Surgalign (SRGAQ) 10-Q 9 Nov 21 2021 Q3 Quarterly report Financial data

Cover

Cover - shares	9 Months Ended
	Sep. 30, 2021	Nov. 05, 2021
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2021
Document Transition Report	false
Entity File Number	001-38832
Entity Registrant Name	SURGALIGN HOLDINGS, INC.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	83-2540607
Entity Address, Address Line One	520 Lake Cook Road
Entity Address, Address Line Two	Suite 315
Entity Address, City or Town	Deerfield
Entity Address, State or Province	IL
Entity Address, Postal Zip Code	60015
City Area Code	224
Local Phone Number	303-4651
Title of 12(b) Security	common stock, $0.001 par value
Trading Symbol	SRGA
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		139,200,855
Amendment Flag	false
Document Fiscal Year Focus	2021
Document Fiscal Period Focus	Q3
Entity Central Index Key	0001760173
Current Fiscal Year End Date	--12-31

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Current Assets:
Cash and cash equivalents	$ 68,360	$ 43,962
Accounts receivable - less allowances of $10,438 at September 30, 2021 and $8,203 at December 31, 2020	20,652	27,095
Inventories - current	27,442	22,841
Prepaid and other current assets	19,625	10,284
Total current assets	136,079	104,182
Non-current inventories	9,591	7,856
Property and equipment - net	1,028	521
Other assets - net	10,045	10,145
Total assets	156,743	122,704
Current Liabilities:
Accounts payable	9,482	13,418
Current portion of acquisition contingency	18,406	8,996
Accrued expenses	26,844	12,648
Accrued income taxes	504	11,761
Total current liabilities	55,236	46,823
Acquisition contingencies	34,556	47,519
Warrant liability	16,487	0
Other long-term liabilities	3,353	4,192
Total liabilities	109,632	98,534
Commitments and contingencies (Note 18)
Stockholders' equity:
Common stock, $.001 par value: 300,000,000 shares authorized; 139,398,324 and 81,678,179 shares issued and outstanding, as of September 30, 2021 and December 31, 2020, respectively	139	81
Additional paid-in capital	579,054	517,123
Accumulated other comprehensive loss	(2,018)	(2,416)
Accumulated deficit	(524,250)	(484,962)
Less treasury stock, 1,519,832 and 1,444,578 shares, as of September 30, 2021 and December 31, 2020, respectively, at cost	(5,814)	(5,656)
Total stockholders' equity	47,111	24,170
Total liabilities and stockholders' equity	$ 156,743	$ 122,704

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Statement of Financial Position [Abstract]
Accounts receivable allowances	$ 10,438	$ 8,203
Common stock, par value (in dollars per share)	$ 0.001	$ 0.001
Common stock, shares authorized (in shares)	300,000,000	300,000,000
Common stock, shares issued (in shares)	139,398,324	81,678,179
Common stock, shares outstanding (in shares)	139,398,324	81,678,179
Treasury stock (in shares)	1,519,832	1,444,578

Condensed Consolidated Statemen

Condensed Consolidated Statements of Comprehensive (Loss) / Income - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Income Statement [Abstract]
Revenues	$ 20,545,000	$ 27,926,000	$ 68,670,000	$ 75,562,000
Cost of goods sold	6,811,000	11,892,000	20,278,000	30,585,000
Gross profit	13,734,000	16,034,000	48,392,000	44,977,000
Operating Expenses:
Marketing, general and administrative	27,564,000	27,684,000	79,264,000	96,842,000
Research and development	2,901,000	2,208,000	8,960,000	9,764,000
Gain on acquisition contingency	(1,266,000)	0	(3,553,000)	(130,000)
Asset impairment and abandonments	5,411,000	9,356,000	9,794,000	12,117,000
Transaction and integration expenses	0	3,411,000	2,510,000	5,826,000
Total operating expenses	34,610,000	42,659,000	96,975,000	124,419,000
Other operating income, net	(3,932,000)	0	(3,932,000)	0
Operating loss	(16,944,000)	(26,625,000)	(44,651,000)	(79,442,000)
Other (income) expense - net:
Other (income) expense - net	(117,000)	(21,000)	(221,000)	(92,000)
Foreign exchange loss (gain)	471,000	(21,000)	921,000	28,000
Change in fair value of warrant liability	(7,739,000)	0	(10,262,000)	0
Total other (income) expense - net	(7,385,000)	(42,000)	(9,562,000)	(64,000)
Loss before income tax (benefit)	(9,559,000)	(26,583,000)	(35,089,000)	(79,378,000)
Income tax (benefit)	(1,304,000)	0	(1,004,000)	(3,492,000)
Net loss from continuing operations	(8,255,000)	(26,583,000)	(34,085,000)	(75,886,000)
Discontinued operations (Note 3)
Income (loss) from operations of discontinued operations (including gain on disposition of $210.9 million for the three and nine months ended September 30, 2020)	0	191,801,000	(6,316,000)	181,333,000
Income tax provision (benefit)	(349,000)	42,534,000	(1,112,000)	39,189,000
Net income (loss) from discontinued operations	349,000	149,267,000	(5,204,000)	142,144,000
Net (loss) income applicable to common shares	(7,906,000)	122,684,000	(39,289,000)	66,258,000
Other comprehensive (loss) income:
Unrealized foreign currency translation (gain) loss	(362,000)	108,000	(398,000)	180,000
Total other comprehensive (loss) income	$ (7,544,000)	$ 122,576,000	$ (38,891,000)	$ 66,078,000
Net loss from continuing operations per common share - basic (in dollars per share)	$ (0.06)	$ (0.36)	$ (0.29)	$ (1.04)
Net loss from continuing operations per common share - diluted (in dollars per share)	(0.06)	(0.36)	(0.29)	(1.04)
Net income (loss) from discontinued operations per common share - basic (in dollars per share)	0	2.04	(0.04)	1.95
Net income (loss) from discontinued operations per common share - diluted (in dollars per share)	$ 0	$ 2.04	$ (0.04)	$ 1.95
Weighted average basic shares (in shares)	138,317,858	73,212,662	117,135,533	72,933,038
Weighted average diluted shares (in shares)	138,317,858	73,212,662	117,135,533	72,933,038

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Comprehensive (Loss) / Income (Parenthetical) - USD ($) $ in Thousands	3 Months Ended	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Statement of Comprehensive Income [Abstract]
Income (loss) from operations of discontinued operations (including gain on disposition)	$ 210,900	$ (6,316)	$ 210,866

Condensed Consolidated Statem_3

Condensed Consolidated Statement of Stockholders' Equity - USD ($) $ in Thousands	Total	Common Stock	Additional Paid-In Capital	Accumulated Other Comprehensive Loss	Accumulated Deficit	Treasury Stock
Beginning Balance at Dec. 31, 2019	$ 34,564	$ 75	$ 498,438	$ (7,629)	$ (451,179)	$ (5,141)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)	(17,863)				(17,863)
Foreign currency translation adjustment	(370)			(370)
Exercise of common stock options	20		20
Stock-based compensation	1,310		1,310
Purchase of treasury stock	(193)					(193)
Amortization of preferred stock series A issuance costs	(44)		(44)
Ending Balance at Mar. 31, 2020	17,424	75	499,724	(7,999)	(469,042)	(5,334)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)	(38,564)				(38,564)
Foreign currency translation adjustment	298			298
Stock-based compensation	1,023		1,023
Purchase of treasury stock	(19)					(19)
Amortization of preferred stock series A issuance costs	(46)		(46)
Ending Balance at Jun. 30, 2020	(19,884)	75	500,701	(7,701)	(507,606)	(5,353)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)	122,684				122,684
Foreign currency translation adjustment	(108)			(108)
Foreign currency translation adjustment related to the impact of discontinued operations	5,190			5,190
Stock-based compensation	3,217		3,217
Purchase of treasury stock	(206)					(206)
Amortization of preferred stock series A issuance costs	(17)		(17)
Ending Balance at Sep. 30, 2020	110,876	75	503,901	(2,619)	(384,922)	(5,559)
Beginning Balance at Dec. 31, 2020	24,170	81	517,123	(2,416)	(484,962)	(5,656)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)	(15,190)				(15,190)
Foreign currency translation adjustment	71			71
Exercise of common stock options	23		23
Stock-based compensation	936		936
Share offering	36,484	29	36,455			0
Purchase of treasury stock	(110)					(110)
Ending Balance at Mar. 31, 2021	46,384	110	554,537	(2,345)	(500,152)	(5,766)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)	(16,192)				(16,192)
Foreign currency translation adjustment	(35)			(35)
Stock-based compensation	1,413		1,413
Share offering	45,842	29	45,813
Warrant issuance	(24,798)		(24,798)
Equity instruments issued in connection with Prompt Prototypes, LLC	221		221
Purchase of treasury stock	(23)					(23)
Ending Balance at Jun. 30, 2021	52,812	139	577,186	(2,380)	(516,344)	(5,789)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)	(7,906)				(7,906)
Foreign currency translation adjustment	362			362
Employee stock purchase plan ("ESPP") expense	113		113
Stock-based compensation	1,755		1,755
Purchase of treasury stock	(25)					(25)
Ending Balance at Sep. 30, 2021	$ 47,111	$ 139	$ 579,054	$ (2,018)	$ (524,250)	$ (5,814)

Condensed Consolidated Statem_4

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020
Cash flows from operating activities:
Net (loss) income	$ (39,289)	$ 66,258
Adjustments to reconcile net (loss) income to net cash used in operating activities:
Depreciation and amortization expense	1,856	6,003
Provision for bad debts and product returns	2,404	2,015
Change in fair value of warrant liability	(10,262)	0
Provision for inventory write-downs	5,754	9,597
Revenue recognized due to change in deferred revenue	0	(2,618)
Deferred income tax benefit	0	(932)
Income taxes payable	(10,294)	0
Stock-based compensation	4,218	5,550
Asset impairment and abandonments	9,794	12,117
Gain on acquisition contingency	(3,553)	(130)
Loss on extinguishment of debt	0	2,686
Bargain purchase gain	(90)	0
Amortization of debt issuance costs	0	283
Amortization of debt discount	0	2,479
Derivative loss	0	12,641
Loss (gain) on sale of OEM business (discontinued operations)	6,316	(210,866)
Other	(5)	214
Change in assets and liabilities:
Accounts receivable	6,059	9,221
Inventories	(12,461)	(7,236)
Accounts payable	(3,868)	1,695
Accrued expenses	23,040	20,694
Deferred revenue	0	2,955
Right-of-use asset and lease liability	(2,814)	0
Other operating assets and liabilities	(18,416)	(5,295)
Net cash used in operating activities	(41,611)	(72,669)
Cash flows from investing activities:
Payments for OEM working capital adjustment	(5,430)	0
Proceeds from sale of OEM business	0	437,097
Purchases of property and equipment	(10,834)	(9,738)
Business acquisitions, net of cash acquired	(328)	0
Patent and acquired intangible asset costs	(496)	(419)
Net cash (used in) provided by investing activities	(17,088)	426,940
Cash flows from financing activities:
Share offering proceeds, net	82,326	0
Proceeds from exercise of common stock options	23	20
Repayment of short-term obligations	0	(76,912)
Proceeds from long-term obligations	0	89,892
Payments of debt issuance costs	0	(1,740)
Payments on long-term obligations	0	(207,266)
Payments for treasury stock	(158)	(418)
Redemption of preferred stock	0	(66,519)
Other	0	38
Net cash provided by (used in) financing activities	82,191	(262,905)
Effect of exchange rate changes on cash and cash equivalents	906	(1,184)
Net increase (decrease) in cash and cash equivalents	24,398	90,182
Cash and cash equivalents, beginning of period	43,962	5,608
Cash and cash equivalents, end of period	68,360	95,790
Supplemental cash flow disclosure:
Cash paid for interest	0	4,488
Net income tax payments, net of refunds	11,710	4,986
Non-cash acquisition of property and equipment	150	0
Non-cash common stock issuance - Prompt	$ 221	$ 0

Business

Business	9 Months Ended
	Sep. 30, 2021
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Business	Business Surgalign Holdings, Inc. (the “Company”), (formerly known as RTI Surgical Holdings, Inc. (“RTI”)) is a global medical technology company focused on elevating the standard of care by driving the evolution of digital surgery. We have a broad portfolio of spinal hardware implants, including solutions for fusion procedures in the lumbar, thoracic, and cervical spine, motion preservation solutions for the lumbar spine, and a minimally invasive surgical implant system for fusion of the sacroiliac joint. We also have a portfolio of advanced and traditional orthobiologics, or biomaterials. In addition to our spinal hardware and biomaterials portfolios, we are developing an augmented reality and artificial intelligence digital surgery platform called HOLO™ to enable digital spine surgery, which we believe is one of the most advanced artificial intelligence technologies being applied to surgery. HOLO Portal™ surgical guidance, a component of our HOLO™ platform, is designed to automatically recognize, identify, and segment patient anatomy to autonomously assist the surgeon throughout the surgical procedure. This proprietary artificial intelligence-based platform system is an intelligent anatomical mapping technology designed to assist surgeons by allowing them to remain in safe anatomical zones, and to enhance surgical performance. We plan to leverage our digital surgery platform to improve patient outcomes and drive adoption of our spinal hardware implants and biomaterials products. We are developing a pipeline of new innovative technologies that we plan to integrate with our digital surgery platform. We currently market and sell products to hospitals, ambulatory surgery centers, and healthcare providers in the United States and in more than 40 countries worldwide. We are headquartered in Deerfield, Illinois, with commercial, innovation and design centers in San Diego, CA; Wurmlingen, Germany; and Warsaw, Poland. OEM Disposition On July 20, 2020, pursuant to the Equity Purchase Agreement, dated as of January 13, 2020 (as amended from time to time, the “OEM Purchase Agreement”), by and between the Company and Ardi Bidco Ltd. (the “Buyer”), the Company completed the sale of its former original equipment manufacturing business, and business related to processing donated human musculoskeletal and other tissue and bovine and porcine animal tissue in producing allograft and xenograft implants using BIOCLEANSE®, TUTOPLAST® and CANCELLE®SP sterilization processes (collectively, the “OEM Businesses”) to Buyer and its affiliates for a purchase price of $440.0 million of cash, subject to certain adjustments (the “Transactions”). More specifically, pursuant to the terms of the OEM Purchase Agreement, the Company sold to the Buyer and its affiliates all of the issued and outstanding shares of RTI OEM, LLC (which, prior to the Transactions, was converted to a corporation and changed its name to “RTI Surgical, Inc.”), RTI Surgical, LLC (which, prior to the Transactions, was converted to a corporation and changed its name to “Pioneer Surgical Technology, Inc.”), Tutogen Medical, Inc. and Tutogen Medical GmbH. The Transactions were previously described in the Proxy Statement filed by the Company with the SEC on June 18, 2020. Subsequent to the Transactions, the Company changed its name to Surgalign Holdings, Inc, operating through its primary subsidiary, Surgalign Spine Technologies, Inc. Where obvious and appropriate from the context, references herein to Surgalign or the Company refer to the Company excluding the disposed OEM Businesses. Prior to the sale of the OEM Businesses, the Company operated two reportable segments: Spine and OEM. Subsequent to the sale of the OEM Businesses, the Company operates only one reportable segment. Refer to Note 3 for further discussion on Discontinued Operations. COVID-19 The continued effects of the coronavirus (“COVID-19”) pandemic, as well as the corresponding governmental response and the Company’s management of the crisis has had a significant impact on the Company’s business. The consequences of the outbreak and impact on the global economy continues to evolve, and the full extent of the impact is uncertain with the existence of variant strains of COVID-19. The variant strains have and will continue to lead to a rise in infections resulting in the reinstatement of certain restrictions previously in place on a global scale. Beginning in 2020, many hospitals and other medical facilities canceled elective surgeries, reduced and diverted staffing and diverted other resources to patients suffering from the infectious disease and limited hospital access for non-patients, including the Company’s direct and indirect sales representatives. Because of the COVID-19 pandemic, surgeons and their patients have been required, or are choosing, to defer procedures in which the Company’s products would be used, and many facilities that specialize in the procedures in which the Company’s products would be used have closed or reduced operating hours. The Company continue to see these measures taken through September 30, 2021 thus negatively impacting the ability of the Company’s employees and distributors to effectively market and sell its products. In addition, even after the pandemic subsides and/or governmental orders no longer prohibit or recommend against performing such procedures, patients may continue to defer such procedures out of concern of being exposed to COVID-19. The COVID-19 pandemic has also caused adverse effects on general commercial activity and the global economy, which led to an economic slowdown in 2020, and which has adversely affected the Company’s business, operating results or financial condition. The adverse effect of the pandemic on the broader economy has also negatively affected demand for procedures using the Company’s products, and could cause one or more of the Company’s distributors, customers, and suppliers to experience financial distress, cancel, postpone or delay orders, be unable to perform under a contract, file for bankruptcy protection, go out of business, or suffer disruptions in their business. This could impact the Company’s ability to provide products and otherwise operate its business, as well as increase its costs and expenses. The COVID-19 pandemic has also led to and could continue to lead to severe disruption and volatility in the global capital markets, which could increase the Company’s cost of future capital and adversely affect its ability to access the capital markets in the future. The Company cannot predict when its operations will fully return to pre-pandemic levels and will continue to carefully monitor the situation and the needs of the business. The above and other continued disruptions to the Company’s business as a result of COVID-19 has resulted in a material adverse effect on its business, operating results and financial condition. Although vaccines have recently been made available, it remains uncertain when our business will return to normal operations. The full extent to which the COVID-19 pandemic will impact the Company’s business will depend on future developments that are highly uncertain and cannot be accurately predicted, including the possibility that new adverse information may emerge concerning COVID-19 and additional actions to contain it or treat its impact may be required. Liquidity As the global outbreak of COVID-19 continues to rapidly evolve, it could continue to materially and adversely affect our revenues, financial condition, profitability, and cash flows for an indeterminate period of time. Going Concern The accompanying unaudited condensed consolidated financial statements of the Company have been prepared assuming the Company will continue as a going concern and in accordance with generally accepted accounting principles in the United States of America. The going concern basis of presentation assumes that we will continue in operation one year after the date these unaudited condensed consolidated financial statements are issued, and we will be able to realize our assets and discharge our liabilities and commitments in the normal course of business. As of September 30, 2021, we had cash of $68.4 million and an accumulated deficit of $524.3 million. For the nine months ended September 30, 2021, we had a loss from continuing operations of $34.1 million. We have incurred losses from operations in the previous two fiscal years and did not generate positive cash flows from operations in fiscal year 2020 or for the nine months ended September 30, 2021. On June 14, 2021, we issued and sold in a registered direct offering an aggregate of 28,985,508 shares of our common stock and investor warrants to purchase up to an aggregate of 28,985,508 million shares at a strike price of $1.725.The Company, also in connection with the direct offering, issued placement agent warrants to purchase an aggregate of up to 1,739,130 million shares of our common stock at a strike price of $2.15625 per share. We received net proceeds of $45.8 million from the offering after deducting investor fees of $4.2 million. On February 1, 2021, we closed a public offering and sold a total 28,700,000 shares of our common stock at a price of $1.50 per share, less the underwriter discounts and commissions. We received net proceeds of $36.5 million from the offering after deducting the underwriting discounts and commission of $4.0 million. The Company is projecting it will continue to generate significant negative operating cash flows over the next 12-months and beyond due, in part, to continued COVID-19 uncertainties, along with approximately $18.4 million of the total contingent consideration of $53.0 million expected to become due to the former owners of Holo Surgical contingent on two milestones expected to be achieved within the next 12 months. These payments will be paid through a combination of common stock and cash. The Company’s operating plan for the next 12-month period also includes continued investments in its product pipeline and funding of future operations through 2022, which will necessitate additional debt and/or equity financing. The Company’s ability to raise additional capital may be adversely impacted by potential worsening global economic conditions and the recent disruptions to, and volatility in, financial markets in the United States, and worldwide, resulting from the ongoing COVID-19 pandemic. If cash resources are insufficient to satisfy the Company’s on-going cash requirements through the third fiscal quarter of 2022, the Company will be required to scale back operations, reduce research and development expenses, and postpone, as well as suspend capital expenditures, in order to preserve liquidity. No assurance can be given that any future financing will be available or, if available, that it will be on terms that are satisfactory to the Company. Even if the Company is able to obtain additional financing, it may contain undue restrictions on our operations, in the case of debt financing, or cause substantial dilution for our stockholders, in the case of equity financing. In consideration of the inherent risks and uncertainties and the Company’s forecasted negative cash flows as described above, management has concluded that substantial doubt exists with respect to the Company’s ability to continue as a going concern within one year after the date the unaudited condensed consolidated financial statements are issued. Management continually evaluates plans to raise additional debt and/or equity financing and will attempt to curtail discretionary expenditures in the future, if necessary; however, in consideration of the risks and uncertainties mentioned, such plans cannot be considered probable of occurring at this time. The recoverability of a major portion of the recorded asset amounts shown in the Company’s accompanying condensed consolidated balance sheets is dependent upon continued operations of the Company, which in turn is dependent upon the Company’s ability to meet its funding requirements on a continuous basis to maintain existing financing to succeed in its future operations. The Company’s unaudited condensed consolidated financial statements do not include any adjustment relating to the recoverability and classification of recorded asset amounts and classification of liabilities that might be necessary should the Company be unable to continue in existence.

Basis of Presentation

Basis of Presentation	9 Months Ended
	Sep. 30, 2021
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Presentation	Basis of Presentation The accompanying unaudited condensed consolidated financial statements include all adjustments, consisting of normal recurring accruals, which the Company considers necessary for a fair presentation of the results of operations for the periods shown. The unaudited condensed consolidated financial statements have been prepared in accordance with the instructions to Form 10-Q and Rule 10-01 of Regulation S-X, and, therefore, do not include all information and footnotes necessary for a fair presentation of the unaudited condensed consolidated financial position, results of operations, comprehensive loss and cash flows in conformity with accounting principles generally accepted in the United States of America (“GAAP”). The preparation of our unaudited condensed consolidated financial statements in accordance with GAAP often requires us to make estimates and judgments that affect reported amounts. These estimates and judgments are based on historical experience and assumptions that we believe to be reasonable under the circumstances. Assumptions and judgments based on historical experience may provide reported results, which differ from actual results; however, these assumptions and judgments historically have not varied significantly from actual experience, and we therefore do not expect them to vary significantly in the future. All intercompany balances and transactions have been eliminated in consolidation. The results of operations for any interim period are not necessarily indicative of the results to be expected for the full year. The Company includes acquisition, disposal, integration and separation related costs, which are predominantly composed of legal, consulting, and advisor fee expenses, within the “Transaction and integration expense” line on the condensed consolidated statements of comprehensive income/(loss). The unaudited condensed consolidated financial statements include the accounts of the Company and its wholly owned subsidiaries, Surgalign Spine Technologies, Inc., Paradigm Spine, LLC (“Paradigm”), Pioneer Surgical Technology, Inc. (“Pioneer Surgical”), Zyga Technology, Inc. (“Zyga”), and Holo Surgical Inc. (“Holo Surgical”). T he operating results of the disposed OEM Businesses have been reported as discontinued operations in the unaudited condensed consolidated financial statements in the prior comparative periods. For further information, refer to the consolidated financial statements and notes thereto included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2020 filed with the Securities and Exchange Commission (“SEC”) on March 16, 2021, and as amended by our Annual Report (Amendment No. 1) on Form 10-K/A filed with the SEC on September 24, 2021. Accounting Standards Issued But Not Yet Adopted In August 2020, the FASB issued ASU 2020-06, Debt—Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging—Contracts in Entity’s Own Equity (Subtopic 815-40). The guidance provides simplifications of the accounting for convertible instruments and reduces the number of accounting models for convertible debt instruments and convertible preferred stock. Limiting the accounting models results in fewer embedded conversion features being separately recognized from the host contract as compared with current U.S. GAAP. The guidance is effective for public business entities for fiscal years beginning after December 15, 2021. Early adoption is permitted, but no earlier than fiscal years beginning after December 15, 2020. The Company is currently evaluating this guidance to determine the impact on its disclosures. Immaterial Restatement of Earnings Per Share (“EPS”) During the first fiscal quarter of 2021, the Company identified errors in the calculation of its historical basic and diluted EPS. In the historical periods presented in the filing, the weighted average basic and diluted shares incorrectly included treasury stock, restricted stock awards, and restricted stock units. The weighted average shares used in the restated basic and diluted EPS from continuing operations and discontinued operations have been corrected. Significant New Accounting Policies Refer to the Company's Annual Report on Form 10-K for the year ended December 31, 2020 as filed with the SEC on March 16, 2021 for discussion of the Company's significant accounting policies. During the three months ended September 30, 2021, the following accounting policy was adopted. Other Operating Income Included within "Other operating income, net" for the three and nine months ended September 30, 2021 is $3.9 million related to the settlement received by the Company from OEM related to inventory purchased during the year that was also paid for by the Company at the date of acquisition.

Discontinued Operations

Discontinued Operations	9 Months Ended
	Sep. 30, 2021
Discontinued Operations and Disposal Groups [Abstract]
Discontinued Operations	Discontinued Operations In connection with the Transactions, on July 20, 2020, the Company completed the disposition of its OEM Businesses. Accordingly, the OEM Businesses are reported as discontinued operations in accordance with ASC 205-20, Discontinued Operations (“ASC 205-20”). The results of operations from the OEM Businesses are classified as discontinued operations in the condensed consolidated statements of comprehensive income/(loss). There were no assets or liabilities of the OEM Businesses as of September 30, 2021 or December 31, 2020 due to the transaction occurring on July 20, 2020. Applicable amounts in prior years have been recast to conform to this discontinued operations presentation. The following table presents the financial results of the discontinued operations: Three Months Ended Nine Months Ended 2021 2020 2021 2020 Major classes of line items constituting net income (loss) from discontinued operations Revenues $ — $ 6,877 $ — $ 87,192 Costs of processing and distribution — 4,006 — 49,679 Gross profit — 2,871 — 37,513 Expenses: Marketing, general and administrative — 2,329 — 12,889 Severance and restructuring costs — — — 604 Transaction and integration expenses — 11,811 — 23,598 Total expenses — 14,140 — 37,091 Operating (loss) income — (11,269) — 422 Other expense - net: OEM working capital adjustment — — 6,316 — Interest expense — 5,093 — 14,631 Derivative loss — — — 12,641 Loss on extinguishment of debt — 2,686 — 2,686 Foreign exchange loss (gain) — 17 — (3) Total other expense - net — 7,796 6,316 29,955 Loss from discontinued operations — (19,065) (6,316) (29,533) Gain on sale of net assets of discontinued operations — 210,866 — 210,866 Income (loss) from discontinued operations before income tax provision (benefit) — 191,801 (6,316) 181,333 Income tax provision (benefit) (349) 42,534 (1,112) 39,189 Net income (loss) from discontinued operations $ 349 $ 149,267 $ (5,204) $ 142,144 In accordance with ASC 205-20, only expenses specifically identifiable and related to a business to be disposed may be presented in discontinued operations. As such, the marketing and general and administrative expenses in discontinued operations include corporate costs incurred directly to solely support the Company’s OEM Businesses. Pursuant to the OEM Purchase Agreement, the Company and the Buyer have also entered into a Transition Services Agreement, through which the disposed OEM Businesses will provide to the Company transitional services related to IT support, customer and vendor management, procurement, and other services for periods ranging 3 to 12 months after the disposal. This contract was extended to the end of 2021. The Company applied the “Intraperiod Tax Allocation” rules under ASC 740, Income Taxes (“ASC 740”), which requires the allocation of an entity’s total annual income tax provision among continuing operations and, in the Company’s case, discontinued operations. On December 1, 2020, pursuant to the OEM Purchase Agreement, the Company received a notice from the Buyer indicating that a post-closing adjustment in an amount of up to $14.0 million may be owed in respect of the working capital adjustment paid at closing. O n June 3, 2021, the firm engaged to resolve the dispute issued a binding, non-appealable resolution whereby it was determined the Company was liable for $5.8 million of the disputed amount, which was finalized and paid during the second quarter of 2021. The final settlement was expensed under "Income (loss) from operations of discontinued operations" in our condensed consolidated statements of comprehensive income/(loss). Total operating and investing cash flows of discontinued operations for the nine months ended September 30, 2021 and 2020 is comprised of the following, which excludes the effect of income taxes: Nine Months Ended Nine Months Ended September 30, September 30, Significant operating non-cash reconciliation items: Depreciation and amortization $ — $ 2,126 Provision for bad debt and products returns $ — $ 650 Revenue recognized due to change in deferred revenue $ — $ (2,618) Deferred income tax provision $ — $ (3,644) Stock-based compensation $ — $ 792 Gain on sale of discontinued assets, net $ — $ (210,866) Loss on extinguishment of debt $ — $ 2,686 Amortizations of debt issuance costs $ — $ 283 Amortizations of debt discount $ — $ 2,479 Significant investing items: Payments for OEM working capital adjustment $ (5,430) $ — Purchases of property and equipment $ — $ (1,867) Patent and acquired intangible asset costs $ — $ (419) Proceeds from sale of OEM Business $ — $ 437,097

Leases

Leases	9 Months Ended
	Sep. 30, 2021
Leases [Abstract]
Leases	Leases The Company’s leases are classified as operating leases that include office space, automobiles, and copiers. The Company does not have any finance leases and the Company’s operating leases do not have any residual value guarantees, restrictions, or covenants. The Company’s leases have remaining lease terms of 1 to 8 years, some of which include options to extend or terminate the leases. The option to extend is only included in the lease term if the Company is reasonably certain of exercising that option. Operating lease right-of-use ("ROU") assets are presented within "Other assets-net" on the condensed consolidated balance sheets. The current portion of operating lease liabilities are presented within "Accrued expenses", and the non-current portion of operating lease liabilities are presented within "Other long-term liabilities" on the condensed consolidated balance sheets. The Company’s lease agreements do not provide a readily determinable implicit rate nor is it available to the Company from its lessors. Instead, the Company estimates its incremental borrowing rate based on information available at lease commencement in order to discount lease payments to present value. A subset of the Company’s automobile and copier leases contain variable payments. The variable lease payments for such automobile leases are based on actual mileage incurred at the standard contractual rate. The variable lease payments for such copier leases are based on actual copies incurred at the standard contractual rate. The variable lease costs for all leases are immaterial. The components of operating lease expense were as follows: For the Three Months Ended For the Nine Months Ended 2021 2020 2021 2020 Operating lease cost $ 179 $ 286 $ 557 $ 1,024 Short-term operating lease cost 112 — 261 — Total operating lease cost $ 291 $ 286 $ 818 $ 1,024 Supplemental cash flow information related to operating leases was as follows: For the Three Months Ended For the Nine Months Ended 2021 2020 2021 2020 Cash paid for amounts included in the measurement of lease liabilities $ 311 $ 293 $ 887 $ 1,026 ROU assets obtained in exchange for lease obligations — — 68 — Supplemental balance sheet information related to operating leases was as follows: Balance Sheet Classification Balance at September 30, 2021 Balance at December 31, 2020 Assets: Right-of-use assets Other assets - net $ 1,008 $ 1,425 Liabilities: Current Accrued expenses $ 363 $ 650 Noncurrent Other long-term liabilities 1,018 1,200 Total operating lease liabilities $ 1,381 $ 1,850 The weighted-average remaining lease terms and discount rates were as follows: For the Nine Months Ended 2021 2020 Weighted-average remaining lease term (years) 6.1 6.1 Weighted-average discount rate 5.0 % 5.0 % As of September 30, 2021, maturities of operating lease liabilities were as follows: Balance at September 30, 2021 (remaining) $ 317 2022 378 2023 218 2024 173 2025 161 2026 and beyond 557 Total future minimum lease payments 1,804 Less imputed interest (423) Total $ 1,381

Revenue from Contracts with Cus

Revenue from Contracts with Customers	9 Months Ended
	Sep. 30, 2021
Revenue from Contract with Customer [Abstract]
Revenue from Contracts with Customers	Revenue from Contracts with Customers The Company recognizes revenue upon transfer of control of promised products in an amount that reflects the consideration it expects to receive in exchange for those products. The Company typically transfers control at a point in time upon shipment or delivery of the implants for direct sales, or upon implantation for sales of consigned inventory. The customer is able to direct the use of and obtain substantially all of the benefits from the implant at the time the implant is shipped, delivered, or implanted, based on the terms of the contract. Disaggregation of Revenue The Company’s entire revenue for the three and nine months ended September 30, 2021 and 2020 was recognized at a point in time. The following table represents total revenue by geographical region for the three and nine months ended September 30, 2021 and 2020, respectively: For the Three Months Ended For the Nine Months Ended 2021 2020 2021 2020 Revenues: Domestic $ 17,306 $ 23,690 $ 57,880 $ 62,917 International 3,239 4,236 10,790 12,645 Total revenues from contracts with customers $ 20,545 $ 27,926 $ 68,670 $ 75,562 The Company’s performance obligations consist mainly of transferring control of implants identified in the contracts. Some of the Company’s contracts offer assurance-type warranties in connection with the sale of a product to a customer. Assurance-type warranties provide a customer with assurance that the related product will function as the parties intended because it complies with agreed-upon specifications. Such warranties do not represent a separate performance obligation and are not material to the unaudited condensed consolidated financial statements.

Business Combinations

Business Combinations	9 Months Ended
	Sep. 30, 2021
Business Combinations [Abstract]
Business Combinations	Business Combinations On April 30, 2021, the Company, entered into an Asset Purchase Agreement (the “Agreement”) with Prompt Prototypes LLC (“Prompt”), a California limited liability company, and Peter Kopley, an individual residing in the State of California (the “Sellers”). The Company purchased the assets of Prompt to expand its research and development capabilities, and create the capacity to produce certain medical prototypes. Pursuant to the terms of the Agreement, the Company purchased specific assets and assumed certain liabilities of Prompt for a purchase price of $1.1 million. At the closing, the Company paid $0.3 million of cash and issued restricted shares with an aggregate fair market value of $0.2 million to the sellers. The remaining $0.6 million of the purchase price will be paid to Mr. Kopley, contingent on the continued employment with the Company, in the form of cash and restricted shares in two equal amounts on the 18 th and 36 th month anniversary of the closing date. These payments are considered future compensation. The following table summarizes the fair value of the identifiable assets acquired and liabilities assumed from the acquisition of Prompt as of April 30, 2021 (in thousands): Inventories $ 140 Right-of-use assets 78 Property and equipment 528 Operating lease liabilities (78) Deferred tax liability (28) Net assets acquired $ 640 Bargain purchase gain (90) Total purchase price $ 550 Based on the preliminary purchase price, the fair value of the assets acquired and liabilities assumed exceeded the purchase price consideration resulting in a bargain purchase gain of $0.1 million, and was recorded in "Other (income) expense – net" in our condensed consolidated statements of comprehensive income/(loss) during the second quarter ended June 30, 2021. The bargain purchase was primarily driven by the potential future compensation expense in lieu of an increased purchase price. Holo Surgical Acquisition On September 29, 2020, the Company entered into a Stock Purchase Agreement (the “Holo Purchase Agreement”), with Roboticine, Inc, a Delaware corporation (the “Seller”), Holo Surgical S.A., a Polish joint-stock company (“Holo S.A.”), Pawel Lewicki, PhD (“Lewicki”), and Krzysztof Siemionow, MD, PhD (“Siemionow”), which provides for the Company to acquire all of the issued and outstanding equity interests in Holo Surgical Inc., a Delaware corporation and a wholly owned subsidiary of the Seller (“Holo Surgical”). The Seller, Holo S.A., Lewicki and Siemionow are together referred to herein as the “Seller Group Members.” The Acquisition was closed on October 23, 2020. As consideration for the Holo Surgical Acquisition, the Company paid to the Seller $30.0 million in cash and issued to the Seller 6,250,000 shares of common stock, par value $0.001 of the Company (“Common Stock”). In addition, the Seller is entitled to receive contingent consideration from the Company valued in an aggregate amount of up to $83.0 million, to be paid through the issuance of Common Stock or the payment of cash, contingent upon and following the achievement of certain regulatory, commercial and utilization milestones by specified time periods occurring up to the sixth (6th) anniversary of the closing. The Purchase Agreement provides that the Company will issue Common Stock to satisfy any contingent consideration payable to the Seller, until the total number of shares of Common Stock issued to the Seller pursuant to the Purchase Agreement (including the 6,250,000 shares of Common Stock issued at closing) is equal to 14,900,000 shares of Common Stock. Following the attainment of that limitation, the post-closing contingent payments would be payable in cash. The number of shares of Common Stock issued as contingent consideration with respect to the achievement of a post-closing milestone, if any, will be calculated based on the volume weighted average price of the Common Stock for the five (5) day trading period commencing on the opening of trading on the third trading day following the achievement of the applicable milestone. The Purchase Agreement also includes certain covenants and obligations of the Company with respect to the operation of the business of Holo Surgical that apply during the period in which the milestones may be achieved. The Company determined that substantially all of the fair value was concentrated in the acquired in-process research and development (“IPR&D”) asset in accordance with the guidance of ASC 805, Business Combinations . As such, the acquisition was accounted for as an asset acquisition. The total consideration of the asset acquisition was determined to be $95.0 million which consisted of a cash consideration of $30.0 million, $12.3 million of the 6,250,000 shares of Common Stock issued to the Seller, direct and incremental costs of $2.1 million incurred for the Holo Surgical Acquisition, and an estimated fair value of $50.6 million related to the contingent consideration. The Company has determined that the contingent consideration was part of the consideration of the asset acquisition and was accounted for as a liability at fair value on the acquisition date of October 23, 2020 in accordance with ASC 480, Distinguishing Liabilities from Equity . Subsequently, the liability shall be marked to market at the end of each reporting period with any change recognized in current earnings. The fair value of the liability was $53.0 million as of September 30, 2021 with $18.4 million classified as current liabilities within "Accrued expenses", while $34.6 million is included as "Other long-term liabilities" in the Company’s accompanying condensed consolidated balance sheets. The change in the fair value of the liability of $3.6 million since December 31, 2020 was recognized in the "Gain on acquisition contingency" line of the condensed consolidated statements of comprehensive income/(loss).

Stock-Based Compensation

Stock-Based Compensation	9 Months Ended
	Sep. 30, 2021
Share-based Payment Arrangement [Abstract]
Stock-Based Compensation	Stock-Based Compensation The following tables summarize our stock option and stock grant awards by plan: For the nine months ended September 30, 2021: Plan Stock Options Restricted Stock Awards Restricted Stock Units Total 2021 Incentive Inducement Plan 422,162 — 430,254 852,416 2021 Incentive Compensation Plan 114,091 — 4,535,032 4,649,123 2018 Incentive Compensation Plan 240,311 147,719 — 388,030 Total 776,564 147,719 4,965,286 5,889,569 For the nine months ended September 30, 2020: Plan Stock Options Restricted Stock Awards Restricted Stock Units Total 2018 Incentive Compensation Plan 1,858,353 1,754,409 — 3,612,762 Total 1,858,353 1,754,409 — 3,612,762 The Company recognized stock-based compensation as follows: For the Three Months Ended For the Nine Months Ended 2021 2020 2021 2020 Stock-based compensation: Costs of goods sold $ — $ 33 $ 21 $ 105 Marketing, general and administrative 1,734 1,112 3,967 3,103 Research and development — 5 — 35 Transaction and integration expenses 134 1,515 230 1,515 Total $ 1,868 $ 2,665 $ 4,218 $ 4,758 The expense in the table above represents stock-based compensation for outstanding awards, and related expenses for the Company's employee stock purchase program. For the three and nine months ended September 30, 2020, the Company incurred $0.6 million, and $0.8 million, respectively, of stock-based compensation expense related to the disposed OEM Businesses. These expenses have been presented in the results from discontinued operations. No stock-based compensation expense related to the disposed OEM Business was incurred in 2021.

Net Loss Per Common Share

Net Loss Per Common Share	9 Months Ended
	Sep. 30, 2021
Earnings Per Share [Abstract]
Net Loss Per Common Share	Net Loss Per Common Share A reconciliation of the number of shares of common stock used in the calculation of basic and diluted net income per common share is presented below: For the Three Months Ended For the Nine Months Ended 2021 2020 2021 2020 Weighted average basic and dilutive shares 138,317,858 73,212,662 117,135,533 72,933,038 For the three and nine months and ended September 30, 2021 and 2020, the Company has recorded a net loss from its continuing operations. As a result, the Company has excluded all potential dilutive shares from the computation of the diluted net loss per common share to avoid the anti-dilutive effect. The following table includes the number of potential dilutive shares that were excluded due to the anti-dilutive effect: For the Three Months Ended For the Nine Months Ended 2021 2020 2021 2020 Stock Options — — 356,307 3,748 Restricted Stock Units and Restricted Stock Awards 5,747,396 1,515,137 1,191,362 1,191,573 Convertible Series A Preferred Stock ("Series A Preferred Stock") — 3,308,854 — 11,221,121 Total 5,747,396 4,823,991 1,547,669 12,416,442 For the three months ended September 30, 2021 and 2020, the company excluded 5,470,364 and 5,305,329 respectively, of issued stock options in the computation of diluted net loss per share, and for the nine months ended September 30, 2021 and 2020, the company excluded 4,936,334 and 4,963,654 respectively, of issued stock options in the computation of diluted net loss per common share because their exercise price exceeded the average market price during the respective periods. The Company’s outstanding warrants were also excluded from the computation of diluted net loss per common share as they were considered “out-of-the-money” as of September 30, 2021. On October 23, 2020, the Company completed the acquisition of Holo Surgical and became obligated for a contingent consideration in an aggregate amount of $50.6 million which must be first paid in shares of the Company’s common stock (in an amount up to 8,650,000 shares) and then paid in cash thereafter, contingent upon and following the achievement of certain regulatory, commercial and utilization milestones by specified time periods occurring up to the sixth (6th) anniversary of the closing. The number of shares of common stock issued as contingent consideration with

Inventories

Inventories	9 Months Ended
	Sep. 30, 2021
Inventory Disclosure [Abstract]
Inventories	Inventories The inventory balances as of September 30, 2021 and December 31, 2020 consist entirely of finished goods. The Company values its inventories at the lower of net realizable value or cost using first-in, first-out (FIFO). For the three months ended September 30, 2021 and 2020, the Company had inventory write-downs of $1.4 million and $5.6 million, respectively, and for the nine months ended September 30, 2021 and 2020, the Company had inventory write-downs of $5.8 million and $9.6 million, respectively.

Prepaid and Other Current Asset

Prepaid and Other Current Assets	9 Months Ended
	Sep. 30, 2021
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]
Prepaid and Other Current Assets	Prepaid and Other Current Assets Prepaid and other current assets are as follows: September 30, December 31, Insurance recovery receivable $ 12,000 $ — Income tax receivable 3,863 4,836 Prepaid expenses 2,956 1,543 Other receivables 806 3,905 $ 19,625 $ 10,284

Property and Equipment

Property and Equipment	9 Months Ended
	Sep. 30, 2021
Property, Plant and Equipment [Abstract]
Property and Equipment	Property and Equipment The net book value of property and equipment after accumulated depreciation and all impairment is as follows: September 30, 2021 December 31, 2020 Processing equipment $ 487 $ 35 Surgical instruments 474 440 Office equipment, furniture and fixtures 20 34 Computer equipment and software 10 12 Construction in process 37 — $ 1,028 $ 521 For the three months ended September 30, 2021 and 2020, the Company recorded depreciation expense in connection with property and equipment of $0.7 million and $1.0 million, respectively. For the nine months ended September 30, 2021 and 2020, the Company recorded depreciation expense in connection with property and equipment of $1.9 million and $3.0 million, respectively. The Company uses the straight-line method of depreciation. For the three months ended September 30, 2021 and 2020, the Company recorded asset impairment and abandonment charges of $5.0 million and $9.2 million, respectively. For the nine months ended September 30, 2021 and 2020, the Company recorded asset impairment and abandonment charges of $9.4 million and $12.0 million, respectively. The fair value of property and equipment was measured utilizing an orderly liquidation value of each of the underlying assets. As of September 30, 2021 and December 31, 2020, the Company capitalized a total of $3.2 million and $0.0 million of internal software expense related to the implementation of a new Enterprise Resource Planning ("ERP") system. These expenses have been recorded within "Construction in process" as the development is still on going. As part of the quarterly impairment analysis, the Company impaired $0.3 million in March 2021, $0.8 million in June 2021, and $2.0 million in September 2021 of the capitalized ERP costs. The impairment charges were triggered by continued negative operating cash flows.

Warrants

Warrants	9 Months Ended
	Sep. 30, 2021
Warrants and Rights Note Disclosure [Abstract]
Warrants	WarrantsOn June 14, 2021, the Company issued and sold in a registered direct offering priced at-the-market an aggregate of 28,985,508 shares of its common stock and warrants exercisable for an aggregate of 28,985,508 shares of Company common stock, at a combined purchase price of $1.725 per share. The warrants have an exercise price equal to $1.725 per share, are exercisable immediately upon issuance and will expire three years from the issuance date. The net proceeds from the direct offering, after deducting investor and management fees, were $45.8 million. Upon any exercise of the offering warrants issued in the offering for cash, the Company agreed to pay the placement agent a total cash fee equal to 7.0% of the aggregate gross proceeds from the exercise of the offering warrants and a management fee equal to 1.0% of the aggregate gross proceeds from the exercise of the offering warrants. The Company, also in connection with the direct offering, issued the placement agent or its designees warrants to purchase an aggregate of up to 1,739,130 shares of its common stock. The placement agent warrants have substantially the same terms as the warrants described above, except that the placement agent warrants will have an exercise price of $2.15625 per share, and holders of the placement agent warrants are not entitled to receive cash dividends issued by the Company during such time as the placement agent warrant is outstanding. The Company accounts for its warrants in accordance with ASC 815-40, “Derivatives and Hedging—Contracts in Entity’s Own Equity” (“ASC 815”), under which the warrants did not meet the criteria for equity classification and thus were recorded as liabilities. Since the warrants met the definition of a derivative in accordance with ASC 815, these warrants were measured at fair value at inception and will be remeasured at each reporting date in accordance with ASC 820, Fair Value Measurement

Fair Value Information

Fair Value Information	9 Months Ended
	Sep. 30, 2021
Fair Value Disclosures [Abstract]
Fair Value Information	Fair Value Information Fair value is defined as the price that would be received upon the sale of an asset or paid to transfer a liability in an orderly transaction between market participants on the measurement date. Valuation techniques used to measure fair value maximize the use of observable inputs and minimize the use of unobservable inputs. The fair value hierarchy defines a three-level valuation hierarchy for classification and disclosure of fair value measurements as follows: Level 1 – Quoted prices in active markets for identical assets or liabilities. Level 2 – Inputs other than Level 1 that are observable, either directly or indirectly, such as quoted prices for similar assets or liabilities; quoted prices in markets that are not active; or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities. Level 3 – Unobservable inputs that are supported by little or no market activity and that are significant to the fair value of the assets or liabilities. Acquisition Contingencies Zyga - On January 4, 2018, the Company acquired Zyga Technology, Inc. (“Zyga”) as further explained in Note 18. As of March 31, 2020, and December 31, 2019, based on a probability weighted model, the Company estimated a contingent liability related to the clinical and revenue milestones of $1.1 million. The fair value of the contingent liability was measured using Level 3 inputs. As of December 31, 2020, the Company determined that Zyga was not expected to meet the clinical milestone to earn the contingent consideration. As such, the liability for the milestone payment was reduced to zero as of December 31, 2020 and continues to be zero at September 30, 2021. Holo Surgical - On October 23, 2020, the Company acquired Holo Surgical as previously explained in Note 6 above. A portion of the consideration is contingent upon the achievement of certain regulatory, commercial and utilization milestones (the “milestone payment”). The contingent consideration is evaluated quarterly, or more frequently, if circumstances dictate. Changes in the fair value of contingent consideration are recorded in the "Gain on acquisition contingency" line item in the condensed consolidated statements of comprehensive income/(loss). Significant changes in unobservable inputs, mainly the probability of success and cash flows projected, could result in material changes to the contingent consideration liabilities. The Company determined the fair value of each milestone payment to be the present value of the future payment amount estimated using a probability weighted model. As of September 30, 2021 and December 31, 2020, a probability of success factor ranging from 0% to 90%, and 60% to 90%, respectively, was used in the fair value calculation to reflect inherent regulatory, development and commercial risk of the contingent payments. As of September 30, 2021 and December 31, 2020, the discount rate applied ranged from 0.05% to 11.17% and 0.11% to 16.86%, respectively. This fair value measurement is based on significant unobservable inputs in the market and thus represents a Level 3 measurement within the fair value hierarchy. The fair value of the milestone payments is based on several factors, such as: the probability of expected achievement of the specific milestones, including risks associated with uncertainty regarding achievement and payment of milestones; obtaining regulatory approvals in the United States and Europe; development of new features used with the product; adaption of the new technology by surgeons; and placement of the devices within the field. As of December 31, 2020, the fair value of the contingent liability was $56.5 million with $9.0 million classified as current liability included within the "Accrued expenses" line, and $47.5 million as long-term liability included within "Other long-term liabilities." As of September 30, 2021, the fair value of the contingent liability was $53.0 million with $18.4 million classified as current liability included within the "Accrued expenses" line, and $34.6 million as long-term liability included within "Other long-term liabilities." A reconciliation of the Company’s acquisition contingencies is as follows: 2021 2020 Beginning balance as of January 1 $ 56,515 $ 1,130 (Gain) loss (3,553) — Other — (130) Ending balance as of September 30 $ 52,962 $ 1,000 Property and Equipment, Intangibles and Other Assets Fair value is measured using Level 3 inputs for property and equipment, other intangible assets, and other assets. As of September 30, 2021, the Level 3 fair value was measured based on orderly liquidation value for the property and equipment and other assets. Other intangible assets Level 3 fair value was measured based on the income approach. Because the Company’s forecasted cash flow is negative, any intangible assets acquired during the period were immediately impaired, as the underlying business could not support the asset value. Unobservable inputs for the orderly liquidation value included replacement costs (unobservable), physical deterioration estimates (unobservable) and market sales data for comparable assets and unobservable inputs for the income approach included forecasted cash flows generated from use of the intangible assets (unobservable). Property and equipment, other intangibles and other assets were impaired and written down to their estimated fair values during the nine months ended September 30, 2021 and year ended December 31, 2020. As a result of impairments recognized, the following table summarizes the fair value of assets subject to fair value measured using Level 3 inputs for the periods presented: September 30, December 31, Property and equipment – net $ 1,028 $ 521 Other assets – net 10,045 10,145 $ 11,073 $ 10,666 Property and equipment was impaired and written down to their estimated fair values during the nine months ended September 30, 2021 and 2020. Other intangible assets and other assets were impaired and written down to their estimated fair values during the nine months ended September 30, 2021. The following table summarizes the impairment of assets subject to fair value measured using Level 3 inputs for the periods presented: For the Three Months Ended For the Nine Months Ended 2021 2020 2021 2020 Property and equipment – net $ 5,186 $ 9,210 $ 8,978 $ 11,971 Other intangibles – net 167 146 478 146 Other assets – net 58 — 338 — $ 5,411 $ 9,356 $ 9,794 $ 12,117 Warrant Liability Warrants are accounted for as liabilities in accordance with ASC 815-40 and are presented within "Warrant liability" in the Company’s condensed consolidated balance sheets. The following table presents information about the Company’s liabilities that are measured at fair value on a recurring basis at September 30, 2021: Level September 30, 2021 December 31, 2020 Warrant liability 3 $ 16,487 $ — The table presented below is a summary of changes in the fair value of the Company’s Level 3 valuation for the warrant liability for the nine months ended September 30, 2021: Warrant Liability December 31, 2020 $ — Fair value of warrants on date of issuance 26,749 Change in fair value (10,262) September 30, 2021 $ 16,487 The warrant liability is revalued each reporting period with the change in fair value recorded in the accompanying condensed consolidated statements of comprehensive income/(loss) until the warrants are exercised or expire. The fair value of the warrant liability is estimated using the Black-Scholes Option Pricing Model using the following valuation inputs: September 30, December 31, Stock price $ 1.09 — Risk-free interest rate 0.46 % — Dividend yield 0.0 % — Volatility 100 % —

Accrued Expenses

Accrued Expenses	9 Months Ended
	Sep. 30, 2021
Payables and Accruals [Abstract]
Accrued Expenses	Accrued Expenses Accrued expenses are as follows: September 30, December 31, Accrued securities class action settlement $ 12,000 $ — Accrued distributor commissions 3,194 4,113 Accrued compensation 5,531 2,268 Other 6,119 6,267 $ 26,844 $ 12,648

Other long-term liabilities

Other long-term liabilities	9 Months Ended
	Sep. 30, 2021
Other Liabilities, Noncurrent [Abstract]
Other long-term liabilities	Other long-term liabilities Other long-term liabilities are as follows: September 30, 2021 December 31, 2020 Acquisition contingencies $ 34,556 $ 47,519 Warrant Liability 16,487 — Lease obligations 1,018 1,200 Other 2,335 2,992 $ 54,396 $ 51,711

Income Taxes

Income Taxes	9 Months Ended
	Sep. 30, 2021
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes The Company evaluates the need for deferred tax asset valuation allowances based on a more likely than not standard. The ability to realize deferred tax assets depends on the ability to generate sufficient taxable income within the carryback or carryforward periods provided for in the tax law for each applicable tax jurisdiction. The Company has evaluated all evidence, both positive and negative, and determined that its deferred tax assets are not more likely than not to be realized. In making this determination, numerous factors were considered including the Company’s cumulative losses in recent years. For the three months ended September 30, 2021 the Company recorded $1.3 million of income tax benefit, and recorded no income tax provision for the three months ended September 30, 2020. The September 30, 2021 three-month income tax provision was primarily a result of the net change in uncertain tax positions. The September 30, 2020 three-month income tax provision was a result of the full valuation allowance. For the nine months ended September 30, 2021 and 2020, the Company recorded $1.0 million of income tax benefit and $3.5 million of income tax benefit, respectively. The September 30, 2021 nine-month income tax provision was primarily a result of federal interest liability as a result of timing of payments and the net change in uncertain tax positions. The September 30, 2020 nine-month income tax benefit was primarily impacted by the CARES Act tax benefit.

Preferred Stock

Preferred Stock	9 Months Ended
	Sep. 30, 2021
Temporary Equity Disclosure [Abstract]
Preferred Stock	Preferred Stock Preferred stock is as follows: Preferred Stock Liquidation Value Preferred Net Balance at January 1, 2021 $ — $ — $ — Amortization of preferred stock issuance costs — — — Balance at June 30, 2021 $ — $ — $ — Amortization of preferred stock issuance costs — — — Balance at September 30, 2021 $ — $ — $ — Preferred Stock Liquidation Value Preferred Stock Issuance Costs Net Balance at January 1, 2020 $ 66,519 $ (109) $ 66,410 Amortization of preferred stock issuance costs — 46 46 Balance at March 31, 2020 66,519 (63) 66,456 Amortization of preferred stock issuance costs — 46 46 Balance at June 30, 2020 66,519 (17) 66,502 Amortization of preferred stock issuance costs — 17 17 Redemption of preferred stock (66,519) — (66,519) Balance at September 30, 2020 $ — $ — $ — On July 17, 2020, the Company received a notification from Water Street Healthcare Partners (“WSHP”) seeking redemption on or before September 14, 2020 of all of the outstanding shares of the Company’s Series A Convertible Preferred Stock (“Series A Preferred Stock”), all of which are held by WSHP. On July 24, 2020, the Company redeemed the Series A Preferred Stock for approximately $66.5 million and a Certificate of Retirement was filed with the Delaware Secretary of State retiring the Series A Preferred Stock.

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
	Sep. 30, 2021
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies Acquisition of Paradigm – On March 8, 2019, pursuant to the Master Transaction Agreement, the Company acquired Paradigm in a cash and stock transaction valued at up to $300.0 million consisting of $150.0 million of cash on March 8, 2019, plus potential future milestone payments. Paradigm’s primary product is the coflex® Interlaminar Stabilization® device, a minimally invasive motion preserving stabilization implant that is FDA premarket approved for the treatment of moderate to severe lumbar spinal stenosis in conjunction with decompression. Under the terms of the agreement, the Company paid $100.0 million in cash and issued 10,729,614 shares of the Company’s common stock. The shares of Company common stock issued on March 8, 2019, were valued based on the volume weighted average closing trading price for the five utilizing a Monte-Carlo simulation model. A Monte-Carlo simulation is an analytical method used to estimate fair value by performing a large number of simulations or trial runs and thereby determining a value based on the possible outcomes. Accounted for as a liability to be revalued at each reporting period, the fair value of the contingent liability was measured using Level 3 inputs, which includes weighted average cost of capital and projected revenues and costs. Acquisition of Zyga – On January 4, 2018, the Company acquired Zyga, a spine-focused medical device company that develops and produces innovative minimally invasive devices to treat underserved conditions of the lumbar spine. Zyga’s primary product is the SImmetry® Sacroiliac Joint Fusion System. Under the terms of the merger agreement dated January 4, 2018, the Company acquired Zyga for $21.0 million in consideration paid at closing (consisting of borrowings of $18.0 million on its revolving credit facility and $3.0 million cash on hand), $1.0 million contingent upon the successful achievement of a clinical milestone, and a revenue based earnout consideration of up to an additional $35.0 million. As of September 30, 2021, the Company determined that Zyga was not expected to meet the clinical milestone to earn the contingent consideration. Aziyo – On August 1, 2018, the Company and Aziyo Biologics, Inc. entered into a Distribution Agreement which was subsequently amended on December 3, 2018, and November 15, 2020 (the “Distribution Agreement”). Pursuant to the Distribution Agreement, the Company has exclusive distribution rights to certain biologic implants manufactured by Aziyo and marketed under the ViBone trade name (“ViBone”). The Distribution Agreement provides for minimum purchases of ViBone implants on an annual basis through calendar 2025. For calendar years 2019-2021, if the minimum purchase obligations for a particular year are not fulfilled, the Distribution Agreement provides various options for the Company to satisfy such obligations (“Shortfall Obligations”) in subsequent years, including a combination of payments and/or providing purchase orders for the shortfall amount in a given year. For calendar years 2022 and beyond, if the Company does not satisfy the minimum purchase obligations specified in the Distribution Agreement, the Company can continue to market the ViBone implants on a non-exclusive basis without any Shortfall Obligations. In January 2021, the Company issued a purchase order to Aziyo for $12.4 million relating to the 2020 Shortfall Obligation. Acquisition of Holo Surgical – As part of the Holo Surgical acquisition, the Company estimated a total contingent liability of $50.6 million with 9.0 million classified as current liabilities and $41.6 million classified as long-term liabilities in the accompanying condensed consolidated balance sheets on the acquisition date of October 23, 2020. The fair value of the liability was subsequently changed to $56.5 million on December 31, 2020 with $9.0 million classified as current liabilities within "Accrued expenses" while $47.5 million classified as "Other long-term liabilities." The fair value of the liability was $53.0 million as of September 30, 2021 with $18.4 million classified as current liabilities within "Accrued expenses" in the accompanying condensed consolidated balance sheets, while $34.6 million is included as "Other long-term liabilities." The change in the fair value of the liability of $3.6 million since December 31, 2020 was recognized in the gain on acquisition contingency line of the condensed consolidated statements of comprehensive income/(loss). See Note 6 for further information of the Holo Surgical acquisition. Manufacturing Agreements with Former OEM Affiliates – In connection with the closing of the OEM Transaction, on July 20, 2020 the Company entered into three manufacturing and distribution agreements with affiliates of Montague Private Equity: (i) a Manufacture and Distribution Agreement (the “Hardware MDA”) with Pioneer Surgical Technology, Inc. (“Pioneer”) pursuant to which Pioneer will manufacture certain hardware implants for the Company; (ii) a Processing and Distribution Agreement with RTI Surgical, Inc. (“RTI”), an affiliate of Pioneer, pursuant to which RTI would process certain biologic implants for the Company (the “PDA”); and (iii) a Manufacture and Distribution Agreement (NanOss) pursuant to which Pioneer would manufacture certain synthetic implants for the Company (the “NanOss MDA”), and together with the Hardware MDA and the PDA, the “OEM Distribution Agreements.” The OEM Distribution Agreements contain aggregate minimum purchase obligations for each of the first three years of the agreements as follows: • Year 1: $24.2 million • Year 2: $25.8 million • Year 3: $27.2 million The OEM Distribution Agreements contain provisions whereby the minimum purchase obligations are reduced under certain circumstances, including certain force majeure events and termination of the agreements for certain specified reasons. In addition, on July 20, 2020, the Company entered into a Design and Development Agreement with Pioneer pursuant to which Pioneer will provide certain design and development services with respect to certain implants (the “Design and Development Agreement”). The Design and Development Agreement contains a provision whereby the Company will pay Pioneer a minimum of $1.7 million for direct labor costs and certain services with respect to maintaining design history files in each of the first two years under the Design and Development Agreement. OPM Agreement – On January 20, 2021, the Company and Oxford Performance Materials, Inc. (“Oxford”) entered into an Amended and Restated License and Supply Agreement (the “Oxford Supply Agreement”) pursuant to which Oxford licenses certain intellectual property to the Company and supplies the Company on an exclusive basis in the United States with Polyetherketoneketone (“PEKK”) material for use in spinal implants. In addition to certain royalties under the Oxford Supply Agreement, the Company is obligated to issue binding purchase orders in each quarter of 2021 of at least $0.2 million, or $0.6 million in the aggregate. Although the contract extends through 2025, there are no minimum purchase obligations beyond 2021 . San Diego Lease – On March 12, 2021, the Company entered into a Lease (the “Lease”) with SNH Medical Office Properties Trust, a Maryland real estate investment trust (the “Landlord”), to house the Company’s offices, lab and innovation space (the “Building”) in San Diego, California. The initial term of the Lease is twelve years, with one extension option for a period of seven years. Under the terms of the Lease, the Company will lease an aggregate of approximately 94,457 rentable square feet building located at 3030 Science Park Road, San Diego, California (the “Premises”). The Landlord will make improvements over the next 12 months, after which occupancy is expected to be delivered to the Company. Aggregate payments towards base rent for the Premises over the term of the lease will be approximately $64.6 million, including 13 months of rent abatement. The Company will recognize the lease assets and liabilities when the Landlord makes the underlying asset available to the Company and as such no amounts were accrued as of September 30, 2021. Concurrent with the Company’s execution of the Lease, as a security deposit, the Company delivered to the Landlord a payment in the amount of $2.5 million which is recorded within "Other assets – net" in our condensed consolidated balance sheets.

Legal Actions

Legal Actions	9 Months Ended
	Sep. 30, 2021
Commitments and Contingencies Disclosure [Abstract]
Legal Actions	Legal Actions The Company is, from time to time, involved in litigation relating to claims arising out of its operations in the ordinary course of business. Based on the information currently available to the Company, including the availability of coverage under its insurance policies, the Company does not believe that any of these claims that were outstanding as of September 30, 2021 will have a material adverse impact on its financial position or results of operations. The Company’s accounting policy is to accrue for legal costs as they are incurred. Coloplast — RTI Surgical, Inc., as a predecessor to the Company, is presently named as co-defendant along with other companies in a small percentage of the transvaginal surgical mesh (“TSM”) mass tort claims being brought in various state and federal courts. The TSM litigation has as its catalyst various Public Health Notifications issued by the FDA with respect to the placement of certain TSM implants that were the subject of 510(k) regulatory clearance prior to their distribution. The Company does not process or otherwise manufacture for distribution in the U.S. any implants that were the subject of these FDA Public Health Notifications. The Company denies any allegations against it and intends to continue to vigorously defend itself. In addition to claims made directly against the Company, Coloplast, a distributor of TSM’s and certain allografts processed and private labeled for them under a contract with the Company, has also been named as a defendant in individual TSM cases in various federal and state courts. Coloplast requested that the Company indemnify or defend Coloplast in those claims which allege injuries caused by the Company’s allograft implants, and on April 24, 2014, Coloplast sued RTI Surgical, Inc. in the Fourth Judicial District of Minnesota for declaratory relief and breach of contract. On December 11, 2014, Coloplast entered into a settlement agreement with RTI Surgical, Inc. and Tutogen Medical, Inc. (the “Company Parties”) resulting in dismissal of the case. Under the terms of the settlement agreement, the Company Parties are responsible for the defense and indemnification of two categories of present and future claims: (1) tissue only (where Coloplast is solely the distributor of Company processed allograft tissue and no Coloplast-manufactured or distributed synthetic mesh is identified) (“Tissue Only Claims”), and (2) tissue plus non-Coloplast synthetic mesh (“Tissue-Non-Coloplast Claims”) (the Tissue Only Claims and the Tissue-Non-Coloplast Claims being collectively referred to as “Indemnified Claims”). As of September 30, 2021, there are a cumulative total of 1,157 Indemnified Claims for which the Company Parties are providing defense and indemnification. In connection with the transactions, liabilities related to these claims remained a liability retained by the Company. The defense and indemnification of these cases are covered under the Company’s insurance policy subject to a reservation of rights by the insurer. Based on the current information available to the Company, the impact that current or any future TSM litigation may have on the Company cannot be reasonably estimated. LifeNet — On June 27, 2018, LifeNet Health, Inc. (“LifeNet”) filed a patent infringement lawsuit in the United States District Court for the Middle District of Florida (since moved to the Northern District of Florida) claiming infringement of five of its patents by the Company’s predecessor RTI Surgical, Inc. The suit requests damages, enhanced damages, reimbursement of costs and expenses, reasonable attorney fees, and an injunction. The asserted patents are expired. On April 7, 2019, the Court granted the Company’s request to stay the lawsuit pending the U.S. Patent Trial and Appeal Board’s (“PTAB”) decision whether to institute review of the patentability of LifeNet’s patents. On August 12, 2019 the PTAB instituted review of three LifeNet patents, and on September 3, 2019 the PTAB instituted review of the remaining two. On August 4, 2020 and August 26, 2020, the PTAB issued final written decisions finding that certain claims were shown to be unpatentable and others not. Neither party appealed the PTAB’s decisions with respect to the three LifeNet patents on which the PTAB instituted review on August 12, 2019. With respect to the remaining two LifeNet patents, Surgalign filed Notices of Appeal with the Federal Circuit on October 27, 2020 and LifeNet filed a Notice of Cross-appeal on November 9, 2020. The briefings related to these appeals were filed in the March through July timeframe and oral argument were heard on November 5, 2021. In connection with the transactions, liabilities related to these claims remained a liability retained by the Company. The Company continues to believe the suit is without merit and will vigorously defend its position. Based on the current information available to the Company, the impact that current or any future litigation may have on the Company cannot be reasonably estimated. Securities Class Action— There is currently ongoing stockholder litigation related to the Company’s Investigation (as defined below). A class action complaint was filed by Patricia Lowry, a purported shareholder of the Company, against the Company, and certain former officers of the Company, in the United States District Court for the Northern District of Illinois on March 23, 2020 asserting claims under Sections 10(b) and 20(a) the Securities Exchange Act of 1934 (the “Exchange Act”) and demanding a jury trial (the “Lowry Action”). The court appointed a different shareholder as Lead Plaintiff and she filed an amended complaint on August 31, 2020. On October 15, 2020, the Company and the other named defendants moved to dismiss the amended complaint. In April 2021, the court denied the defendants’ motions to dismiss. On June 30, 2021, the parties to the Lowry Action conducted a mediation session, after which negotiations among the parties continued into July. On July 27, 2021 a binding term sheet settling the Lowry Action was entered into whereby the defendants will pay $10.5 million (inclusive of attorneys’ fees and administrative costs) in exchange for the dismissal with prejudice of all claims against the defendants in connection with the Lowry Action (the “Lowry Settlement”). On September 22, 2021 the court granted preliminary approval to the Lowry Settlement, and the settlement amount was paid by the Company’s insurers under its directors and officers’ insurance policies in October 2021. The Lowry Settlement is subject to final court approval. A hearing is scheduled for January 24, 2022 for the court to determine whether to give final approval to the Lowry Settlement. The Company has recorded a $10.5 million loss contingency and a $10.5 million insurance recovery as of September 30, 2021 within the "Marketing, general and administrative" expense line on the condensed consolidated statements of comprehensive income/(loss). A corresponding receivable and liability of $10.5 million was recorded within "Prepaid and other current assets," and "Accrued expenses" on the condensed consolidated balance sheets. This amount was paid and settled by the insurance company on October 5, 2021. Derivative Lawsuits— Three derivative lawsuits have also been filed on behalf of the Company, naming it as a nominal defendant, and demanding a jury trial. On June 5, 2020, David Summers filed a shareholder derivative lawsuit (the “Summers Action”) against certain current and former directors and officers of the Company (as well as the Company as a nominal defendant), in the United States District Court for the Northern District of Illinois asserting statutory claims under Sections 10(b), 14(a) and 20(a) of the Exchange Act, as well as common law claims for breach of fiduciary duty, unjust enrichment and corporate waste. Thereafter, two similar shareholder derivative lawsuits asserting many of the same claims were filed in the same court against the same current and former directors and officers of the Company (as well as the Company as a nominal defendant). The three derivative lawsuits have been consolidated into the first-filed Summers Action. On September 6, 2020 the court entered an order staying the Summers Action pending resolution of the motions to dismiss in the Lowry Action. On September 30, 2021, the court granted preliminary approval of a proposed settlement of the Derivative Actions (the “Derivative Actions Settlement”). Pursuant to the Derivative Actions Settlement, the Company has agreed to adopt or revise certain corporate governance policies and procedures, and the Company’s insurers will pay attorney’s fees and expenses of no more than $1.5 million to plaintiffs’ counsel. Based on this a corresponding receivable and liability of $1.5 million was recorded within "Prepaid and other current assets," and "Accrued expenses" on the condensed consolidated balance sheets. The Derivative Actions Settlement is subject to final court approval. A hearing is scheduled for January 24, 2022 for the court to determine whether to give final approval to the Derivative Actions Settlement. In the future, we may become subject to additional litigation or governmental proceedings or investigations that could result in additional unanticipated legal costs regardless of the outcome of the litigation. If we are not successful in any such litigation, we may be required to pay substantial damages or settlement costs. Based on the current information available to the Company, the impact that current or any future stockholder litigation may have on the Company cannot be reasonably estimated.

Regulatory Actions

Regulatory Actions	9 Months Ended
	Sep. 30, 2021
Regulatory Actions [Abstract]
Regulatory Actions	Regulatory Actions SEC Investigations — As previously disclosed in the Company’s Current Report on Form 8-K filed with the SEC on March 16, 2020, and the Form 10-K filed with the SEC on June 8, 2020, the Audit Committee of the Board of Directors, with the assistance of independent legal and forensic accounting advisors, conducted an internal investigation of matters relating to the Company’s revenue recognition practices for certain contractual arrangements, primarily with customers of the Company’s formerly-owned OEM Businesses, including the accounting treatment, financial reporting and internal controls related to such arrangements (the “Investigation”). The Investigation also examined transactions to understand the practices related to manual journal entries for accrual and reserve accounts. As a result of the Investigation, the Audit Committee concluded that the Company would restate its previously issued audited financial statements for fiscal years 2018, 2017 and 2016, selected financial data for fiscal years 2015 and 2014, the unaudited condensed consolidated financial statements for the quarterly periods within these years commencing with the first quarter of 2016, as well as the unaudited condensed consolidated financial statements for the quarterly periods within the 2019 fiscal year. The Investigation was precipitated by an investigation by the SEC initially related to the periods 2014 through 2016 (the “SEC Investigation”). The SEC Investigation is ongoing and the Company is cooperating with the SEC. The Company has contacted the SEC regarding a potential settlement of the SEC Investigation and is awaiting a response. Based on the current information available to the Company the financial or other impact of the SEC Investigation cannot be reasonably determined. In addition, on April 30, 2021, the Company and one of its executive officers each received a subpoena from the SEC requesting documents in an investigation relating to trading in the Company’s securities in late 2019 and early 2020. On October 18, 2021, the Company and the executive officer each received a termination letter from the SEC advising them that the SEC had concluded its investigation as to them and that the Staff did not intend to recommend any enforcement action by the SEC.

Related Party Transactions

Related Party Transactions	9 Months Ended
	Sep. 30, 2021
Related Party Transactions [Abstract]
Related Party Transactions	Related Party Transactions The Company’s related parties include: i) a person who is or was (since the beginning of the last fiscal year for which the Company has filed a Form 10-K and proxy statement, even if he or she does not presently serve in that role) an executive officer, director or nominee for election as a director; ii) granter than five percent beneficial owner of the Company’s common stock; or iii) immediate family member of any of the foregoing. The Company did not enter into any related party transactions in 2018 and 2019. In 2020, the Company has entered into the following related party transactions: The Holo Surgical Acquisition As discussed in Note 6, on September 29, 2020, the Company entered into the Holo Purchase Agreement, pursuant to which, among other things, the Company consummated the Acquisition on October 23, 2020. As consideration for the Acquisition, the Company paid to Seller $30.0 million in cash and issued to Seller 6,250,000 shares of its common stock with a fair value of $12.3 million. In addition, the Seller will be entitled to receive contingent consideration from the Company valued at $50.6 million as of October 23, 2020, which must be first paid in shares of our common stock (in an amount up to 8,650,000 shares) and then paid in cash thereafter, contingent upon and following the achievement of certain regulatory, commercial and utilization milestones by specified time periods occurring up to the sixth (6th) anniversary of the Closing Date. Dr. Pawel Lewicki, a member of the Company’s board of directors, indirectly owns approximately 57.5% of the outstanding ownership interests in the Seller. Dr. Lewicki was appointed to the Company’s board of directors on November 23, 2020. Simpson Consulting Agreement On July 15, 2020, the Board appointed Stuart F. Simpson to serve as the Chairman of the Board, effective immediately upon consummation of the transactions contemplated by the Holo Surgical Purchase Agreement. On July 20, 2020, Mr. Simpson entered into a consulting agreement (“the Consulting Agreement”) with the Company, pursuant to which he will provide consulting services to the Company. The Consulting Agreement has an initial term of three years, but may be extended with the mutual agreement of the parties. On September 10, 2021, Mr. Simpson resigned as Chairman of the Board and as a member of the Board of Directors of the Company. Due to his resignation, Mr. Simpson's Consulting agreement with the Company was terminated. Total cash compensation paid to Mr. Simpson for his services during the nine months ending September 30, 2021 was approximately $0.3 million.

Subsequent Events

Subsequent Events	9 Months Ended
	Sep. 30, 2021
Subsequent Events [Abstract]
Subsequent Events	Subsequent Events The Company evaluated subsequent events as of the issuance date of the unaudited condensed consolidated financial statements as defined by FASB ASC 855, Subsequent Events.

Basis of Presentation (Policies

Basis of Presentation (Policies)	9 Months Ended
	Sep. 30, 2021
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Liquidity	Liquidity As the global outbreak of COVID-19 continues to rapidly evolve, it could continue to materially and adversely affect our revenues, financial condition, profitability, and cash flows for an indeterminate period of time. Going Concern The accompanying unaudited condensed consolidated financial statements of the Company have been prepared assuming the Company will continue as a going concern and in accordance with generally accepted accounting principles in the United States of America. The going concern basis of presentation assumes that we will continue in operation one year after the date these unaudited condensed consolidated financial statements are issued, and we will be able to realize our assets and discharge our liabilities and commitments in the normal course of business. As of September 30, 2021, we had cash of $68.4 million and an accumulated deficit of $524.3 million. For the nine months ended September 30, 2021, we had a loss from continuing operations of $34.1 million. We have incurred losses from operations in the previous two fiscal years and did not generate positive cash flows from operations in fiscal year 2020 or for the nine months ended September 30, 2021. On June 14, 2021, we issued and sold in a registered direct offering an aggregate of 28,985,508 shares of our common stock and investor warrants to purchase up to an aggregate of 28,985,508 million shares at a strike price of $1.725.The Company, also in connection with the direct offering, issued placement agent warrants to purchase an aggregate of up to 1,739,130 million shares of our common stock at a strike price of $2.15625 per share. We received net proceeds of $45.8 million from the offering after deducting investor fees of $4.2 million. On February 1, 2021, we closed a public offering and sold a total 28,700,000 shares of our common stock at a price of $1.50 per share, less the underwriter discounts and commissions. We received net proceeds of $36.5 million from the offering after deducting the underwriting discounts and commission of $4.0 million. The Company is projecting it will continue to generate significant negative operating cash flows over the next 12-months and beyond due, in part, to continued COVID-19 uncertainties, along with approximately $18.4 million of the total contingent consideration of $53.0 million expected to become due to the former owners of Holo Surgical contingent on two milestones expected to be achieved within the next 12 months. These payments will be paid through a combination of common stock and cash. The Company’s operating plan for the next 12-month period also includes continued investments in its product pipeline and funding of future operations through 2022, which will necessitate additional debt and/or equity financing. The Company’s ability to raise additional capital may be adversely impacted by potential worsening global economic conditions and the recent disruptions to, and volatility in, financial markets in the United States, and worldwide, resulting from the ongoing COVID-19 pandemic. If cash resources are insufficient to satisfy the Company’s on-going cash requirements through the third fiscal quarter of 2022, the Company will be required to scale back operations, reduce research and development expenses, and postpone, as well as suspend capital expenditures, in order to preserve liquidity. No assurance can be given that any future financing will be available or, if available, that it will be on terms that are satisfactory to the Company. Even if the Company is able to obtain additional financing, it may contain undue restrictions on our operations, in the case of debt financing, or cause substantial dilution for our stockholders, in the case of equity financing. In consideration of the inherent risks and uncertainties and the Company’s forecasted negative cash flows as described above, management has concluded that substantial doubt exists with respect to the Company’s ability to continue as a going concern within one year after the date the unaudited condensed consolidated financial statements are issued. Management continually evaluates plans to raise additional debt and/or equity financing and will attempt to curtail discretionary expenditures in the future, if necessary; however, in consideration of the risks and uncertainties mentioned, such plans cannot be considered probable of occurring at this time. The recoverability of a major portion of the recorded asset amounts shown in the Company’s accompanying condensed consolidated balance sheets is dependent upon continued operations of the Company, which in turn is dependent upon the Company’s ability to meet its funding requirements on a continuous basis to maintain existing financing to succeed in its future operations. The Company’s unaudited condensed consolidated financial statements do not include any adjustment relating to the recoverability and classification of recorded asset amounts and classification of liabilities that might be necessary should the Company be unable to continue in existence.
Basis of Presentation	Basis of Presentation The accompanying unaudited condensed consolidated financial statements include all adjustments, consisting of normal recurring accruals, which the Company considers necessary for a fair presentation of the results of operations for the periods shown. The unaudited condensed consolidated financial statements have been prepared in accordance with the instructions to Form 10-Q and Rule 10-01 of Regulation S-X, and, therefore, do not include all information and footnotes necessary for a fair presentation of the unaudited condensed consolidated financial position, results of operations, comprehensive loss and cash flows in conformity with accounting principles generally accepted in the United States of America (“GAAP”). The preparation of our unaudited condensed consolidated financial statements in accordance with GAAP often requires us to make estimates and judgments that affect reported amounts. These estimates and judgments are based on historical experience and assumptions that we believe to be reasonable under the circumstances. Assumptions and judgments based on historical experience may provide reported results, which differ from actual results; however, these assumptions and judgments historically have not varied significantly from actual experience, and we therefore do not expect them to vary significantly in the future. All intercompany balances and transactions have been eliminated in consolidation. The results of operations for any interim period are not necessarily indicative of the results to be expected for the full year. The Company includes acquisition, disposal, integration and separation related costs, which are predominantly composed of legal, consulting, and advisor fee expenses, within the “Transaction and integration expense” line on the condensed consolidated statements of comprehensive income/(loss).The unaudited condensed consolidated financial statements include the accounts of the Company and its wholly owned subsidiaries, Surgalign Spine Technologies, Inc., Paradigm Spine, LLC (“Paradigm”), Pioneer Surgical Technology, Inc. (“Pioneer Surgical”), Zyga Technology, Inc. (“Zyga”), and Holo Surgical Inc. (“Holo Surgical”). The operating results of the disposed OEM Businesses have been reported as discontinued operations in the unaudited condensed consolidated financial statements in the prior comparative periods.
Accounting Standards Issued But Not Yet Adopted and Significant New Accounting Policies	Accounting Standards Issued But Not Yet Adopted In August 2020, the FASB issued ASU 2020-06, Debt—Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging—Contracts in Entity’s Own Equity (Subtopic 815-40). The guidance provides simplifications of the accounting for convertible instruments and reduces the number of accounting models for convertible debt instruments and convertible preferred stock. Limiting the accounting models results in fewer embedded conversion

Discontinued Operations (Tables

Discontinued Operations (Tables)	9 Months Ended
	Sep. 30, 2021
Discontinued Operations and Disposal Groups [Abstract]
Schedule of Financial Results and Operating and Investing Cash Flows of Discontinued Operations	The following table presents the financial results of the discontinued operations: Three Months Ended Nine Months Ended 2021 2020 2021 2020 Major classes of line items constituting net income (loss) from discontinued operations Revenues $ — $ 6,877 $ — $ 87,192 Costs of processing and distribution — 4,006 — 49,679 Gross profit — 2,871 — 37,513 Expenses: Marketing, general and administrative — 2,329 — 12,889 Severance and restructuring costs — — — 604 Transaction and integration expenses — 11,811 — 23,598 Total expenses — 14,140 — 37,091 Operating (loss) income — (11,269) — 422 Other expense - net: OEM working capital adjustment — — 6,316 — Interest expense — 5,093 — 14,631 Derivative loss — — — 12,641 Loss on extinguishment of debt — 2,686 — 2,686 Foreign exchange loss (gain) — 17 — (3) Total other expense - net — 7,796 6,316 29,955 Loss from discontinued operations — (19,065) (6,316) (29,533) Gain on sale of net assets of discontinued operations — 210,866 — 210,866 Income (loss) from discontinued operations before income tax provision (benefit) — 191,801 (6,316) 181,333 Income tax provision (benefit) (349) 42,534 (1,112) 39,189 Net income (loss) from discontinued operations $ 349 $ 149,267 $ (5,204) $ 142,144 Total operating and investing cash flows of discontinued operations for the nine months ended September 30, 2021 and 2020 is comprised of the following, which excludes the effect of income taxes: Nine Months Ended Nine Months Ended September 30, September 30, Significant operating non-cash reconciliation items: Depreciation and amortization $ — $ 2,126 Provision for bad debt and products returns $ — $ 650 Revenue recognized due to change in deferred revenue $ — $ (2,618) Deferred income tax provision $ — $ (3,644) Stock-based compensation $ — $ 792 Gain on sale of discontinued assets, net $ — $ (210,866) Loss on extinguishment of debt $ — $ 2,686 Amortizations of debt issuance costs $ — $ 283 Amortizations of debt discount $ — $ 2,479 Significant investing items: Payments for OEM working capital adjustment $ (5,430) $ — Purchases of property and equipment $ — $ (1,867) Patent and acquired intangible asset costs $ — $ (419) Proceeds from sale of OEM Business $ — $ 437,097

Leases (Tables)

Leases (Tables)	9 Months Ended
	Sep. 30, 2021
Leases [Abstract]
Schedule of Components of Operating Lease Expense	The components of operating lease expense were as follows: For the Three Months Ended For the Nine Months Ended 2021 2020 2021 2020 Operating lease cost $ 179 $ 286 $ 557 $ 1,024 Short-term operating lease cost 112 — 261 — Total operating lease cost $ 291 $ 286 $ 818 $ 1,024
Schedule of Supplemental Cash Flow Information Related to Operating Leases	Supplemental cash flow information related to operating leases was as follows: For the Three Months Ended For the Nine Months Ended 2021 2020 2021 2020 Cash paid for amounts included in the measurement of lease liabilities $ 311 $ 293 $ 887 $ 1,026 ROU assets obtained in exchange for lease obligations — — 68 —
Schedule of Supplemental Balance Sheet Information Related to Operating Leases	Supplemental balance sheet information related to operating leases was as follows: Balance Sheet Classification Balance at September 30, 2021 Balance at December 31, 2020 Assets: Right-of-use assets Other assets - net $ 1,008 $ 1,425 Liabilities: Current Accrued expenses $ 363 $ 650 Noncurrent Other long-term liabilities 1,018 1,200 Total operating lease liabilities $ 1,381 $ 1,850
Schedule of Weighted-Average Remaining Lease Terms and Discount Rates	The weighted-average remaining lease terms and discount rates were as follows: For the Nine Months Ended 2021 2020 Weighted-average remaining lease term (years) 6.1 6.1 Weighted-average discount rate 5.0 % 5.0 %
Schedule of Maturities of Operating Lease Liabilities	As of September 30, 2021, maturities of operating lease liabilities were as follows: Balance at September 30, 2021 (remaining) $ 317 2022 378 2023 218 2024 173 2025 161 2026 and beyond 557 Total future minimum lease payments 1,804 Less imputed interest (423) Total $ 1,381

Revenue from Contracts with C_2

Revenue from Contracts with Customers (Tables)	9 Months Ended
	Sep. 30, 2021
Revenue from Contract with Customer [Abstract]
Schedule of Total Revenue by Geographical Region	The Company’s entire revenue for the three and nine months ended September 30, 2021 and 2020 was recognized at a point in time. The following table represents total revenue by geographical region for the three and nine months ended September 30, 2021 and 2020, respectively: For the Three Months Ended For the Nine Months Ended 2021 2020 2021 2020 Revenues: Domestic $ 17,306 $ 23,690 $ 57,880 $ 62,917 International 3,239 4,236 10,790 12,645 Total revenues from contracts with customers $ 20,545 $ 27,926 $ 68,670 $ 75,562

Business Combinations (Tables)

Business Combinations (Tables)	9 Months Ended
	Sep. 30, 2021
Business Combinations [Abstract]
Schedule of Fair Value of Identifiable Assets Acquired and Liabilities Assumed	The following table summarizes the fair value of the identifiable assets acquired and liabilities assumed from the acquisition of Prompt as of April 30, 2021 (in thousands): Inventories $ 140 Right-of-use assets 78 Property and equipment 528 Operating lease liabilities (78) Deferred tax liability (28) Net assets acquired $ 640 Bargain purchase gain (90) Total purchase price $ 550

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	9 Months Ended
	Sep. 30, 2021
Share-based Payment Arrangement [Abstract]
Schedule of Stock Option And Stock Grant Awards By Plan	The following tables summarize our stock option and stock grant awards by plan: For the nine months ended September 30, 2021: Plan Stock Options Restricted Stock Awards Restricted Stock Units Total 2021 Incentive Inducement Plan 422,162 — 430,254 852,416 2021 Incentive Compensation Plan 114,091 — 4,535,032 4,649,123 2018 Incentive Compensation Plan 240,311 147,719 — 388,030 Total 776,564 147,719 4,965,286 5,889,569 For the nine months ended September 30, 2020: Plan Stock Options Restricted Stock Awards Restricted Stock Units Total 2018 Incentive Compensation Plan 1,858,353 1,754,409 — 3,612,762 Total 1,858,353 1,754,409 — 3,612,762
Schedule of Stock-Based Compensation Recognized	The Company recognized stock-based compensation as follows: For the Three Months Ended For the Nine Months Ended 2021 2020 2021 2020 Stock-based compensation: Costs of goods sold $ — $ 33 $ 21 $ 105 Marketing, general and administrative 1,734 1,112 3,967 3,103 Research and development — 5 — 35 Transaction and integration expenses 134 1,515 230 1,515 Total $ 1,868 $ 2,665 $ 4,218 $ 4,758

Net Loss Per Common Share (Tabl

Net Loss Per Common Share (Tables)	9 Months Ended
	Sep. 30, 2021
Earnings Per Share [Abstract]
Reconciliation of Common Stock used in Calculation of Basic and Diluted Earnings Per Share	A reconciliation of the number of shares of common stock used in the calculation of basic and diluted net income per common share is presented below: For the Three Months Ended For the Nine Months Ended 2021 2020 2021 2020 Weighted average basic and dilutive shares 138,317,858 73,212,662 117,135,533 72,933,038
Schedule of Number of Potential Dilutive Shares that Excluded Due to Anti-dilutive Effect	The following table includes the number of potential dilutive shares that were excluded due to the anti-dilutive effect: For the Three Months Ended For the Nine Months Ended 2021 2020 2021 2020 Stock Options — — 356,307 3,748 Restricted Stock Units and Restricted Stock Awards 5,747,396 1,515,137 1,191,362 1,191,573 Convertible Series A Preferred Stock ("Series A Preferred Stock") — 3,308,854 — 11,221,121 Total 5,747,396 4,823,991 1,547,669 12,416,442

Prepaid and Other Current Ass_2

Prepaid and Other Current Assets (Tables)	9 Months Ended
	Sep. 30, 2021
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]
Schedule of Prepaid and Other Current Assets	Prepaid and other current assets are as follows: September 30, December 31, Insurance recovery receivable $ 12,000 $ — Income tax receivable 3,863 4,836 Prepaid expenses 2,956 1,543 Other receivables 806 3,905 $ 19,625 $ 10,284

Property and Equipment (Tables)

Property and Equipment (Tables)	9 Months Ended
	Sep. 30, 2021
Property, Plant and Equipment [Abstract]
Schedule of Net Book Value of Property and Equipment after Accumulated Depreciation and Impairment	The net book value of property and equipment after accumulated depreciation and all impairment is as follows: September 30, 2021 December 31, 2020 Processing equipment $ 487 $ 35 Surgical instruments 474 440 Office equipment, furniture and fixtures 20 34 Computer equipment and software 10 12 Construction in process 37 — $ 1,028 $ 521

Fair Value Information (Tables)

Fair Value Information (Tables)	9 Months Ended
	Sep. 30, 2021
Fair Value Disclosures [Abstract]
Schedule of Reconciliation of Acquisition Contingencies	A reconciliation of the Company’s acquisition contingencies is as follows: 2021 2020 Beginning balance as of January 1 $ 56,515 $ 1,130 (Gain) loss (3,553) — Other — (130) Ending balance as of September 30 $ 52,962 $ 1,000
Schedule of Fair Value Assets Subject to Fair Value Measured Using Level 3 Inputs	As a result of impairments recognized, the following table summarizes the fair value of assets subject to fair value measured using Level 3 inputs for the periods presented: September 30, December 31, Property and equipment – net $ 1,028 $ 521 Other assets – net 10,045 10,145 $ 11,073 $ 10,666
Schedule of Impairments of Assets Subject to Fair Value Measured Using Level 3 Inputs	The following table summarizes the impairment of assets subject to fair value measured using Level 3 inputs for the periods presented: For the Three Months Ended For the Nine Months Ended 2021 2020 2021 2020 Property and equipment – net $ 5,186 $ 9,210 $ 8,978 $ 11,971 Other intangibles – net 167 146 478 146 Other assets – net 58 — 338 — $ 5,411 $ 9,356 $ 9,794 $ 12,117
Schedule of Liabilities Measured at Fair Value on Recurring Basis	The following table presents information about the Company’s liabilities that are measured at fair value on a recurring basis at September 30, 2021: Level September 30, 2021 December 31, 2020 Warrant liability 3 $ 16,487 $ —
Schedule of Changes in Fair Value of Level 3 Valuation for the Warrant Lability	The table presented below is a summary of changes in the fair value of the Company’s Level 3 valuation for the warrant liability for the nine months ended September 30, 2021: Warrant Liability December 31, 2020 $ — Fair value of warrants on date of issuance 26,749 Change in fair value (10,262) September 30, 2021 $ 16,487
Schedule of Fair Value of Warrant Liability Valuation Inputs	The warrant liability is revalued each reporting period with the change in fair value recorded in the accompanying condensed consolidated statements of comprehensive income/(loss) until the warrants are exercised or expire. The fair value of the warrant liability is estimated using the Black-Scholes Option Pricing Model using the following valuation inputs: September 30, December 31, Stock price $ 1.09 — Risk-free interest rate 0.46 % — Dividend yield 0.0 % — Volatility 100 % —

Accrued Expenses (Tables)

Accrued Expenses (Tables)	9 Months Ended
	Sep. 30, 2021
Payables and Accruals [Abstract]
Schedule of Accrued Expenses	Accrued expenses are as follows: September 30, December 31, Accrued securities class action settlement $ 12,000 $ — Accrued distributor commissions 3,194 4,113 Accrued compensation 5,531 2,268 Other 6,119 6,267 $ 26,844 $ 12,648

Other long-term liabilities (Ta

Other long-term liabilities (Tables)	9 Months Ended
	Sep. 30, 2021
Other Liabilities, Noncurrent [Abstract]
Schedule of Other long-term liabilities	Other long-term liabilities are as follows: September 30, 2021 December 31, 2020 Acquisition contingencies $ 34,556 $ 47,519 Warrant Liability 16,487 — Lease obligations 1,018 1,200 Other 2,335 2,992 $ 54,396 $ 51,711

Preferred Stock (Tables)

Preferred Stock (Tables)	9 Months Ended
	Sep. 30, 2021
Temporary Equity Disclosure [Abstract]
Schedule of Preferred Stock	Preferred stock is as follows: Preferred Stock Liquidation Value Preferred Net Balance at January 1, 2021 $ — $ — $ — Amortization of preferred stock issuance costs — — — Balance at June 30, 2021 $ — $ — $ — Amortization of preferred stock issuance costs — — — Balance at September 30, 2021 $ — $ — $ — Preferred Stock Liquidation Value Preferred Stock Issuance Costs Net Balance at January 1, 2020 $ 66,519 $ (109) $ 66,410 Amortization of preferred stock issuance costs — 46 46 Balance at March 31, 2020 66,519 (63) 66,456 Amortization of preferred stock issuance costs — 46 46 Balance at June 30, 2020 66,519 (17) 66,502 Amortization of preferred stock issuance costs — 17 17 Redemption of preferred stock (66,519) — (66,519) Balance at September 30, 2020 $ — $ — $ —

Business - Additional Informati

Business - Additional Information (Details) $ / shares in Units, $ in Thousands	Jun. 14, 2021USD ($)$ / sharesshares	Feb. 01, 2021USD ($)$ / sharesshares	Jul. 20, 2020USD ($)segment	Jul. 19, 2020segment	Sep. 30, 2021USD ($)country	Sep. 30, 2020USD ($)	Sep. 30, 2021USD ($)country	Sep. 30, 2020USD ($)	Dec. 31, 2020USD ($)	Dec. 31, 2019USD ($)
Business [Line Items]
Countries in which we market and sell (more than) | country					40		40
Number of reportable segments | segment			1	2
Cash and cash equivalents					$ 68,360		$ 68,360		$ 43,962
Accumulated deficit					(524,250)		(524,250)		(484,962)
Net loss from continuing operations					(8,255)	$ (26,583)	(34,085)	$ (75,886)
Strike price of warrants (in dollars per share) | $ / shares	$ 1.725
Contingent consideration amounts					52,962	$ 1,000	52,962	$ 1,000	$ 56,515	$ 1,130
COVID-19
Business [Line Items]
Expected contingent consideration amounts					53,000		53,000
Contingent consideration amounts					$ 18,400		$ 18,400
Placement Agent Warrants
Business [Line Items]
Strike price of warrants (in dollars per share) | $ / shares	$ 2.15625
Public Offering
Business [Line Items]
Common stock sold (in shares) | shares	28,985,508	28,700,000
Net proceeds from issuance of common stock	$ 45,800	$ 36,500
Investor fees	$ 4,200
Common stock price per share (in dollars per share) | $ / shares		$ 1.50
Underwriting discounts and commission		$ 4,000
Public Offering | Placement Agent Warrants
Business [Line Items]
Strike price of warrants (in dollars per share) | $ / shares	$ 2.15625
Public Offering | Investor
Business [Line Items]
Strike price of warrants (in dollars per share) | $ / shares	$ 1.725
Maximum | Placement Agent Warrants
Business [Line Items]
Number of common stock shares issuable upon conversion of warrants (in shares) | shares	1,739,130
Maximum | Public Offering | Placement Agent Warrants
Business [Line Items]
Number of common stock shares issuable upon conversion of warrants (in shares) | shares	1,739,130
Maximum | Public Offering | Investor
Business [Line Items]
Number of common stock shares issuable upon conversion of warrants (in shares) | shares	28,985,508
Ardi Bidco Ltd. | Sold
Business [Line Items]
Consideration received or receivable for disposal of assets			$ 440,000

Basis of Presentation (Details)

Basis of Presentation (Details) - USD ($) $ in Millions	3 Months Ended	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2021
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Wrong pocket claim and settlement received	$ 3.9	$ 3.9

Discontinued Operations - Sched

Discontinued Operations - Schedule of Financial Results of Discontinued Operations (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Other expense - net:
Income (loss) from discontinued operations before income tax provision (benefit)	$ 0	$ 191,801	$ (6,316)	$ 181,333
Income tax provision (benefit)	(349)	42,534	(1,112)	39,189
OEM Business | Sold
Major classes of line items constituting net income (loss) from discontinued operations
Revenues	0	6,877	0	87,192
Costs of processing and distribution	0	4,006	0	49,679
Gross profit	0	2,871	0	37,513
Marketing, general and administrative	0	2,329	0	12,889
Expenses:
Marketing, general and administrative	0	2,329	0	12,889
Severance and restructuring costs	0	0	0	604
Transaction and integration expenses	0	11,811	0	23,598
Total expenses	0	14,140	0	37,091
Operating (loss) income	0	(11,269)	0	422
Other expense - net:
OEM working capital adjustment	0	0	6,316	0
Interest expense	0	5,093	0	14,631
Derivative loss	0	0	0	12,641
Loss on extinguishment of debt	0	2,686	0	2,686
Foreign exchange loss (gain)	0	17	0	(3)
Total other expense - net	0	7,796	6,316	29,955
Loss from discontinued operations	0	(19,065)	(6,316)	(29,533)
Gain on sale of net assets of discontinued operations	0	210,866	0	210,866
Income (loss) from discontinued operations before income tax provision (benefit)	0	191,801	(6,316)	181,333
Income tax provision (benefit)	(349)	42,534	(1,112)	39,189
Net income (loss) from discontinued operations	$ 349	$ 149,267	$ (5,204)	$ 142,144

Discontinued Operations - Addit

Discontinued Operations - Additional Information (Details) - OEM Business - Sold - USD ($) $ in Millions	3 Months Ended	9 Months Ended
	Jun. 30, 2021	Sep. 30, 2021	Jun. 03, 2021	Dec. 01, 2020
Income Statement Balance Sheet And Additional Disclosures By Disposal Groups Including Discontinued Operations [Line Items]
Maximum working capital adjustment amount				$ 14
Liable amount, remaining in dispute			$ 5.8
Liable dispute amount paid	$ 5.8
Minimum
Income Statement Balance Sheet And Additional Disclosures By Disposal Groups Including Discontinued Operations [Line Items]
Transitional services period related to it support, customer and vendor management, and procurement		3 months
Maximum
Income Statement Balance Sheet And Additional Disclosures By Disposal Groups Including Discontinued Operations [Line Items]
Transitional services period related to it support, customer and vendor management, and procurement		12 months

Discontinued Operations - Sch_2

Discontinued Operations - Schedule of Operating and Investing Cash Flows of Discontinued Operations (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020
Significant operating non-cash reconciliation items:
Stock-based compensation	$ 4,218	$ 5,550
Loss on extinguishment of debt	0	2,686
Amortizations of debt issuance costs	0	283
Amortizations of debt discount	0	2,479
Significant investing items:
Payments for OEM working capital adjustment	(5,430)	0
Purchases of property and equipment	(10,834)	(9,738)
Patent and acquired intangible asset costs	(496)	(419)
Proceeds from sale of OEM Business	0	437,097
Discontinued Operations | OEM Business
Significant operating non-cash reconciliation items:
Depreciation and amortization	0	2,126
Provision for bad debt and products returns	0	650
Revenue recognized due to change in deferred revenue	0	(2,618)
Deferred income tax provision	0	(3,644)
Stock-based compensation	0	792
Gain on sale of discontinued assets, net	0	(210,866)
Loss on extinguishment of debt	0	2,686
Amortizations of debt issuance costs	0	283
Amortizations of debt discount	0	2,479
Significant investing items:
Payments for OEM working capital adjustment	(5,430)	0
Purchases of property and equipment	0	(1,867)
Patent and acquired intangible asset costs	0	(419)
Proceeds from sale of OEM Business	$ 0	$ 437,097

Leases - Additional Information

Leases - Additional Information (Details)	Sep. 30, 2021
Minimum
Lessee, Lease, Description [Line Items]
Remaining lease term	1 year
Maximum
Lessee, Lease, Description [Line Items]
Remaining lease term	8 years

Leases - Schedule of Operating

Leases - Schedule of Operating Leases (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Leases [Abstract]
Operating lease cost	$ 179	$ 286	$ 557	$ 1,024
Short-term operating lease cost	112	0	261	0
Total operating lease cost	$ 291	$ 286	$ 818	$ 1,024

Leases - Schedule of Supplement

Leases - Schedule of Supplemental Cash Flow Information Related to Leases (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Leases [Abstract]
Cash paid for amounts included in the measurement of lease liabilities	$ 311	$ 293	$ 887	$ 1,026
ROU assets obtained in exchange for lease obligations	$ 0	$ 0	$ 68	$ 0

Leases - Schedule of Suppleme_2

Leases - Schedule of Supplemental Balance Sheet Information Related to Leases (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Assets:
Right-of-use assets	$ 1,008	$ 1,425
Liabilities:
Current	363	650
Noncurrent	1,018	1,200
Total operating lease liabilities	$ 1,381	$ 1,850
Operating Lease, Right-of-Use Asset, Statement of Financial Position [Extensible Enumeration]	Other assets - net	Other assets - net
Operating Lease, Liability, Current, Statement of Financial Position [Extensible Enumeration]	Accrued expenses	Accrued expenses
Operating Lease, Liability, Noncurrent, Statement of Financial Position [Extensible Enumeration]	Other long-term liabilities	Other long-term liabilities

Leases - Schedule of Weighted-A

Leases - Schedule of Weighted-Average Remaining Lease Terms and Discount Rates (Details)	Sep. 30, 2021	Sep. 30, 2020
Leases [Abstract]
Weighted-average remaining lease term (years)	6 years 1 month 6 days	6 years 1 month 6 days
Weighted-average discount rate	5.00%	5.00%

Leases - Schedule of Maturities

Leases - Schedule of Maturities of Operating Lease Liabilities (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Leases [Abstract]
2021 (remaining)	$ 317
2022	378
2023	218
2024	173
2025	161
2026 and beyond	557
Total future minimum lease payments	1,804
Less imputed interest	(423)
Total operating lease liabilities	$ 1,381	$ 1,850

Revenue from Contracts with C_3

Revenue from Contracts with Customers - Schedule of Total Revenue by Geographical Region (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Disaggregation Of Revenue [Line Items]
Total revenues from contracts with customers	$ 20,545	$ 27,926	$ 68,670	$ 75,562
Point In Time
Disaggregation Of Revenue [Line Items]
Total revenues from contracts with customers	20,545	27,926	68,670	75,562
Point In Time | Domestic
Disaggregation Of Revenue [Line Items]
Total revenues from contracts with customers	17,306	23,690	57,880	62,917
Point In Time | International
Disaggregation Of Revenue [Line Items]
Total revenues from contracts with customers	$ 3,239	$ 4,236	$ 10,790	$ 12,645

Business Combinations - Additio

Business Combinations - Additional Information (Details) - USD ($)	Apr. 30, 2021	Oct. 23, 2020	Sep. 29, 2020	Jun. 30, 2021	Sep. 30, 2021	Sep. 30, 2020	Dec. 31, 2020
Business Combinations [Line Items]
Common stock, par value (in dollars per share)					$ 0.001		$ 0.001
Cash consideration					$ 328,000	$ 0
Prompt
Business Combinations [Line Items]
First payment	18 months
Second payment	36 months
Prompt | Agreement
Business Combinations [Line Items]
Payments to acquire businesses	$ 1,100,000
Cash to be paid at closing	300,000
Contingent consideration	600,000
Prompt | Agreement | Other (income) expense – net
Business Combinations [Line Items]
Bargain purchase gain				$ 100,000
Prompt | Agreement | Restricted Stock
Business Combinations [Line Items]
Common shares issuable	$ 200,000
Holo Surgical | Holo Purchase Agreement
Business Combinations [Line Items]
Payments to acquire businesses			$ 95,000,000
Cash to be paid at closing		$ 30,000,000	$ 30,000,000
Common shares issuable		$ 12,300,000
Common shares issuable at closing (in shares)		6,250,000
Common stock, par value (in dollars per share)			$ 0.001
Aggregate contingent consideration		$ 50,600,000	$ 83,000,000
Contingent consideration payable closing milestones, term		6 years
Cash consideration			30,000,000
Direct and incremental costs			2,100,000
Estimated fair value related to contingent consideration			50,600,000
Fair value of liability					53,000,000		$ 56,500,000
Change in fair value of liability					3,600,000
Holo Surgical | Holo Purchase Agreement | Accrued expenses
Business Combinations [Line Items]
Fair value of liability					18,400,000		9,000,000
Holo Surgical | Holo Purchase Agreement | Other long-term liabilities
Business Combinations [Line Items]
Fair value of liability					34,600,000		$ 47,500,000
Holo Surgical | Holo Purchase Agreement | Common Stock
Business Combinations [Line Items]
Common shares issuable			$ 12,300,000
Common shares issuable at closing (in shares)			6,250,000
Aggregate contingent consideration		$ 50,600,000
Common Stock to satisfy any contingent consideration payable (in shares)			14,900,000
Holo Surgical | Holo Purchase Agreement | Gain on acquisition contingency
Business Combinations [Line Items]
Change in fair value of liability					$ 3,600,000

Business Combinations - Schedul

Business Combinations - Schedule of Fair Value of Identifiable Assets Acquired and Liabilities Assumed (Details) - Agreement - Prompt $ in Thousands	Apr. 30, 2021USD ($)
Business Combinations [Line Items]
Inventories	$ 140
Right-of-use assets	78
Property and equipment	528
Operating lease liabilities	(78)
Deferred tax liability	(28)
Net assets acquired	640
Bargain purchase gain	(90)
Total purchase price	$ 550

Stock-Based Compensation - Sche

Stock-Based Compensation - Schedule of Stock Option And Stock Grant Awards By Plan (Details) - shares	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Total, granted (in shares)	5,889,569	3,612,762
Stock Options
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock Options, granted (in shares)	776,564	1,858,353
Restricted Stock Awards
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Restricted Stock Awards and Units, granted (in shares)	147,719	1,754,409
Restricted Stock Units
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Restricted Stock Awards and Units, granted (in shares)	4,965,286	0
2021 Incentive Inducement Plan
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Total, granted (in shares)	852,416
2021 Incentive Inducement Plan | Stock Options
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock Options, granted (in shares)	422,162
2021 Incentive Inducement Plan | Restricted Stock Awards
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Restricted Stock Awards and Units, granted (in shares)	0
2021 Incentive Inducement Plan | Restricted Stock Units
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Restricted Stock Awards and Units, granted (in shares)	430,254
2021 Incentive Compensation Plan
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Total, granted (in shares)	4,649,123
2021 Incentive Compensation Plan | Stock Options
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock Options, granted (in shares)	114,091
2021 Incentive Compensation Plan | Restricted Stock Awards
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Restricted Stock Awards and Units, granted (in shares)	0
2021 Incentive Compensation Plan | Restricted Stock Units
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Restricted Stock Awards and Units, granted (in shares)	4,535,032
2018 Incentive Compensation Plan
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Total, granted (in shares)	388,030	3,612,762
2018 Incentive Compensation Plan | Stock Options
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock Options, granted (in shares)	240,311	1,858,353
2018 Incentive Compensation Plan | Restricted Stock Awards
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Restricted Stock Awards and Units, granted (in shares)	147,719	1,754,409
2018 Incentive Compensation Plan | Restricted Stock Units
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Restricted Stock Awards and Units, granted (in shares)	0	0

Stock-Based Compensation - Stoc

Stock-Based Compensation - Stock-Based Compensation Recognized (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation	$ 1,868	$ 2,665	$ 4,218	$ 4,758
Costs of goods sold
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation	0	33	21	105
Marketing, general and administrative
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation	1,734	1,112	3,967	3,103
Research and development
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation	0	5	0	35
Transaction and integration expenses
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation	$ 134	$ 1,515	$ 230	$ 1,515

Stock-Based Compensation - Addi

Stock-Based Compensation - Additional Information (Details) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock-based compensation expense	$ 1,868,000	$ 2,665,000	$ 4,218,000	$ 4,758,000
Discontinued Operations | OEM Business
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock-based compensation expense		$ 600,000	$ 0	$ 800,000

Net Loss Per Common Share - Rec

Net Loss Per Common Share - Reconciliation of Common Stock Used in Calculation of Basic and Diluted Earnings Per Share (Details) - shares	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Earnings Per Share [Abstract]
Weighted average basic shares (in shares)	138,317,858	73,212,662	117,135,533	72,933,038
Weighted average diluted shares (in shares)	138,317,858	73,212,662	117,135,533	72,933,038

Net Loss Per Common Share - Sch

Net Loss Per Common Share - Schedule of Number of Potential Dilutive Shares that Excluded Due to Anti-dilutive Effect (Details) - shares	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Number of potential dilutive shares excluded due to anti-dilutive effect (in shares)	5,747,396	4,823,991	1,547,669	12,416,442
Stock Options
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Number of potential dilutive shares excluded due to anti-dilutive effect (in shares)	0	0	356,307	3,748
Restricted Stock Units and Restricted Stock Awards
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Number of potential dilutive shares excluded due to anti-dilutive effect (in shares)	5,747,396	1,515,137	1,191,362	1,191,573
Convertible Series A Preferred Stock ("Series A Preferred Stock")
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Number of potential dilutive shares excluded due to anti-dilutive effect (in shares)	0	3,308,854	0	11,221,121

Net Loss Per Common Share - Add

Net Loss Per Common Share - Additional Information (Details) - USD ($)	Oct. 23, 2020	Sep. 29, 2020	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Anti-dilutive stock excluded from the computation of diluted EPS (in shares)			5,747,396	4,823,991	1,547,669	12,416,442
Holo Purchase Agreement | Holo Surgical
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Aggregate contingent consideration	$ 50,600,000	$ 83,000,000
Common shares issuable at closing (up to) (in shares)	6,250,000
Contingent consideration payable closing milestones, term	6 years
Trading days		5 days
Holo Purchase Agreement | Holo Surgical | Maximum
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Common shares issuable at closing (up to) (in shares)	8,650,000
Holo Purchase Agreement | Common Stock | Holo Surgical
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Aggregate contingent consideration	$ 50,600,000
Common shares issuable at closing (up to) (in shares)		6,250,000
Holo Purchase Agreement | Common Stock | Holo Surgical | Maximum
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Common shares issuable at closing (up to) (in shares)	8,650,000
Stock Options
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Anti-dilutive stock excluded from the computation of diluted EPS (in shares)			5,470,364	5,305,329	4,936,334	4,963,654

Inventories - Additional Inform

Inventories - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Inventory Disclosure [Abstract]
Provision for inventory write-downs	$ 1,400	$ 5,600	$ 5,754	$ 9,597

Prepaid and Other Current Ass_3

Prepaid and Other Current Assets - Schedule of Prepaid and Other Current Assets (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]
Insurance recovery receivable	$ 12,000	$ 0
Income tax receivable	3,863	4,836
Prepaid expenses	2,956	1,543
Other receivables	806	3,905
Prepaid and other current assets	$ 19,625	$ 10,284

Property and Equipment - Schedu

Property and Equipment - Schedule of Net Book Value of Property and Equipment after Accumulated Depreciation and Impairment (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Property, Plant and Equipment [Line Items]
Property and equipment - net	$ 1,028	$ 521
Processing equipment
Property, Plant and Equipment [Line Items]
Property and equipment - net	487	35
Surgical instruments
Property, Plant and Equipment [Line Items]
Property and equipment - net	474	440
Office equipment, furniture and fixtures
Property, Plant and Equipment [Line Items]
Property and equipment - net	20	34
Computer equipment and software
Property, Plant and Equipment [Line Items]
Property and equipment - net	10	12
Construction in process
Property, Plant and Equipment [Line Items]
Property and equipment - net	$ 37	$ 0

Property and Equipment - Additi

Property and Equipment - Additional Information (Details) - USD ($) $ in Millions	1 Months Ended			3 Months Ended		9 Months Ended
	Sep. 30, 2021	Jun. 30, 2021	Mar. 31, 2021	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020	Dec. 31, 2020
Property, Plant and Equipment [Line Items]
Depreciation expense				$ 0.7	$ 1	$ 1.9	$ 3
Capitalized cost of internal software expense related to new ERP system	$ 3.2			3.2		3.2		$ 0
Property And Equipment
Property, Plant and Equipment [Line Items]
Asset impairment and abandonment charges				5	9.2	9.4	12
ERP
Property, Plant and Equipment [Line Items]
Asset impairment and abandonment charges	$ 2	$ 0.8	$ 0.3
ERP implementation expense				$ 0	$ 0	$ 0.1	$ 0

Warrants - Additional Informati

Warrants - Additional Information (Details) $ / shares in Units, $ in Millions	Jun. 14, 2021USD ($)$ / sharesshares
Class Of Warrant Or Right [Line Items]
Strike price of warrants (in dollars per share) | $ / shares	$ 1.725
Period of warrants exercisable expiration period	3 years
Percentage of placement agent sash fee equal to gross proceeds from warrants	7.00%
Management fee equal to aggregate of gross proceeds of warrants	1.00%
Placement Agent Warrants
Class Of Warrant Or Right [Line Items]
Strike price of warrants (in dollars per share) | $ / shares	$ 2.15625
Placement Agent Warrants | Maximum
Class Of Warrant Or Right [Line Items]
Number of common stock shares issuable upon conversion of warrants (up to) (in shares) | shares	1,739,130
At-the-Market Offering
Class Of Warrant Or Right [Line Items]
Common stock sold (in shares) | shares	28,985,508
Warrants exercisable aggregate of common stock (in shares) | shares	28,985,508
Common stock price per share (in dollars per share) | $ / shares	$ 1.725
Net proceeds from the direct offering, after deducting investor and management fees | $	$ 45.8

Fair Value Information - Additi

Fair Value Information - Additional Information (Details)	Sep. 30, 2021USD ($)	Dec. 31, 2020USD ($)	Sep. 30, 2020USD ($)	Mar. 31, 2020USD ($)	Dec. 31, 2019USD ($)
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Contingent consideration amounts	$ 52,962,000	$ 56,515,000	$ 1,000,000		$ 1,130,000
Contingent consideration classified as current liabilities	18,406,000	8,996,000
Contingent consideration classified as long-term liabilities	34,556,000	47,519,000
Zyga Technology Inc | Clinical and Revenue Milestones
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Contingent consideration amounts	0	0		$ 1,100,000	$ 1,100,000
Holo Surgical
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Contingent consideration amounts	53,000,000	56,500,000
Contingent consideration classified as current liabilities	18,400,000	9,000,000
Contingent consideration classified as long-term liabilities	$ 34,600,000	$ 47,500,000
Holo Surgical | Probability of success factor | Minimum
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Contingent consideration measurement input	0	0.60
Holo Surgical | Probability of success factor | Maximum
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Contingent consideration measurement input	0.90	0.90
Holo Surgical | Discount rate | Minimum
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Contingent consideration measurement input	0.0005	0.0011
Holo Surgical | Discount rate | Maximum
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Contingent consideration measurement input	0.1117	0.1686

Fair Value Information - Schedu

Fair Value Information - Schedule of Reconciliation of Acquisition Contingencies (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020
Business Combination, Contingent Consideration, Liability [Roll Forward]
Beginning balance as of January 1	$ 56,515	$ 1,130
(Gain) loss	(3,553)	0
Other	0	(130)
Ending balance as of September 30	$ 52,962	$ 1,000

Fair Value Information - Sche_2

Fair Value Information - Schedule of Fair Value Assets Subject to Fair Value Measured Using Level 3 Inputs (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Impaired Long Lived Assets Held And Used [Line Items]
Property and equipment - net	$ 1,028	$ 521
Other assets - net	10,045	10,145
Level 3
Impaired Long Lived Assets Held And Used [Line Items]
Property and equipment - net	1,028	521
Other assets - net	10,045	10,145
Long lived assets	$ 11,073	$ 10,666

Fair Value Information - Sche_3

Fair Value Information - Schedule of Impairments of Assets Subject to Fair Value Measured Using Level 3 Inputs (Details) - Level 3 - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Impaired Long Lived Assets Held And Used [Line Items]
Property and equipment – net	$ 5,186	$ 9,210	$ 8,978	$ 11,971
Other intangibles – net	167	146	478	146
Other assets – net	58	0	338	0
Total impairment	$ 5,411	$ 9,356	$ 9,794	$ 12,117

Fair Value Information - Sche_4

Fair Value Information - Schedule of Liabilities Measured at Fair Value on Recurring Basis (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Level 3 | Warrant liability
Fair Value Liabilities Measured On Recurring Basis [Line Items]
Fair value liability	$ 16,487	$ 0

Fair Value Information - Sche_5

Fair Value Information - Schedule of Changes in Fair Value of Level 3 Valuation for the Warrant Liability (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Business Combination, Contingent Consideration, Liability [Roll Forward]
Change in fair value	$ 7,739	$ 0	$ 10,262	$ 0
Warrant liability | Level 3
Business Combination, Contingent Consideration, Liability [Roll Forward]
December 31, 2020			0
Fair value of warrants on date of issuance			26,749
Change in fair value			(10,262)
September 30, 2021	$ 16,487		$ 16,487

Fair Value Information - Fair V

Fair Value Information - Fair Value of Warrant Liability Valuation Inputs (Details)	Sep. 30, 2021	Dec. 31, 2020
Stock price
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis Valuation Techniques [Line Items]
Measurement inputs	1.09	0
Risk-free interest rate
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis Valuation Techniques [Line Items]
Measurement inputs	0.0046	0
Dividend yield
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis Valuation Techniques [Line Items]
Measurement inputs	0	0
Volatility
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis Valuation Techniques [Line Items]
Measurement inputs	1	0

Accrued Expenses - Accrued Expe

Accrued Expenses - Accrued Expenses (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Payables and Accruals [Abstract]
Accrued securities class action settlement	$ 12,000	$ 0
Accrued distributor commissions	3,194	4,113
Accrued compensation	5,531	2,268
Other	6,119	6,267
Total accrued expenses	$ 26,844	$ 12,648

Other Long-Term Liabilities - S

Other Long-Term Liabilities - Schedule of Other Long-term Liabilities (Details) - USD ($) $ in Thousands	Sep. 30, 2021	Dec. 31, 2020
Other Long Term Liabilities [Line Items]
Acquisition contingencies	$ 34,556	$ 47,519
Warrant Liability	16,487	0
Lease obligations	1,018	1,200
Other	2,335	2,992
Total other long-term liabilities	54,396	51,711
Other long-term liabilities
Other Long Term Liabilities [Line Items]
Lease obligations	$ 1,018	$ 1,200

Income Taxes - Additional Infor

Income Taxes - Additional Information (Details) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Sep. 30, 2021	Sep. 30, 2020
Income Tax Disclosure [Abstract]
Income tax (benefit)	$ (1,304,000)	$ 0	$ (1,004,000)	$ (3,492,000)

Preferred Stock - Schedule of P

Preferred Stock - Schedule of Preferred Stock (Details) - USD ($) $ in Thousands	3 Months Ended				6 Months Ended
	Sep. 30, 2021	Sep. 30, 2020	Jun. 30, 2020	Mar. 31, 2020	Jun. 30, 2021
Increase (Decrease) in Temporary Equity [Roll Forward]
Preferred stock liquidation value, beginning balance	$ 0	$ 66,519	$ 66,519	$ 66,519	$ 0
Preferred stock issuance costs, beginning balance	0	(17)	(63)	(109)	0
Net total, beginning balance	0	66,502	66,456	66,410	0
Amortization of preferred stock issuance costs	0	17	46	46	0
Redemption of preferred stock		(66,519)
Preferred stock liquidation value, ending balance	0	0	66,519	66,519	0
Preferred stock issuance costs, ending balance	0	0	(17)	(63)	0
Net total, ending balance	$ 0	$ 0	$ 66,502	$ 66,456	$ 0

Preferred Stock - Additional In

Preferred Stock - Additional Information (Details) $ in Millions	Jul. 24, 2020USD ($)
Temporary Equity Disclosure [Abstract]
Redemption of preferred stock	$ 66.5

Commitments and Contingencies -

Commitments and Contingencies - Additional Information (Details)

Mar. 12, 2021USD ($)ft²claim

Jan. 20, 2021USD ($)

Oct. 23, 2020USD ($)shares

Sep. 29, 2020USD ($)

Jul. 20, 2020USD ($)agreement

Mar. 08, 2019USD ($)shares

Jan. 04, 2018USD ($)

Jan. 31, 2021USD ($)

Sep. 30, 2021USD ($)

Sep. 30, 2020USD ($)

Sep. 30, 2021USD ($)

Sep. 30, 2020USD ($)

Dec. 31, 2020USD ($)

Dec. 31, 2019USD ($)

Commitment And Contingencies [Line Items]

Cash consideration

$ 328,000

$ 0

Contingent consideration amounts

$ 52,962,000

$ 1,000,000

52,962,000

1,000,000

$ 56,515,000

$ 1,130,000

Operating lease cost

179,000

286,000

557,000

1,024,000

Operating lease payments

311,000

$ 293,000

887,000

$ 1,026,000

Manufacturing and Distribution Agreements with Affiliates of Montague Private Equity

Commitment And Contingencies [Line Items]

Number of manufacturing and distribution agreements | agreement

3

Purchase obligation, year one

$ 24,200,000

Purchase obligation, year two

25,800,000

Purchase obligation, year three

27,200,000

Design and Development Agreement with Pioneer

Commitment And Contingencies [Line Items]

Direct labor costs

$ 1,700,000

Collaborative arrangement term

2 years

Oxford Supply Agreement

Commitment And Contingencies [Line Items]

Minimum purchase obligations beyond 2021

$ 0

San Diego Lease

Commitment And Contingencies [Line Items]

Operating lease term of contract

12 years

Number of lease extension options | claim

1

Lease extension term

7 years

San Diego Lease | Premises

Commitment And Contingencies [Line Items]

Lease rentable area | ft²

94,457

Lease improvement term

12 months

Operating lease cost

$ 64,600,000

Rent abatement term

13 months

Other assets - net | San Diego Lease | Premises

Commitment And Contingencies [Line Items]

Operating lease payments

$ 2,500,000

Aziyo Biologics, Inc. | 2020 Shortfall Obligation | Distribution Agreements

Commitment And Contingencies [Line Items]

Purchase order issued

$ 12,400,000

Maximum | Oxford Supply Agreement

Commitment And Contingencies [Line Items]

Purchase order issued

600,000

Minimum | Oxford Supply Agreement

Commitment And Contingencies [Line Items]

Purchase order issued

$ 200,000

Paradigm Spine

Commitment And Contingencies [Line Items]

Agreement to acquire business

$ 300,000,000

Cash to be paid at closing

150,000,000

Potential debt to finance business combination

$ 100,000,000

Common shares issuable at closing (in shares) | shares

10,729,614

Trading days

5 days

Number of common stock to be issued at closing, value

$ 50,000,000

Revenue based earnout considerations

0

First potential earnout payment

20,000,000

Paradigm Spine | Maximum

Commitment And Contingencies [Line Items]

Revenue based earnout considerations

$ 150,000,000

Zyga Technology Inc

Commitment And Contingencies [Line Items]

Payments to acquire businesses

$ 21,000,000

Cash consideration

3,000,000

Zyga Technology Inc | Clinical Milestones

Commitment And Contingencies [Line Items]

Contingent consideration amounts

1,000,000

0

0

Zyga Technology Inc | Earn Out Payment

Commitment And Contingencies [Line Items]

Revenue based earnout consideration

35,000,000

Zyga Technology Inc | Revolving credit facility

Commitment And Contingencies [Line Items]

Cash proceeds from credit facility

$ 18,000,000

Holo Surgical

Commitment And Contingencies [Line Items]

Contingent consideration amounts

53,000,000

53,000,000

56,500,000

Holo Surgical | Holo Purchase Agreement

Commitment And Contingencies [Line Items]

Cash to be paid at closing

$ 30,000,000

$ 30,000,000

Common shares issuable at closing (in shares) | shares

6,250,000

Trading days

5 days

Payments to acquire businesses

$ 95,000,000

Cash consideration

30,000,000

Aggregate contingent consideration

$ 50,600,000

$ 83,000,000

Fair value of liability

53,000,000

53,000,000

56,500,000

Change in fair value of liability

3,600,000

Holo Surgical | Current liabilities | Holo Purchase Agreement

Commitment And Contingencies [Line Items]

Aggregate contingent consideration

9,000,000

Holo Surgical | Long-term liabilities | Holo Purchase Agreement

Commitment And Contingencies [Line Items]

Aggregate contingent consideration

$ 41,600,000

Holo Surgical | Other long-term liabilities | Holo Purchase Agreement

Commitment And Contingencies [Line Items]

Fair value of liability

34,600,000

34,600,000

47,500,000

Holo Surgical | Accrued expenses | Holo Purchase Agreement

Commitment And Contingencies [Line Items]

Fair value of liability

$ 18,400,000

$ 18,400,000

$ 9,000,000

Holo Surgical | Maximum | Holo Purchase Agreement

Commitment And Contingencies [Line Items]

Common shares issuable at closing (in shares) | shares

8,650,000

Legal Actions - Additional Info

Legal Actions - Additional Information (Details) $ in Thousands	Jul. 27, 2021USD ($)	Jul. 27, 2018patent	Sep. 30, 2021USD ($)claimlawsuit	Dec. 31, 2020USD ($)
Loss Contingencies [Line Items]
Insurance recovery receivable			$ 12,000	$ 0
Indemnified Claims
Loss Contingencies [Line Items]
Number of pending claims | lawsuit			1,157
LifeNet
Loss Contingencies [Line Items]
Number of patents claims | patent		5
Securities Class Action | Judicial Ruling
Loss Contingencies [Line Items]
Litigation settlement to other party	$ 10,500
Loss contingency			$ 10,500
Insurance recovery			10,500
Securities Class Action | Judicial Ruling | Prepaid and other current assets
Loss Contingencies [Line Items]
Insurance recovery receivable			10,500
Securities Class Action | Judicial Ruling | Accrued expenses
Loss Contingencies [Line Items]
Liability			$ 10,500
Derivative Actions
Loss Contingencies [Line Items]
Number of pending claims | claim			3
Damages sought value, liability			$ 1,500
Derivative Actions | Prepaid and other current assets
Loss Contingencies [Line Items]
Insurance recovery receivable			1,500
Derivative Actions | Accrued expenses
Loss Contingencies [Line Items]
Liability			$ 1,500

Related Party Transactions - Ad

Related Party Transactions - Additional Information (Details) - USD ($)	Oct. 23, 2020	Sep. 29, 2020	Jul. 20, 2020	Sep. 30, 2021
Related Party Transaction [Line Items]
Percent of beneficial owner of common stock				5.00%
Consulting Agreement | Mr. Simpson
Related Party Transaction [Line Items]
Agreement initial term period			3 years
Total cash compensation				$ 300,000
Holo Purchase Agreement | Holo Surgical
Related Party Transaction [Line Items]
Cash to be paid at closing	$ 30,000,000	$ 30,000,000
Common shares issuable at closing (in shares)	6,250,000
Common shares issuable	$ 12,300,000
Aggregate contingent consideration	$ 50,600,000	$ 83,000,000
Contingent consideration payable closing milestones, term	6 years
Holo Purchase Agreement | Holo Surgical | Dr. Pawel Lewicki
Related Party Transaction [Line Items]
Indirect outstanding ownership percent	57.50%
Holo Purchase Agreement | Holo Surgical | Maximum
Related Party Transaction [Line Items]
Common shares issuable at closing (in shares)	8,650,000