Xtant Medical (XTNT) 10-Q 8 May 18 2018 Q1 Quarterly report Financial data

Document And Entity Information

Document And Entity Information - shares	3 Months Ended
	Mar. 31, 2018	May 08, 2018
Document Information [Line Items]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Mar. 31, 2018
Document Fiscal Year Focus	2,018
Document Fiscal Period Focus	Q1
Entity Registrant Name	Xtant Medical Holdings, Inc.
Entity Central Index Key	1,453,593
Current Fiscal Year End Date	--12-31
Entity Filer Category	Smaller Reporting Company
Trading Symbol	XTNT
Entity Common Stock, Shares Outstanding		13,077,468

CONDENSED CONSOLIDATED BALANCE

CONDENSED CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Mar. 31, 2018	Dec. 31, 2017
Current Assets:
Cash and cash equivalents	$ 6,172	$ 2,856
Trade accounts receivable, net of allowance for doubtful accounts of $1,945 and $2,135, respectively	10,340	12,714
Current inventories, net	22,512	22,229
Prepaid and other current assets	1,107	1,706
Total current assets	40,131	39,505
Non-current inventories, net	138	194
Property and equipment, net	9,331	9,913
Goodwill	41,535	41,535
Intangible assets, net	12,977	13,826
Other assets	670	732
Total Assets	104,782	105,705
Current Liabilities:
Accounts payable	7,528	9,316
Accounts payable - related party (note 13)	63	160
Accrued liabilities	3,852	15,845
Warrant derivative liability	169	131
Current portion of capital lease obligations	383	366
Total current liabilities	11,995	25,818
Long-term Liabilities:
Capital lease obligation, less current portion	526	623
Long-term convertible debt, less issuance costs	0	70,854
Long-term debt, less issuance costs	76,651	67,109
Total Liabilities	89,172	164,404
Commitments and Contingencies (note 10)
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; 13,077,468 shares issued and outstanding as of March 31, 2018 and 1,514,899 shares issued and outstanding as of December 31, 2017	0	0
Additional paid-in capital	165,808	86,247
Accumulated deficit	(150,198)	(144,946)
Total Stockholders’ Equity (Deficit)	15,610	(58,699)
Total Liabilities & Stockholders’ Equity (Deficit)	$ 104,782	$ 105,705

CONDENSED CONSOLIDATED BALANCE3

CONDENSED CONSOLIDATED BALANCE SHEETS [Parenthetical] - USD ($) $ in Thousands	Mar. 31, 2018	Dec. 31, 2017
Trade accounts receivable, allowance for doubtful accounts (in dollars)	$ 1,945	$ 2,135
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	13,077,468	1,514,899
Common Stock, shares outstanding	13,077,468	1,514,899

CONDENSED CONSOLIDATED STATEMEN

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2018	Mar. 31, 2017
Revenue
Orthopedic product sales	$ 17,830	$ 21,996
Other revenue	104	87
Total Revenue	17,934	22,083
Cost of sales	5,702	7,176
Gross Profit	12,232	14,907
Operating Expenses
General and administrative	3,025	4,128
Sales and marketing	8,349	10,997
Research and development	414	699
Depreciation and amortization	1,004	1,281
Restructuring expenses	733	0
Separation related expenses	0	224
Non-cash compensation expense	364	145
Total Operating Expenses	13,889	17,474
Loss from Operations	(1,657)	(2,567)
Other (Expense) Income
Interest expense	(3,545)	(3,400)
Change in warrant derivative liability	(38)	170
Other (expense) income	(13)	12
Total Other (Expense)	(3,596)	(3,218)
Net Loss from Operations	$ (5,253)	$ (5,785)
Net loss per share:
Basic	$ (0.7)	$ (3.87)
Dilutive	$ (0.7)	$ (3.87)
Shares used in the computation:
Basic	7,481,550	1,494,443
Dilutive	7,481,550	1,494,443

CONDENSED CONSOLIDATED STATEME5

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2018	Mar. 31, 2017
Operating activities:
Net loss	$ (5,253)	$ (5,785)
Adjustments to reconcile net loss to net cash provided by operating activities:
Depreciation and amortization	1,586	2,071
Non-cash interest	3,446	3,151
(Gain)/Loss on disposal of fixed assets	(23)	617
Non-cash compensation expense/stock option expense	364	230
Provision for losses on accounts receivable and inventory	39	313
Change in derivative warrant liability	38	(170)
Changes in operating assets and liabilities:
Accounts receivable	2,290	2,536
Inventories	(182)	261
Prepaid and other assets	660	(647)
Accounts payable	(1,884)	(1,743)
Accrued liabilities	(845)	(397)
Net cash provided by operating activities	236	437
Investing activities:
Purchases of property and equipment and intangible assets	(132)	(310)
Net cash used by investing activities	(132)	(310)
Financing activities:
Payments on capital leases	(79)	(63)
Payments on revolving line of credit	0	(155)
Expense associated with private placement and convertible debt conversion/exchange	(3,519)	0
Proceeds from issuance of stock	6,810	0
Net cash provided by (used by) financing activities	3,212	(218)
Net change in cash and cash equivalents	3,316	(91)
Cash and cash equivalents at beginning of period	2,856	2,578
Cash and cash equivalents at end of period	$ 6,172	$ 2,487

Business Description and Summar

Business Description and Summary of Significant Accounting Policies	3 Months Ended
	Mar. 31, 2018
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Business Description and Summary of Significant Accounting Policies	Notes to Unaudited Condensed Consolidated Financial Statements The accompanying condensed consolidated financial statements include the accounts of Xtant Medical Holdings, Inc. (“Xtant”), a Delaware corporation, and its wholly owned subsidiaries, Xtant Medical, Inc. (“Xtant Medical”), a Delaware corporation, Bacterin International, Inc., (“Bacterin”) a Nevada corporation, and X-Spine Systems, Inc. (“X-spine”), an Ohio corporation (Xtant, Xtant Medical, Bacterin and X-spine are jointly referred to herein as the “Company” or sometimes “we”, “our” or “us”). 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 accompanying interim condensed consolidated financial statements of Xtant for the three months ended March 31, 2018 and 2017 are unaudited and are prepared in accordance with accounting principles generally accepted in the United States of America. They do not include all disclosures required by generally accepted accounting principles for annual consolidated financial statements, but in the opinion of management, include all adjustments, consisting only of normal recurring items, necessary for a fair presentation. Interim results are not necessarily indicative of results which may be achieved in the future for the full year ending December 31, 2018. These condensed consolidated financial statements should be read in conjunction with the consolidated financial statements and notes thereto which are included in Xtant’s Annual Report on Form 10-K for the year ended December 31, 2017. The accounting policies set forth in those annual consolidated financial statements are the same as the accounting policies utilized in the preparation of these condensed consolidated financial statements, except as modified for appropriate interim consolidated financial statement presentation. As described in more detail below, effective as of February 13, 2018, the Company effected a 1-for-12 reverse split of its common stock (the “Reverse Stock Split”). The Reverse Stock Split is reflected in the share amounts in all periods presented in this report. Restructuring Agreement On January 11, 2018, we entered into a Restructuring and Exchange Agreement (the “Restructuring Agreement”) with ROS Acquisition Offshore LP, OrbiMed Royalty Opportunities II, LP (collectively referred to herein as the “Investors”), Bruce Fund, Inc., Park West Partners International, Limited (“PWPI”), Park West Investors Master Fund, Limited (“PWIMF”), and Telemetry Securities, L.L.C., and with the Investors, are collectively referred to herein as the “Holders”. Pursuant to the Restructuring Agreement, and following the execution of the Sixth Amendment to the 2017 Notes, described in the “Debt” and “Equity” sections below, on January 17, 2018, the Investors converted certain of the 2017 Notes, plus accrued and unpaid interest, at the $ 9.11 189,645 In connection with the Restructuring Agreement, we held a special meeting of stockholders on February 13, 2018 (“Special Meeting”), where our stockholders approved the following actions: · 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 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 six new directors to constitute a new board of directors, 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 (described below), the remaining $ 70.2 6.00 138.8889 1,000 7.20 10,401,309 The Investors have approximately a 70 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”) The Certificate Amendment amended and restated our Charter, to, among other things: · effect 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 of Directors (“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 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 stock options, restricted stock, 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. All share and per share amounts have been retroactively restated to reflect the Reverse Stock Split. Private Placement SPA On February 14, 2018, we entered into a Securities Purchase Agreement (the “Private Placement SPA”) with the Investors for the purchase of 945,819 7.20 6.8 Investor Rights Agreement Effective February 14, 2018, we entered into an Investor Rights Agreement (the “Investor Rights Agreement”) with certain the Holders. Under the Investor Rights Agreement, the Investors are permitted to nominate a majority of our directors and designate the chairperson of the Board at subsequent annual meetings, as long as Investors 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 the Investors to proceed with the following actions: (i) issue new securities; (ii) incur over $0.25 million of debt in a fiscal year; (iii) sell or transfer over $0.25 million of our assets or businesses or our subsidiaries in a fiscal year; (iv) acquire over $0.25 million of assets or properties in a fiscal year; (v) make capital expenditures over $0.125 million individually, or $1.5 million 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 $0.25 million in a fiscal year. The Investor Rights Agreement grants the Holders 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 or an Investor, if such Investor’s ownership percentage of our then outstanding common stock is less than 10%, or (c) upon written notice by the Investors. PWPI and PWIMF’s right to purchase from us a pro rata amount of any new securities will also terminate at such time as their aggregate ownership percentage of our then outstanding common stock is less than 8.5%. 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 U. S. Securities and Exchange Commission (“SEC”) a shelf registration statement within 90 days of the date of the Registration Rights Agreement covering the resale, from time to time, of our common stock issued. We agree to use our best efforts to cause the shelf registration statement to become effective under the Securities Act of 1933, as amended (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; and · allow the Board to declare dividends on our capital stock, subject to any provisions of our Charter and applicable law; The Company’s accounts receivables are due from a variety of health care organizations and distributors throughout the world. No single customer accounted for more than 10% of revenue or accounts receivable for the comparable periods. The Company provides for uncollectible amounts when specific credit issues arise. Management’s estimates for uncollectible amounts have been adequate during prior periods, and management believes that all significant credit risks have been identified at March 31, 2018. The preparation of the consolidated 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 consolidated financial statements and the reported amounts of revenue and expenses during the period. Significant estimates include the carrying amount of property and equipment, goodwill, and intangible assets and liabilities; valuation allowances for trade receivables, inventory, and deferred income tax assets and liabilities; valuation of the warrant derivative liability, inventory, and estimates for the fair value of stock options grants and other equity awards upon which the Company determines stock-based compensation expense. Actual results could differ from those estimates. Long-lived assets, including intangible assets, are reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Recoverability of assets to be held and used is measured by a comparison of the carrying amount of an asset to future net cash flows expected to be generated by the asset. If such assets are considered to be impaired, the impairment to be recognized is measured by the amount by which the carrying amount of the assets exceeds the estimated fair value of the assets. Goodwill represents the excess of costs over fair value of assets of businesses acquired. Goodwill and intangible assets acquired in a purchase business combination and determined to have indefinite useful lives are not amortized, instead they are tested for impairment at least annually and whenever events or circumstances indicate the carrying amount of 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. The Company adopted the provisions of Accounting Standards Update (“ASU”) 2014-09, Topic 606, Revenue from Contracts with Customers The Company’s contracts with its customers are generally reviewed and revised on an annual basis. The Company does not incur upfront costs or exclusivity fees in conjunction with entering into a customer contract. The Company’s customer contracts do not provide for percentage of completion performance measures or contingent consideration. The Company does not have deferred or unearned revenue arrangements with its customers that would give rise to contract liabilities. No contract assets or contract liabilities are recorded in our consolidated balance sheets as of March 31, 2018 or December 31, 2017. 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 usage of the product to the Company and, upon such notice, the Company invoices the customer and revenue is recognized. In the normal course of business, the Company accepts returns of product that have not been implanted. Product returns are not material to the Company’s consolidated statements of operations. The Company accounts for shipping and handling activities as a fulfillment cost rather than a separate performance obligation. The Company’s policy is to record revenue net of any applicable sales, use, or excise taxes. Payment terms are generally net 30 days from invoice date and some customers are offered discounts for early pay. Research and development costs, which are principally related to internal costs for the development of new devices and biologics and processes are expensed as incurred. Other income (expense) primarily consists of non-recurring items that are outside of the normal Company’s operations such gain or loss on the sale of fixed assets. Basic net income (loss) per share is computed by dividing net income (loss) by the weighted average number of common shares outstanding. Shares issued during the period and shares reacquired during the period are weighted for the portion of the period that they were outstanding. Diluted net income (loss) per share is computed in a manner consistent with that of basic earnings per share while giving effect to all potentially dilutive common shares outstanding during the period, which include the assumed exercise of stock options and warrants using the treasury stock method. Diluted net loss per share was the same as basic net loss per share for the quarter ended March 31, 2018 and 2017, as shares issuable upon the exercise of stock options and warrants were anti-dilutive as a result of the net losses incurred for those periods. Dilutive earnings per share are not reported as their effects of including 587,251 623,251 The carrying values of financial instruments, including trade accounts receivable, accounts payable, other accrued expenses and long-term debt, approximate their fair values based on terms and related interest rates. The Company follows a framework for measuring fair value. The framework provides a hierarchy that prioritizes the inputs to valuation techniques used to measure fair value. The hierarchy gives the highest priority to unadjusted quoted prices in active markets for identical assets or liabilities (Level 1) and the lowest priority to unobservable inputs (Level 3). The three levels of the fair value hierarchy are described below: Level 1: Inputs to the valuation methodology are unadjusted quoted prices for identical assets or liabilities in active markets. Level 2: Inputs to the valuation methodology include quoted prices for similar assets and liabilities in active markets, and inputs that are observable for the asset or liability, either directly or indirectly, for substantially the full term of the financial instrument. Level 3: Inputs to the valuation methodology are unobservable and significant to the fair value measurement. A financial instrument’s level within the fair value hierarchy is based on the lowest level of any input that is significant to the fair value measurement. During the quarter ended March 31, 2018 and 2017, there was no reclassification in financial assets or liabilities between Level 1, 2 or 3 categories. (in thousands): As of As of Level 1 - - Level 2 - - Level 3 $ 169 $ 131 The valuation technique used to measure fair value of the warrant liability is based on a lattice valuation model and significant assumptions and inputs determined by us (See Note 9, “Warrants” below). Level 3 Changes Warrant derivative liability (in thousands): Balance at January 1, 2017 $ 334 Gain recognized in earnings (203) Balance at January 1, 2018 $ 131 Loss recognized in earnings 38 Balance at March 31, 2018 $ 169 During the quarter ended March 31, 2018, the Company did not change any of the valuation techniques used to measure its liabilities at fair value. 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

Inventories, Net

Inventories, Net	3 Months Ended
	Mar. 31, 2018
Inventory Disclosure [Abstract]
Inventories, Net	(2) Inventories, Net (in thousands): March 31, December 31, 2018 2017 Current inventories: Raw materials $ 4,401 $ 4,277 Work in process 1,433 1,515 Finished goods 23,561 23,270 Gross current inventories 29,395 29,062 Reserve for obsolescence (6,883) (6,833) Current inventories, net 22,512 22,229 Non-current inventories: Finished goods 958 1,072 Reserve for obsolescence (820) (878) Non-current inventories, net 138 194 Total inventories, net $ 22,650 $ 22,423 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 $ 11.6 12.0

Property and Equipment, Net

Property and Equipment, Net	3 Months Ended
	Mar. 31, 2018
Property, Plant and Equipment [Abstract]
Property and Equipment, Net	(3) Property and Equipment, Net (in thousands): March 31, December 31, 2018 2017 Equipment $ 4,466 $ 4,471 Computer equipment 497 490 Computer software 523 523 Furniture and fixtures 215 215 Leasehold improvements 4,017 4,030 Vehicles 10 10 Surgical instruments 11,353 11,462 Total cost 21,081 21,201 Less: accumulated depreciation (11,750) (11,288) Property and equipment, net $ 9,331 $ 9,913 The Company deploys certain surgical instruments through its various sales channels for use with implant and biologic inventory to be utilized 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 $ 3.5 4.6 Depreciation expense related to property and equipment, including property under capital lease, for the first quarter of 2018 and 2017 was $ 0.7 0.9 The Company leases certain equipment under capital leases. For financial reporting purposes, minimum lease payments relating to the assets have been capitalized. As of March 31, 2018, the Company has recorded $ 1.6 1.0

Intangible Assets

Intangible Assets	3 Months Ended
	Mar. 31, 2018
Goodwill and Intangible Assets Disclosure [Abstract]
Intangible Assets	(4) Intangible Assets in thousands): March 31, December 31, Patents $ 847 $ 847 Acquisition related intangibles: Technology 13,789 13,789 Customer relationships 9,911 9,911 Tradename 1,867 1,867 Non-compete 41 41 Accumulated amortization (13,478) (12,629) Intangible assets, net $ 12,977 $ 13,826 Aggregate amortization expense: $ 849 $ 4,629 (in thousands): Remainder of 2018 $ 2,503 2019 3,121 2020 2,091 2021 1,367 2022 1,024 Thereafter 2,871 Total $ 12,977

Accrued Liabilities

Accrued Liabilities	3 Months Ended
	Mar. 31, 2018
Payables and Accruals [Abstract]
Accrued Liabilities	(5) Accrued Liabilities (in thousands): March 31, December 31, 2018 2017 Accrued stock compensation $ 20 $ 120 Wages/commissions payable 2,015 2,831 Accrued interest payable - 10,834 Other accrued expenses 1,817 2,060 Accrued liabilities $ 3,852 $ 15,845

Debt

Debt	3 Months Ended
	Mar. 31, 2018
Debt Disclosure [Abstract]
Debt	(6) Debt Convertible Notes During the first quarter of 2018 in connection with our Restructuring, all of the outstanding 6.00% convertible senior unsecured notes due 2021 were converted into shares of our common stock and the Indenture governing such notes was discharged. Twenty-Second Amendment to the Amended and Restated Credit Agreement Effective January 30, 2018, the Company and Investors entered into the Twenty-Second Amendment to the Amended and Restated Credit Agreement, which amended the Amended and Restated Credit Agreement dated July 27, 2015 by and between Bacterin and ROS Acquisition Offshore LP (collectively, the “Amended and Restated Credit Agreement” and the facility created under such agreement, the “Credit Facility”). This amendment further deferred the Company’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. Twenty-Third Amendment to the Amended and Restated Credit Agreement Effective February 14, 2018, the Company and Investors entered into the Twenty-Third Amendment to the Amended and Restated Credit Agreement, which further amended the Amended and Restated Credit Agreement and terms of the Credit Facility. As of this amendment, the interest payable has been carried forward and as modified, the interest rate options within the Credit Facility are 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 . This amendment also modified the financial covenants of the Credit Facility, including removing the minimum revenue covenant, providing a minimum liquidity covenant, a consolidated leverage ratio, and minimum consolidated EBITDA, all as defined in the Amended and Restated Credit Agreement. (in thousands): March 31, December 31, 2018 2017 Amounts due under the Credit Facility $ 55,787 $ 55,787 PIK interest payable related to the Credit Facility 21,099 11,582 6% convertible senior unsecured notes due 2021 - 71,866 Gross long-term debt 76,886 139,235 Less: total debt issuance costs (235) (1,272) Long-term debt, less issuance costs $ 76,651 $ 137,963 (in thousands): Remainder of 2018 $ - 2019 - 2020 - 2021 76,886 2022 - Thereafter - Total $ 76,886

Equity

Equity	3 Months Ended
	Mar. 31, 2018
Equity [Abstract]
Equity	Convertible Note Indenture During the first quarter of 2018, in connection with our Restructuring (defined above), all of the outstanding 6.00% convertible senior unsecured notes due 2021 were converted or exchanged into shares of our common stock and the Indenture governing such notes was discharged. Effective January 17, 2017, we issued in a private placement to the Investors an aggregate principal amount of approximately $ 1.6 6.00 189,645 70.238 10.4 Private Placement SPA On February 14, 2018, we sold to the Investors pursuant to the Private Placement SPA 945,819 7.20 6.8

Stock-Based Compensation

Stock-Based Compensation	3 Months Ended
	Mar. 31, 2018
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Stock-Based Compensation	(8) Stock-Based Compensation The Amended and Restated Xtant Medical Equity Incentive Plan (the “Plan”) provides for stock awards, including options and performance stock awards, to be granted to employees, consultants, independent contractors, officers and directors. The purpose of the Plan is to enable us to attract, retain and motivate key employees, directors and, on occasion, independent consultants, by providing them with stock options and restricted stock grants. Stock options granted under the Plan may be either incentive stock options to employees, as defined in Section 422A of the Internal Revenue Code of 1986, or non-qualified stock options. The Plan is administered by the Board. Stock options granted under the Plan are generally not transferable, vest in installments over the requisite service period and are exercisable during the stated contractual term of the option only by such optionee. Executives may be awarded an option to purchase common stock outside of the Plan (collectively the “Non-Plan Grants”), as described below. The exercise price of all incentive stock options granted under the Plan must be at least equal to the fair market value of the shares of common stock on the date of the grant. 153,333 18.000 Stock compensation expense recognized in the condensed consolidated statements of operations for the three months ended March 31, 2018 and 2017 is based on awards ultimately expected to vest and reflects an estimate of awards that will be forfeited. ASC 718 requires forfeitures to be estimated at the time of grant and revised, if necessary, in subsequent periods if actual forfeitures differ from those estimates. No stock options were issued in the first quarter of 2018 or 2017. (in thousands, except number of shares and per share amounts): 2018 2017 Shares Weighted Weighted Shares Weighted Weighted Outstanding at January 1 67,465 $ 71.03 $ 36.85 100,492 $ 62.52 $ 33.84 Cancelled or expired (131) 88.82 55.76 (1,486) 88.08 50.88 Outstanding at March 31 67,334 $ 74.70 $ 36.74 99,006 $ 62.16 $ 33.60 Exercisable at March 31 67,334 $ 74.70 $ 36.74 30,971 $ 141.72 $ 68.52 The aggregate intrinsic value of options outstanding as of March 31, 2018 was zero because the closing price of the stock at March 31, 2018 was less than the strike price of all options outstanding. As of February 13, 2018, all options were fully vested and $ 0.2 Total stock-based compensation recognized for employees and directors was $ 0.4 On February 14, 2018, the Company granted 67,708 0.3 4.80 27 On July 25, 2017, the Company granted 25,974 9.24 0.2 0.1 Effective October 6, 2016, our board of directors granted to our current Chief Executive Officer, Carl O’Connell, an option to purchase 25,000 13.32

Warrants

Warrants	3 Months Ended
	Mar. 31, 2018
Warrants and Rights Note Disclosure [Abstract]
Warrants	(9) Warrants Weighted Common Average Stock Exercise Warrants Price Outstanding as of January 1, 2017 524,277 $ 26.76 Expired (4,360) 135.36 Outstanding at January 1, 2018 519,917 $ 25.68 Expired - - Outstanding at March 31, 2018 519,917 $ 25.68 We utilize a lattice valuation model to determine the fair market value of the warrants accounted for as liabilities. The lattice valuation model accommodates the probability of exercise price adjustment features as outlined in the warrant agreements. We recorded an unrealized loss of $ 38 Quarter Ended March 31, 2018 2017 Value of underlying common stock (per share) $ 7.89 $ 7.44 Risk free interest rate 2.3 % 1.9 % Expected term in years 4.3 5.3 Volatility 98 % 91 % Dividend yield 0 % 0 % 2018 2017 Balance at January 1, 93,759 93,759 Derivative warrants issued, exercised and expired - - Balance at March 31, 93,759 93,759

Commitments and Contingencies

Commitments and Contingencies	3 Months Ended
	Mar. 31, 2018
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	(10) Commitments and Contingencies Operating Leases We lease five office facilities under non-cancelable operating lease agreements with expiration dates between 2019 and 2025. We have the option to extend the five leases for up to another ten-year term and for one facility, we have the right of first refusal on any sale. (in thousands): Remainder of 2018 $ 606 2019 669 2020 396 2021 375 2022 354 Thereafter 685 Total $ 3,085 Rent expense was $ 0.2 Capital Leases (in thousands): Remainder of 2018 $ 400 2019 502 2020 218 2021 - 2022 - Thereafter - Total minimum lease payments 1,120 Less amount representing interest (211) Present value of obligations under capital leases 909 Less current portion (383) Long-term capital lease obligations $ 526 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 $ 1.0 In addition, we are engaged in ordinary routine litigation incidental to our business from time to time, including product liability disputes. Indemnifications Our arrangements generally include limited warranties and certain provisions for indemnifying customers against liabilities if our products or services infringe a third-party’s intellectual property rights. To date, we have not incurred any material costs as a result of such warranties or indemnification provisions and have not accrued any liabilities related to such obligations in the accompanying condensed consolidated financial statements. We have also agreed to indemnify our directors and executive officers for costs associated with any fees, expenses, judgments, fines and settlement amounts incurred by any of these persons in any action or proceeding to which any of those persons is, or is threatened to be, made a party by reason of the person’s service as a director or officer, including any action by us, arising out of that person’s services as our director or officer or that person’s services provided to any other company or enterprise at our request.

Income Taxes

Income Taxes	3 Months Ended
	Mar. 31, 2018
Income Tax Disclosure [Abstract]
Income Taxes	(11) Income Taxes In evaluating the realizability of the net deferred tax assets, we take into account a number of factors, primarily relating to the ability to generate taxable income. Where it is determined that it is likely that we will be unable to realize deferred tax assets, a valuation allowance is established against the portion of the deferred tax asset. Because it cannot be accurately determined when or if we will become profitable, a valuation allowance was provided against the entire deferred income tax asset balance. The Company did not recognize any interest or penalties related to income taxes for the quarter ended March 31, 2018 and 2017. On December 22, 2017, the Tax Cuts and Jobs Act (the “Act”) was signed into legislation. At December 31, 2017, the Company made a reasonable estimate of the effects on the existing deferred tax balances and recorded a provisional amount in the 2017 financial statements. 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. There has been no change to the provisional adjustment recorded in 2017 during the first quarter of 2018. 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.

Supplemental Disclosure of Cash

Supplemental Disclosure of Cash Flow Information	3 Months Ended
	Mar. 31, 2018
Supplemental Cash Flow Elements [Abstract]
Supplemental Disclosure of Cash Flow Information	(12) Supplemental Disclosure of Cash Flow Information (in thousands): Three Months Ended March 31, 2018 2017 Supplemental disclosure of cash flow information Cash paid during the period for: Interest $ 259 $ 249 Non-cash activity: Issuance of capital leases $ 84 $ 967 Interest converted into common stock $ 556 $ 480 Conversion of convertible debt to equity $ 71,865 $ - Convertible PIK interest $ 4,764 $ - Conversion of interest related to the Credit Facility to long-term debt $ 7,977 $ - Write-off of convertible debt issuance cost $ 1,012 $ -

Related Party Transactions

Related Party Transactions	3 Months Ended
	Mar. 31, 2018
Related Party Transactions [Abstract]
Related Party Transactions	Certain of X-spine’s former shareholders, also have a controlling interest in one of X-spine’s major suppliers, Norwood Tool Company d/b/a Norwood Medical. In the first quarter of both 2018 and 2017, Xtant purchased less than 10 63 0.2 The Audit Committee or the disinterested members of the full Board reviews and approves all related party transactions. The Investors, owning approximately 70

Segment and Geographic Informat

Segment and Geographic Information	3 Months Ended
	Mar. 31, 2018
Segment Reporting [Abstract]
Segment and Geographic Information	(14) Segment and Geographic Information The Company’s management reviews financial results and manages the business on an aggregate basis. Therefore, financial results are reported in a single operating segment: the development, manufacture and marketing of orthopedic medical products and devices. The Company attributes revenues to geographic areas based on the location of the customer. Approximately, 96 (in thousands): Three Months Ended 2018 2017 United States $ 17,153 $ 21,105 Rest of world 781 978 Total revenue $ 17,934 $ 22,083

Subsequent Events

Subsequent Events	3 Months Ended
	Mar. 31, 2018
Subsequent Events [Abstract]
Subsequent Events	(15) Subsequent Events On May 18, 2018, the Company will distribute to holders of its common stock, at no charge, non-transferable subscription rights to purchase up to an aggregate of 1,137,515 0.0869816 7.20 If a holder exercises its basic subscription rights in full, the holder may also choose to exercise an over-subscription privilege to purchase a portion of any shares that other record holders do not purchase. Available shares will be allocated pro-rata among the holders exercising their over-subscription privilege. The Rights Offering will commence on May 18, 2018 and the subscription rights will expire on June 18, 2018, unless the offering is extended by the Company. Assuming that all shares are sold in the Rights Offering, including the full exercise of all over-subscription privileges, we estimate that the net proceeds from the Rights Offering will be approximately $ 8.0 A registration statement on Form S-1, as amended (File No. 333-222918), relating to the securities being offered and sold in connection with the Rights Offering was declared effective by the U.S. Securities and Exchange Commission (“SEC”) on April 27, 2018. A prospectus and prospectus supplement relating to and describing the terms of the Rights Offering has been filed with the SEC as a part of the registration statement and is available on the SEC’s web site at http://www.sec.gov

Business Description and Summ21

Business Description and Summary of Significant Accounting Policies (Policies)	3 Months Ended
	Mar. 31, 2018
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Business Description	The accompanying condensed consolidated financial statements include the accounts of Xtant Medical Holdings, Inc. (“Xtant”), a Delaware corporation, and its wholly owned subsidiaries, Xtant Medical, Inc. (“Xtant Medical”), a Delaware corporation, Bacterin International, Inc., (“Bacterin”) a Nevada corporation, and X-Spine Systems, Inc. (“X-spine”), an Ohio corporation (Xtant, Xtant Medical, Bacterin and X-spine are jointly referred to herein as the “Company” or sometimes “we”, “our” or “us”). 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 accompanying interim condensed consolidated financial statements of Xtant for the three months ended March 31, 2018 and 2017 are unaudited and are prepared in accordance with accounting principles generally accepted in the United States of America. They do not include all disclosures required by generally accepted accounting principles for annual consolidated financial statements, but in the opinion of management, include all adjustments, consisting only of normal recurring items, necessary for a fair presentation. Interim results are not necessarily indicative of results which may be achieved in the future for the full year ending December 31, 2018. These condensed consolidated financial statements should be read in conjunction with the consolidated financial statements and notes thereto which are included in Xtant’s Annual Report on Form 10-K for the year ended December 31, 2017. The accounting policies set forth in those annual consolidated financial statements are the same as the accounting policies utilized in the preparation of these condensed consolidated financial statements, except as modified for appropriate interim consolidated financial statement presentation. As described in more detail below, effective as of February 13, 2018, the Company effected a 1-for-12 reverse split of its common stock (the “Reverse Stock Split”). The Reverse Stock Split is reflected in the share amounts in all periods presented in this report.
Corporate Restructuring	Restructuring Agreement On January 11, 2018, we entered into a Restructuring and Exchange Agreement (the “Restructuring Agreement”) with ROS Acquisition Offshore LP, OrbiMed Royalty Opportunities II, LP (collectively referred to herein as the “Investors”), Bruce Fund, Inc., Park West Partners International, Limited (“PWPI”), Park West Investors Master Fund, Limited (“PWIMF”), and Telemetry Securities, L.L.C., and with the Investors, are collectively referred to herein as the “Holders”. Pursuant to the Restructuring Agreement, and following the execution of the Sixth Amendment to the 2017 Notes, described in the “Debt” and “Equity” sections below, on January 17, 2018, the Investors converted certain of the 2017 Notes, plus accrued and unpaid interest, at the $ 9.11 189,645 In connection with the Restructuring Agreement, we held a special meeting of stockholders on February 13, 2018 (“Special Meeting”), where our stockholders approved the following actions: · 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 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 six new directors to constitute a new board of directors, 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 (described below), the remaining $ 70.2 6.00 138.8889 1,000 7.20 10,401,309 The Investors have approximately a 70 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”) The Certificate Amendment amended and restated our Charter, to, among other things: · effect 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 of Directors (“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 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 stock options, restricted stock, 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. All share and per share amounts have been retroactively restated to reflect the Reverse Stock Split. Private Placement SPA On February 14, 2018, we entered into a Securities Purchase Agreement (the “Private Placement SPA”) with the Investors for the purchase of 945,819 7.20 6.8 Investor Rights Agreement Effective February 14, 2018, we entered into an Investor Rights Agreement (the “Investor Rights Agreement”) with certain the Holders. Under the Investor Rights Agreement, the Investors are permitted to nominate a majority of our directors and designate the chairperson of the Board at subsequent annual meetings, as long as Investors 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 the Investors to proceed with the following actions: (i) issue new securities; (ii) incur over $0.25 million of debt in a fiscal year; (iii) sell or transfer over $0.25 million of our assets or businesses or our subsidiaries in a fiscal year; (iv) acquire over $0.25 million of assets or properties in a fiscal year; (v) make capital expenditures over $0.125 million individually, or $1.5 million 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 $0.25 million in a fiscal year. The Investor Rights Agreement grants the Holders 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 or an Investor, if such Investor’s ownership percentage of our then outstanding common stock is less than 10%, or (c) upon written notice by the Investors. PWPI and PWIMF’s right to purchase from us a pro rata amount of any new securities will also terminate at such time as their aggregate ownership percentage of our then outstanding common stock is less than 8.5%. 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 U. S. Securities and Exchange Commission (“SEC”) a shelf registration statement within 90 days of the date of the Registration Rights Agreement covering the resale, from time to time, of our common stock issued. We agree to use our best efforts to cause the shelf registration statement to become effective under the Securities Act of 1933, as amended (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; and · allow the Board to declare dividends on our capital stock, subject to any provisions of our Charter and applicable law;
Concentrations and Credit Risk	Concentrations and Credit Risk The Company’s accounts receivables are due from a variety of health care organizations and distributors throughout the world. No single customer accounted for more than 10% of revenue or accounts receivable for the comparable periods. The Company provides for uncollectible amounts when specific credit issues arise. Management’s estimates for uncollectible amounts have been adequate during prior periods, and management believes that all significant credit risks have been identified at March 31, 2018.
Use of Estimates	Use of Estimates The preparation of the consolidated 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 consolidated financial statements and the reported amounts of revenue and expenses during the period. Significant estimates include the carrying amount of property and equipment, goodwill, and intangible assets and liabilities; valuation allowances for trade receivables, inventory, and deferred income tax assets and liabilities; valuation of the warrant derivative liability, inventory, and estimates for the fair value of stock options grants and other equity awards upon which the Company determines stock-based compensation expense. Actual results could differ from those estimates.
Long-Lived Assets	Long-Lived Assets Long-lived assets, including intangible assets, are reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Recoverability of assets to be held and used is measured by a comparison of the carrying amount of an asset to future net cash flows expected to be generated by the asset. If such assets are considered to be impaired, the impairment to be recognized is measured by the amount by which the carrying amount of the assets exceeds the estimated fair value of the assets.
Goodwill	Goodwill Goodwill represents the excess of costs over fair value of assets of businesses acquired. Goodwill and intangible assets acquired in a purchase business combination and determined to have indefinite useful lives are not amortized, instead they are tested for impairment at least annually and whenever events or circumstances indicate the carrying amount of 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 The Company adopted the provisions of Accounting Standards Update (“ASU”) 2014-09, Topic 606, Revenue from Contracts with Customers The Company’s contracts with its customers are generally reviewed and revised on an annual basis. The Company does not incur upfront costs or exclusivity fees in conjunction with entering into a customer contract. The Company’s customer contracts do not provide for percentage of completion performance measures or contingent consideration. The Company does not have deferred or unearned revenue arrangements with its customers that would give rise to contract liabilities. No contract assets or contract liabilities are recorded in our consolidated balance sheets as of March 31, 2018 or December 31, 2017. 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 usage of the product to the Company and, upon such notice, the Company invoices the customer and revenue is recognized. In the normal course of business, the Company accepts returns of product that have not been implanted. Product returns are not material to the Company’s consolidated statements of operations. The Company accounts for shipping and handling activities as a fulfillment cost rather than a separate performance obligation. The Company’s policy is to record revenue net of any applicable sales, use, or excise taxes. Payment terms are generally net 30 days from invoice date and some customers are offered discounts for early pay.
Research and Development	Research and Development Research and development costs, which are principally related to internal costs for the development of new devices and biologics and processes are expensed as incurred.
Other Income (Expense)	Other Income (Expense) Other income (expense) primarily consists of non-recurring items that are outside of the normal Company’s operations such gain or loss on the sale of fixed assets.
Net Loss Per Share	Net Loss Per Share Basic net income (loss) per share is computed by dividing net income (loss) by the weighted average number of common shares outstanding. Shares issued during the period and shares reacquired during the period are weighted for the portion of the period that they were outstanding. Diluted net income (loss) per share is computed in a manner consistent with that of basic earnings per share while giving effect to all potentially dilutive common shares outstanding during the period, which include the assumed exercise of stock options and warrants using the treasury stock method. Diluted net loss per share was the same as basic net loss per share for the quarter ended March 31, 2018 and 2017, as shares issuable upon the exercise of stock options and warrants were anti-dilutive as a result of the net losses incurred for those periods. Dilutive earnings per share are not reported as their effects of including 587,251 623,251
Fair Value of Financial Instruments	Fair Value of Financial Instruments The carrying values of financial instruments, including trade accounts receivable, accounts payable, other accrued expenses and long-term debt, approximate their fair values based on terms and related interest rates. The Company follows a framework for measuring fair value. The framework provides a hierarchy that prioritizes the inputs to valuation techniques used to measure fair value. The hierarchy gives the highest priority to unadjusted quoted prices in active markets for identical assets or liabilities (Level 1) and the lowest priority to unobservable inputs (Level 3). The three levels of the fair value hierarchy are described below: Level 1: Inputs to the valuation methodology are unadjusted quoted prices for identical assets or liabilities in active markets. Level 2: Inputs to the valuation methodology include quoted prices for similar assets and liabilities in active markets, and inputs that are observable for the asset or liability, either directly or indirectly, for substantially the full term of the financial instrument. Level 3: Inputs to the valuation methodology are unobservable and significant to the fair value measurement. A financial instrument’s level within the fair value hierarchy is based on the lowest level of any input that is significant to the fair value measurement. During the quarter ended March 31, 2018 and 2017, there was no reclassification in financial assets or liabilities between Level 1, 2 or 3 categories. (in thousands): As of As of Level 1 - - Level 2 - - Level 3 $ 169 $ 131 The valuation technique used to measure fair value of the warrant liability is based on a lattice valuation model and significant assumptions and inputs determined by us (See Note 9, “Warrants” below). Level 3 Changes Warrant derivative liability (in thousands): Balance at January 1, 2017 $ 334 Gain recognized in earnings (203) Balance at January 1, 2018 $ 131 Loss recognized in earnings 38 Balance at March 31, 2018 $ 169 During the quarter ended March 31, 2018, 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 ASU 2014-09, Revenue from Contracts with Customers (Topic 606) (“ASU 2014-09”). Using a five-step framework set forth in Accounting Standards Codification (“ASC”) 606, ASU 2014-09 requires entities to recognize revenue at an amount that the entity expects to be entitled to upon transferring control of goods or services to a customer, as opposed to when risks and rewards transfer to a customer under the existing revenue recognition guidance. In August 2015, the FASB issued ASU 2015-14 to defer the effective date of ASU 2014-09 for one year, which makes the guidance effective for the Company’s first fiscal year beginning after December 15, 2017. Additionally, the FASB is permitting entities to early adopt the standard, which allows for either full retrospective or modified retrospective methods of adoption, for reporting periods beginning after December 15, 2016. We adopted the provisions of ASU 2014-09 effective January 1, 2018 using the modified retrospective method given we determined the timing of our revenues to remain the same. 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

Business Description and Summ22

Business Description and Summary of Significant Accounting Policies (Tables)	3 Months Ended
	Mar. 31, 2018
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Schedule of Assets and Liabilities Measured on Recurring Basis	(in thousands): As of As of Level 1 - - Level 2 - - Level 3 $ 169 $ 131
Schedule of Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation	Warrant derivative liability (in thousands): Balance at January 1, 2017 $ 334 Gain recognized in earnings (203) Balance at January 1, 2018 $ 131 Loss recognized in earnings 38 Balance at March 31, 2018 $ 169

Inventories, Net (Tables)

Inventories, Net (Tables)	3 Months Ended
	Mar. 31, 2018
Inventory Disclosure [Abstract]
Schedule of Inventories	Inventories consist of the following (in thousands): March 31, December 31, 2018 2017 Current inventories: Raw materials $ 4,401 $ 4,277 Work in process 1,433 1,515 Finished goods 23,561 23,270 Gross current inventories 29,395 29,062 Reserve for obsolescence (6,883) (6,833) Current inventories, net 22,512 22,229 Non-current inventories: Finished goods 958 1,072 Reserve for obsolescence (820) (878) Non-current inventories, net 138 194 Total inventories, net $ 22,650 $ 22,423

Property and Equipment, Net (Ta

Property and Equipment, Net (Tables)	3 Months Ended
	Mar. 31, 2018
Property, Plant and Equipment [Abstract]
Schedule of Property and Equipment, Net	Property and equipment, net are as follows (in thousands): March 31, December 31, 2018 2017 Equipment $ 4,466 $ 4,471 Computer equipment 497 490 Computer software 523 523 Furniture and fixtures 215 215 Leasehold improvements 4,017 4,030 Vehicles 10 10 Surgical instruments 11,353 11,462 Total cost 21,081 21,201 Less: accumulated depreciation (11,750) (11,288) Property and equipment, net $ 9,331 $ 9,913

Intangible Assets (Tables)

Intangible Assets (Tables)	3 Months Ended
	Mar. 31, 2018
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Intangible Assets	The following table sets forth information regarding intangible assets ( in thousands): March 31, December 31, Patents $ 847 $ 847 Acquisition related intangibles: Technology 13,789 13,789 Customer relationships 9,911 9,911 Tradename 1,867 1,867 Non-compete 41 41 Accumulated amortization (13,478) (12,629) Intangible assets, net $ 12,977 $ 13,826 Aggregate amortization expense: $ 849 $ 4,629
Schedule of Estimated Amortization Expense for Intangible Assets	The following is a summary of estimated future amortization expense for intangible assets as of March 31, 2018 (in thousands): Remainder of 2018 $ 2,503 2019 3,121 2020 2,091 2021 1,367 2022 1,024 Thereafter 2,871 Total $ 12,977

Accrued Liabilities (Tables)

Accrued Liabilities (Tables)	3 Months Ended
	Mar. 31, 2018
Payables and Accruals [Abstract]
Schedule of Accrued Liabilities	Accrued liabilities consist of the following (in thousands): March 31, December 31, 2018 2017 Accrued stock compensation $ 20 $ 120 Wages/commissions payable 2,015 2,831 Accrued interest payable - 10,834 Other accrued expenses 1,817 2,060 Accrued liabilities $ 3,852 $ 15,845

Debt (Tables)

Debt (Tables)	3 Months Ended
	Mar. 31, 2018
Debt Disclosure [Abstract]
Schedule of Long-term Debt	Long-term debt consists of the following (in thousands): March 31, December 31, 2018 2017 Amounts due under the Credit Facility $ 55,787 $ 55,787 PIK interest payable related to the Credit Facility 21,099 11,582 6% convertible senior unsecured notes due 2021 - 71,866 Gross long-term debt 76,886 139,235 Less: total debt issuance costs (235) (1,272) Long-term debt, less issuance costs $ 76,651 $ 137,963
Schedule of Maturities of Long-term Debt	The following is a summary of maturities due on the debt as of March 31, 2018 (in thousands): Remainder of 2018 $ - 2019 - 2020 - 2021 76,886 2022 - Thereafter - Total $ 76,886

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	3 Months Ended
	Mar. 31, 2018
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 (in thousands, except number of shares and per share amounts): 2018 2017 Shares Weighted Weighted Shares Weighted Weighted Outstanding at January 1 67,465 $ 71.03 $ 36.85 100,492 $ 62.52 $ 33.84 Cancelled or expired (131) 88.82 55.76 (1,486) 88.08 50.88 Outstanding at March 31 67,334 $ 74.70 $ 36.74 99,006 $ 62.16 $ 33.60 Exercisable at March 31 67,334 $ 74.70 $ 36.74 30,971 $ 141.72 $ 68.52

Warrants (Tables)

Warrants (Tables)	3 Months Ended
	Mar. 31, 2018
Warrants and Rights Note Disclosure [Abstract]
Schedule of Warrant Activity	The following table summarizes our warrant activities for the quarter ended March 31, 2018: Weighted Common Average Stock Exercise Warrants Price Outstanding as of January 1, 2017 524,277 $ 26.76 Expired (4,360) 135.36 Outstanding at January 1, 2018 519,917 $ 25.68 Expired - - Outstanding at March 31, 2018 519,917 $ 25.68
Schedule of Warrant Valuation Assumptions	The estimated fair value was derived using a valuation model with the following weighted-average assumptions: Quarter Ended March 31, 2018 2017 Value of underlying common stock (per share) $ 7.89 $ 7.44 Risk free interest rate 2.3 % 1.9 % Expected term in years 4.3 5.3 Volatility 98 % 91 % 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 quarter ended March 31, 2018 and 2017: 2018 2017 Balance at January 1, 93,759 93,759 Derivative warrants issued, exercised and expired - - Balance at March 31, 93,759 93,759

Commitments and Contingencies (

Commitments and Contingencies (Tables)	3 Months Ended
	Mar. 31, 2018
Commitments and Contingencies Disclosure [Abstract]
Schedule of Future Minimum Rental Payments for Operating Leases	Future minimum payments for the next five years and thereafter as of March 31, 2018, under these leases, are as follows (in thousands): Remainder of 2018 $ 606 2019 669 2020 396 2021 375 2022 354 Thereafter 685 Total $ 3,085
Schedule of Future Minimum Lease Payments for Capital Leases	Future minimum payments for the next five years and thereafter as of March 31, 2018, under capital leases for equipment, are as follows (in thousands): Remainder of 2018 $ 400 2019 502 2020 218 2021 - 2022 - Thereafter - Total minimum lease payments 1,120 Less amount representing interest (211) Present value of obligations under capital leases 909 Less current portion (383) Long-term capital lease obligations $ 526

Supplemental Disclosure of Ca31

Supplemental Disclosure of Cash Flow Information (Tables)	3 Months Ended
	Mar. 31, 2018
Supplemental Cash Flow Elements [Abstract]
Supplemental Disclosure of Cash Flow Information	Supplemental cash flow information is as follows (in thousands): Three Months Ended March 31, 2018 2017 Supplemental disclosure of cash flow information Cash paid during the period for: Interest $ 259 $ 249 Non-cash activity: Issuance of capital leases $ 84 $ 967 Interest converted into common stock $ 556 $ 480 Conversion of convertible debt to equity $ 71,865 $ - Convertible PIK interest $ 4,764 $ - Conversion of interest related to the Credit Facility to long-term debt $ 7,977 $ - Write-off of convertible debt issuance cost $ 1,012 $ -

Segment and Geographic Inform32

Segment and Geographic Information (Tables)	3 Months Ended
	Mar. 31, 2018
Segment Reporting [Abstract]
Schedule of Revenues by Geographic Region	Total revenue by major geographic area is as follows (in thousands): Three Months Ended 2018 2017 United States $ 17,153 $ 21,105 Rest of world 781 978 Total revenue $ 17,934 $ 22,083

Business Description and Summ33

Business Description and Summary of Significant Accounting Policies (Details) - USD ($)	Mar. 31, 2018	Dec. 31, 2017
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Warrant derivative liability	$ 169,000	$ 131,000
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	$ 169	$ 131

Business Description and Summ34

Business Description and Summary of Significant Accounting Policies (Details 1) - USD ($)	3 Months Ended	12 Months Ended
	Mar. 31, 2018	Dec. 31, 2017
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Balance	$ 131	$ 334
Gain recognized in earnings	38	(203)
Balance	$ 169	$ 131

Business Description and Summ35

Business Description and Summary of Significant Accounting Policies (Details Textual)	1 Months Ended		3 Months Ended		12 Months Ended
	Feb. 14, 2018USD ($)$ / sharesshares	Jan. 17, 2018$ / sharesshares	Mar. 31, 2018USD ($)$ / sharesshares	Mar. 31, 2017USD ($)	Dec. 31, 2017shares	Feb. 13, 2018shares
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount			587,251		623,251
Debt Instrument, Convertible, Conversion Price | $ / shares		$ 9.11
Debt Conversion, Converted Instrument, Amount | $			$ 71,865,000	$ 0
Debt Conversion, Converted Instrument, Shares Issued		189,645
Common Stock, Shares Authorized			50,000,000		50,000,000
Preferred Stock, Shares Authorized			10,000,000		10,000,000
Description Of Royalty Opportunities	(i) issue new securities; (ii) incur over $0.25 million of debt in a fiscal year; (iii) sell or transfer over $0.25 million of our assets or businesses or our subsidiaries in a fiscal year; (iv)acquire over $0.25 million of assets or properties in a fiscal year; (v)make capital expenditures over $0.125 million individually, or $1.5 million 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 $0.25 million in a fiscal year.
Noncontrolling Interest, Ownership Percentage by Parent			70.00%
Reverse Stock Split Before [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Common Stock, Shares Authorized						95,000,000
Preferred Stock, Shares Authorized						50,000,000
Reverse Stock Split After [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Common Stock, Shares Authorized						5,000,000
Preferred Stock, Shares Authorized						10,000,000
Six percentage of Convertible Senior Unsecured Notes [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Debt Instrument, Convertible, Conversion Price | $ / shares			$ 7.20
Debt Conversion, Converted Instrument, Amount | $			$ 70,200,000
Debt Instrument, Interest Rate, Stated Percentage			6.00%
Debt Instrument, Convertible, Conversion Ratio			138.8889
Debt Instrument, Face Amount | $			$ 1,000
Debt Conversion, Converted Instrument, Shares Issued			10,401,309
Minimum [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Outstanding Common Stock In Percentage	40.00%
Securities Purchase Agreement [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Stock Issued During Period, Shares, New Issues	945,819
Shares Issued, Price Per Share | $ / shares	$ 7.20
Stock Issued During Period, Value, New Issues | $	$ 6,800,000

Inventories, Net (Details)

Inventories, Net (Details) - USD ($) $ in Thousands	Mar. 31, 2018	Dec. 31, 2017
Current inventories
Raw materials	$ 4,401	$ 4,277
Work in process	1,433	1,515
Finished goods	23,561	23,270
Gross current inventories	29,395	29,062
Reserve for obsolescence	(6,883)	(6,833)
Current inventories, net	22,512	22,229
Non-current inventories
Finished goods	958	1,072
Reserve for obsolescence	(820)	(878)
Non-current inventories, net	138	194
Total inventories, net	$ 22,650	$ 22,423

Inventories, Net (Details Textu

Inventories, Net (Details Textual) - USD ($) $ in Millions	Mar. 31, 2018	Dec. 31, 2017
Consigned Inventory [Member]
Other Inventory, Inventory at off Site Premises, Gross	$ 11.6	$ 12

Property and Equipment, Net (De

Property and Equipment, Net (Details) - USD ($) $ in Thousands	Mar. 31, 2018	Dec. 31, 2017
Property, Plant and Equipment [Line Items]
Total cost	$ 21,081	$ 21,201
Less: accumulated depreciation	(11,750)	(11,288)
Property and equipment, net	9,331	9,913
Equipment
Property, Plant and Equipment [Line Items]
Total cost	4,466	4,471
Computer equipment
Property, Plant and Equipment [Line Items]
Total cost	497	490
Computer software
Property, Plant and Equipment [Line Items]
Total cost	523	523
Furniture and fixtures
Property, Plant and Equipment [Line Items]
Total cost	215	215
Leasehold improvements
Property, Plant and Equipment [Line Items]
Total cost	4,017	4,030
Vehicles
Property, Plant and Equipment [Line Items]
Total cost	10	10
Surgical instruments
Property, Plant and Equipment [Line Items]
Total cost	$ 11,353	$ 11,462

Property and Equipment, Net (39

Property and Equipment, Net (Details Textual) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2018	Dec. 31, 2017
Property, Plant and Equipment [Line Items]
Capital Leased Assets, Gross	$ 1,600
Capital Leases, Lessee Balance Sheet, Assets by Major Class, Accumulated Depreciation	1,000
Depreciation	700	$ 900
Property, Plant and Equipment, Net	9,331	9,913
Surgical Instruments Property Equipments [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Net	$ 3,500	$ 4,600

Intangible Assets (Details)

Intangible Assets (Details) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2018	Dec. 31, 2017
Finite Lived Intangible Assets Future Amortization Expense [Line Items]
Accumulated amortization	$ (13,478)	$ (12,629)
Intangible assets, net	12,977	13,826
Aggregate amortization expense:	849	4,629
Patents [Member]
Finite Lived Intangible Assets Future Amortization Expense [Line Items]
Gross carrying value	847	847
Technology [Member]
Finite Lived Intangible Assets Future Amortization Expense [Line Items]
Gross carrying value	13,789	13,789
Customer relationships [Member]
Finite Lived Intangible Assets Future Amortization Expense [Line Items]
Gross carrying value	9,911	9,911
Tradename [Member]
Finite Lived Intangible Assets Future Amortization Expense [Line Items]
Gross carrying value	1,867	1,867
Non-compete [Member]
Finite Lived Intangible Assets Future Amortization Expense [Line Items]
Gross carrying value	$ 41	$ 41

Intangible Assets (Details 1)

Intangible Assets (Details 1) - USD ($) $ in Thousands	Mar. 31, 2018	Dec. 31, 2017
Estimated amortization expense:
Remainder of 2018	$ 2,503
2,019	3,121
2,020	2,091
2,021	1,367
2,022	1,024
Thereafter	2,871
Total	$ 12,977	$ 13,826

Accrued Liabilities (Details)

Accrued Liabilities (Details) - USD ($) $ in Thousands	Mar. 31, 2018	Dec. 31, 2017
Accrued Liabilities [Line Items]
Accrued stock compensation	$ 20	$ 120
Wages/commissions payable	2,015	2,831
Accrued interest payable	0	10,834
Other accrued expenses	1,817	2,060
Accrued Liabilities	$ 3,852	$ 15,845

Debt (Details)

Debt (Details) - USD ($) $ in Thousands	Mar. 31, 2018	Dec. 31, 2017
Debt Instrument [Line Items]
Amounts due under the Credit Facility	$ 55,787	$ 55,787
PIK interest payable related to the Credit Facility	21,099	11,582
6% convertible senior unsecured notes due 2021	0	71,866
Total	76,886	139,235
Less: total debt issuance costs	(235)	(1,272)
Long-term debt, less issuance costs	$ 76,651	$ 137,963

Debt (Details 1)

Debt (Details 1) - USD ($) $ in Thousands	Mar. 31, 2018	Dec. 31, 2017
Schedule of maturities due on debt [Line Items]
Remainder of 2018	$ 0
2,019	0
2,020	0
2,021	76,886
2,022	0
Thereafter	0
Total	$ 76,886	$ 139,235

Debt (Details Textual)

Debt (Details Textual)	1 Months Ended
	Feb. 14, 2018	Mar. 31, 2018
Twenty-Third Amendment to Amended and Restated Credit Agreement [Member] | Through December 31, 2018 [Member]
Debt Instrument [Line Items]
Debt Instrument Interest Rate Portion Payable In Cash	10.00%
Debt Instrument, Basis Spread on Variable Rate	12.00%
Twenty-Third Amendment to Amended and Restated Credit Agreement [Member] | January 1, 2019 through June 30, 2019 [Member]
Debt Instrument [Line Items]
Debt Instrument Interest Rate Portion Payable In Cash	10.00%
Debt Instrument, Basis Spread on Variable Rate	15.00%
Twenty-Third Amendment to Amended and Restated Credit Agreement [Member] | July 1, 2019 through the maturity date [Member]
Debt Instrument [Line Items]
Debt Instrument Interest Rate Portion Payable In Cash	10.00%
Debt Instrument, Fee Percentage	1.00%
Convertible Senior Unsecured Notes [Member]
Debt Instrument [Line Items]
Debt Instrument, Interest Rate, Stated Percentage		6.00%

Equity (Details Textual)

Equity (Details Textual) - USD ($)	1 Months Ended
	Feb. 14, 2018	Jan. 17, 2018	Mar. 31, 2018	Dec. 31, 2017	Jan. 17, 2017
Schedule of Equity Method Investments [Line Items]
Long-term Debt, Gross			$ 76,886,000	$ 139,235,000
Debt Conversion, Converted Instrument, Shares Issued		189,645
Private Placement SPA [Member]
Schedule of Equity Method Investments [Line Items]
Stock Issued During Period, Shares, New Issues	945,819
Shares Issued, Price Per Share	$ 7.20
Stock Issued During Period, Value, New Issues	$ 6,800,000
Convertible Senior Unsecured Promissory Notes [Member]
Schedule of Equity Method Investments [Line Items]
Long-term Debt, Gross	$ 70,238				$ 1,600,000
Debt Instrument, Interest Rate, Stated Percentage					6.00%
Debt Conversion, Converted Instrument, Shares Issued	10,400,000	189,645

Stock-Based Compensation (Detai

Stock-Based Compensation (Details) - Stock Option - $ / shares	3 Months Ended
	Mar. 31, 2018	Mar. 31, 2017
Schedule of activity under stock option plans [Line Items]
Outstanding at January 1	67,465	100,492
Cancelled or expired, Shares	(131)	(1,486)
Outstanding at March 31	67,334	99,006
Exercisable at March 31	67,334	30,971
Outstanding at January 1, Weighted Average Exercise Price	$ 71.03	$ 62.52
Cancelled or expired, Weighted Average Exercise Price	88.82	88.08
Outstanding at March 31, Weighted Average Exercise Price	74.70	62.16
Exercisable at March 31, Weighted Average Exercise Price	74.70	141.72
Outstanding at January 1, Weighted Average Fair Value At Grant Date	36.85	33.84
Cancelled or expired, Weighted Average Fair Value At Grant Date	55.76	50.88
Outstanding at March 31, Weighted Average Fair Value At Grant Date	36.74	33.60
Exercisable at March 31, Weighted Average Fair Value At Grant Date	$ 36.74	$ 68.52

Stock-Based Compensation (Det48

Stock-Based Compensation (Details Textual) - USD ($) $ / shares in Units, $ in Thousands	Oct. 06, 2016	Feb. 14, 2018	Feb. 13, 2018	Jul. 25, 2017	Mar. 31, 2018	Mar. 31, 2017	Feb. 14, 2020	Feb. 14, 2019
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Shares authorized under the Plan					153,333
Aggregate intrinsic value of options outstanding					18
Other Noncash Expense					$ 364	$ 145
Restructuring Costs			$ 200
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
Employees and Directors [Member]
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Allocated Share-based Compensation Expense					400	$ 200
Restricted Stock [Member] | Director [Member]
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Employee Service Share-based Compensation, Nonvested Awards, Compensation Not yet Recognized, Share-based Awards Other than Options								$ 300
Stock Issued During Period, Shares, Restricted Stock Award, Net of Forfeitures, Total		67,708
Shares Issued, Price Per Share							$ 4.80
Other Noncash Expense					27
Restricted Stock [Member] | Former 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
Employee Service Share-based Compensation, Nonvested Awards, Compensation Not yet Recognized, Share-based Awards Other than Options				$ 200
Shares Issued, Price Per Share				$ 9.24
Other Noncash Expense					$ 100

Warrants (Details)

Warrants (Details) - $ / shares	3 Months Ended	12 Months Ended
	Mar. 31, 2018	Dec. 31, 2017
Warrant activity [Line Items]
Outstanding	519,917	524,277
Expired	0	(4,360)
Outstanding	519,917	519,917
Outstanding Weighted Average Exercise Price	$ 25.68	$ 26.76
Expired, Weighted Average Exercise Price	0	135.36
Outstanding Weighted Average Exercise Price	$ 25.68	$ 25.68

Warrants (Details 1)

Warrants (Details 1) - Warrant [Member] - $ / shares	3 Months Ended
	Mar. 31, 2018	Mar. 31, 2017
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Value of underlying common stock (per share)	$ 7.89	$ 7.44
Risk free interest rate	2.30%	1.90%
Expected term in years	4 years 3 months 18 days	5 years 3 months 18 days
Volatility	98.00%	91.00%
Dividend yield	0.00%	0.00%

Warrants (Details 2)

Warrants (Details 2) - shares	3 Months Ended
	Mar. 31, 2018	Mar. 31, 2017
Class of Warrant or Right [Line Items]
Outstanding	519,917	524,277
Outstanding	519,917
Warrant [Member]
Class of Warrant or Right [Line Items]
Outstanding	93,759	93,759
Derivative warrants issued, exercised and expired	0	0
Outstanding	93,759	93,759

Warrants (Details Textual)

Warrants (Details Textual) $ in Thousands	3 Months Ended
	Mar. 31, 2018USD ($)
Class of Warrant or Right [Line Items]
Unrealized Loss On Warranty Derivative Liability	$ 38

Commitments and Contingencies53

Commitments and Contingencies (Details) $ in Thousands	Mar. 31, 2018USD ($)
Schedule of future minimum payments by operating lease [Line Items]
Remainder of 2018	$ 606
2,019	669
2,020	396
2,021	375
2,022	354
Thereafter	685
Total	$ 3,085

Commitments and Contingencies54

Commitments and Contingencies (Details 1) - USD ($) $ in Thousands	Mar. 31, 2018	Dec. 31, 2017
Remainder of 2018	$ 400
2,019	502
2,020	218
2,021	0
2,022	0
Thereafter	0
Total minimum lease payments	1,120
Less amount representing interest	(211)
Present value of obligations under capital leases	909
Less current portion	(383)	$ (366)
Long-term capital lease obligations	$ 526	$ 623

Commitments and Contingencies55

Commitments and Contingencies (Details Textual) - USD ($) $ in Millions	Aug. 10, 2017	Mar. 31, 2018	Mar. 31, 2017
Schedule of commitment and contingencies [Line Items]
Loss Contingency, Damages Sought, Value	$ 1
Sale-leaseback Transaction for the Property Located at 664 Cruiser Lane, Belgrade, Montana [Member]
Schedule of commitment and contingencies [Line Items]
Operating Leases, Rent Expense, Net		$ 0.2	$ 0.2
Lessee Leasing Arrangements Operating Leases Term Of Each Option To Extend		5 years

Supplemental Disclosure of Ca56

Supplemental Disclosure of Cash Flow Information (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2018	Mar. 31, 2017
Cash paid during the period for:
Interest	$ 259	$ 249
Non-cash activity:
Issuance of capital leases	84	967
Interest converted into common stock	556	480
Conversion of convertible debt to equity	71,865	0
Convertible PIK interest	4,764	0
Conversion of interest related to the Credit Facility to long-term debt	7,977	0
Write-off of convertible debt issuance cost	$ 1,012	$ 0

Related Party Transactions (Det

Related Party Transactions (Details Textual) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2018	Mar. 31, 2017	Dec. 31, 2017
Related Party Transaction [Line Items]
Due to Related Parties, Current	$ 63		$ 160
Noncontrolling Interest, Ownership Percentage by Parent	70.00%
One Vendor [Member] | Sales Revenue, Net [Member]
Related Party Transaction [Line Items]
Concentration Risk, Percentage	10.00%	10.00%

Segment and Geographic Inform58

Segment and Geographic Information (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2018	Mar. 31, 2017
Revenue, Net, Total	$ 17,934	$ 22,083
United States [Member]
Revenue, Net, Total	17,153	21,105
Rest Of World [Member]
Revenue, Net, Total	$ 781	$ 978

Segment and Geographic Inform59

Segment and Geographic Information (Details Textual)	3 Months Ended
	Mar. 31, 2018	Mar. 31, 2017
Geographic Concentration Risk [Member] | UNITED STATES | Sales Revenue, Net [Member]
Concentration Risk, Percentage	96.00%	96.00%

Subsequent Events (Details Text

Subsequent Events (Details Textual) - Subsequent Event [Member] - USD ($) $ / shares in Units, $ in Millions	1 Months Ended
	May 18, 2018	Apr. 27, 2018
Subsequent Event [Line Items]
Class of Warrant or Right, Number of Securities Called by Warrants or Rights	1,137,515
Number of Warrants Issued for Each Share of Common Stock	0.0869816
Share Price		$ 7.20
Net Proceeds to be Received from Rights Offering after Deducting Expenses		$ 8