Xtant Medical (XTNT) 10-Q 3 Nov 22 2022 Q3 Quarterly report Financial data

Cover

Cover - shares	9 Months Ended
	Sep. 30, 2022	Nov. 01, 2022
Cover [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Quarterly Report	true
Document Transition Report	false
Document Period End Date	Sep. 30, 2022
Document Fiscal Period Focus	Q3
Document Fiscal Year Focus	2022
Current Fiscal Year End Date	--12-31
Entity File Number	001-34951
Entity Registrant Name	XTANT MEDICAL HOLDINGS, INC.
Entity Central Index Key	0001453593
Entity Tax Identification Number	20-5313323
Entity Incorporation, State or Country Code	DE
Entity Address, Address Line One	664 Cruiser Lane
Entity Address, City or Town	Belgrade
Entity Address, State or Province	MT
Entity Address, Postal Zip Code	59714
City Area Code	(406)
Local Phone Number	388-0480
Title of 12(b) Security	Common stock, par value $0.000001 per share
Trading Symbol	XTNT
Security Exchange Name	NYSE
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Non-accelerated Filer
Entity Small Business	true
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		108,659,388

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Current Assets:
Cash and cash equivalents	$ 17,363	$ 18,243
Restricted cash	240	144
Trade accounts receivable, net of allowance for credit losses and doubtful accounts of $549 and $552, respectively	9,839	7,154
Inventories	16,993	17,945
Prepaid and other current assets	673	844
Total current assets	45,108	44,330
Property and equipment, net	5,669	5,212
Right-of-use asset, net	1,490	1,258
Goodwill	3,205	3,205
Intangible assets, net	358	400
Other assets	219	287
Total Assets	56,049	54,692
Current Liabilities:
Accounts payable	3,779	2,615
Accrued liabilities	5,021	4,349
Current portion of lease liability	443	462
Current portion of finance lease obligations	61	31
Line of credit	720	3,620
Current portion of long-term debt	1,335
Total current liabilities	11,359	11,077
Long-term Liabilities:
Lease liability, less current portion	1,094	842
Finance lease obligation, less current portion	197	103
Long-term debt, plus premium and less issuance costs	10,626	11,787
Total Liabilities	23,276	23,809
Commitments and Contingencies (Note 11)
Stockholders’ Equity:
Preferred stock, $0.000001 par value; 10,000,000 shares authorized; no shares issued and outstanding
Common stock, $0.000001 par value; 300,000,000 shares authorized; 101,981,250 shares issued and outstanding as of September 30, 2022 and 87,068,980 shares issued and outstanding as of December 31, 2021
Additional paid-in capital	274,234	266,068
Accumulated deficit	(241,461)	(235,185)
Total Stockholders’ Equity	32,773	30,883
Total Liabilities & Stockholders’ Equity	$ 56,049	$ 54,692

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Statement of Financial Position [Abstract]
Allowance of accounts receivable, net	$ 549	$ 552
Preferred stock, par value	$ 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	$ 0.000001	$ 0.000001
Common stock, shares authorized	300,000,000	300,000,000
Common stock, shares issued	101,981,250	87,068,980
Common stock, shares outstanding	101,981,250	87,068,980

Condensed Consolidated Statemen

Condensed Consolidated Statements of Operations (Unaudited) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Revenue
Orthopedic product sales	$ 14,462	$ 13,743	$ 42,689	$ 41,193
Other revenue		34	10	100
Total Revenue	14,462	13,777	42,699	41,293
Cost of sales	6,566	6,586	18,868	16,498
Gross Profit	7,896	7,191	23,831	24,795
Operating Expenses
General and administrative	3,729	3,107	11,496	10,307
Sales and marketing	5,838	5,267	16,683	15,712
Research and development	229	262	683	719
Total Operating Expenses	9,796	8,636	28,862	26,738
Loss from Operations	(1,900)	(1,445)	(5,031)	(1,943)
Other Expense
Interest expense	(440)	(329)	(1,197)	(529)
Total Other Expense	(440)	(329)	(1,197)	(529)
Net Loss Before Provision for Income Taxes	(2,340)	(1,774)	(6,228)	(2,472)
Provision for Income Taxes Current and Deferred	(13)	(30)	(48)	(94)
Net Loss	$ (2,353)	$ (1,804)	$ (6,276)	$ (2,566)
Net loss per share:
Basic	$ (0.03)	$ (0.02)	$ (0.07)	$ (0.03)
Dilutive	$ (0.03)	$ (0.02)	$ (0.07)	$ (0.03)
Shares used in the computation:
Basic	93,278,610	86,763,210	89,236,832	84,926,656
Dilutive	93,278,610	86,763,210	89,236,832	84,926,656

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Equity (Unaudited) - USD ($) $ in Thousands	Total	Common Stock [Member]	Additional Paid-in Capital [Member]	Retained Earnings [Member]
Beginning balance at Dec. 31, 2020	$ 14,514		$ 244,850	$ (230,336)
Beginning balance, shares at Dec. 31, 2020		77,573,680
Warrants issued in connection with the private placement to placement agents	351		351
Common stock issued on vesting of restricted stock units
Common stock issued on vesting of restricted stock units, shares		244,716
Stock-based compensation	456		456
Net loss	(29)			(29)
Private placement of common stock, net of issuance costs of $1,926	12,831		12,831
Private placement of common stock, net of issuance costs of $1,926, shares		8,888,890
Warrants issued in connection with the private placement	5,243		5,243
Ending balance at Mar. 31, 2021	33,366		263,731	(230,365)
Ending balance, shares at Mar. 31, 2021		86,707,286
Beginning balance at Dec. 31, 2020	14,514		244,850	(230,336)
Beginning balance, shares at Dec. 31, 2020		77,573,680
Net loss	(2,566)
Ending balance at Sep. 30, 2021	32,637		265,539	(232,902)
Ending balance, shares at Sep. 30, 2021		86,796,175
Beginning balance at Mar. 31, 2021	33,366		263,731	(230,365)
Beginning balance, shares at Mar. 31, 2021		86,707,286
Gain on debt extinguishment	786		786
Stock-based compensation	465		465
Net loss	(733)			(733)
Ending balance at Jun. 30, 2021	33,884		264,982	(231,098)
Ending balance, shares at Jun. 30, 2021		86,707,286
Common stock issued on vesting of restricted stock units
Common stock issued on vesting of restricted stock units, shares		104,856
Withholding of common stock upon vesting of restricted stock units	(23)		(23)
Withholding of common stock upon vesting of restricted stock units, shares		(15,967)
Stock-based compensation	580		580
Net loss	(1,804)			(1,804)
Ending balance at Sep. 30, 2021	32,637		265,539	(232,902)
Ending balance, shares at Sep. 30, 2021		86,796,175
Beginning balance at Dec. 31, 2021	30,883		266,068	(235,185)
Beginning balance, shares at Dec. 31, 2021		87,068,980
Common stock issued on vesting of restricted stock units
Common stock issued on vesting of restricted stock units, shares		244,721
Stock-based compensation	613		613
Net loss	(2,213)			(2,213)
Ending balance at Mar. 31, 2022	29,283		266,681	(237,398)
Ending balance, shares at Mar. 31, 2022		87,313,701
Beginning balance at Dec. 31, 2021	30,883		266,068	(235,185)
Beginning balance, shares at Dec. 31, 2021		87,068,980
Net loss	(6,276)
Ending balance at Sep. 30, 2022	32,773		274,234	(241,461)
Ending balance, shares at Sep. 30, 2022		101,981,250
Beginning balance at Mar. 31, 2022	29,283		266,681	(237,398)
Beginning balance, shares at Mar. 31, 2022		87,313,701
Stock-based compensation	571		571
Net loss	(1,710)			(1,710)
Ending balance at Jun. 30, 2022	28,144		267,252	(239,108)
Ending balance, shares at Jun. 30, 2022		87,313,701
Common stock issued on vesting of restricted stock units
Common stock issued on vesting of restricted stock units, shares		607,234
Stock-based compensation	641		641
Net loss	(2,353)			(2,353)
Private placement of common stock, net of issuance costs of $1,926	5,225		5,225
Private placement of common stock, net of issuance costs of $1,926, shares		14,060,315
Warrants issued in connection with the private placement	1,116		1,116
Ending balance at Sep. 30, 2022	$ 32,773		$ 274,234	$ (241,461)
Ending balance, shares at Sep. 30, 2022		101,981,250

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Equity (Unaudited) (Parenthetical) - USD ($) $ in Thousands	3 Months Ended
	Sep. 30, 2022	Mar. 31, 2021
Statement of Cash Flows [Abstract]
Payments of stock issuance costs	$ 409	$ 1,926

Condensed Consolidated Statem_4

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021
Operating activities:
Net loss	$ (6,276)	$ (2,566)
Adjustments to reconcile net loss to net cash (used in) provided by operating activities:
Depreciation and amortization	971	1,041
Gain on disposal of fixed assets	(91)	(164)
Non-cash interest	175	38
Non-cash rent	2	8
Stock-based compensation	1,825	1,501
Provision for reserve (recovery) on accounts receivable	277	(25)
Provision for excess and obsolete inventory	1,568	572
Changes in operating assets and liabilities:
Accounts receivable	(2,962)	584
Inventories	(616)	1,128
Prepaid and other assets	239	(126)
Accounts payable	1,164	(592)
Accrued liabilities	671	(1,383)
Net cash (used in) provided by operating activities	(3,053)	16
Investing activities:
Purchases of property and equipment and intangible assets	(1,321)	(1,489)
Proceeds from sale of fixed assets	184	194
Net cash used in investing activities	(1,137)	(1,295)
Financing activities:
Payment of taxes from withholding of common stock on vesting of restricted stock units		(23)
Payments on financing leases	(35)	(42)
Costs associated with refinancing		(136)
Payments on long-term debt		(411)
Borrowings on line of credit	36,680	22,767
Repayments of line of credit	(39,580)	(23,029)
Proceeds from private placement, net of cash issuance costs	6,341	18,426
Net cash provided by financing activities	3,406	17,552
Net change in cash and cash equivalents and restricted cash	(784)	16,273
Cash and cash equivalents and restricted cash at beginning of period	18,387	2,341
Cash and cash equivalents and restricted cash at end of period	17,603	18,614
Reconciliation of cash and restricted cash reported in the condensed consolidated balance sheets
Cash and cash equivalents	17,363	18,175
Restricted cash	240	439
Total cash and restricted cash reported in the condensed consolidated balance sheets	$ 17,603	$ 18,614

Business Description, Basis of

Business Description, Basis of Presentation and Summary of Significant Accounting Policies	9 Months Ended
	Sep. 30, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Business Description, Basis of Presentation and Summary of Significant Accounting Policies	(1) Business Description, Basis of Presentation and Summary of Significant Accounting Policies Business Description and Basis of Presentation 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 is a global medical technology company focused on the design, development, and commercialization of a comprehensive portfolio of orthobiologics and spinal implant systems to facilitate spinal fusion in complex spine, deformity, and degenerative procedures. At the onset of, and at various times during, the COVID-19 pandemic, hospitals and other medical facilities cancelled or deferred elective procedures, diverted resources to patients suffering from infections and limited access for non-patients, including our direct and indirect sales representatives. Especially during waves of increased cases and hospitalizations, surgeons and their patients have been required or chosen to defer procedures in which our products otherwise would be used, and many facilities that specialize in the procedures in which our products otherwise would be used have experienced temporary closures or reduced operating hours. These circumstances have negatively impacted, and may continue to negatively impact, the ability of our employees, independent sales representatives and distributors to effectively market and sell our products, which has had and may continue to have a material adverse effect on our revenues. The accompanying condensed consolidated balance sheet as of December 31, 2021, which has been derived from audited financial statements, and the unaudited interim condensed consolidated financial statements have been 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 that may be achieved in the future for the full year ending December 31, 2022. 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, 2021. 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. Private Placement On August 25, 2022, the Company closed the first tranche of a private placement (the “First Closing”) with several accredited investors (the “Private Placement”). At the First Closing, the Company sold approximately 14.1 3.5 6.75 We received net cash proceeds of approximately $ 6.3 The closing of the second tranche of the Private Placement (the “Second Closing”) occurred on October 7, 2022. At the Second Closing, the Company sold an additional approximately 6.2 1.6 3.0 The Warrants, described in more detail in Note 10, “Warrants”, 0.48 Use of Estimates The preparation of the condensed 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 condensed 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, current and long-term lease obligations and corresponding right-of-use asset and estimates for the fair value of long-term debt, stock options and other equity awards upon which the Company determines stock-based compensation expense. Actual results could differ from those estimates. Restricted Cash Cash and cash equivalents classified as restricted cash on our condensed consolidated balance sheets are restricted as to withdrawal or use under the terms of certain credit agreements. The September 30, 2022 balance included lockbox deposits that are temporarily restricted due to timing at the period end. The lockbox deposits are applied against our line of credit the next business day. Long-Lived Assets The Company reviews its long-lived assets for impairment whenever events or changes in circumstances indicate that the carrying amount of the asset may not be recovered. No impairments of long-lived assets were recorded for the three and nine months ended September 30, 2022 and 2021. 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. No impairments of goodwill were recorded for the three and nine months ended September 30, 2022 and 2021. Net Loss Per Share Basic net loss per share is computed by dividing net loss by the weighted average number of shares of common stock outstanding. Shares issued during the period and shares reacquired during the period are weighted for the portion of the period that they were outstanding. Diluted net loss per share is computed in a manner consistent with that of basic earnings per share while giving effect to all potentially dilutive shares of common stock outstanding during the period, which include the assumed exercise of stock options and warrants using the treasury stock method. Our diluted earnings per share is the same as basic earnings per share, as the effects of including 17,192,048 14,138,224 Fair Value of Financial Instruments The carrying values of financial instruments, including trade accounts receivable, accounts payable, accrued liabilities, and long-term debt, approximate their fair values based on terms and related interest rates as of September 30, 2022 and December 31, 2021.

Revenue

Revenue	9 Months Ended
	Sep. 30, 2022
Revenue from Contract with Customer [Abstract]
Revenue	(2) Revenue In the United States, we generate most of our revenue from independent commissioned sales agents. We consign our orthobiologics products to hospitals and consign or loan our spinal implant sets to the independent sales agents. The spinal implant sets typically contain the instruments, disposables, and spinal implants required to complete a surgery. Consigned sets are managed by the sales agent to service hospitals that are high volume users for multiple procedures. We ship replacement inventory to independent sales agents to replace the consigned inventory used in surgeries. Loaned sets are returned to the Company’s distribution center, replenished, and made available to sales agents for the next surgical procedure. For each surgical procedure, the sales agent reports use of the product by the hospital and, as soon as practicable thereafter, ensures that the hospital provides a purchase order to the Company. Upon receipt of the hospital purchase order, the Company invoices the hospital, and revenue is recognized in the proper period. Additionally, the Company sells product directly to domestic and international stocking resellers and private label resellers. Upon receipt and acceptance of a purchase order from a stocking reseller, the Company ships product and invoices the reseller. The Company recognizes revenue when control of the promised goods is transferred to the customer, in an amount that reflects the consideration the Company expects to collect in exchange for those goods or services. There is generally no customer acceptance or other condition that prevents the Company from recognizing revenue in accordance with the delivery terms for these sales transactions. The Company operates in one reportable segment with its net revenue derived primarily from the sale of orthopaedic medical products and devices across North America, Europe, Asia Pacific, and Latin America. Sales are reported net of returns. The following table presents revenues from these product lines for the three and nine months ended September 30, 2022 and 2021 (in thousands): Summary of Revenues from Product Lines Three Months Ended September Percentage of Total Revenue Three Months Ended September 30, 2021 Percentage of Total Revenue Orthobiologics $ 12,046 83 % $ 10,795 78 % Spinal implant 2,416 17 % 2,948 22 % Other revenue — 0 % 34 0 % Total revenue $ 14,462 100 % $ 13,777 100 % Nine Months Ended 30, 2022 Percentage Revenue Nine Months Ended 30, 2021 Percentage Revenue Orthobiologics $ 34,614 81 % $ 31,264 76 % Spinal implant 8,075 19 % 9,929 24 % Other revenue 10 0 % 100 0 % Total revenue $ 42,699 100 % $ 41,293 100 %

Receivables

Receivables	9 Months Ended
	Sep. 30, 2022
Credit Loss [Abstract]
Receivables	(3) Receivables The Company’s provision for current expected credit loss is determined based on historical collection experience adjusted for current economic conditions affecting collectability. Actual customer collections could differ from estimates. Account balances are charged to the allowance after all means of collection have been exhausted and the potential for recovery is considered remote. Provisions to the allowance for credit losses are charged to expense. Activity within the allowance for credit losses was as follows for the three and nine months ended September 30, 2022 and 2021 (in thousands): Schedule of Allowance for Credit Losses September 30, September 30, Balance at January 1 $ 552 $ 653 Provision for current expected credit losses 191 (63 ) Write-offs charged against allowance (173 ) (36 ) Balance at March 31 570 554 Provision for current expected credit losses (49 ) (81 ) Write-offs charged against allowance (11 ) (3 ) Balance at June 30 510 470 Provision for current expected credit losses 54 118 Write-offs charged against allowance (15 ) (12 ) Balance at September 30 $ 549 $ 576

Inventories

Inventories	9 Months Ended
	Sep. 30, 2022
Inventory Disclosure [Abstract]
Inventories	(4) Inventories Inventories consist of the following (in thousands): Schedule of Inventories September 30, December 31, Raw materials $ 5,121 $ 5,613 Work in process 957 571 Finished goods 10,915 11,761 Total $ 16,993 $ 17,945

Property and Equipment, Net

Property and Equipment, Net	9 Months Ended
	Sep. 30, 2022
Property, Plant and Equipment [Abstract]
Property and Equipment, Net	(5) Property and Equipment, Net Property and equipment, net are as follows (in thousands): Schedule of Property and Equipment, Net September 30, December 31, Equipment $ 6,302 $ 5,541 Computer equipment 1,090 828 Computer software 490 490 Furniture and fixtures 104 94 Leasehold improvements 4,333 3,994 Other 10 10 Surgical instruments 11,307 11,424 Total cost 23,636 22,381 Less: accumulated depreciation (17,967 ) (17,169 ) Property and equipment, net $ 5,669 $ 5,212 Depreciation expense related to property and equipment, including property under finance leases, for the three months ended September 30, 2022 and 2021 was $ 0.4 0.3 1

Intangible Assets

Intangible Assets	9 Months Ended
	Sep. 30, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
Intangible Assets	(6) Intangible Assets The following table sets forth information regarding intangible assets (in thousands): Schedule of Intangible Assets September 30, December 31, Patents $ 807 $ 847 Accumulated amortization (449 ) (447 ) Intangible assets, net $ 358 $ 400

Accrued Liabilities

Accrued Liabilities	9 Months Ended
	Sep. 30, 2022
Payables and Accruals [Abstract]
Accrued Liabilities	(7) Accrued Liabilities Accrued liabilities consist of the following (in thousands): Schedule of Accrued Liabilities September 30, December 31, Cash compensation/commissions payable $ 3,844 $ 3,184 Other accrued liabilities 1,177 1,165 Accrued liabilities $ 5,021 $ 4,349

Debt

Debt	9 Months Ended
	Sep. 30, 2022
Debt Disclosure [Abstract]
Debt	(8) Debt Long-term debt consists of the following (in thousands): Schedule of Long-term Debt September 30, 2022 December 31, 2021 Amounts due under the Term Facility $ 12,000 $ 12,000 Accrued end-of-term payments 182 83 Less: unamortized debt issuance costs (221 ) (296 ) Less: current maturities (1,335 ) — Long-term debt $ 10,626 $ 11,787 On March 7, 2022, the Company’s term loan agreement and revolving credit agreement were amended to, among other things, (i) provide for a waiver of compliance with respect to the Company’s minimum adjusted EBITDA requirement if and so long as the Company’s liquidity (as specifically defined in the term loan agreement and revolving credit agreement) is in excess of $ 14 The effective rate of the term loan, inclusive of amortization of debt issuance costs and accretion of the final payment, was 11.53 7.07 7.3 On October 27, 2022, the Company’s term loan and revolving credit agreements were amended to transition the reference rate from LIBOR to term SOFR. The term SOFR reference rate will apply to amounts outstanding and draws that place on or after November 1, 2022.

Stock-Based Compensation

Stock-Based Compensation	9 Months Ended
	Sep. 30, 2022
Share-Based Payment Arrangement [Abstract]
Stock-Based Compensation	(9) Stock-Based Compensation Stock option activity, including options granted under the Xtant Medical Holdings, Inc. 2018 Equity Incentive Plan, as amended (the “2018 Plan”), and the Amended and Restated Xtant Medical Equity Incentive Plan and options granted to new hires to purchase shares of our common stock outside of any stockholder-approved plan, was as follows for the nine months ended September 30, 2022 and 2021: Schedule of Share-based Compensation, Stock Options, Activity 2022 2021 Shares Weighted Weighted Shares Weighted Weighted Average Remaining Contract Term (years) Outstanding at January 1 3,201,666 $ 1.80 2,190,892 $ 2.25 Granted 109,164 $ 0.65 1,012,083 $ 1.27 Cancelled or expired (443,125 ) $ 2.39 (269 ) $ 314.19 Outstanding at September 30 2,867,705 $ 1.66 8.1 3,202,706 $ 1.92 9.1 Exercisable at September 30 828,978 $ 2.37 7.8 210,028 $ 9.02 7.4 Restricted stock unit activity for awards granted under the 2018 Plan was as follows for the nine months ended September 30, 2022 and 2021: Schedule of Restricted Stock Activity 2022 2021 Shares Weighted Average Value at Date Per Share Shares Weighted Average Value at Date Per Outstanding at January 1 2,970,104 $ 1.39 2,503,698 $ 1.54 Granted 1,898,808 $ 0.53 1,249,002 $ 1.27 Vested (851,955 ) $ 1.33 (349,572 ) $ 1.92 Cancelled (318,805 ) $ 1.38 — $ — Outstanding at September 30 3,698,152 $ 0.96 3,403,128 $ 1.40 At the 2022 annual meeting of stockholders held on October 26, 2022, our shareholders approved an amendment to the 2018 Plan to increase the number of shares of common stock available thereunder by 8,500,000

Warrants

Warrants	9 Months Ended
	Sep. 30, 2022
Warrants
Warrants	(10) Warrants As noted in Note 1, “ Business Description, Basis of Presentation and Summary of Significant Accounting Policies While the Warrants are classified as a component of equity, we were required to allocate the proceeds of the Private Placement between the shares of common stock and the Warrants issued based on their relative fair values. The fair value of the Warrants, $ 0.40 5 107 Our warrant activity during the nine months ended September 30, 2022 was as follows: Schedule of Warrant Activity Common Stock Weighted Average Outstanding at January 1, 2022 7,111,112 $ 2.29 Issued 3,515,079 0.48 Outstanding at September 30, 2022 10,626,191 $ 1.69

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
	Sep. 30, 2022
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	(11) Commitments and Contingencies Operating Leases We lease three office facilities as of September 30, 2022 in Belgrade, Montana under non-cancelable operating lease agreements. On July 14, 2022, the Company’s lease agreement for facilities at 600 Cruiser Lane in Belgrade, Montana was amended to, among other things, extend the lease term through October 2025 to align the lease term with the Company’s lease agreement for facilities at 664 Cruisier Lane in Belgrade, Montana. In addition, the Company’s lease agreement for facilities at 732 Cruiser Lane in Belgrade, Montana was amended on July 29, 2022 to extend the lease term through October 2025. 3.1 Present Value of Long-term Leases Schedule of Lease Liability (in thousands): September 30, Right-of-use assets, net $ 1,490 Current portion of lease liability $ 443 Lease liability, less current portion 1,094 Total lease liability $ 1,537 Future minimum payments for the next five years and thereafter as of September 30, 2022 under these long-term operating leases are as follows (in thousands): Schedule of Future Minimum Rental Payments for Operating Leases Remainder of 2022 131 2023 534 2024 559 2025 470 Total future minimum lease payments 1,694 Less amount representing interest (157 ) Present value of obligations under operating leases 1,537 Less current portion (443 ) Long-term operating lease obligations $ 1,094 Rent expense was $ 0.1 0.4 Litigation We are subject to potential liabilities under government regulations and various claims and legal actions that are pending or may be asserted from time to time. These matters arise in the ordinary course and conduct of our business and may include, for example, commercial, product liability, intellectual property, and employment matters. When we believe that a loss is probable and reasonably estimable, we record a charge on our condensed consolidated statements of operations for our estimated loss. We do not believe that the ultimate resolution of any such potential liabilities, claims or legal actions will have a material adverse effect upon our consolidated financial position, results of operations, or cash flows. Indemnifications Our indemnification 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	9 Months Ended
	Sep. 30, 2022
Income Tax Disclosure [Abstract]
Income Taxes	(12) 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 applicable 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 three and nine months ended September 30, 2022 and 2021.

Supplemental Disclosure of Cash

Supplemental Disclosure of Cash Flow Information	9 Months Ended
	Sep. 30, 2022
Supplemental Cash Flow Elements [Abstract]
Supplemental Disclosure of Cash Flow Information	(13) Supplemental Disclosure of Cash Flow Information Supplemental cash flow information is as follows (in thousands): Schedule of Supplemental Cash Flow Information 2022 2021 Nine Months Ended September 30, 2022 2021 Supplemental disclosure of cash flow information Cash paid during the period for: Interest $ 1,022 $ 485 Non-cash activities: Fixed assets acquired under finance lease $ 159 $ 163 Revaluation of lease liability and right of use asset $ 234 $ — Gain on extinguishment of Second A&R Credit Agreement $ — $ 786 Extinguishment of Second A&R Credit Agreement financed by line of credit $ — $ 3,755 Prepaid debt issuance costs $ — $ 75 Warrants issued in connection with the Private Placement to placement agents $ — $ 351

Related Party Transactions

Related Party Transactions	9 Months Ended
	Sep. 30, 2022
Related Party Transactions [Abstract]
Related Party Transactions	(14) Related Party Transactions As described in more detail under Note 1, “ Business Description and Summary of Significant Accounting Policies 72% All related party transactions are reviewed and approved by the Audit Committee or the disinterested members of the full Board of Directors.

Segment and Geographic Informat

Segment and Geographic Information	9 Months Ended
	Sep. 30, 2022
Segment Reporting [Abstract]
Segment and Geographic Information	(15) Segment and Geographic Information The Company’s management reviews financial results and manages the business on an aggregate basis. Therefore, financial results are reported in a single operating segment: the development, manufacture, and marketing of orthopedic medical products and devices. The Company attributes revenues to geographic areas based on the location of the customer. Approximately 99% 99% Schedule of Revenues by Geographic Region Three Months Ended 2022 2021 United States $ 14,370 $ 13,629 Rest of world 92 148 Total revenue $ 14,462 $ 13,777 Nine Months Ended 2022 2021 United States $ 42,089 $ 40,813 Rest of world 610 480 Total revenue $ 42,699 $ 41,293

Business Description, Basis o_2

Business Description, Basis of Presentation and Summary of Significant Accounting Policies (Policies)	9 Months Ended
	Sep. 30, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Business Description and Basis of Presentation	Business Description and Basis of Presentation 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 is a global medical technology company focused on the design, development, and commercialization of a comprehensive portfolio of orthobiologics and spinal implant systems to facilitate spinal fusion in complex spine, deformity, and degenerative procedures. At the onset of, and at various times during, the COVID-19 pandemic, hospitals and other medical facilities cancelled or deferred elective procedures, diverted resources to patients suffering from infections and limited access for non-patients, including our direct and indirect sales representatives. Especially during waves of increased cases and hospitalizations, surgeons and their patients have been required or chosen to defer procedures in which our products otherwise would be used, and many facilities that specialize in the procedures in which our products otherwise would be used have experienced temporary closures or reduced operating hours. These circumstances have negatively impacted, and may continue to negatively impact, the ability of our employees, independent sales representatives and distributors to effectively market and sell our products, which has had and may continue to have a material adverse effect on our revenues. The accompanying condensed consolidated balance sheet as of December 31, 2021, which has been derived from audited financial statements, and the unaudited interim condensed consolidated financial statements have been 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 that may be achieved in the future for the full year ending December 31, 2022. 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, 2021. 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.
Private Placement	Private Placement On August 25, 2022, the Company closed the first tranche of a private placement (the “First Closing”) with several accredited investors (the “Private Placement”). At the First Closing, the Company sold approximately 14.1 3.5 6.75 We received net cash proceeds of approximately $ 6.3 The closing of the second tranche of the Private Placement (the “Second Closing”) occurred on October 7, 2022. At the Second Closing, the Company sold an additional approximately 6.2 1.6 3.0 The Warrants, described in more detail in Note 10, “Warrants”, 0.48
Use of Estimates	Use of Estimates The preparation of the condensed 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 condensed 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, current and long-term lease obligations and corresponding right-of-use asset and estimates for the fair value of long-term debt, stock options and other equity awards upon which the Company determines stock-based compensation expense. Actual results could differ from those estimates.
Restricted Cash	Restricted Cash Cash and cash equivalents classified as restricted cash on our condensed consolidated balance sheets are restricted as to withdrawal or use under the terms of certain credit agreements. The September 30, 2022 balance included lockbox deposits that are temporarily restricted due to timing at the period end. The lockbox deposits are applied against our line of credit the next business day.
Long-Lived Assets	Long-Lived Assets The Company reviews its long-lived assets for impairment whenever events or changes in circumstances indicate that the carrying amount of the asset may not be recovered. No impairments of long-lived assets were recorded for the three and nine months ended September 30, 2022 and 2021.
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. No impairments of goodwill were recorded for the three and nine months ended September 30, 2022 and 2021.
Net Loss Per Share	Net Loss Per Share Basic net loss per share is computed by dividing net loss by the weighted average number of shares of common stock outstanding. Shares issued during the period and shares reacquired during the period are weighted for the portion of the period that they were outstanding. Diluted net loss per share is computed in a manner consistent with that of basic earnings per share while giving effect to all potentially dilutive shares of common stock outstanding during the period, which include the assumed exercise of stock options and warrants using the treasury stock method. Our diluted earnings per share is the same as basic earnings per share, as the effects of including 17,192,048 14,138,224
Fair Value of Financial Instruments	Fair Value of Financial Instruments The carrying values of financial instruments, including trade accounts receivable, accounts payable, accrued liabilities, and long-term debt, approximate their fair values based on terms and related interest rates as of September 30, 2022 and December 31, 2021.

Revenue (Tables)

Revenue (Tables)	9 Months Ended
	Sep. 30, 2022
Revenue from Contract with Customer [Abstract]
Summary of Revenues from Product Lines	Summary of Revenues from Product Lines Three Months Ended September Percentage of Total Revenue Three Months Ended September 30, 2021 Percentage of Total Revenue Orthobiologics $ 12,046 83 % $ 10,795 78 % Spinal implant 2,416 17 % 2,948 22 % Other revenue — 0 % 34 0 % Total revenue $ 14,462 100 % $ 13,777 100 % Nine Months Ended 30, 2022 Percentage Revenue Nine Months Ended 30, 2021 Percentage Revenue Orthobiologics $ 34,614 81 % $ 31,264 76 % Spinal implant 8,075 19 % 9,929 24 % Other revenue 10 0 % 100 0 % Total revenue $ 42,699 100 % $ 41,293 100 %

Receivables (Tables)

Receivables (Tables)	9 Months Ended
	Sep. 30, 2022
Credit Loss [Abstract]
Schedule of Allowance for Credit Losses	Schedule of Allowance for Credit Losses September 30, September 30, Balance at January 1 $ 552 $ 653 Provision for current expected credit losses 191 (63 ) Write-offs charged against allowance (173 ) (36 ) Balance at March 31 570 554 Provision for current expected credit losses (49 ) (81 ) Write-offs charged against allowance (11 ) (3 ) Balance at June 30 510 470 Provision for current expected credit losses 54 118 Write-offs charged against allowance (15 ) (12 ) Balance at September 30 $ 549 $ 576

Inventories (Tables)

Inventories (Tables)	9 Months Ended
	Sep. 30, 2022
Inventory Disclosure [Abstract]
Schedule of Inventories	Inventories consist of the following (in thousands): Schedule of Inventories September 30, December 31, Raw materials $ 5,121 $ 5,613 Work in process 957 571 Finished goods 10,915 11,761 Total $ 16,993 $ 17,945

Property and Equipment, Net (Ta

Property and Equipment, Net (Tables)	9 Months Ended
	Sep. 30, 2022
Property, Plant and Equipment [Abstract]
Schedule of Property and Equipment, Net	Property and equipment, net are as follows (in thousands): Schedule of Property and Equipment, Net September 30, December 31, Equipment $ 6,302 $ 5,541 Computer equipment 1,090 828 Computer software 490 490 Furniture and fixtures 104 94 Leasehold improvements 4,333 3,994 Other 10 10 Surgical instruments 11,307 11,424 Total cost 23,636 22,381 Less: accumulated depreciation (17,967 ) (17,169 ) Property and equipment, net $ 5,669 $ 5,212

Intangible Assets (Tables)

Intangible Assets (Tables)	9 Months Ended
	Sep. 30, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Intangible Assets	The following table sets forth information regarding intangible assets (in thousands): Schedule of Intangible Assets September 30, December 31, Patents $ 807 $ 847 Accumulated amortization (449 ) (447 ) Intangible assets, net $ 358 $ 400

Accrued Liabilities (Tables)

Accrued Liabilities (Tables)	9 Months Ended
	Sep. 30, 2022
Payables and Accruals [Abstract]
Schedule of Accrued Liabilities	Accrued liabilities consist of the following (in thousands): Schedule of Accrued Liabilities September 30, December 31, Cash compensation/commissions payable $ 3,844 $ 3,184 Other accrued liabilities 1,177 1,165 Accrued liabilities $ 5,021 $ 4,349

Debt (Tables)

Debt (Tables)	9 Months Ended
	Sep. 30, 2022
Debt Disclosure [Abstract]
Schedule of Long-term Debt	Long-term debt consists of the following (in thousands): Schedule of Long-term Debt September 30, 2022 December 31, 2021 Amounts due under the Term Facility $ 12,000 $ 12,000 Accrued end-of-term payments 182 83 Less: unamortized debt issuance costs (221 ) (296 ) Less: current maturities (1,335 ) — Long-term debt $ 10,626 $ 11,787

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	9 Months Ended
	Sep. 30, 2022
Share-Based Payment Arrangement [Abstract]
Schedule of Share-based Compensation, Stock Options, Activity	Schedule of Share-based Compensation, Stock Options, Activity 2022 2021 Shares Weighted Weighted Shares Weighted Weighted Average Remaining Contract Term (years) Outstanding at January 1 3,201,666 $ 1.80 2,190,892 $ 2.25 Granted 109,164 $ 0.65 1,012,083 $ 1.27 Cancelled or expired (443,125 ) $ 2.39 (269 ) $ 314.19 Outstanding at September 30 2,867,705 $ 1.66 8.1 3,202,706 $ 1.92 9.1 Exercisable at September 30 828,978 $ 2.37 7.8 210,028 $ 9.02 7.4
Schedule of Restricted Stock Activity	Restricted stock unit activity for awards granted under the 2018 Plan was as follows for the nine months ended September 30, 2022 and 2021: Schedule of Restricted Stock Activity 2022 2021 Shares Weighted Average Value at Date Per Share Shares Weighted Average Value at Date Per Outstanding at January 1 2,970,104 $ 1.39 2,503,698 $ 1.54 Granted 1,898,808 $ 0.53 1,249,002 $ 1.27 Vested (851,955 ) $ 1.33 (349,572 ) $ 1.92 Cancelled (318,805 ) $ 1.38 — $ — Outstanding at September 30 3,698,152 $ 0.96 3,403,128 $ 1.40

Warrants (Tables)

Warrants (Tables)	9 Months Ended
	Sep. 30, 2022
Warrants
Schedule of Warrant Activity	Our warrant activity during the nine months ended September 30, 2022 was as follows: Schedule of Warrant Activity Common Stock Weighted Average Outstanding at January 1, 2022 7,111,112 $ 2.29 Issued 3,515,079 0.48 Outstanding at September 30, 2022 10,626,191 $ 1.69

Commitments and Contingencies (

Commitments and Contingencies (Tables)	9 Months Ended
	Sep. 30, 2022
Commitments and Contingencies Disclosure [Abstract]
Schedule of Lease Liability	Present Value of Long-term Leases Schedule of Lease Liability (in thousands): September 30, Right-of-use assets, net $ 1,490 Current portion of lease liability $ 443 Lease liability, less current portion 1,094 Total lease liability $ 1,537
Schedule of Future Minimum Rental Payments for Operating Leases	Future minimum payments for the next five years and thereafter as of September 30, 2022 under these long-term operating leases are as follows (in thousands): Schedule of Future Minimum Rental Payments for Operating Leases Remainder of 2022 131 2023 534 2024 559 2025 470 Total future minimum lease payments 1,694 Less amount representing interest (157 ) Present value of obligations under operating leases 1,537 Less current portion (443 ) Long-term operating lease obligations $ 1,094

Supplemental Disclosure of Ca_2

Supplemental Disclosure of Cash Flow Information (Tables)	9 Months Ended
	Sep. 30, 2022
Supplemental Cash Flow Elements [Abstract]
Schedule of Supplemental Cash Flow Information	Supplemental cash flow information is as follows (in thousands): Schedule of Supplemental Cash Flow Information 2022 2021 Nine Months Ended September 30, 2022 2021 Supplemental disclosure of cash flow information Cash paid during the period for: Interest $ 1,022 $ 485 Non-cash activities: Fixed assets acquired under finance lease $ 159 $ 163 Revaluation of lease liability and right of use asset $ 234 $ — Gain on extinguishment of Second A&R Credit Agreement $ — $ 786 Extinguishment of Second A&R Credit Agreement financed by line of credit $ — $ 3,755 Prepaid debt issuance costs $ — $ 75 Warrants issued in connection with the Private Placement to placement agents $ — $ 351

Segment and Geographic Inform_2

Segment and Geographic Information (Tables)	9 Months Ended
	Sep. 30, 2022
Segment Reporting [Abstract]
Schedule of Revenues by Geographic Region	Schedule of Revenues by Geographic Region Three Months Ended 2022 2021 United States $ 14,370 $ 13,629 Rest of world 92 148 Total revenue $ 14,462 $ 13,777 Nine Months Ended 2022 2021 United States $ 42,089 $ 40,813 Rest of world 610 480 Total revenue $ 42,699 $ 41,293

Business Description, Basis o_3

Business Description, Basis of Presentation and Summary of Significant Accounting Policies (Details Narrative) - USD ($) $ / shares in Units, $ in Thousands			3 Months Ended		9 Months Ended
	Oct. 07, 2022	Aug. 25, 2022	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Subsidiary, Sale of Stock [Line Items]
Warrant exercise price			$ 0.40		$ 0.40
Antidilutive securities excluded from computation of earnings per share, amount			17,192,048	14,138,224	17,192,048	14,138,224
Private Placement [Member] | Share-Based Payment Arrangement, Tranche One [Member]
Subsidiary, Sale of Stock [Line Items]
Number of stock sold		14,100,000
Warrants to purchase common stock		3,500,000
Proceeds from private placement		$ 6,750
Cash proceeds		$ 6,300
Warrant exercise price		$ 0.48
Private Placement [Member] | Share-Based Payment Arrangement, Tranche Two [Member] | Subsequent Event [Member]
Subsidiary, Sale of Stock [Line Items]
Number of stock sold	6,200,000
Warrants to purchase common stock	1,600,000
Proceeds from private placement	$ 3,000

Summary of Revenues from Produc

Summary of Revenues from Product Lines (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Disaggregation of Revenue [Line Items]
Total revenue	$ 14,462	$ 13,777	$ 42,699	$ 41,293
Percentage of total revenue	100%	100%	100%	100%
Orthobiologics [Member]
Disaggregation of Revenue [Line Items]
Total revenue	$ 12,046	$ 10,795	$ 34,614	$ 31,264
Percentage of total revenue	83%	78%	81%	76%
Spinal Implant [Member]
Disaggregation of Revenue [Line Items]
Total revenue	$ 2,416	$ 2,948	$ 8,075	$ 9,929
Percentage of total revenue	17%	22%	19%	24%
Other Revenue [Member]
Disaggregation of Revenue [Line Items]
Total revenue		$ 34	$ 10	$ 100
Percentage of total revenue	0%	0%	0%	0%

Schedule of Allowance for Credi

Schedule of Allowance for Credit Losses (Details) - USD ($) $ in Thousands	3 Months Ended
	Sep. 30, 2022	Jun. 30, 2022	Mar. 31, 2022	Sep. 30, 2021	Jun. 30, 2021	Mar. 31, 2021
Credit Loss [Abstract]
Beginning balance	$ 510	$ 570	$ 552	$ 470	$ 554	$ 653
Provision for expected credit losses	54	49	191	118	81	63
Provision for expected credit losses	(54)	(49)	(191)	(118)	(81)	(63)
Write-offs against allowance	(15)	(11)	(173)	(12)	(3)	(36)
Ending balance	$ 549	$ 510	$ 570	$ 576	$ 470	$ 554

Schedule of Inventories (Detail

Schedule of Inventories (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Inventory Disclosure [Abstract]
Raw materials	$ 5,121	$ 5,613
Work in process	957	571
Finished goods	10,915	11,761
Total	$ 16,993	$ 17,945

Schedule of Property and Equipm

Schedule of Property and Equipment, Net (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Property, Plant and Equipment [Line Items]
Total cost	$ 23,636	$ 22,381
Less: accumulated depreciation	(17,967)	(17,169)
Property and equipment, net	5,669	5,212
Equipment [Member]
Property, Plant and Equipment [Line Items]
Total cost	6,302	5,541
Computer Equipment [Member]
Property, Plant and Equipment [Line Items]
Total cost	1,090	828
Computer Softwares [Member]
Property, Plant and Equipment [Line Items]
Total cost	490	490
Furniture and Fixtures [Member]
Property, Plant and Equipment [Line Items]
Total cost	104	94
Leasehold Improvements [Member]
Property, Plant and Equipment [Line Items]
Total cost	4,333	3,994
Other Properties [Member]
Property, Plant and Equipment [Line Items]
Total cost	10	10
Surgical Instruments [Member]
Property, Plant and Equipment [Line Items]
Total cost	$ 11,307	$ 11,424

Property and Equipment, Net (De

Property and Equipment, Net (Details Narrative) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Property, Plant and Equipment [Abstract]
Depreciation expenses	$ 0.4	$ 0.3	$ 1	$ 1

Schedule of Intangible Assets (

Schedule of Intangible Assets (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
Patents	$ 807	$ 847
Accumulated amortization	(449)	(447)
Intangible assets, net	$ 358	$ 400

Schedule of Accrued Liabilities

Schedule of Accrued Liabilities (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Payables and Accruals [Abstract]
Cash compensation/commissions payable	$ 3,844	$ 3,184
Other accrued liabilities	1,177	1,165
Accrued liabilities	$ 5,021	$ 4,349

Schedule of Long-term Debt (Det

Schedule of Long-term Debt (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Debt Disclosure [Abstract]
Amounts due under the Term Facility	$ 12,000	$ 12,000
Accrued end-of-term payments	182	83
Less: unamortized debt issuance costs	(221)	(296)
Less: current maturities	(1,335)
Long-term debt	$ 10,626	$ 11,787

Debt (Details Narrative)

Debt (Details Narrative) - USD ($) $ in Millions	Mar. 07, 2022	Sep. 30, 2022
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Debt instrument interest rate		11.53%
Credit Agreement [Member]
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Increase in liquidity amount	$ 14
Debt instrument interest rate		7.07%
Line of credit		$ 7.3

Schedule of Share-based Compens

Schedule of Share-based Compensation, Stock Options, Activity (Details) - Equity Option [Member] - 2018 Equity Incentive Plan [Member] - $ / shares	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Shares, Outstanding, Beginning Balance	3,201,666	2,190,892
Weighted Average Exercise Price, Outstanding Beginning Balance	$ 1.80	$ 2.25
Shares, Granted	109,164	1,012,083
Weighted Average Exercise Price, Cancelled or expired	$ 0.65	$ 1.27
Shares, Cancelled or expired	(443,125)	(269)
Weighted Average Exercise Price, Cancelled or expired	$ 2.39	$ 314.19
Shares, Outstanding, Ending Balance	2,867,705	3,202,706
Weighted Average Exercise Price, Outstanding Ending Balance	$ 1.66	$ 1.92
Weighted Average Remaining Contractual Term (Years) Outstanding	8 years 1 month 6 days	9 years 1 month 6 days
Shares, Exercisable, Ending Balance	828,978	210,028
Weighted Average Exercise Price, Exercisable Ending Balance	$ 2.37	$ 9.02
Weighted Average Remaining Contractual Term (Years) Exercisable	7 years 9 months 18 days	7 years 4 months 24 days

Schedule of Restricted Stock Ac

Schedule of Restricted Stock Activity (Details) - Restricted Stock Units (RSUs) [Member] - 2018 Equity Incentive Plan [Member] - $ / shares	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Shares Outstanding, Beginning Balance	2,970,104	2,503,698
Weighted Average Fair Value at Grant Date, Outstanding Beginning Balance	$ 1.39	$ 1.54
Shares Granted	1,898,808	1,249,002
Weighted Average Fair Value at Grant Date, Granted	$ 0.53	$ 1.27
Shares Vested	(851,955)	(349,572)
Weighted Average Fair Value at Grant Date, Vested	$ 1.33	$ 1.92
Shares Cancelled	(318,805)
Weighted Average Fair Value at Grant Date, Cancelled	$ 1.38
Shares Outstanding, Ending Balance	3,698,152	3,403,128
Weighted Average Fair Value at Grant Date, Outstanding Ending Balance	$ 0.96	$ 1.40

Stock-Based Compensation (Detai

Stock-Based Compensation (Details Narrative)	Sep. 30, 2022 shares
2018 Equity Incentive Plan [Member]
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Number of shares available for issuance	8,500,000

Schedule of Warrant Activity (D

Schedule of Warrant Activity (Details)	9 Months Ended
	Sep. 30, 2022 $ / shares shares
Warrants
Common Stock Warrants Outstanding, Beginning Balance | shares	7,111,112
Weighted Average Exercise Price Outstanding Beginning Balance | $ / shares	$ 2.29
Common Stock Warrants, Issued | shares	3,515,079
Weighted Average Exercise Price, Issued | $ / shares	$ 0.48
Common Stock Warrants Outstanding, Ending Balance | shares	10,626,191
Weighted Average Exercise Price Outstanding Ending Balance | $ / shares	$ 1.69

Warrants (Details Narrative)

Warrants (Details Narrative)	Sep. 30, 2022 $ / shares
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Class of warrant or right, exercise price of warrants or rights	$ 0.40
Measurement Input, Expected Term [Member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Warrants contractual term	5 years
Measurement Input, Price Volatility [Member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Warrants and rights outstanding, measurement input	107

Schedule of Lease Liability (De

Schedule of Lease Liability (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Commitments and Contingencies Disclosure [Abstract]
Right-of-use assets, net	$ 1,490	$ 1,258
Current portion of lease liability	443	462
Lease liability, less current portion	1,094	$ 842
Total lease liability	$ 1,537

Schedule of Future Minimum Rent

Schedule of Future Minimum Rental Payments for Operating Leases (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Commitments and Contingencies Disclosure [Abstract]
Remainder of 2022	$ 131
2023	534
2024	559
2025	470
Total future minimum lease payments	1,694
Less amount representing interest	(157)
Present value of obligations under operating leases	1,537
Less current portion	(443)	$ (462)
Long-term operating lease obligations	$ 1,094	$ 842

Commitments and Contingencies_2

Commitments and Contingencies (Details Narrative) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Commitments and Contingencies Disclosure [Abstract]
Operating lease weighted-average remaining lease term	3 years 1 month 6 days		3 years 1 month 6 days
Rent expense	$ 0.1	$ 0.1	$ 0.4	$ 0.4

Schedule of Supplemental Cash F

Schedule of Supplemental Cash Flow Information (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021
Supplemental Cash Flow Elements [Abstract]
Interest	$ 1,022	$ 485
Fixed assets acquired under finance lease	159	163
Revaluation of lease liability and right of use asset	234
Gain on extinguishment of Second A&R Credit Agreement		786
Extinguishment of Second A&R Credit Agreement financed by line of credit		3,755
Prepaid debt issuance costs		75
Warrants issued in connection with the Private Placement to placement agents		$ 351

Related Party Transactions (Det

Related Party Transactions (Details Narrative)	Sep. 30, 2022
OrbiMed Advisors LLC [Member]
Equity method investment, ownership percentage	72%

Schedule of Revenues by Geograp

Schedule of Revenues by Geographic Region (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Revenues from External Customers and Long-Lived Assets [Line Items]
Total revenue	$ 14,462	$ 13,777	$ 42,699	$ 41,293
UNITED STATES
Revenues from External Customers and Long-Lived Assets [Line Items]
Total revenue	14,370	13,629	42,089	40,813
Rest of World [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Total revenue	$ 92	$ 148	$ 610	$ 480

Segment and Geographic Inform_3

Segment and Geographic Information (Details Narrative)	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Revenue from Contract with Customer Benchmark [Member] | Geographic Concentration Risk [Member] | UNITED STATES
Revenue, Major Customer [Line Items]
Concentration risk, percentage	99%	99%	99%	99%