Cover
Cover - shares | 6 Months Ended | |
Jun. 30, 2023 | Jul. 28, 2023 | |
Cover [Abstract] | ||
Document Type | 10-Q | |
Amendment Flag | false | |
Document Quarterly Report | true | |
Document Transition Report | false | |
Document Period End Date | Jun. 30, 2023 | |
Document Fiscal Period Focus | Q2 | |
Document Fiscal Year Focus | 2023 | |
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 $0.000001 per share | |
Trading Symbol | XTNT | |
Security Exchange Name | NYSE | |
Entity Current Reporting Status | Yes | |
Entity Interactive Data Current | Yes | |
Entity Filer Category | Non-accelerated Filer | |
Entity Small Business | true | |
Entity Emerging Growth Company | false | |
Entity Shell Company | false | |
Entity Common Stock, Shares Outstanding | 128,897,048 |
Condensed Consolidated Balance
Condensed Consolidated Balance Sheets - USD ($) $ in Thousands | Jun. 30, 2023 | Dec. 31, 2022 |
Current Assets: | ||
Cash and cash equivalents | $ 4,138 | $ 20,298 |
Restricted cash | 310 | 209 |
Trade accounts receivable, net of allowance for credit losses and doubtful accounts of $740 and $515, respectively | 13,744 | 10,853 |
Inventories | 20,364 | 17,285 |
Prepaid and other current assets | 1,015 | 673 |
Total current assets | 39,571 | 49,318 |
Property and equipment, net | 6,875 | 5,785 |
Right-of-use asset, net | 1,155 | 1,380 |
Goodwill | 6,514 | 3,205 |
Intangible assets, net | 10,920 | 344 |
Other assets | 183 | 197 |
Total Assets | 65,218 | 60,229 |
Current Liabilities: | ||
Accounts payable | 4,444 | 3,490 |
Accrued liabilities | 6,255 | 5,496 |
Current portion of lease liability | 488 | 458 |
Current portion of finance lease obligations | 63 | 62 |
Line of credit | 5,031 | 3,379 |
Current portion of long-term debt | 708 | 2,333 |
Total current liabilities | 16,989 | 15,218 |
Long-term Liabilities: | ||
Lease liability, less current portion | 720 | 972 |
Finance lease obligation, less current portion | 149 | 181 |
Long-term debt, plus premium and less issuance costs | 16,401 | 9,687 |
Total Liabilities | 34,259 | 26,058 |
Commitments and Contingencies (note 13) | ||
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; 108,897,048 shares issued and outstanding as of June 30, 2023 and 108,874,803 shares issued and outstanding as of December 31, 2022 | ||
Additional paid-in capital | 278,897 | 277,841 |
Accumulated deficit | (247,938) | (243,670) |
Total Stockholders’ Equity | 30,959 | 34,171 |
Total Liabilities & Stockholders’ Equity | $ 65,218 | $ 60,229 |
Condensed Consolidated Balanc_2
Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands | Jun. 30, 2023 | Dec. 31, 2022 |
Statement of Financial Position [Abstract] | ||
Allowance of accounts receivable, net | $ 740 | $ 515 |
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 | 108,897,048 | 108,874,803 |
Common stock, shares outstanding | 108,897,048 | 108,874,803 |
Condensed Consolidated Statemen
Condensed Consolidated Statements of Operations (Unaudited) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Revenue | ||||
Orthopedic product sales | $ 20,232 | $ 15,277 | $ 38,175 | $ 28,227 |
Other revenue | 1 | 9 | ||
Total Revenue | 20,232 | 15,277 | 38,176 | 28,236 |
Cost of sales | 7,773 | 6,903 | 15,180 | 12,302 |
Gross Profit | 12,459 | 8,374 | 22,995 | 15,934 |
Operating Expenses | ||||
General and administrative | 4,954 | 3,797 | 9,839 | 7,766 |
Sales and marketing | 8,716 | 5,636 | 15,770 | 10,845 |
Research and development | 180 | 241 | 354 | 454 |
Total Operating Expenses | 13,850 | 9,674 | 25,963 | 19,065 |
Loss from Operations | (1,391) | (1,300) | (2,967) | (3,131) |
Other Expense | ||||
Interest expense | (786) | (397) | (1,360) | (757) |
Interest income | 85 | |||
Total Other Expense | (786) | (397) | (1,275) | (757) |
Net Loss from Operations Before Provision for Income Taxes | (2,177) | (1,697) | (4,242) | (3,888) |
Provision for Income Taxes Current and Deferred | (13) | (13) | (26) | (35) |
Net Loss | $ (2,190) | $ (1,710) | $ (4,268) | $ (3,923) |
Net Loss Per Share: | ||||
Basic | $ (0.02) | $ (0.02) | $ (0.04) | $ (0.04) |
Dilutive | $ (0.02) | $ (0.02) | $ (0.04) | $ (0.04) |
Shares used in the computation: | ||||
Basic | 108,897,048 | 87,313,701 | 108,895,327 | 87,252,521 |
Dilutive | 108,897,048 | 87,313,701 | 108,895,327 | 87,252,521 |
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] |
Balance at Dec. 31, 2021 | $ 30,883 | $ 266,068 | $ (235,185) | |
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) | ||
Balance at Mar. 31, 2022 | 29,283 | 266,681 | (237,398) | |
Balance, shares at Mar. 31, 2022 | 87,313,701 | |||
Balance at Dec. 31, 2021 | 30,883 | 266,068 | (235,185) | |
Balance, shares at Dec. 31, 2021 | 87,068,980 | |||
Net loss | (3,923) | |||
Balance at Jun. 30, 2022 | 28,144 | 267,252 | (239,108) | |
Balance, shares at Jun. 30, 2022 | 87,313,701 | |||
Balance at Mar. 31, 2022 | 29,283 | 266,681 | (237,398) | |
Balance, shares at Mar. 31, 2022 | 87,313,701 | |||
Stock-based compensation | 571 | 571 | ||
Net loss | (1,710) | (1,710) | ||
Balance at Jun. 30, 2022 | 28,144 | 267,252 | (239,108) | |
Balance, shares at Jun. 30, 2022 | 87,313,701 | |||
Balance at Dec. 31, 2022 | 34,171 | 277,841 | (243,670) | |
Balance, shares at Dec. 31, 2022 | 108,874,803 | |||
Common stock issued on vesting of restricted stock units | ||||
Common stock issued on vesting of restricted stock units, shares | 22,245 | |||
Stock-based compensation | 617 | 617 | ||
Net loss | (2,078) | (2,078) | ||
Balance at Mar. 31, 2023 | 32,710 | 278,458 | (245,748) | |
Balance, shares at Mar. 31, 2023 | 108,897,048 | |||
Balance at Dec. 31, 2022 | 34,171 | 277,841 | (243,670) | |
Balance, shares at Dec. 31, 2022 | 108,874,803 | |||
Net loss | (4,268) | |||
Balance at Jun. 30, 2023 | 30,959 | 278,897 | (247,938) | |
Balance, shares at Jun. 30, 2023 | 108,897,048 | |||
Balance at Mar. 31, 2023 | 32,710 | 278,458 | (245,748) | |
Balance, shares at Mar. 31, 2023 | 108,897,048 | |||
Stock-based compensation | 439 | 439 | ||
Net loss | (2,190) | (2,190) | ||
Balance at Jun. 30, 2023 | $ 30,959 | $ 278,897 | $ (247,938) | |
Balance, shares at Jun. 30, 2023 | 108,897,048 |
Condensed Consolidated Statem_3
Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands | 6 Months Ended | |
Jun. 30, 2023 | Jun. 30, 2022 | |
Operating activities: | ||
Net loss | $ (4,268) | $ (3,923) |
Adjustments to reconcile net loss to net cash used in operating activities: | ||
Depreciation and amortization | 1,274 | 599 |
Gain on disposal of fixed assets | (21) | (84) |
Non-cash interest | 189 | 116 |
Non-cash rent | 3 | (1) |
Stock-based compensation | 1,056 | 1,184 |
Provision for reserve on accounts receivable | 225 | 143 |
Provision for excess and obsolete inventory | 243 | 825 |
Changes in operating assets and liabilities, net of the effects of the acquisition: | ||
Accounts receivable | (3,116) | (1,589) |
Inventories | (1,733) | 659 |
Prepaid and other assets | (330) | 465 |
Accounts payable | 954 | 428 |
Accrued liabilities | 758 | 189 |
Net cash used in operating activities | (4,766) | (989) |
Investing activities: | ||
Purchases of property and equipment and intangible assets | (870) | (810) |
Proceeds from sale of fixed assets | 55 | 165 |
Acquisition of Surgalign SPV, Inc. | (17,000) | |
Net cash used in investing activities | (17,815) | (645) |
Financing activities: | ||
Payments on financing leases | (30) | (22) |
Borrowings on line of credit | 36,256 | 26,567 |
Repayments on line of credit | (34,603) | (26,451) |
Net proceeds from issuance of long-term debt, net of issuance costs | 4,899 | |
Net cash provided by financing activities | 6,522 | 94 |
Net change in cash and cash equivalents and restricted cash | (16,059) | (1,540) |
Cash and cash equivalents and restricted cash at beginning of period | 20,507 | 18,387 |
Cash and cash equivalents and restricted cash at end of period | 4,448 | 16,847 |
Reconciliation of cash and cash equivalents and restricted cash reported in the condensed consolidated balance sheets | ||
Cash and cash equivalents | 4,138 | 16,495 |
Restricted cash | 310 | 352 |
Total cash and restricted cash reported in condensed consolidated balance sheets | $ 4,448 | $ 16,847 |
Business Description, Basis of
Business Description, Basis of Presentation and Summary of Significant Accounting Policies | 6 Months Ended |
Jun. 30, 2023 | |
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, Surgalign SPV, Inc., a Delaware corporation, and X-spine Systems, Inc. (“X-spine”), an Ohio corporation (Xtant, Xtant Medical, Bacterin, Surgalign SPV, Inc. 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. The accompanying condensed consolidated balance sheet as of December 31, 2022, 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, 2023. 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, 2022. 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. 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, intangible assets and liabilities; valuation allowances for trade receivables, inventory, deferred income tax assets and liabilities; current and long-term lease obligations and corresponding right-of-use asset; estimates for the fair value of assets acquired as part of business combinations; 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 contractual agreements. The June 30, 2023 and December 31, 2022 balances 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. Concentration of Credit Risk Financial instruments that potentially expose the Company to concentration of credit risk consist primarily of cash, cash equivalents and restricted cash. The Company maintains its cash balances primarily with two financial institutions. These balances generally exceed federally insured limits. The Company has not experienced any losses in such accounts and believes it is not exposed to any significant credit risk in cash and cash equivalents. 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 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 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. Diluted net loss per share was the same as basic net loss per share for the three and six months ended June 30, 2023 and 2022, 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. Our diluted earnings per share is the same as basic earnings per share, as the effects of including 18,885,572 12,474,376 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 June 30, 2023 and December 31, 2022. |
Acquisition of Coflex and CoFix
Acquisition of Coflex and CoFix Product Lines | 6 Months Ended |
Jun. 30, 2023 | |
Business Combination and Asset Acquisition [Abstract] | |
Acquisition of Coflex and CoFix Product Lines | (2) Acquisition of Coflex and CoFix Product Lines On February 28, 2023, we entered into an Equity Purchase Agreement (the “Equity Purchase Agreement”) with Surgalign SPV, Inc., a wholly owned subsidiary of Surgalign Spine Technologies, Inc., (“Seller”), Seller and Surgalign Holdings, Inc., pursuant to which we purchased all of the issued and outstanding shares of common stock of Surgalign SPV, which shares constituted all of the outstanding equity of Surgalign SPV, for an aggregate purchase price of $ 17.0 Immediately prior to the Closing, Seller and its affiliates transferred and assigned to Surgalign SPV, a newly formed entity wholly owned by Seller, certain intellectual property, contractual rights and other assets related to the design, manufacture, sale and distribution of Seller’s Coflex and CoFix products in the United States (the “Coflex Business”). The Coflex and CoFix products have been approved by the U.S. Food and Drug Administration for the treatment of moderate to severe lumbar spinal stenosis in conjunction with decompression and provide minimally invasive, motion preserving stabilization. In conjunction with the Equity Purchase Agreement, on February 28, 2023, we entered into a Transition Services Agreement with Surgalign SVP and Seller, whereby Seller agreed to provide, or cause to be provided, to us on and after the effective date of the Equity Purchase Agreement, after giving effect to the Closing, certain transitional services related to the transition of the Coflex Business. We funded the Purchase Price with cash on hand and approximately $ 5.0 We recorded the purchase of this acquisition using the acquisition method of accounting and, accordingly, recognized the assets acquired at their fair values as of the date of acquisition. The valuation of the acquired assets was refined during the three months ended June 30, 2023 resulting in adjustments to our allocation of the purchase price for additional inventory of $ 0.5 0.5 Schedule of Recognized Identified Assets Acquired and Liabilities Assumed Inventories $ 1,589 Equipment 947 Intangible assets 11,155 Net assets acquired 13,691 Goodwill 3,309 Total purchase consideration $ 17,000 The acquisition was recorded by allocating the costs of the net assets acquired based on their estimated fair values at the acquisition date. The fair values were based on management’s analysis, including work performed by third-party valuation specialists. Management’s estimates and assumptions are subject to change during the measurement period (up to one year from the acquisition date) as we finalize our valuations of assets acquired and liabilities assumed in connection with the acquisition. The primary areas of the purchase price allocation that are not yet finalized relate to identifiable intangible assets and goodwill. The acquisition strengthened the Company’s spine portfolio with the addition of the Coflex Business. Coflex is a differentiated and minimally invasive motion preserving stabilization implant that is FDA PMA-approved for the treatment of moderate to severe lumbar spinal stenosis in conjunction with decompression. This potential benefit resulted in the Company paying a premium for the acquisition resulting in the recognition of $ 3.3 The following unaudited pro forma combined financial information summarizes the results of operations for the periods indicated as if the acquisition had been completed as of January 1, 2022 (in thousands): Schedule of Pro forma Financial Information of Operations Six Months Ended June 30, 2023 2022 Revenues $ 40,000 $ 31,828 Net loss (3,745 ) (2,543 ) Pro forma information reflects adjustments that are expected to have a continuing impact on our results of operations and are directly attributable to the acquisition. The unaudited pro forma results include adjustments to reflect the amortization of the inventory step-up and the incremental intangible asset amortization to be incurred based on the preliminary values of each identifiable intangible asset. The pro forma amounts do not purport to be indicative of the results that would have actually been obtained if the acquisition had occurred as of January 1, 2022 or that may be obtained in the future, and do not reflect future synergies, integration costs, or other such costs or savings. |
Asset Purchase Agreement
Asset Purchase Agreement | 6 Months Ended |
Jun. 30, 2023 | |
Business Combination and Asset Acquisition [Abstract] | |
Asset Purchase Agreement | (3) Asset Purchase Agreement As previously disclosed, on June 18, 2023, we entered into an Asset Purchase Agreement (the “Asset Purchase Agreement”) with Surgalign Holdings, Inc. (“Surgalign Holdings”), pursuant to which, subject to the terms and conditions set forth in the Asset Purchase Agreement, we agreed to acquire certain assets of Surgalign Holdings and its subsidiaries on an as-is, where-is basis, including specified inventory, intellectual property and intellectual property rights, contracts, records and all outstanding equity securities of its international subsidiaries, and intangibles related to the business of designing, developing and manufacturing hardware medical technology and distributing biologics medical technology, as conducted by Surgalign Holdings and its subsidiaries (collectively, the “Assets”), and assume certain specified liabilities of Surgalign Holdings and its subsidiaries (collectively, the “Liabilities” and such acquisition of the Assets and assumption of the Liabilities together, the “Transaction”) for a total purchase price of $ 5 10 Surgalign Holdings, together with certain of its subsidiaries, is a debtor in a voluntary Chapter 11 case before the United States Bankruptcy Court for the Southern District of Texas (the “Bankruptcy Court”), which commenced on June 19, 2023, and therefore, the Transaction is being conducted through a Bankruptcy Court-supervised process and is subject to approval of the sale by the Bankruptcy Court and the satisfaction of certain conditions. Following Bankruptcy Court approval, we were designated as the initial bidder in connection with a sale of the Assets under Section 363 of the Bankruptcy Code. On July 28, 2023, the Seller filed a Notice of Successful Bidder announcing the Company as the successful bidder in an auction conducted under Bankruptcy-court approved bidding procedures. Pursuant to the terms of the Asset Purchase Agreement, and pending the issuance of a Sale Order by the Bankruptcy Court, closing of the Transaction is expected to occur after the Bankruptcy Court sale hearing, scheduled for August 8, 2023, but in no event later than September 1, 2023. |
Revenue
Revenue | 6 Months Ended |
Jun. 30, 2023 | |
Revenue from Contract with Customer [Abstract] | |
Revenue | (4) 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. Revenue is recognized upon utilization of product. 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 our net revenue derived primarily from the sale of orthobiologics and spinal implant products 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 six months ended June 30, 2023 and 2022 (in thousands): Summary of Revenues from Product Lines Three Months Ended Percentage of Three Months Ended Percentage of June 30, 2023 Total Revenue June 30, 2022 Total Revenue Orthobiologics $ 14,315 71 % $ 12,402 81 % Spinal implant 5,917 29 % 2,875 19 % Other revenue — 0 % — 0 % Total revenue $ 20,232 100 % $ 15,277 100 % Six Months Ended Percentage of Six Months Percentage of June 30, 2023 Total Revenue June 30, 2022 Total Revenue Orthobiologics $ 27,866 73 % $ 22,568 80 % Spinal implant 10,309 27 % 5,659 20 % Other revenue 1 0 % 9 0 % Total revenue $ 38,176 100 % $ 28,236 100 % |
Receivables
Receivables | 6 Months Ended |
Jun. 30, 2023 | |
Credit Loss [Abstract] | |
Receivables | (5) 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 months and six months ended June 30, 2023 and 2022 (in thousands): Schedule of Allowance for Credit Losses June 30, 2023 June 30, 2022 Balance at January 1 $ 515 $ 552 Provision for expected credit losses 106 191 Write-offs charged against allowance — (173 ) Balance at March 31 621 570 Provision for expected credit losses 119 (49 ) Write-offs charged against allowance — (11 ) Balance at June 30 $ 740 $ 510 |
Inventories
Inventories | 6 Months Ended |
Jun. 30, 2023 | |
Inventory Disclosure [Abstract] | |
Inventories | (6) Inventories Inventories consist of the following (in thousands): Schedule of Inventories June 30, 2023 December 31, 2022 Raw materials $ 6,359 $ 5,628 Work in process 1,406 798 Finished goods 12,599 10,859 Total $ 20,364 $ 17,285 |
Property and Equipment, Net
Property and Equipment, Net | 6 Months Ended |
Jun. 30, 2023 | |
Property, Plant and Equipment [Abstract] | |
Property and Equipment, Net | (7) Property and Equipment, Net Property and equipment, net are as follows (in thousands): Schedule of Property and Equipment, Net June 30, 2023 December 31, 2022 Equipment $ 5,597 $ 5,598 Computer equipment 1,158 1,043 Computer software 230 230 Leasehold improvements 4,105 4,105 Surgical instruments 12,209 11,266 Assets not yet in service 2,079 1,507 Total cost 25,378 23,749 Property and equipment, gross 25,378 23,749 Less: accumulated depreciation (18,503 ) (17,964 ) Property and equipment, net $ 6,875 $ 5,785 Depreciation expense related to property and equipment, including property under finance leases, for the three months ended June 30, 2023 and 2022 was $ 0.4 0.3 0.7 0.6 |
Intangible Assets
Intangible Assets | 6 Months Ended |
Jun. 30, 2023 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Intangible Assets | (8) Intangible Assets The following table sets forth information regarding intangible assets based on the preliminary purchase accounting discussed in Note 2 – Acquisition of Coflex and CoFix Product Lines (in thousands): Schedule of Intangible of Assets June 30, 2023 December 31, 2022 Patents $ 2,617 $ 807 Customer relationships 8,100 — Trade names 1,245 — Total cost 11,962 807 Intangible assets, gross 11,962 807 Less: accumulated amortization (1,042 ) (463 ) Intangible assets, net $ 10,920 $ 344 |
Accrued Liabilities
Accrued Liabilities | 6 Months Ended |
Jun. 30, 2023 | |
Payables and Accruals [Abstract] | |
Accrued Liabilities | (9) Accrued Liabilities Accrued liabilities consist of the following (in thousands): Schedule of Accrued Liabilities June 30, 2023 December 31, 2022 Cash compensation/commissions payable $ 5,455 $ 4,464 Other accrued liabilities 800 1,032 Accrued liabilities $ 6,255 $ 5,496 |
Debt
Debt | 6 Months Ended |
Jun. 30, 2023 | |
Debt Disclosure [Abstract] | |
Debt | (10) Debt Long-term debt consists of the following (in thousands): Schedule of Long-term Debt June 30, 2023 December 31, 2022 Amounts due under the term loan $ 17,000 $ 12,000 Accrued end-of-term payments 337 216 Less: unamortized debt issuance costs (228 ) (196 ) Less: current maturities (708 ) (2,333 ) Long-term debt, less issuance costs $ 16,401 $ 9,687 On February 28, 2023, the Company’s term loan agreement was amended to provide an additional $ 5.0 1 2.5 In May 2023, the Company extended its interest only period on the term loan until June 2024 when the Company is required to make monthly principal payments of approximately $ 0.7 The effective rate of the term loan, inclusive of amortization of debt issuance costs and accretion of the final payment, was 13.79 9.77 3.0 |
Stock-Based Compensation
Stock-Based Compensation | 6 Months Ended |
Jun. 30, 2023 | |
Share-Based Payment Arrangement [Abstract] | |
Stock-Based Compensation | (11) 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 six months ended June 30, 2023 and 2022: Schedule of Share-based Compensation, Stock Options Activity 2023 2022 Shares Weighted Average Exercise Price Per Share Weighted Average Remaining Contractual Term (years) Shares Weighted Average Exercise Price Per Share Weighted Average Remaining Contractual Term (years) Outstanding at January 1 3,360,664 $ 1.51 3,201,666 $ 1.80 Granted 130,000 0.74 109,164 0.65 Cancelled or expired (75,460 ) $ 18.61 (443,125 ) $ 2.39 Outstanding at June 30 3,415,204 $ 1.49 7.7 2,867,705 $ 1.66 8.4 Exercisable at June 30 1,438,894 $ 1.93 7.3 599,063 $ 2.71 7.8 As of June 30, 2023, there was approximately $ 1.5 2.0 years. The weighted average grant date fair value of options granted during the three months ended June 30, 2023 was $ 0.61 . Restricted stock unit activity for awards granted under the 2018 Plan was as follows for the six months ended June 30, 2023 and 2022: Schedule of Restricted Stock Activity 2023 2022 Shares Weighted Average Value at Date Per Share Shares Weighted Average Value at Date Per Outstanding at January 1 3,612,433 $ 0.88 2,970,104 $ 1.39 Granted 186,831 $ 0.71 88,983 $ 0.65 Vested (22,245 ) $ 0.65 (244,721 ) $ 1.45 Cancelled (494,121 ) $ 0.54 (318,807 ) $ 1.32 Outstanding at June 30 3,282,898 $ 0.92 2,495,559 $ 1.36 Total compensation expense related to unvested restricted stock units not yet recognized was $ 2.0 2.0 On July 26, 2023, our stockholders approved and adopted the Xtant Medical Holdings, Inc. 2023 Equity Incentive Plan (the “2023 Plan”), which replaced the 2018 Plan with respect to future grants of equity awards, although the 2018 Plan continues to govern equity awards granted under the 2018 Plan. The 2023 Plan permits the Board of Directors, or a committee thereof, to grant to eligible employees, non-employee directors, and consultants of the Company non-statutory and incentive stock options, stock appreciation rights, restricted stock awards, restricted stock units, deferred stock units, performance awards, non-employee director awards, and other stock-based awards. The Board of Directors may select 2023 Plan participants and determine the nature and amount of awards to be granted. The maximum number of shares of our common stock available for issuance under the 2023 Plan, subject to adjustment pursuant to the terms of the 2023 Plan, is (i) 5,500,000 7,695,812 6,686,090 |
Warrants
Warrants | 6 Months Ended |
Jun. 30, 2023 | |
Warrants | |
Warrants | (12) Warrants As of June 30, 2023 and December 31, 2022, there were outstanding and exercisable warrants to purchase 12,187,470 1.53 3.3 |
Commitments and Contingencies
Commitments and Contingencies | 6 Months Ended |
Jun. 30, 2023 | |
Commitments and Contingencies Disclosure [Abstract] | |
Commitments and Contingencies | (13) Commitments and Contingencies Operating Leases We lease three office facilities as of June 30, 2023 in Belgrade, Montana under non-cancelable operating lease agreements with expiration dates in 2025. We have the option to extend certain leases for additional five or ten-year term(s), and we have the right of first refusal on any sale. As of June 30, 2023, the weighted-average remaining lease term was 2.3 Future minimum payments for the next five years and thereafter as of June 30, 2023 under these long-term operating leases are as follows (in thousands): Schedule of Future Minimum Rental Payments for Operating Leases Remainder of 2023 $ 271 2024 559 2025 470 Total future minimum lease payments 1,300 Less amount representing interest (92 ) Present value of obligations under operating leases 1,208 Less current portion (488 ) Long-term operating lease obligations $ 720 Rent expense was $ 0.1 0.3 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. We intend to continue to defend the Company vigorously in such matters and, when warranted, take legal action against others. Furthermore, we regularly assess contingencies to determine the degree of probability and range of possible loss for potential accrual in our financial statements. An estimated loss contingency is accrued in our financial statements if it is probable that a liability has been incurred and the amount of the loss can be reasonably estimated. Based on our assessment, we have adequately accrued an amount for contingent liabilities currently in existence. We do not accrue amounts for liabilities that we do not believe are probable or that we consider immaterial to our overall financial position. Litigation is inherently unpredictable, and unfavorable resolutions could occur. As a result, assessing contingencies is highly subjective and requires judgment about future events. While we do not believe that the ultimate resolution of any claims and lawsuits will have a material adverse effect upon our consolidated financial position, results of operations or cash flows, it is possible that the amount of ultimate loss may exceed our current accruals and that our cash flows or results of operations could be materially affected in any particular period by the unfavorable resolution of one or more of these contingencies. Indemnification Arrangements 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 | 6 Months Ended |
Jun. 30, 2023 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | (14) 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 three and six months ended June 30, 2023 and 2022. |
Supplemental Disclosure of Cash
Supplemental Disclosure of Cash Flow Information | 6 Months Ended |
Jun. 30, 2023 | |
Supplemental Cash Flow Elements [Abstract] | |
Supplemental Disclosure of Cash Flow Information | (15) Supplemental Disclosure of Cash Flow Information Supplemental cash flow information is as follows (in thousands): Schedule of Supplemental Cash Flow Information 2023 2022 Six Months Ended June 30, 2023 2022 Supplemental disclosure of cash flow information Cash paid during the period for: Interest $ 1,171 $ 667 Non-cash activities: Fixed assets acquired under finance lease $ — $ 159 |
Related Party Transactions
Related Party Transactions | 6 Months Ended |
Jun. 30, 2023 | |
Related Party Transactions [Abstract] | |
Related Party Transactions | (16) Related Party Transactions As described in more detail under Note 1 – Business Description and Summary of Significant Accounting Policies in the Company’s Annual Report on Form 10-K for the year ended December 31, 2022 and Item 5 of Part II of this Quarterly Report on Form 10-Q, we are party to an Investor Rights Agreement, Registration Rights Agreements and certain other agreements with OrbiMed Royalty Opportunities II, LP (“Royalty Opportunities”) and ROS Acquisition Offshore LP (“ROS”), which are funds affiliated with OrbiMed Advisors LLC (“OrbiMed”). OrbiMed beneficially owns 67 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 | 6 Months Ended |
Jun. 30, 2023 | |
Segment Reporting [Abstract] | |
Segment and Geographic Information | (17) 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 2023 2022 Three Months Ended June 30, 2023 2022 United States $ 19,987 $ 15,025 Rest of world 245 252 Total revenue $ 20,232 $ 15,277 2023 2022 Six Months Ended June 30, 2023 2022 United States $ 37,501 $ 27,719 Rest of world 675 517 Total revenue $ 38,176 $ 28,236 |
Subsequent Event
Subsequent Event | 6 Months Ended |
Jun. 30, 2023 | |
Subsequent Events [Abstract] | |
Subsequent Event | (18) Subsequent Event On July 3, 2023, we entered into a securities purchase agreement pursuant to which we issued an aggregate of 20,000,000 0.75 15.0 |
Business Description, Basis o_2
Business Description, Basis of Presentation and Summary of Significant Accounting Policies (Policies) | 6 Months Ended |
Jun. 30, 2023 | |
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, Surgalign SPV, Inc., a Delaware corporation, and X-spine Systems, Inc. (“X-spine”), an Ohio corporation (Xtant, Xtant Medical, Bacterin, Surgalign SPV, Inc. 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. The accompanying condensed consolidated balance sheet as of December 31, 2022, 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, 2023. 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, 2022. 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. |
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, intangible assets and liabilities; valuation allowances for trade receivables, inventory, deferred income tax assets and liabilities; current and long-term lease obligations and corresponding right-of-use asset; estimates for the fair value of assets acquired as part of business combinations; 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 contractual agreements. The June 30, 2023 and December 31, 2022 balances 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. |
Concentration of Credit Risk | Concentration of Credit Risk Financial instruments that potentially expose the Company to concentration of credit risk consist primarily of cash, cash equivalents and restricted cash. The Company maintains its cash balances primarily with two financial institutions. These balances generally exceed federally insured limits. The Company has not experienced any losses in such accounts and believes it is not exposed to any significant credit risk in cash and cash equivalents. |
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 |
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 |
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. Diluted net loss per share was the same as basic net loss per share for the three and six months ended June 30, 2023 and 2022, 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. Our diluted earnings per share is the same as basic earnings per share, as the effects of including 18,885,572 12,474,376 |
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 June 30, 2023 and December 31, 2022. |
Acquisition of Coflex and CoF_2
Acquisition of Coflex and CoFix Product Lines (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Business Combination and Asset Acquisition [Abstract] | |
Schedule of Recognized Identified Assets Acquired and Liabilities Assumed | Schedule of Recognized Identified Assets Acquired and Liabilities Assumed Inventories $ 1,589 Equipment 947 Intangible assets 11,155 Net assets acquired 13,691 Goodwill 3,309 Total purchase consideration $ 17,000 |
Schedule of Pro forma Financial Information of Operations | The following unaudited pro forma combined financial information summarizes the results of operations for the periods indicated as if the acquisition had been completed as of January 1, 2022 (in thousands): Schedule of Pro forma Financial Information of Operations Six Months Ended June 30, 2023 2022 Revenues $ 40,000 $ 31,828 Net loss (3,745 ) (2,543 ) |
Revenue (Tables)
Revenue (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Revenue from Contract with Customer [Abstract] | |
Summary of Revenues from Product Lines | Summary of Revenues from Product Lines Three Months Ended Percentage of Three Months Ended Percentage of June 30, 2023 Total Revenue June 30, 2022 Total Revenue Orthobiologics $ 14,315 71 % $ 12,402 81 % Spinal implant 5,917 29 % 2,875 19 % Other revenue — 0 % — 0 % Total revenue $ 20,232 100 % $ 15,277 100 % Six Months Ended Percentage of Six Months Percentage of June 30, 2023 Total Revenue June 30, 2022 Total Revenue Orthobiologics $ 27,866 73 % $ 22,568 80 % Spinal implant 10,309 27 % 5,659 20 % Other revenue 1 0 % 9 0 % Total revenue $ 38,176 100 % $ 28,236 100 % |
Receivables (Tables)
Receivables (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Credit Loss [Abstract] | |
Schedule of Allowance for Credit Losses | Schedule of Allowance for Credit Losses June 30, 2023 June 30, 2022 Balance at January 1 $ 515 $ 552 Provision for expected credit losses 106 191 Write-offs charged against allowance — (173 ) Balance at March 31 621 570 Provision for expected credit losses 119 (49 ) Write-offs charged against allowance — (11 ) Balance at June 30 $ 740 $ 510 |
Inventories (Tables)
Inventories (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Inventory Disclosure [Abstract] | |
Schedule of Inventories | Inventories consist of the following (in thousands): Schedule of Inventories June 30, 2023 December 31, 2022 Raw materials $ 6,359 $ 5,628 Work in process 1,406 798 Finished goods 12,599 10,859 Total $ 20,364 $ 17,285 |
Property and Equipment, Net (Ta
Property and Equipment, Net (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
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 June 30, 2023 December 31, 2022 Equipment $ 5,597 $ 5,598 Computer equipment 1,158 1,043 Computer software 230 230 Leasehold improvements 4,105 4,105 Surgical instruments 12,209 11,266 Assets not yet in service 2,079 1,507 Total cost 25,378 23,749 Property and equipment, gross 25,378 23,749 Less: accumulated depreciation (18,503 ) (17,964 ) Property and equipment, net $ 6,875 $ 5,785 |
Intangible Assets (Tables)
Intangible Assets (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Schedule of Intangible of Assets | The following table sets forth information regarding intangible assets based on the preliminary purchase accounting discussed in Note 2 – Acquisition of Coflex and CoFix Product Lines (in thousands): Schedule of Intangible of Assets June 30, 2023 December 31, 2022 Patents $ 2,617 $ 807 Customer relationships 8,100 — Trade names 1,245 — Total cost 11,962 807 Intangible assets, gross 11,962 807 Less: accumulated amortization (1,042 ) (463 ) Intangible assets, net $ 10,920 $ 344 |
Accrued Liabilities (Tables)
Accrued Liabilities (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Payables and Accruals [Abstract] | |
Schedule of Accrued Liabilities | Accrued liabilities consist of the following (in thousands): Schedule of Accrued Liabilities June 30, 2023 December 31, 2022 Cash compensation/commissions payable $ 5,455 $ 4,464 Other accrued liabilities 800 1,032 Accrued liabilities $ 6,255 $ 5,496 |
Debt (Tables)
Debt (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Debt Disclosure [Abstract] | |
Schedule of Long-term Debt | Long-term debt consists of the following (in thousands): Schedule of Long-term Debt June 30, 2023 December 31, 2022 Amounts due under the term loan $ 17,000 $ 12,000 Accrued end-of-term payments 337 216 Less: unamortized debt issuance costs (228 ) (196 ) Less: current maturities (708 ) (2,333 ) Long-term debt, less issuance costs $ 16,401 $ 9,687 |
Stock-Based Compensation (Table
Stock-Based Compensation (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Share-Based Payment Arrangement [Abstract] | |
Schedule of Share-based Compensation, Stock Options Activity | Schedule of Share-based Compensation, Stock Options Activity 2023 2022 Shares Weighted Average Exercise Price Per Share Weighted Average Remaining Contractual Term (years) Shares Weighted Average Exercise Price Per Share Weighted Average Remaining Contractual Term (years) Outstanding at January 1 3,360,664 $ 1.51 3,201,666 $ 1.80 Granted 130,000 0.74 109,164 0.65 Cancelled or expired (75,460 ) $ 18.61 (443,125 ) $ 2.39 Outstanding at June 30 3,415,204 $ 1.49 7.7 2,867,705 $ 1.66 8.4 Exercisable at June 30 1,438,894 $ 1.93 7.3 599,063 $ 2.71 7.8 |
Schedule of Restricted Stock Activity | Restricted stock unit activity for awards granted under the 2018 Plan was as follows for the six months ended June 30, 2023 and 2022: Schedule of Restricted Stock Activity 2023 2022 Shares Weighted Average Value at Date Per Share Shares Weighted Average Value at Date Per Outstanding at January 1 3,612,433 $ 0.88 2,970,104 $ 1.39 Granted 186,831 $ 0.71 88,983 $ 0.65 Vested (22,245 ) $ 0.65 (244,721 ) $ 1.45 Cancelled (494,121 ) $ 0.54 (318,807 ) $ 1.32 Outstanding at June 30 3,282,898 $ 0.92 2,495,559 $ 1.36 |
Commitments and Contingencies (
Commitments and Contingencies (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
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 June 30, 2023 under these long-term operating leases are as follows (in thousands): Schedule of Future Minimum Rental Payments for Operating Leases Remainder of 2023 $ 271 2024 559 2025 470 Total future minimum lease payments 1,300 Less amount representing interest (92 ) Present value of obligations under operating leases 1,208 Less current portion (488 ) Long-term operating lease obligations $ 720 |
Supplemental Disclosure of Ca_2
Supplemental Disclosure of Cash Flow Information (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
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 2023 2022 Six Months Ended June 30, 2023 2022 Supplemental disclosure of cash flow information Cash paid during the period for: Interest $ 1,171 $ 667 Non-cash activities: Fixed assets acquired under finance lease $ — $ 159 |
Segment and Geographic Inform_2
Segment and Geographic Information (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Segment Reporting [Abstract] | |
Schedule of Revenues by Geographic Region | Schedule of Revenues by Geographic Region 2023 2022 Three Months Ended June 30, 2023 2022 United States $ 19,987 $ 15,025 Rest of world 245 252 Total revenue $ 20,232 $ 15,277 2023 2022 Six Months Ended June 30, 2023 2022 United States $ 37,501 $ 27,719 Rest of world 675 517 Total revenue $ 38,176 $ 28,236 |
Business Description, Basis o_3
Business Description, Basis of Presentation and Summary of Significant Accounting Policies (Details Narrative) - USD ($) | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | ||||
Impairments of long-lived assets | $ 0 | $ 0 | $ 0 | $ 0 |
Impairments of goodwill | $ 0 | $ 0 | $ 0 | $ 0 |
Antidilutive securities excluded from computation of earnings per share, amount | 18,885,572 | 18,885,572 | 12,474,376 | 12,474,376 |
Schedule of Recognized Identifi
Schedule of Recognized Identified Assets Acquired and Liabilities Assumed (Details) - USD ($) $ in Thousands | Jun. 30, 2023 | Feb. 28, 2023 | Dec. 31, 2022 |
Business Acquisition [Line Items] | |||
Goodwill | $ 6,514 | $ 3,205 | |
Surgalign SPV Inc [Member] | |||
Business Acquisition [Line Items] | |||
Inventories | $ 1,589 | ||
Equipment | 947 | ||
Intangible assets | 11,155 | ||
Net assets acquired | 13,691 | ||
Goodwill | 3,309 | ||
Total purchase consideration | $ 17,000 |
Schedule of Pro forma Financial
Schedule of Pro forma Financial Information of Operations (Details) - USD ($) $ in Thousands | 6 Months Ended | |
Jun. 30, 2023 | Jun. 30, 2022 | |
Business Combination and Asset Acquisition [Abstract] | ||
Revenues | $ 40,000 | $ 31,828 |
Net loss | $ (3,745) | $ (2,543) |
Acquisition of Coflex and CoF_3
Acquisition of Coflex and CoFix Product Lines (Details Narrative) - USD ($) $ in Thousands | Feb. 28, 2023 | Jun. 30, 2023 | Dec. 31, 2022 |
Business Acquisition [Line Items] | |||
Goodwill | $ 6,514 | $ 3,205 | |
Surgalign SPV Inc [Member] | |||
Business Acquisition [Line Items] | |||
Additional inventory | $ 1,589 | ||
Additional intangible assets | 11,155 | ||
Goodwill | 3,309 | ||
Equity Purchase Agreement [Member] | Surgalign SPV Inc [Member] | |||
Business Acquisition [Line Items] | |||
Aggregate purchase price in cash | 17,000 | ||
Purchase price in hand | 5,000 | ||
Additional inventory | 500 | ||
Additional intangible assets | $ 500 |
Asset Purchase Agreement (Detai
Asset Purchase Agreement (Details Narrative) - Asset Purchase Agreement [Member] $ in Millions | Jun. 18, 2023 USD ($) |
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items] | |
Total purchase price | $ 5 |
Purchase price escrow, rate | 10% |
Summary of Revenues from Produc
Summary of Revenues from Product Lines (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Disaggregation of Revenue [Line Items] | ||||
Total revenue | $ 20,232 | $ 15,277 | $ 38,176 | $ 28,236 |
Percentage of total revenue | 100% | 100% | 100% | 100% |
Orthobiologics [Member] | ||||
Disaggregation of Revenue [Line Items] | ||||
Total revenue | $ 14,315 | $ 12,402 | $ 27,866 | $ 22,568 |
Percentage of total revenue | 71% | 81% | 73% | 80% |
Spinal Implant [Member] | ||||
Disaggregation of Revenue [Line Items] | ||||
Total revenue | $ 5,917 | $ 2,875 | $ 10,309 | $ 5,659 |
Percentage of total revenue | 29% | 19% | 27% | 20% |
Other Revenue [Member] | ||||
Disaggregation of Revenue [Line Items] | ||||
Total revenue | $ 1 | $ 9 | ||
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 | |||
Jun. 30, 2023 | Mar. 31, 2023 | Jun. 30, 2022 | Mar. 31, 2022 | |
Credit Loss [Abstract] | ||||
Beginning balance | $ 621 | $ 515 | $ 570 | $ 552 |
Provision for expected credit losses | 119 | 106 | (49) | 191 |
Write-offs charged against allowance | (11) | (173) | ||
Ending balance | $ 740 | $ 621 | $ 510 | $ 570 |
Schedule of Inventories (Detail
Schedule of Inventories (Details) - USD ($) $ in Thousands | Jun. 30, 2023 | Dec. 31, 2022 |
Inventory Disclosure [Abstract] | ||
Raw materials | $ 6,359 | $ 5,628 |
Work in process | 1,406 | 798 |
Finished goods | 12,599 | 10,859 |
Total | $ 20,364 | $ 17,285 |
Schedule of Property and Equipm
Schedule of Property and Equipment, Net (Details) - USD ($) $ in Thousands | Jun. 30, 2023 | Dec. 31, 2022 |
Property, Plant and Equipment [Line Items] | ||
Property and equipment, gross | $ 25,378 | $ 23,749 |
Less: accumulated depreciation | (18,503) | (17,964) |
Property and equipment, net | 6,875 | 5,785 |
Equipment [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Property and equipment, gross | 5,597 | 5,598 |
Computer Equipment [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Property and equipment, gross | 1,158 | 1,043 |
Computer Software [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Property and equipment, gross | 230 | 230 |
Leasehold Improvements [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Property and equipment, gross | 4,105 | 4,105 |
Surgical Instruments [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Property and equipment, gross | 12,209 | 11,266 |
Assets Not Yet In Service [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Property and equipment, gross | $ 2,079 | $ 1,507 |
Property and Equipment, Net (De
Property and Equipment, Net (Details Narrative) - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Property, Plant and Equipment [Abstract] | ||||
Depreciation expenses | $ 0.4 | $ 0.3 | $ 0.7 | $ 0.6 |
Schedule of Intangible of Asset
Schedule of Intangible of Assets (Details) - USD ($) $ in Thousands | Jun. 30, 2023 | Dec. 31, 2022 |
Finite-Lived Intangible Assets [Line Items] | ||
Intangible assets, gross | $ 11,962 | $ 807 |
Less: accumulated amortization | (1,042) | (463) |
Intangible assets, net | 10,920 | 344 |
Patents [Member] | ||
Finite-Lived Intangible Assets [Line Items] | ||
Intangible assets, gross | 2,617 | 807 |
Customer Relationships [Member] | ||
Finite-Lived Intangible Assets [Line Items] | ||
Intangible assets, gross | 8,100 | |
Trade Names [Member] | ||
Finite-Lived Intangible Assets [Line Items] | ||
Intangible assets, gross | $ 1,245 |
Schedule of Accrued Liabilities
Schedule of Accrued Liabilities (Details) - USD ($) $ in Thousands | Jun. 30, 2023 | Dec. 31, 2022 |
Payables and Accruals [Abstract] | ||
Cash compensation/commissions payable | $ 5,455 | $ 4,464 |
Other accrued liabilities | 800 | 1,032 |
Accrued liabilities | $ 6,255 | $ 5,496 |
Schedule of Long-term Debt (Det
Schedule of Long-term Debt (Details) - USD ($) $ in Thousands | Jun. 30, 2023 | Dec. 31, 2022 |
Debt Disclosure [Abstract] | ||
Amounts due under the term loan | $ 17,000 | $ 12,000 |
Accrued end-of-term payments | 337 | 216 |
Less: unamortized debt issuance costs | (228) | (196) |
Less: current maturities | (708) | (2,333) |
Long-term debt, less issuance costs | $ 16,401 | $ 9,687 |
Debt (Details Narrative)
Debt (Details Narrative) - USD ($) $ in Millions | 1 Months Ended | ||
Feb. 28, 2023 | May 31, 2023 | Jun. 30, 2023 | |
Line of Credit Facility [Line Items] | |||
Debt instrument interest rate | 13.79% | ||
Term Loan And Revolving Credit Facility [Member] | Minimum [Member] | |||
Line of Credit Facility [Line Items] | |||
Line of credit, interest rate | 1% | ||
Term Loan And Revolving Credit Facility [Member] | Maximum [Member] | |||
Line of Credit Facility [Line Items] | |||
Line of credit, interest rate | 2.50% | ||
Term Loan Agreement [Member] | |||
Line of Credit Facility [Line Items] | |||
Indebtedness incurred | $ 5 | ||
Monthly periodic payment | $ 0.7 | ||
Revolving Credit Agreement [Member] | |||
Line of Credit Facility [Line Items] | |||
Debt instrument interest rate | 9.77% | ||
Line of credit | $ 3 |
Schedule of Share-based Compens
Schedule of Share-based Compensation, Stock Options Activity (Details) - Equity Option [Member] - 2018 Equity Incentive Plan [Member] - $ / shares | 6 Months Ended | |
Jun. 30, 2023 | Jun. 30, 2022 | |
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items] | ||
Shares, Outstanding, Balance | 3,360,664 | 3,201,666 |
Weighted Average Exercise Price Per Share, Outstanding Balance | $ 1.51 | $ 1.80 |
Shares, Granted | 130,000 | 109,164 |
Weighted Average Exercise Price Per Share, Granted | $ 0.74 | $ 0.65 |
Shares, Cancelled or expired | (75,460) | (443,125) |
Weighted Average Exercise Price Per Share, Cancelled or expired | $ 18.61 | $ 2.39 |
Shares, Outstanding, Balance | 3,415,204 | 2,867,705 |
Weighted Average Exercise Price Per Share, Outstanding Balance | $ 1.49 | $ 1.66 |
Weighted Average Remaining Contractual Term (Years) Outstanding | 7 years 8 months 12 days | 8 years 4 months 24 days |
Shares, Exercisable, Ending Balance | 1,438,894 | 599,063 |
Weighted Average Exercise Price Per Share, Exercisable Ending Balance | $ 1.93 | $ 2.71 |
Weighted Average Remaining Contractual Term (Years) Exercisable | 7 years 3 months 18 days | 7 years 9 months 18 days |
Schedule of Restricted Stock Ac
Schedule of Restricted Stock Activity (Details) - Restricted Stock Units (RSUs) [Member] - 2018 Equity Incentive Plan [Member] - $ / shares | 6 Months Ended | |
Jun. 30, 2023 | Jun. 30, 2022 | |
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items] | ||
Shares Outstanding, Balance | 3,612,433 | 2,970,104 |
Weighted Average Fair Value at Grant Date Per Share, Outstanding Balance | $ 0.88 | $ 1.39 |
Shares Granted | 186,831 | 88,983 |
Weighted Average Fair Value at Grant Date Per Share, Granted | $ 0.71 | $ 0.65 |
Shares Vested | (22,245) | (244,721) |
Weighted Average Fair Value at Grant Date Per Share, Vested | $ 0.65 | $ 1.45 |
Shares Cancelled | (494,121) | (318,807) |
Weighted Average Fair Value at Grant Date Per Share, Cancelled | $ 0.54 | $ 1.32 |
Shares Outstanding, Balance | 3,282,898 | 2,495,559 |
Weighted Average Fair Value at Grant Date Per Share, Outstanding Balance | $ 0.92 | $ 1.36 |
Stock-Based Compensation (Detai
Stock-Based Compensation (Details Narrative) - USD ($) $ / shares in Units, $ in Millions | 6 Months Ended | ||||
Jul. 26, 2023 | Jun. 30, 2023 | Dec. 31, 2022 | Jun. 30, 2022 | Dec. 31, 2021 | |
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items] | |||||
Weighted average granted date fair value | $ 0.61 | ||||
2023 Equity Incentive Plan [Member] | Forecast [Member] | |||||
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items] | |||||
Share based compensation, description | The maximum number of shares of our common stock available for issuance under the 2023 Plan, subject to adjustment pursuant to the terms of the 2023 Plan, is (i) 5,500,000 shares of common stock; (ii) 7,695,812 shares of common stock remaining available for issuance under the 2018 Plan but not subject to outstanding awards under the 2018 Plan as of July 26, 2023; and (iii) up to 6,686,090 shares of common stock subject to awards outstanding under the 2018 Plan as of July 26, 2023 but only to the extent such awards are subsequently forfeited, cancelled, expire, or otherwise terminate without the issuance of such shares of common stock after such date. | ||||
Share based compensation, grant | 5,500,000 | ||||
2018 Equity Incentive Plan [Member] | Forecast [Member] | |||||
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items] | |||||
Share based compensation, grant | 7,695,812 | ||||
Share based compensation, award outstanding | 6,686,090 | ||||
Restricted Stock Units (RSUs) [Member] | |||||
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items] | |||||
Unvested employee stock options not yet recognized | $ 2 | ||||
Stock option vested weighted average period | 2 years | ||||
Equity Option [Member] | |||||
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items] | |||||
Unvested employee stock options not yet recognized | $ 1.5 | ||||
Stock option vested weighted average period | 2 years | ||||
Equity Option [Member] | 2018 Equity Incentive Plan [Member] | |||||
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items] | |||||
Share based compensation, award outstanding | 3,415,204 | 3,360,664 | 2,867,705 | 3,201,666 |
Warrants (Details Narrative)
Warrants (Details Narrative) - Warrant [Member] - $ / shares | Jun. 30, 2023 | Dec. 31, 2022 |
Outstanding and exercisable warrants to purchase | 12,187,470 | 12,187,470 |
Weighted average exercise price | $ 1.53 | |
Warrants contractual term | 3 years 3 months 18 days |
Schedule of Future Minimum Rent
Schedule of Future Minimum Rental Payments for Operating Leases (Details) - USD ($) $ in Thousands | Jun. 30, 2023 | Dec. 31, 2022 |
Commitments and Contingencies Disclosure [Abstract] | ||
Remainder of 2023 | $ 271 | |
2024 | 559 | |
2025 | 470 | |
Total future minimum lease payments | 1,300 | |
Less amount representing interest | (92) | |
Present value of obligations under operating leases | 1,208 | |
Less current portion | (488) | $ (458) |
Long-term operating lease obligations | $ 720 | $ 972 |
Commitments and Contingencies_2
Commitments and Contingencies (Details Narrative) - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Commitments and Contingencies Disclosure [Abstract] | ||||
Operating lease weighted-average remaining lease term | 2 years 3 months 18 days | 2 years 3 months 18 days | ||
Rent expense | $ 0.1 | $ 0.1 | $ 0.3 | $ 0.3 |
Schedule of Supplemental Cash F
Schedule of Supplemental Cash Flow Information (Details) - USD ($) $ in Thousands | 6 Months Ended | |
Jun. 30, 2023 | Jun. 30, 2022 | |
Supplemental Cash Flow Elements [Abstract] | ||
Interest | $ 1,171 | $ 667 |
Fixed assets acquired under finance lease | $ 159 |
Related Party Transactions (Det
Related Party Transactions (Details Narrative) | Jun. 30, 2023 |
OrbiMed Advisors LLC [Member] | |
Ownership percentage | 67% |
Schedule of Revenues by Geograp
Schedule of Revenues by Geographic Region (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Revenues from External Customers and Long-Lived Assets [Line Items] | ||||
Total revenue | $ 20,232 | $ 15,277 | $ 38,176 | $ 28,236 |
UNITED STATES | ||||
Revenues from External Customers and Long-Lived Assets [Line Items] | ||||
Total revenue | 19,987 | 15,025 | 37,501 | 27,719 |
Rest Of World [Member] | ||||
Revenues from External Customers and Long-Lived Assets [Line Items] | ||||
Total revenue | $ 245 | $ 252 | $ 675 | $ 517 |
Segment and Geographic Inform_3
Segment and Geographic Information (Details Narrative) | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Customer Concentration Risk [Member] | Revenue Benchmark [Member] | Customer [Member] | ||||
Revenue, Major Customer [Line Items] | ||||
Concentration risk, percentage | 99% | 99% | 99% | 99% |
Subsequent Event (Details Narra
Subsequent Event (Details Narrative) - Investor [Member] - Private Placement [Member] - Subsequent Event [Member] $ / shares in Units, $ in Millions | Jul. 03, 2023 USD ($) $ / shares shares |
Subsequent Event [Line Items] | |
Number of issuance, shares | shares | 20,000,000 |
Shares issued price per share | $ / shares | $ 0.75 |
Number of issuance, value | $ | $ 15 |