Converted Instrument, Shares Issued	1,104,905
Telemetry [Member]
Debt Conversion, Converted Instrument, Shares Issued	814,474

Subsequent Events (Details 1)

Subsequent Events (Details 1) - Twenty-Third Amendment to Amended and Restated Credit Agreement [Member] - Scenario, Forecast [Member] - USD ($) $ in Millions	3 Months Ended
	Jun. 30, 2020	Mar. 31, 2020	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018
Debt Instrumen Covenant, Maximum Consolidated Senior Leverage Ratio	7.00:1.00	7.00:1.00	8.00:1.00	10.00:1.00	10.00:1.00
Debt Covenant, Minimum EBIDTA			$ 10	$ 8.5	$ 7	$ 5.5	$ 4	$ 2.2
Debt Covenant, Minimum EBIDTA, Description	The greater of (a) $10 million or (b) 75% of projected Adjusted EBITDA for such period pursuant to projections, based on good faith estimates and assumptions believed to be reasonable at the time made, delivered to ROS no later than December 31, 2019	The greater of (a) $10 million or (b) 75% of projected Adjusted EBITDA for such period pursuant to projections, based on good faith estimates and assumptions believed to be reasonable at the time made, delivered to ROS no later than December 31, 2019

Subsequent Events (Details Text

Subsequent Events (Details Textual)	1 Months Ended						12 Months Ended
	Feb. 28, 2018USD ($)	Feb. 14, 2018USD ($)$ / sharesshares	Feb. 13, 2018shares	Jan. 30, 2018	Jan. 17, 2018$ / sharesshares	Jul. 31, 2015USD ($)	Dec. 31, 2016USD ($)shares	Feb. 15, 2018USD ($)	Dec. 31, 2017USD ($)shares	Dec. 31, 2015USD ($)
Subsequent Event [Line Items]
Debt Instrument, Face Amount						$ 65,000,000
Debt Instrument, Description of Variable Rate Basis						6.00% per annum plus 100 basis points.
Stockholders Equity Attributable to Parent, Total							$ (7,073,297)		$ (58,698,992)	$ 8,876,527
Equity Method Investment, Ownership Percentage									4.99%
Interest Payable							$ 7,648,776		$ 11,582,306
Common Stock, Shares Authorized | shares							50,000,000		50,000,000
Preferred Stock, Shares Authorized | shares							10,000,000		10,000,000
Stock Issued During Period, Value, New Issues							$ 2,562,462
Subsequent Event [Member]
Subsequent Event [Line Items]
Description Regarding Termination of Previously Granted Royalty opportunities		The Investor Rights Agreement may be terminated (a) upon the mutual written agreement of all the parties, (b) upon written notice of the Company, ROS or Royalty Opportunities, if ROS and Royalty Opportunities ownership percentage of our then outstanding common stock is less than 10%, or (c) upon written notice of ROS and Royalty Opportunities.
Description Of Royalty Opportunities		(i) issue new securities; (ii) incur over $250,000 of debt in a fiscal year; (iii) sell or transfer over $250,000 of our assets or businesses or our subsidiaries in a fiscal year; (iv) acquire over $250,000 of assets or properties in a fiscal year; (v) make capital expenditures over $125,000 individually, or $1,500,000 in the aggregate during a fiscal year; (vi) approve our annual budget; (vii) hire or terminate our chief executive officer; (viii) appoint or remove the chairperson of the Board; and (ix) make, loans to, investments in, or purchase, or permit any subsidiary to purchase, any stock or other securities in another entity in excess of $250,000 in a fiscal year.
Stockholders Equity Attributable to Parent, Total								$ 47,362,434
Line Of Credit Facility Minimum Expected Liquidity	$ 100,000
Line Of Credit Facility Minimum Expected Liquidity in Subsequent Years	$ 5,000,000
Stockholders' Equity, Reverse Stock Split			Upon the effectiveness of the Reverse Stock Split, every 12 shares of our issued and outstanding common stock automatically converted into one share of common stock, without any change in the par value per share.
Subsequent Event [Member] | Reverse Stock Split Before [Member]
Subsequent Event [Line Items]
Common Stock, Shares Authorized | shares			95,000,000
Preferred Stock, Shares Authorized | shares			5,000,000
Subsequent Event [Member] | Reverse Stock Split After [Member]
Subsequent Event [Line Items]
Common Stock, Shares Authorized | shares			50,000,000
Preferred Stock, Shares Authorized | shares			10,000,000
Subsequent Event [Member] | Securities Purchase Agreement [Member]
Subsequent Event [Line Items]
Stock Issued During Period, Shares, New Issues | shares		945,819
Shares Issued, Price Per Share | $ / shares		$ 7.20
Stock Issued During Period, Value, New Issues		$ 6,809,896
Subsequent Event [Member] | Minimum [Member]
Subsequent Event [Line Items]
Outstanding Common Stock In Percentage		40
Subsequent Event [Member] | 2017 Notes [Member]
Subsequent Event [Line Items]
Debt Instrument, Convertible, Conversion Price | $ / shares					$ 9.11
Debt Conversion, Converted Instrument, Shares Issued | shares					189,645
Subsequent Event [Member] | 6.00% Convertible Senior Unsecured Notes [Member]
Subsequent Event [Line Items]
Debt Instrument, Face Amount		$ 1,000
Debt Instrument, Interest Rate, Stated Percentage		6.00%
Debt Instrument, Convertible, Conversion Price | $ / shares		$ 7.20
Debt Conversion, Converted Instrument, Amount		$ 70,238,000
Debt Conversion, Converted Instrument, Shares Issued | shares		10,401,309
Debt Instrument, Convertible, Conversion Ratio		138.8889
Subsequent Event [Member] | Sixth Amendment to the 2017 Notes [Member] | Quarter Ended December 31 2016 Interest [Member]
Subsequent Event [Line Items]
Debt Instrument, Interest Rate Terms	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 Credit Facility) for the fiscal quarter ended on December 31, 2016, or 1%
Interest Payable	$ 1,147,329
Subsequent Event [Member] | Sixth Amendment to the 2017 Notes [Member] | Quarter Ended March 31 2017 Interest [Member]
Subsequent Event [Line Items]
Debt Instrument, Interest Rate Terms	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
Subsequent Event [Member] | Sixth Amendment to the 2017 Notes [Member] | Quarter Ended June 30 2017 Interest [Member]
Subsequent Event [Line Items]
Debt Instrument, Interest Rate Terms	interest accrued on such interest from July 1, 2017 until paid at a rate equal to 14% plus the higher of the LIBO Rate for the fiscal quarter ended on June 30, 2017, or 1%
Interest Payable	$ 1,303,935
Subsequent Event [Member] | Sixth Amendment to the 2017 Notes [Member] | Quarter Ended September 30 2017 Interest [Member]
Subsequent Event [Line Items]
Debt Instrument, Interest Rate Terms	interest accrued on such interest from October 2, 2017 until paid at a rate equal to 14% plus the higher of the LIBO Rate for the fiscal quarter ended on September 30, 2017, or 1%
Interest Payable	$ 1,482,406
Subsequent Event [Member] | Sixth Amendment to the 2017 Notes [Member] | Quarter Ended December 31 2017 Interest [Member]
Subsequent Event [Line Items]
Debt Instrument, Interest Rate Terms	interest accrued on such interest from January 2, 2018 until paid at a rate equal to 14% plus the higher of the LIBO Rate for the fiscal quarter ended on December 31, 2017, or 1%.
Interest Payable	$ 1,521,262
Subsequent Event [Member] | Amendment Number 6 to Indenture [Member]
Subsequent Event [Line Items]
Debt Instrument, Description of Variable Rate Basis				6.00% per annum plus 100 basis points.
Debt Instrument, Basis Spread on Variable Rate				6.00%
Subsequent Event [Member] | Sixth Amendment and Waiver to the 2016 Notes [Member]
Subsequent Event [Line Items]
Debt Instrument, Description of Variable Rate Basis				6.00% per annum plus 100 basis points.
Subsequent Event [Member] | Twenty-Third Amendment to Amended and Restated Credit Agreement [Member]
Subsequent Event [Line Items]
Line Of Credit Facility Minimum Expected Liquidity		$ 500,000
Subsequent Event [Member] | Twenty-Third Amendment to Amended and Restated Credit Agreement [Member] | Through December 31, 2018 [Member]
Subsequent Event [Line Items]
Debt Instrument, Basis Spread on Variable Rate		12.00%
Debt Instrument Interest Rate Portion Payable In Cash		10.00%
Subsequent Event [Member] | Twenty-Third Amendment to Amended and Restated Credit Agreement [Member] | January 1, 2019 through June 30, 2019 [Member]
Subsequent Event [Line Items]
Debt Instrument, Basis Spread on Variable Rate		15.00%
Debt Instrument Interest Rate Portion Payable In Cash		10.00%
Subsequent Event [Member] | Twenty-Third Amendment to Amended and Restated Credit Agreement [Member] | July 1, 2019 through the maturity date [Member]
Subsequent Event [Line Items]
Debt Instrument Interest Rate Portion Payable In Cash		10.00%
Debt Instrument, Fee Percentage		1.00%
Subsequent Event [Member] | ROS [Member]
Subsequent Event [Line Items]
Debt Conversion, Converted Instrument, Shares Issued | shares		5,126,534
Subsequent Event [Member] | ROS [Member] | Securities Purchase Agreement [Member]
Subsequent Event [Line Items]
Stock Issued During Period, Shares, New Issues | shares		603,687
Subsequent Event [Member] | ROS [Member] | 2017 Notes [Member]
Subsequent Event [Line Items]
Debt Conversion, Converted Instrument, Shares Issued | shares					121,045
Subsequent Event [Member] | Royalty Opportunities [Member]
Subsequent Event [Line Items]
Debt Conversion, Converted Instrument, Shares Issued | shares		2,905,396
Subsequent Event [Member] | Royalty Opportunities [Member] | Securities Purchase Agreement [Member]
Subsequent Event [Line Items]
Stock Issued During Period, Shares, New Issues | shares		342,132
Subsequent Event [Member] | Royalty Opportunities [Member] | 2017 Notes [Member]
Subsequent Event [Line Items]
Debt Conversion, Converted Instrument, Shares Issued | shares					68,600
Subsequent Event [Member] | Beneficial Owner [Member]
Subsequent Event [Line Items]
Equity Method Investment, Ownership Percentage					9.99%