Surgalign (SRGAQ) 10-K 15 Mar 22 2021 FY Annual report Financial data

Cover

Cover - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2021	Mar. 11, 2022	Jun. 30, 2021
Cover [Abstract]
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2021
Current Fiscal Year End Date	--12-31
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 Well-known Seasoned Issuer	No
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
ICFR Auditor Attestation Flag	true
Entity Shell Company	false
Entity Public Float			$ 174.4
Entity Common Stock, Shares Outstanding		198,752,913
Documents Incorporated by Reference	As stated in Part III of this Annual Report on Form 10-K, portions of the registrant’s definitive proxy statement for the registrant’s 2021 Annual Meeting of Stockholders are incorporated by reference in Part III of this Annual Report on Form 10-K.
Amendment Flag	false
Document Fiscal Year Focus	2021
Document Fiscal Period Focus	FY
Entity Central Index Key	0001760173

Audit Information

Audit Information	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Auditor Information [Abstract]
Auditor Name	GRANT THORNTON LLP	DELOITTE & TOUCHE LLP
Auditor Location	Chicago, Illinois	Tampa, Florida
Auditor Firm ID	248	23

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Current Assets:
Cash and cash equivalents	$ 51,287	$ 43,962
Accounts receivable - less allowances of $9,272 at December 31, 2021 and $8,203 at December 31, 2020	19,197	27,095
Inventories - current	26,204	22,841
Prepaid and other current assets	8,984	10,284
Total current assets	105,672	104,182
Non-current inventories	10,212	7,856
Property and equipment - net	945	521
Other assets - net	6,970	10,145
Total assets	123,799	122,704
Current Liabilities:
Accounts payable	10,204	13,418
Current portion of accrued acquisition contingency - Holo	25,585	8,996
Accrued expenses	17,769	12,648
Accrued income taxes	484	11,761
Total current liabilities	54,042	46,823
Acquisition contingencies - Holo	26,343	47,519
Warrant liability	12,013	0
Notes payable - related party	9,982	0
Other long-term liabilities	3,176	4,192
Total liabilities	105,556	98,534
Commitments and contingencies (Note 23)
Mezzanine equity	10,006	0
Stockholders' equity:
Common stock, $.001 par value: 300,000,000 shares authorized; 146,640,069 and 81,678,179 shares issued and outstanding, as of December 31, 2021 and 2020, respectively	147	81
Additional paid-in capital	585,375	517,123
Accumulated other comprehensive loss	(1,820)	(2,416)
Accumulated deficit	(569,613)	(484,962)
Less treasury stock, 1,543,446 and 1,444,578 shares, as of December 31, 2021 and 2020, respectively, at cost	(5,852)	(5,656)
Total stockholders' equity	8,237	24,170
Total liabilities, mezzanine equity and stockholders' equity	$ 123,799	$ 122,704

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Statement of Financial Position [Abstract]
Accounts receivable, allowances	$ 9,272	$ 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)	146,640,069	81,678,179
Common stock, shares outstanding (in shares)	146,640,069	81,678,179
Treasury stock, shares (in shares)	1,543,446	1,444,578

Consolidated Statements of Comp

Consolidated Statements of Comprehensive Loss - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Income Statement [Abstract]
Revenues	$ 90,500	$ 101,749	$ 117,423
Costs of goods sold	29,775	44,002	32,777
Gross profit	60,725	57,747	84,646
Operating Expenses:
General and administrative	104,668	124,424	135,396
Research and development	13,888	11,947	16,836
Loss (gain) on acquisition contingency	(4,587)	4,753	(76,033)
Asset acquisition expenses	72,100	94,999	0
Asset impairment and abandonments	12,195	14,773	97,341
Goodwill impairment	0	0	140,003
Transaction and integration expenses	3,689	4,872	13,999
Total operating expenses	201,940	255,768	327,542
Other operating income, net	(3,932)	0	0
Operating loss	(137,283)	(198,021)	(242,896)
Other (income) expense - net
Other (income) expense - net	(202)	(61)	(161)
Foreign exchange loss (gain)	1,447	(279)	122
Change in fair value of warrant liability	(14,736)	0	0
Total other (income) expense - net	(13,491)	(340)	(39)
Loss before income tax (benefit) provision	(123,792)	(197,681)	(242,857)
Income tax (benefit) provision	(886)	(3,486)	5,921
Net loss from continuing operations	(122,906)	(194,195)	(248,778)
Discontinued operations (Note 5)
(Loss) Income from operations of discontinued operations	(6,316)	179,934	48,452
Income tax (benefit) provision	(2,674)	19,522	11,316
Net (loss) income from discontinued operations	(3,642)	160,412	37,136
Net loss	(126,548)	(33,783)	(211,642)
Net loss applicable to noncontrolling interests	41,897	0	0
Net (loss) applicable to Surgalign Holdings, Inc.	(84,651)	(33,783)	(211,642)
Other comprehensive (loss) income:
Unrealized foreign currency translation loss (gain)	(596)	(23)	351
Total other comprehensive loss	$ (84,055)	$ (33,760)	$ (211,993)
Net loss from continuing operations per share applicable to Surgalign Holdings, Inc. - basic (in dollars per share)	$ (1)	$ (2.61)	$ (3.55)
Net income from discontinued operations per share applicable to Surgalign Holdings, Inc. - basic (in dollars per share)	(0.03)	2.16	0.53
Net loss per share applicable to Surgalign Holdings, Inc.- basic (in dollars per share)	(0.69)	(0.45)	(3.02)
Net loss from continuing operations per share attributable to Surgalign Holdings, Inc. - diluted (in dollars per share)	(1)	(2.61)	(3.55)
Net income from discontinued operations per share attributable to Surgalign Holdings, Inc. - diluted (in dollars per share)	(0.03)	2.16	0.53
Net loss per share attributable to Surgalign Holdings, Inc. - diluted (in dollars per share)	$ (0.69)	$ (0.45)	$ (3.02)
Weighted average shares outstanding - basic (in shares)	122,592,569	74,403,155	70,150,492
Weighted average shares outstanding - diluted (in shares)	122,592,569	74,403,155	70,150,492

Consolidated Statements of Stoc

Consolidated Statements of Stockholders' Equity - USD ($) $ in Thousands	Total	Total Stockholders' Equity	Total Stockholders' EquityHolo Surgical Inc.	Total Stockholders' EquityPrompt	Total Stockholders' EquityINN Acquisition	Common Stock	Common StockHolo Surgical Inc.	Common StockINN Acquisition	Additional Paid-in Capital	Additional Paid-in CapitalHolo Surgical Inc.	Additional Paid-in CapitalPrompt	Additional Paid-in CapitalINN Acquisition	Accumulated Other Comprehensive Loss	Accumulated Deficit	Treasury Stock
Beginning Balance at Dec. 31, 2018		$ 181,531				$ 64			$ 433,143				$ (7,270)	$ (239,537)	$ (4,869)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net (loss) income	$ (211,642)	(211,642)												(211,642)
Foreign currency translation adjustment		(359)											(359)
Exercise of common stock options		395							395
Equity instruments issued in connection with acquisition		60,730				11			60,719
Stock-based compensation		4,367							4,367
Purchase of treasury stock	(300)	(272)													(272)
Amortization of preferred stock		(186)							(186)
Ending Balance at Dec. 31, 2019		34,564				75			498,438				(7,629)	(451,179)	(5,141)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net (loss) income	(33,783)	(33,783)												(33,783)
Foreign currency translation adjustment		23											23
Foreign currency translation adjustment related to the impact of discontinued operations		5,190											5,190
Vesting of Restricted Stock Awards		22							22
Equity instruments issued in connection with acquisition			$ 12,250				$ 6			$ 12,244
Stock-based compensation		6,528							6,528
Purchase of treasury stock	(500)	(515)													(515)
Amortization of preferred stock		(109)							(109)
Ending Balance at Dec. 31, 2020		24,170				81			517,123				(2,416)	(484,962)	(5,656)
Net total, ending balance at Dec. 31, 2020	0
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net (loss) income	(126,548)	(84,651)												(84,651)
Foreign currency translation adjustment		596											596
Exercise of common stock options		23							23
Equity instruments issued in connection with acquisition				$ 221	$ 4,927			$ 7			$ 221	$ 4,920
Stock-based compensation		5,212							5,212
Purchase of treasury stock	(200)	(196)				0			0						(196)
Share offering		82,326				58			82,268
Warrant issuance costs		(24,798)							(24,798)
Purchase of noncontrolling interest		0
Purchases of stock in the ESPP plan		407				1			406
Ending Balance at Dec. 31, 2021		$ 8,237				$ 147			$ 585,375				$ (1,820)	$ (569,613)	$ (5,852)
Increase (Decrease) in Temporary Equity [Roll Forward]
Net (loss) income	(41,897)
Purchase of noncontrolling interest	51,903
Net total, ending balance at Dec. 31, 2021	$ 10,006

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Cash flows from operating activities:
Net (loss) income	$ (126,548)	$ (33,783)	$ (211,642)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation and amortization expense	2,479	6,581	22,675
Provision for bad debts and product returns	2,064	4,286	2,937
Change in fair value of warrant liability	(14,736)	0	0
Provision for inventory write-downs	9,096	17,691	8,493
Investor Fee	2,119	0	0
Revenue recognized due to change in deferred revenue	0	(2,618)	(4,906)
Deferred income tax provision	(171)	(1,807)	17,066
Stock-based compensation	5,212	6,528	4,367
Asset impairment and abandonments	12,195	14,773	97,341
Goodwill impairment	0	0	140,003
Asset acquisition expenses	72,087	94,999	0
Loss (Gain) on acquisition contingency	(4,587)	4,753	(76,033)
Paid in kind interest expense	0	0	4,408
Loss on extinguishment of debt	0	2,686	0
Bargain purchase gain	(90)	0	0
Amortization of debt issuance costs	0	283	0
Amortization of debt discount	0	2,479	0
Derivative loss	0	12,641	0
Loss (gain) on sale of OEM business (discontinued operations)	6,316	(209,800)	0
Other	24	279	1,673
Change in assets and liabilities:
Accounts receivable	5,701	4,444	(9,013)
Inventories	(15,480)	(12,607)	(14,219)
Accounts payable	(3,112)	5,306	(974)
Accrued expenses and income taxes payable	10,542	3,731	4,489
Right-of-use asset and lease liability	(2,542)	0	0
Contract liability	0	2,956	2,000
Other operating assets and liabilities	(12,361)	(11,839)	1,879
Net cash used in operating activities	(51,792)	(88,038)	(9,456)
Cash flows from investing activities:
Payments for OEM working capital adjustment	(5,430)	0	0
Purchases of property and equipment	(13,423)	(10,115)	(14,426)
Patent and acquired intangible asset costs	(649)	(3,923)	(2,007)
Proceeds from sale of OEM business	0	437,097	0
Net cash provided by (used in) investing activities	(24,832)	390,942	(116,125)
Cash flows from financing activities:
Share offering proceeds, net	82,326	0	0
Proceeds from exercise of common stock options	23	22	395
Proceeds from Employee Stock Purchase Program (ESPP)	407	0	0
Repayment of short-term obligations	0	(76,912)	0
Proceeds from long-term obligations	0	89,892	121,500
Payments of debt issuance costs	0	(1,740)	(826)
Payments on long-term obligations	0	(207,266)	(500)
Payments for treasury stock	(196)	(515)	(273)
Redemption of preferred stock	0	(66,519)	0
Net cash provided by (used in) financing activities	82,560	(263,038)	120,296
Effect of exchange rate changes on cash and cash equivalents	1,389	(1,512)	(56)
Net increase (decrease) in cash and cash equivalents	7,325	38,354	(5,341)
Cash and cash equivalents, beginning of period	43,962	5,608	10,949
Cash and cash equivalents, end of period	51,287	43,962	5,608
Supplemental cash flow disclosure:
Cash paid for interest	0	14,964	7,121
Cash paid for income taxes, net of refunds	7,990	7,103	(1,994)
Non-cash acquisition of property and equipment	195	750	1,468
Non-cash common stock issuance - Prompt	221	0	0
Non-cash acquisition of INN	14,909	0	0
INN Acquisition
Cash flows from investing activities:
Acquisition	(5,000)	0	0
Acquisition of Prompt Prototype, net of cash acquired
Cash flows from investing activities:
Acquisition of Prompt Prototype, net of cash acquired	(330)	0	0
Paradigm
Cash flows from investing activities:
Acquisition	0	0	(99,692)
Holo Surgical Inc.
Cash flows from investing activities:
Acquisition	$ 0	$ (32,117)	$ 0

Business

Business	12 Months Ended
	Dec. 31, 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 through the evolution of digital health. Uniquely aligned and resourced to advance the standard of care, the company is building technologies physicians and other health providers will look to for what is truly possible for their patients. Surgalign is focused on developing solutions that predictably deliver superior clinical and economic outcomes . On January 14, 2022, we received FDA 510(k) clearance for HOLO Portal™, a surgical guidance system utilizing augmented reality ("AR") and artificial intelligence ("AI") to intraoperatively assist spine surgery. HOLO Portal™ technology combines image-based guidance with AR, automated spine segmentation, and automated surgical planning utilizing proprietary AI software. Intraoperative 3D digital imaging is autonomously processed by the system to create a patient-specific plan that is presented to the surgeon using an AR display. We are developing additional applications utilizing HOLO™ AI technology for use in multiple clinical specialties across the continuum of patient care. The first example of this is with the acquisition of an equity interest in Inteneural Networks, Inc. ("INN") which uses proprietary AI technology to autonomously segment and identify neural structures in medical images. We believe HOLO™ AI, our portfolio of neural network technologies, is one of the most advanced artificial intelligence technologies being applied to surgery. In addition to the development of our digital health products 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 biomaterials portfolio of advanced and traditional orthobiologics. We currently market and sell products to hospitals, ambulatory surgery centers, and healthcare providers in the United States and in more than 50 countries worldwide. We are headquartered in Deerfield, Illinois, with commercial, innovation and design centers in San Diego, California; Wurmlingen, Germany; and Warsaw, Poland. Acquisition of equity interest in INN On December 30, 2021, we completed a Stock Purchase Agreement (“Purchase Agreement”) to acquire 42% of INN for a non-exclusive license to use INN's proprietary AI technology for autonomously segmenting and identifying neural structures in medical images and helping identify possible pathological states to advance our digital health strategy. INN is a private technology company that is developing technology that harnesses machine learning ("ML") and AI to autonomously and accurately identify and segment neural structures in medical images and integrate specific reference information regarding possible pathological states to physicians caring for patients. As consideration for the 42% ownership, we paid total consideration of $19.9 million which consisted of $5.0 million in cash, issuance to the Sellers 6,820,792 shares of our common stock with a fair value of $4.9 million and issuance of unsecured promissory notes to the Sellers in an aggregate principal amount of $10.6 million with a fair value of $10.0 million. As part of the transaction, subject to certain contingencies, the Company must purchase up to 100% of the equity of INN if the three additional clinical, regulatory, and revenue milestones are met. With the achievement off each milestone and the satisfaction of the related contingencies, the Company will acquire an additional 19.3% equity interest in INN for $19.3 million. Prompt Prototypes LLC Acquisition On April 30, 2021, The Company, entered into an Asset Purchase Agreement with Prompt Prototype LLC ("Prompt"). 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 agreement 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 seller. The remaining $0.6 million of the purchase price will be paid to the seller, contingent on the continued employment with the Company, in the form of cash and restricted shares in two equal amounts on the 18th and 36th month anniversary of the closing date. These payments are considered future compensation. Holo Surgical Acquisition On October 23, 2020, the Company completed the acquisition of Holo Surgical Inc. (“Holo Surgical”) pursuant to the Stock Purchase Agreement dated as of September 29, 2020 (the “Holo Surgical Purchase Agreement”), by and among the Company, Roboticine, Inc. (the “Seller”) and the other parties signatory thereto. Holo Surgical is a privately-held company that is developing the HOLO™ technology, to enable digital spine surgery. As consideration for the transactions contemplated by the Holo Surgical Purchase Agreement, at closing, the Company paid to the Seller $30.0 million in cash and issued to the 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 in an aggregate amount of $51.9 million as of December 31, 2021, 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 first milestone was achieved on January 14, 2022, when Holo was cleared by the FDA. Subsequently this milestone was paid by issuing 8,650,000 share of common stock at a value of $5.9 million and the Company also paid $4.1 million in cash for a total payment for achieving the milestone of $10.0 million. 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. 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 (United States), 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 as Surgalign Spine Technologies. Where obvious and appropriate from the context, references herein to Surgalign or the Company refer to the Company including the disposed OEM Businesses. In connection with the sale of the OEM Businesses on July 20, 2020, the Company (i) paid in full its $80.0 million revolving credit facility under that certain Credit Agreement dated as of June 5, 2018, by and among Surgalign Spine Technologies, Inc. (formerly known as RTI Surgical, Inc.) , as borrower, Pioneer Surgical Technology, Inc., our wholly-owned subsidiary, as a borrower, the other loan parties thereto as guarantors, JPMorgan Chase Bank, N.A., as lender and as administrative agent for the JPM Lenders, as amended (the “2018 Credit Agreement”), (ii) terminated the 2018 Credit Agreement, (iii) paid in full its $100.0 million term loan and $30.0 million incremental term loan commitment under that certain Second Lien Credit Agreement, dated as of March 8, 2019, by and among Surgalign Spine Technologies, Inc., as borrower, the lenders party thereto from time to time and Ares Capital Corporation, as administrative agent for the other lenders party thereto, as amended (the “2019 Credit Agreement”) and (iv) terminated the 2019 Credit Agreement. Refer to Note 5 for further discussion on Discontinued Operations. Retirement of Series A Convertible Preferred Stock On July 17, 2020, the Company received a notification from WSHP Biologics Holdings, LLC (“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, a Certificate of Retirement was filed with the Delaware Secretary of State retiring the Series A Preferred Stock, and the WSHP representatives on the Company’s Board of Directors, Curtis M. Selquist and Chris Sweeney resigned from the Board of Directors. 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 continue 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 year end and impact from Omicron 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 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 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 December 31, 2021, the Company had cash of $51.3 million and an accumulated deficit of $569.6 million. For the year ended December 31, 2021, the Company had a loss from continuing operations of $122.9 million and a net loss applicable to Surgalign Holdings, Inc. of $84.7 million. The Company has incurred losses from operations in the previous two fiscal years and did not generate positive cash flows from operations in fiscal year 2021 nor in 2020. On February 15, 2022, we issued and sold in an underwritten public offering 43,478,264 shares of its common stock (or pre-funded warrants to purchase common stock in lieu thereof) and warrants to purchase up to an aggregate of 32,608,698 shares of common stock at a combined effective public offering price of $0.46 per share of common stock (or pre-funded warrant) and investor warrants to purchase up to an aggregate of 32,608,698 shares at a strike price of $0.60 and are exercisable over the next five years. The Company, also in connection with the offering, issued placement agent warrants to purchase an aggregate of up 2,608,696 shares of common stock at a strike price of $0.575 per share. We received net proceeds of $17.8 million from the offering after deducting investor and other filing fees of $2.2 million. On June 14, 2021, we issued and sold in a registered direct offering an aggregate of 29.0 million shares of our common stock and investor warrants to purchase up to an aggregate of 29.0 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 1.7 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 $40.5 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. In management's evaluation of the going concern conclusion we considered the following i) continued COVID-19 uncertainties; ii) negative cash flows that are projected over the next 12-month period; iii) uncertainty regarding potential settlements related to ongoing litigation and regulatory investigations; and iv) approximately $25.6 million of the total contingent consideration of $51.9 million are expected to become due to the former owners of Holo Surgical if certain milestones are met over the next 12 months which would be paid in cash; v) total payments of $10.3 million at fair value for INN related milestones are expected to be paid in cash when milestones are achieved in the future and; vi) seller notes in the amount of $10.0 million a fair value due to the seller of INN on December 31, 2024; and vii) various supplier minimum purchase agreements. The Company’s operating plan for the next 12-month period also includes continued investments in its product pipeline including both within digital health and hardware and biologics, which will necessitate additional financing. In addition to these efforts the Company will need continued capital and cash flows to fund the future operations through 2022 and beyond. 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. If cash resources are insufficient to satisfy the Company’s on-going cash requirements through 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 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 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 and to succeed in its future operations. The Company’s 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.

Summary of Significant Accounti

Summary of Significant Accounting Policies	12 Months Ended
	Dec. 31, 2021
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	Summary of Significant Accounting Policies Principles of Consolidation — The consolidated financial statements include the accounts of the Company and its wholly owned subsidiaries, Surgalign, Inc., Paradigm Spine, LLC (“Paradigm”), Pioneer Surgical Technology, Inc. (“Pioneer Surgical”), Zyga Technology, Inc. (“Zyga”) and Holo Surgical Inc. (“Holo Surgical”). The Company consolidates the accounts of Inteneural Networks, Inc. ("INN"), a 42% owned subsidiary as control is achieved through means other than voting rights ("variable interest entities" or "VIE") as the Company is deemed to be the primary beneficiary of INN . The financial positions and operating results of the disposed OEM Businesses have been reported as discontinued operations in the consolidated financial statements in the current as well as prior comparative periods. The consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“U.S. GAAP”). All intercompany balances and transactions have been eliminated in consolidation. Reclassification —The Company reclassified certain amounts from prior periods to conform with current period presentation of certain consolidated financial statements with no effect on previously reported net income, equity, total assets, or total liabilities. Use of Estimates —The preparation of consolidated financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosures of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Estimates and assumptions relating to inventories, receivables, long-lived assets, contingent considerations, and litigation are made at the end of each financial reporting period by management. Actual results could differ from those estimates. Foreign Currency Translation —The functional currency of the Company’s foreign subsidiaries is the Euro. Assets and liabilities of the foreign subsidiaries are translated at the period end exchange rate while revenues and expenses are translated at the average exchange rate for the period. The resulting translation adjustments, representing unrealized, noncash gains and losses are recorded and presented as a component of comprehensive loss. Gains and losses resulting from transactions of the Company and its subsidiaries, which are made in currencies different from their own, are included in income or loss as they occur and are included in other expenses in the consolidated statements of comprehensive loss. Fair Value of Financial Instruments —The estimated fair value of financial instruments disclosed in the consolidated financial statements has been determined by using available market information and appropriate valuation methodologies. The carrying value of all current assets and current liabilities approximates fair value because of their short-term nature. Cash and Cash Equivalents — The Company considers all funds in banks and short-term highly liquid investments with an original maturity of three months or less to be cash and cash equivalents. Cash equivalents comprise overnight repurchase agreements. Cash balances are held at a few financial institutions and usually exceed insurable amounts. The Company mitigates this risk by depositing its uninsured cash in major well capitalized financial institutions. At December 31, 2021 and 2020, the Company had no cash equivalents. Accounts Receivable Allowances — The Company maintains the allowance for estimated losses resulting from the inability of its customers to make required payments. The allowance represents the current estimate of lifetime expected credit losses over the remaining duration of existing accounts receivable considering current market conditions and supportable forecasts when appropriate. The estimate is a result of the Company’s ongoing evaluation of collectability, customer creditworthiness, historical levels of credit losses, and future expectations. Write-off activity and recoveries for the years were not material. Inventories — Inventories are stated at lower of cost or net realizable value, with cost determined using the first-in, first-out method. Non-current inventory represents those the Company anticipates will not be sold within the next year. Non-current inventory is estimated by comparing historical and projected sales trends and inventory quantities on hand. Inventory is evaluated for obsolescence and excess quantities by analyzing inventory levels, historical loss trends, expected product lives, product at risk of expiration, sales levels by product and projections of future sales demand. The Company’s calculation of the amount of inventory that is excess, obsolete, or will expire prior to sale has two components: 1) compares projected sales, expected consumption and historical sales to inventory quantities on hand; and 2) for expiring inventory management assesses the risk related to inventory that is near expiration by analyzing historical expiration trends to project inventory that will expire prior to being sold. The Company’s consumption model assumes that inventory will be sold on a first-in-first-out basis. The Company’s metal inventory does not expire and can be re-sterilized and sold; however, the Company assesses quantities on hand, historical sales, projected sales, the number of forecasted years, safety stock and those products we have determined to sunset when calculating the estimate. Property and equipment —Property and equipment are stated at cost less accumulated depreciation. The cost of leasehold improvements is amortized on the straight-line method over the shorter of the lease term or the estimated useful life of the asset. Included in property and equipment are costs related to purchased software that are capitalized. Surgical instruments which are included in property and equipment are handheld devices used by surgeons during implant procedures. The Company retains title to the surgical instruments. Depreciation for surgical instruments is included in general and administrative expenses in the accompanying consolidated statements of comprehensive loss. Depreciation is computed on the straight-line method over the following estimated useful lives of the assets: Processing equipment 7 to 10 years Office equipment, furniture and fixtures 5 to 7 years Computer equipment and software 3 to 7 years Surgical instruments 1 year Internal use Software - The Company accounts for its costs to develop computer software for internal use in accordance with Accounting Standards (“ASC”) 350-40, Internal use Software . These costs are directly attributable to the development and implementation of the new ERP system. The Company capitalizes the costs incurred during the application development stage, which generally include costs to design the software configuration and interfaces, coding, installation, and testing. Derivative Instruments— The Company reviews debt agreements for embedded features. If these features are not clearly and closely related to the debt host, they meet the definition of a derivative and require bifurcation from the host contract. All derivative instruments, including embedded derivatives are recorded on the balance sheet at their respective fair values. The Company will adjust the carrying value of the derivative liability to fair value at each subsequent reporting date. The changes in the fair value of the derivatives are recorded in the period they occur. Warrant Financing— The Company accounts for its warrants as derivative liabilities as the warrants did not meet the criteria for the equity scope exception from derivative accounting. As derivatives, these warrants were measured at fair value at inception and will be remeasured at each reporting date with changes in fair value recognized in the consolidated statements of comprehensive loss in the period of change. Debt Issuance Costs— Debt issuance costs include costs incurred to obtain financing and are amortized using the straight-line method, which approximates the effective interest method, over the life of the related debt. Debt issuance costs related to a recognized debt liability are presented in the balance sheet as a direct deduction from the carrying amount of that debt liability. No amounts are recorded as debt issuance costs for December 31, 2021 and 2020. Long-Lived Assets —The Company reviews its long-lived assets for impairment whenever events or changes in circumstances indicate the carrying value of an asset may not be recoverable. Recoverability is measured by a comparison of the carrying amount to the net undiscounted cash flows expected to be generated by the asset. An impairment loss would be recorded for the excess of net carrying value over the fair value of the asset impaired. The fair value is estimated based on expected discounted future cash flows. The results of impairment tests are subject to management’s estimates and assumptions of projected cash flows and operating results. Changes in assumptions or market conditions could result in a change in estimated future cash flows and the likelihood of materially different reported results. Because the Company’s forecasted cash flow is negative, Long-lived assets, including property and equipment and intangible assets subject to amortization were impaired and written down to their estimated fair values in 2021 and 2020. Other Intangible Assets —Other intangible assets, which constitutes finite lives assets, generally consist of patents, acquired exclusivity rights, licensing rights, distribution agreements, and procurement contracts. Patents are amortized on the straight-line method over the shorter of the remaining protection period or estimated useful lives of between 8 and 16 years. Trade names, procurement contracts, customer lists, acquired exclusivity rights, and distribution agreements are amortized over estimated useful lives of between 5 to 25 years. For the years ended December 31, 2021, 2020 and 2019, the amortization expense is $0.0 million, $0.9 million and $10.7 million , respectively. Revenue Recognition — The Company recognizes revenue upon transfer of control of promised implants 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, respectively based on the terms of the contract. The Company’s performance obligations consist mainly of transferring control of implants identified in the contracts. The Company’s transaction price is generally fixed. Any discounts or rebates are estimated at the inception of the contract and recognized as a reduction of the revenue. We generally do not bill customers for shipping and handling of our products. We treat shipping and handling costs performed after a customer obtains control of the good as a fulfillment cost and record these costs as a selling expense when incurred. 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 consolidated financial statements. Stock-Based Compensation Plans —The Company accounts for its stock-based compensation plans in accordance with ASC 718, Accounting for Stock Compensation (“ASC 718”). ASC 718 requires the measurement and recognition of compensation expense for all stock-based awards made to employees and directors, including restricted stock awards, restricted stock units, stock options and the employee stock purchase plan ("ESPP") purchase rights (i.e., equity-classified awards). Under the provisions of ASC 718, stock-based compensation cost for equity-classified awards is measured at the grant date, based on the calculated fair value of the award, and is recognized as an expense on a straight-line basis over the requisite service period of the entire award (generally the vesting period of an option, including graded vesting schedules, or share award and the offering period of an ESPP purchase right award). The Company currently measures the grant date fair value of restricted stock awards and restricted stock units based on the market value of the Company’s stock on the grant date. Prior to 2021 the Company used a Monte Carlo simulation model to estimate the grant date fair value of certain restricted stock awards that contain a market condition. The Company uses the Black-Scholes model to value its stock option grants and ESPP purchase rights. The fair value of stock options and awards is determined on the grant date, and the fair value of the ESPP purchase rights is determined on the offering date using assumptions for the expected term, expected volatility, dividend yield, and the risk-free interest rate. The details of those assumptions, is as follows: • The term assumption for stock options is primarily based on the contractual vesting term and historic data related to exercise and post-vesting expiration history experienced by the Company. The Company uses the simplified method for estimating the expected term used to determine the fair value under ASC 718. The expected term is determined separately for the Company’s directors and employees. The term assumption for ESPP purchase is primarily based on the offering period. • The Company’s anticipated volatility level for both stock options and ESPP purchase rights are primarily based on the historic volatility of the Company’s common stock. • The Company’s models for stock options and ESPP purchase rights includes a 0% expected dividend yield assumption, as the Company has not historically paid, nor does it anticipate paying dividends on its common stock. • The risk-free interest rate approximates recent U.S. Treasury note auction results with a similar life to that of the option or ESPP purchase right. The Company’s model does not include a discount for post-vesting restrictions, as the Company has not issued awards with such restrictions. The compensation cost recognized for stock options is determined based on the grant date fair value of the options and the number of options granted, net of an estimated forfeiture rate. The Company’s estimate of pre-vesting forfeitures is primarily based on the recent historical experience of the Company and is adjusted to reflect actual forfeitures. The compensation cost recognized for restricted stock awards, restricted stock units, and ESPP purchase rights is determined based on the grant date fair value of the awards. Research and Development Costs —Research and development costs, including the cost of research and development conducted for others and the cost of contracted research and development, are expensed as incurred. Income Taxes —The Company uses the asset and liability method of accounting for income taxes. Deferred income taxes are recorded to reflect the tax consequences on future years for differences between the tax basis of assets and liabilities and their financial reporting amounts at each year-end based on enacted tax laws and statutory tax rates applicable to the periods in which the differences are expected to affect taxable income. Valuation allowances are established when necessary to reduce deferred tax assets to amounts which are more likely than not to be realized. Contingent Consideration — The Company accounts for the contingent consideration related to the Holo Surgical Acquisition as a liability in accordance with the guidance of ASC 480, Distinguishing Liabilities from Equity , because the contingent consideration represents a conditional obligation that has a fixed monetary value known at inception and we may settle by issuing a variable number of our equity shares. The liability is recorded at its fair value at inception and shall be marked to market subsequently at the end of each reporting period, with any change recognized in the current earnings. See Note 7 for further discussion related to the Holo Surgical Acquisition. Noncontrolling Interest — The Company's consolidated noncontrolling interest is comprised of its investment in INN. The Company evaluated whether noncontrolling interest is subject to redemption features outside of the Company's control. We evaluated noncontrolling interest to determine whether it is currently redeemable for cash or probable of being redeemable for cash in the future within the mezzanine section of the consolidated balance sheet. As the noncontrolling interest is not currently redeemable, and is only redeemable upon the occurrence of FDA approval, we will not remeasure at each reporting period until approval is obtained. Treasury Stock — The Company may periodically repurchase shares of its common stock from employees for the satisfaction of their individual payroll tax withholding upon vesting of restricted stock awards in connection with the Company’s incentive plans. The Company’s repurchases of common stock are recorded at the stock price on the vesting date of the common stock. The Company repurchased 109,018 , 159,354, and 64,044 shares of its common stock for $0.2 million, $0.5 million, and $0.3 million for the years ended December 31, 2021, 2020, and 2019, respectively . Earnings Per Share —Basic earnings per share (“EPS”) is computed by dividing earnings attributable to common stockholders by the weighted-average number of common shares outstanding for the periods. Diluted EPS reflects the incremental shares issuable upon the assumed exercise of securities that could share in earnings. Shares whose issuance is contingent upon the satisfaction of certain conditions shall be considered outstanding and included in the computation of diluted EPS as follows: a. If all necessary conditions have been satisfied by the end of the period (the events have occurred), those shares shall be included as of the beginning of the period in which the conditions were satisfied (or as of the date of the contingent stock agreement, if later). b. If all necessary conditions have not been satisfied by the end of the period, the number of contingently issuable shares included in diluted EPS shall be based on the number of shares, if any, that would be issuable if the end of the reporting period were the end of the contingency period (for example, the number of shares that would be issuable based on current period earnings or period-end market price) and if the result would be dilutive. Those contingently issuable shares shall be included in the denominator of diluted EPS as of the beginning of the period (or as of the date of the contingent stock agreement, if later). Other Operating Income — Included within "Other operating income, net" for the year ended December 31, 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.

Recently Issued and Adopted Acc

Recently Issued and Adopted Accounting Standards	12 Months Ended
	Dec. 31, 2021
Accounting Changes and Error Corrections [Abstract]
Recently Issued and Adopted Accounting Standards	Recently Issued and Adopted Accounting Standards. 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

Leases

Leases	12 Months Ended
	Dec. 31, 2021
Leases [Abstract]
Leases	Leases The Company’s leases are classified as operating leases and includes 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. As of December 31, 2021 the only lease that has yet to commence is for our San Diego Research and Design Center, which is expected to open in 2022. The majority of our 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 or terminate is only included in the lease term if the Company is reasonably certain of exercising that option. Operating lease ROU assets are presented within other assets-net on the consolidated balance sheet. 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 consolidated balance sheet. Short-term leases with an initial term of 12 months or less are not recorded on the consolidated balance sheet. 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 Year Ended December 31, For the Year Ended December 31, For the Year Ended December 31, 2019 Operating lease cost $ 706 $ 1,179 $ 1,108 Short-term operating lease cost 335 — 36 Total operating lease cost $ 1,041 $ 1,179 $ 1,144 Supplemental cash flow information related to operating leases was as follows: For the Year Ended December 31, For the Year Ended December 31, Cash paid for amounts included in the measurement of lease liabilities $ 1,237 $ 1,313 ROU assets obtained in exchange for lease obligations 57 242 Supplemental balance sheet information related to operating leases was as follows: Balance Sheet Classification Balance at December 31, Balance at December 31, Assets: Right-of-use assets Other assets - net $ 876 $ 1,425 Liabilities: Current Accrued expenses $ 294 $ 650 Noncurrent Other long-term liabilities 947 1,200 Total operating lease liabilities $ 1,241 $ 1,850 The weighted-average remaining lease terms and discount rates were as follows: For the Year Ended December 31, For the Year Ended December 31, Weighted-average remaining lease term (years) 6.3 5.5 Weighted-average discount rate 5.09 % 4.92 % As of December 31, 2021, maturities of operating lease liabilities were as follows: Maturity of Operating Lease Liabilities Balance at December 31, 2022 $ 374 2023 217 2024 173 2025 161 2026 159 2027 and beyond 398 Total future minimum lease payments 1,482 Less imputed interest (241) Total $ 1,241

Discontinued Operations

Discontinued Operations	12 Months Ended
	Dec. 31, 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 consolidated statements of comprehensive income/(loss). There were no assets or liabilities of the OEM Business as of year(s) ended December 31, 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. In accordance with the terms and conditions in the OEM Purchase Agreement and approved by respective lenders, on July 20, 2020, the Company (i) paid in full its $80.0 million revolving credit facility under the 2018 Credit Agreement; (ii) terminated the 2018 Credit Agreement; (iii) paid in full its $100.0 million term loan and $30.0 million incremental term loan commitment under the 2019 Credit Agreement; and (iv) terminated the 2019 Credit Agreement. The related obligations as of December 31, 2019, as well as the related interest expense and debt issuance costs for the years ended December 31, 2021, 2020 and 2019 related to these loans have been included in the discontinued operations. The following table presents the financial results of the discontinued operations: Year Ended December 31, Year Ended December 31, Year Ended December 31, 2021 2020 2019 Major classes of line items constituting net income from discontinued operations: Revenues $ — $ 87,192 $ 190,961 Costs of goods sold — 49,678 104,482 Gross profit — 37,514 86,479 Expenses: General and administrative — 12,889 22,279 Severance and restructuring costs — 604 — Transaction and integration expenses — 23,598 3,160 Total operating expenses — 37,091 25,439 Operating income — 423 61,040 Other expense (income): OEM working capital adjustment 6,316 — — Interest expense — 14,965 12,571 Loss on extinguishment of debt — 2,686 — Derivative loss — 12,641 — Foreign exchange (gain) loss — (3) 17 Total other expense - net 6,316 30,289 12,588 (Loss) income from discontinued operations (6,316) (29,866) 48,452 Gain on sale of net assets of discontinued operations — 209,800 — (Loss) Income from discontinued operations before income tax provision (6,316) 179,934 48,452 Income tax (benefit) provision (2,674) 19,522 11,316 Net (loss) income on discontinued operations $ (3,642) $ 160,412 $ 37,136 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 general and administrative expenses in discontinued operations include corporate costs incurred directly to solely support the Company’s OEM Businesses. 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. On 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 consolidated statements of comprehensive income/(loss). Total operating and investing cash flows of discontinued operations for the years ended December 31, 2021, 2020, and 2019 are comprised of the following, which exclude the effect of income taxes: Year Ended December 31, Year Ended December 31, Year Ended December 31, 2021 2020 2019 Significant operating non-cash reconciliation items: Depreciation and amortization $ — $ 2,125 $ 4,466 Provision for bad debts and product returns $ — $ 456 $ 101 Provision for inventory write-downs $ — $ — $ 6,340 Revenue recognized due to change in deferred revenue $ — $ (2,618) $ (4,906) Deferred income tax (benefit) provision $ — $ (1,609) $ (3,989) Stock-based compensation $ — $ 792 $ 540 Gain on sale of discontinued assets, net $ — $ (209,800) $ — Paid in kind interest expense $ — $ — $ 4,408 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) $ (6,866) Patent and acquired intangible asset costs $ — $ (419) $ (578) Proceeds from sale of OEM Businesses $ — $ 437,097 $ —

Revenue from Contracts with Cus

Revenue from Contracts with Customers	12 Months Ended
	Dec. 31, 2021
Revenue from Contract with Customer [Abstract]
Revenue from Contracts with Customers	Revenue from Contracts with Customers Disaggregation of Revenue The Company’s entire revenue for the years ended December 31, 2021, 2020, and 2019, were recognized at a point in time. The following table represents total revenue by geographical region for the years ended December 31, 2021, 2020 and 2019: Year Ended December 31, 2021 Year Ended December 31, 2020 Year Ended December 31, 2019 Revenues: Domestic $ 77,927 $ 85,612 $ 97,703 International 12,573 16,137 19,720 Total revenues from contracts with customers $ 90,500 $ 101,749 $ 117,423

Business Combinations and Acqui

Business Combinations and Acquisitions	12 Months Ended
	Dec. 31, 2021
Business Combination and Asset Acquisition [Abstract]
Business Combinations and Acquisitions	Business Combinations and Acquisitions Inteneural Networks Inc. On December 30, 2021, the Company entered into a Stock Purchase Agreement with Dearborn Capital Management LLC, and Neva, LLC, a Delaware limited liability company (collectively the sellers of INN), that are owned by Krzysztof Siemionow, MD, PhD (“Siemionow”), Pawel Lewicki, PhD ("Lewicki") respectively to acquire a 42% equity interest in the issued and outstanding shares of INN for a non-exclusive right to use their proprietary technology. Lewicki is a member of the Board of Directors (the “Board”) and Siemionow is the Company's Chief Medical Officer. INN is a medical high-tech company, specializing in AI and big data learning analysis of brain imaging. INN has a proprietary AI technology that autonomously segments and identifies neural structures in medical images and helps identify possible pathological states. This technology has future applications in neurosurgery as well as the potential to address a wide variety of potential disorders, including dementia, autism, tumors, aneurysm, stroke, and neurovascular structures using magnetic resonance imaging and computed tomography platforms. The Company believes the transaction has the following benefits: i) the integration of INN’s ML and AI technologies positions the Company as a leader in intelligent digital health; ii) bringing INN’s intercranial capabilities to the HOLO TM platform, the Company can expand the applicability of HOLO TM AI technology into significant segments beyond spine, in particular neurosurgery; iii) the synergies in the research and development and eventual commercial functions should provide for a particularly efficient integration of INN’s technology and talent; and iv) the transaction materially contributes to the Company's mission to improve patient's lives through better outcomes. As consideration for the 42% ownership we paid $19.9 million which consisted of $5.0 million in cash, issuance to the Sellers of 6,820,792 shares of our common stock, par value of $0.001, which had a fair value of $4.9 million and issuance of unsecured promissory notes to the Sellers in fair value of the principal in the amount of $10.0 million. In exchange for 42% equity interest the Company is able to use the proprietary AI technology as a nonexclusive licensee. As part of the transaction, the Company must purchase up to 100% of the equity of INN if the three additional clinical, regulatory, and revenue milestones are met. With each additional closing, the Company will acquire an additional 19.3% equity within INN for an additional $19.3 million in cash payment for each milestone. Management has determined that the Company has obtained control through means other than voting rights as the Company is deemed to be the primary beneficiary and is the most closely associated decision maker under ASC 810, Consolidation. Based on this the Company has considered INN to be a VIE and has fully consolidated INN into the consolidated financial statements as of December 31, 2021. INN does not have any assets or liabilities as of December 31, 2021. The Company further determined that substantially all of the fair value of INN was concentrated in the acquired in-process research and development ("IPR&D") asset in accordance with ASC 805, Business Combination and therefore accounted for this as an asset acquisition. The total consideration of the asset acquisition was determined to be $72.3 million, which consisted of cash consideration of $5.0 million, $4.9 million of fair value of shares issued to the seller, $10.0 million of seller notes issued to the sellers, direct and incremental expenses of $0.4 million incurred for the INN acquisition, $10.3 million in forward contracts related to the three potential milestone payments and $41.7 million in noncontrolling interest related to the 58% equity interest not purchased. The total purchase price paid in the INN acquisition has been allocated to the net assets acquired based on the relative fair value as the completion of the acquisition, primarily including the IPR&D related to INN's development of their AI technology that autonomously segments neural structures and other intangible assets for assembled workforce. The neuro networks and segmentation has not yet reached technological feasibility and has no alternative use; thus, the purchased IPR&D was expensed immediately to the acquisition, resulting in a one-time charge of $72.1 million recognized in the asset acquisition expense line on the consolidated statement of comprehensive loss for the year ended December 31, 2021. Additionally, the intangible asset related to the assembled workforce, in the amount of $0.2 million was immediately impaired together with other intangible assets during the fourth quarter of 2021 due to the Company's negative projected cash flows. The Company recorded non controlling interest of $52.0 million which is comprised of $41.7 million related to the investment in INN and $10.3 million related to the embedded forward contracts. Management determined that because the IPR&D asset was immediately expensed as it did not have technological feasibility. As a result of the transaction, the company recorded a $72.1 million loss within the consolidated Statements of Comprehensive Loss for the year ended December 31, 2021. This loss has a net impact of $30.2 million to Surgalign, and $41.9 million impact to INN. Prompt Prototypes Acquisition On April 30, 2021, the Company, entered into an Asset Purchase Agreement (the “Agreement”) with Prompt Prototypes LLC (“Prompt”). 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 agreement 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 the seller, contingent on the continued employment with the Company, in the form of cash and restricted shares in two equal amounts on the 18th and 36th 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): Balance at April 30, 2021 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 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) for the year ended December 31, 2021. The bargain purchase was primarily driven by the potential future compensation expense in lieu of an increased purchase price. Purchase accounting has been finalized and no adjustments were made to those amounts originally recorded. 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, following the closing, the Seller will be entitled to receive contingent consideration from the Company valued in an aggregate amount of up to $83 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 (6 th ) 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 (or otherwise, to the extent a lower number, the maximum number of shares of Common Stock that would not require obtaining stockholder approval under the applicable rules of the Nasdaq Stock Market). 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 trading periods 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 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 shall be 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 $51.9 million as of December 31, 2021, with $25.6 million classified as current liabilities within the "Accrued expenses" while $26.3 million is included as "other long-term liabilities" in the Company’s accompanying consolidated balance sheets. The fair value of the liability was $56.5 million as of December 31, 2020, with $9.0 million classified as current liabilities within the "Accrued expenses" while $47.5 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 $4.6 million and ($4.7 million) gain/(loss) for the periods ending December 31, 2021 and 2020, respectively and was recognized in the loss (gain) on acquisition contingency line of the consolidated statements of comprehensive loss. The total purchase price paid in the Holo Surgical Acquisition has been allocated to the net assets acquired based on their relative fair value as of the completion of the acquisition, primarily including the IPR&D related to Holo Surgical’s development of the HOLO™ platform and other intangible asset for assembled workforce. The HOLO™ platform has not yet reached technological feasibility and has no alternative future use; thus, the purchased IPR&D was expensed immediately subsequent to the acquisition, result in a one-time charge of $94.5 million recognized in the asset acquisition expenses line of the consolidated statements of comprehensive loss for the year ended December 31, 2020. Additionally, the intangible asset related to the assembled workforce was immediately impaired together with other intangible assets on the date of the acquisition in 2020 due to the Company’s negative projected cash flow. The related expense of $0.5 million was also included in the asset acquisition expenses. On January 12, 2022 the Company entered into a Second Amendment to the Stock Purchase Agreement with the sellers of Holo Surgical to amendment one of the regulatory milestones beyond December 31, 2021. This regulatory milestone was subsequently achieved on January 14, 2022 when the Company received 510(k) clearance for Holo. Upon achievement of this milestone the Company issued 8,650,000 in common stock at a value of $5.9 million, and also paid the sellers $4.1 million in cash for a total payment for achieving the milestone of $10.0 million pursuant to the terms of the agreement. Paradigm Spine Acquisition On March 8, 2019, pursuant to the Master Transaction Agreement (the “Master Transaction Agreement”), dated as of November 1, 2018, by and among Legacy RTI, PS Spine Holdco, LLC, a Delaware limited liability company (“PS Spine”), the Company, and Bears Merger Sub, Inc., a Delaware corporation and direct wholly owned subsidiary of the Company (“Merger Sub”), the Company acquired all of the outstanding equity interests of Paradigm, through a transaction in which: (i) PS Spine contributed all of the issued and outstanding equity interests in Paradigm to the Company (the “Contribution”); (ii) Merger Sub merged with and into Legacy RTI (the “Merger”), with Legacy RTI surviving as a wholly owned direct subsidiary of the Company; and (iii) the Company was renamed “RTI Surgical Holdings, Inc.” (collectively, the “Transaction”). Legacy RTI retained its existing name “RTI Surgical, Inc.” Pursuant to the Master Transaction Agreement: (i) each share of common stock, par value $0.001 per share, of Legacy RTI issued and outstanding immediately prior to the Transaction (other than shares held by Legacy RTI as treasury shares or by the Company or Merger Sub immediately prior to the Transaction, which were automatically cancelled and ceased to exist) was converted automatically into one fully paid and non-assessable share of Company common stock , par value $0.001 per share; (ii) each share of Series A convertible preferred stock, par value $0.001 per share, of Legacy RTI issued and outstanding immediately prior to the Transaction (other than shares held by Legacy RTI as treasury shares or by the Company or Merger Sub immediately prior to the Transaction, which were automatically cancelled and ceased to exist) was converted automatically into one fully paid and non-assessable share of Series A convertible preferred stock, par value $0.001 per share, of the Company; and (iii) each stock option and restricted stock award granted by Legacy RTI was converted into a stock option or restricted stock award, as applicable, of the Company with respect to an equivalent number of shares of the Company common stock on the same terms and conditions as were applicable prior to the closing. The consideration for the Contribution was $100.0 million (the “Cash Consideration Amount”) in cash and 10,729,614 shares of Company common stock (the “Stock Consideration Amount”). The Cash Consideration Amount was adjusted by Paradigm’s working capital of $7.0 million. In addition to the Cash Consideration Amount and the Stock Consideration Amount, the Company may be required to make further cash payments or issue additional shares of Company common stock to PS Spine in an amount up to $50.0 million of shares of Company common stock to be valued based upon the Legacy RTI Price and an additional $100.0 million of cash and/or Company common stock to be valued at the time of issuance, in each case, if certain revenue targets are achieved between closing, March 8, 2019, and December 31, 2022. The first two milestones were not met as of December 31, 2021 and the Company has no remaining obligation related to them. The third revenue milestone is revalued at each reporting period using Level 3 inputs, which includes weighted average cost of capital and projected revenues and costs. The estimated contingent liability as of December 31, 2021, related to this milestone is $0.0 million. The Company has accounted for the acquisition of Paradigm under ASC 805, Business Combinations (“ASC 805”). Paradigm’s results of operations are included in the consolidated financial statements beginning after March 8, 2019, the acquisition date. The purchase price was financed as follows: Cash proceeds from second lien credit agreement $ 100,000 Fair market value of securities issued 60,730 Fair market value of contingent earnout 72,177 Total purchase price $ 232,907 In the first quarter of 2019, the Company completed its valuations and purchase price allocation. The table below represents the final allocation of the total purchase price to Paradigm’s tangible and intangible assets and liabilities fair values as of March 8, 2019. Balance at March 8, Cash $ 307 Accounts receivable 5,220 Inventories 17,647 Other current assets 934 Property, plant and equipment 379 Other non-current assets 1,079 Current liabilities (6,169) Lease liabilities (1,079) Net tangible assets acquired 18,318 Other intangible assets 79,000 Goodwill 135,589 Total net assets acquired $ 232,907 As of March 8, 2019, the inventory fair value was composed of current inventory of $7.1 million and non-current inventory of $10.5 million. Total net assets acquired as of March 8, 2019, were included in the Company’s only operating segment at that time. Fair values are based on management’s estimates and assumptions including variations of the income approach, the cost approach, and the market approach. The Company believes that the acquisition of Paradigm, a spine focused business, offers the potential for substantial strategic and financial benefits. The transaction further advances the Company’s strategic transformation focused on reducing complexity, driving operational excellence, and accelerating growth. The Company believes the acquisition will enhance stockholder value through, among other things, enabling the Company to capitalize on the following strategic advantages and opportunities: • Paradigm will strengthen the Company’s spine portfolio with the addition of the Coflex ® Interlaminar Stabilization ® device. The Coflex ® device is a differentiated and minimally invasive motion preserving stabilization implant that is FDA PMA-approved for the treatment of moderate to severe lumbar spinal stenosis (“LSS”) in conjunction with decompression. • The Coflex ® device allows the Company to provide surgeons who treat patients with moderate to severe LSS with a PMA-approved device supported by more than 12 years of clinical data. These potential benefits resulted in the Company paying a premium for Paradigm resulting in the recognition of $135.6 million of goodwill, which was subsequently impaired in 2019. The following unaudited pro forma information shows the results of the Paradigm’s operations as though the acquisition had occurred as of the beginning of the prior comparable period, January 1, 2018, (in thousands): For the Year Ended December 31, 2019 Revenues $ 37,374 Net loss applicable to common shares (16,547) The pro forma results have been prepared for comparative purposes only and are not necessarily indicative of the actual results of operations had the acquisition taken place as of the beginning of the periods presented, or the results that may occur in the future.

Stock-Based Compensation

Stock-Based Compensation	12 Months Ended
	Dec. 31, 2021
Share-based Payment Arrangement [Abstract]
Stock-Based Compensation	Stock-Based Compensation The Company has four active stock-based compensation plans: the 2021 Incentive Compensation Plan, the 2021 Inducement Plan, the 2021 Employee Stock Purchase Plan ("ESPP"), and the 2018 Incentive Compensation Plan. The Company accounts for its stock-based compensation plans in accordance with ASC 718. The Company grants stock-based awards to its employees, including officers and directors, comprised of restricted stock, restricted stock units, stock options and ESPP purchase rights. Employee Equity Plans 2021 Incentive Compensation Plan On May 7, 2021, the Company’s stockholders approved and adopted the 2021 Incentive Compensation Plan (the "Incentive Plan"). The Incentive Plan permits the grant of stock options, stock appreciation rights, restricted stock, restricted stock units and performance shares to our officers, directors, employees, and consultants of the Company. The plan allows for up to 5,842,608 shares of common stock to be issued with respect to awards granted. 2021 Inducement Compensation Plan On May 7, 2021, the Company’s stockholders approved and adopted the 2021 Inducement Plan (the "Inducement Plan"). The Inducement Plan purpose is to advance the interests of the Company by providing a material inducement for the best available individuals to join the Company and its subsidiaries as employees by affording such individuals an opportunity to acquire a proprietary interest in the Company. The Inducement Plan permits the grant of stock appreciation rights, restricted stock, restricted stock units and performance shares to our officers, directors, employees, and consultants of the Company. The plan allows for up to 4,500,000 shares of common stock to be issued with respect to awards granted. 2018 Incentive Compensation Plan On April 30, 2018, the Company’s stockholders approved and adopted the 2018 Incentive Compensation Plan (the “2018 Plan”). The 2018 Plan provides for the grant of incentive and non-qualified stock options, restricted stock, and restricted stock units to key employees, including officers and directors of the Company. The 2018 Plan allows for up to 5,726,035 shares of common stock to be issued with respect to awards granted. Employee Stock Purchase Plan On May 7, 2021, our board of directors adopted the ESPP, which became effective July 1, 2021. Under our ESPP, employees can purchase shares of our common stock based equal to no less than 1% of the employee's compensation, up to a maximum of 15%, subject to certain limits. The offering period is every six-month period beginning January 1st and July 1st of each year. The ESPP offers a six-month look-back feature. The purchase price per share is equal to the lower of 85% of the fair market value of our common stock on the offering date or the purchase date. ESPP purchases are settled with common stock from the ESPP’s previously authorized and available pool of shares. During 2021, 667,399 shares were issued under the ESPP for $0.4 million. A total of 5,000,000 million shares of common stock have been authorized for issuance under the ESPP, and there were 4,332,601 million shares available for issuance under the ESPP as of December 31, 2021. Impact on Net Loss For the years ended December 31, 2021, 2020, and 2019, the Company recognized stock-based compensation related to equity-classified awards as follows: For the Year Ended December 31, 2021 2020 2019 Stock-based compensation: Costs of goods sold $ 21 $ 169 $ 144 General and administrative 4,839 3,980 3,623 Research and development 352 72 60 Transaction and integration expenses — 1,515 — Total $ 5,212 $ 5,736 $ 3,827 Stock Options The Company’s policy is to grant stock options at an exercise price equal to 100% of the market value of a share of common stock at closing on the date of the grant. The Company’s stock options generally have five one As of December 31, 2021, there was $1.7 million of total unrecognized stock-based compensation expense related to nonvested stock options. That expense is expected to be recognized over a weighted-average period of 3 years. Stock options outstanding, exercisable and available for grant at December 31, 2021, are summarized as follows: Number of Weighted Weighted Aggregate (in thousands, except for share and per share information) Outstanding at January 1, 2021 4,979,180 $ 3.28 5.30 $ 142 Granted 776,564 1.82 Exercised (1,007) 2.69 Forfeited or expired (423,517) 3.29 Outstanding at December 31, 2021 5,331,220 $ 3.08 4.43 $ — Vested or expected to vest at December 31, 2021 5,331,220 $ 3.08 4.43 $ — Exercisable at December 31, 2021 3,487,657 $ 3.37 2.15 $ — Available for grant at December 31, 2021 5,777,619 The aggregate intrinsic value in the table above represents the total pre-tax intrinsic value of stock options for which the fair market value of the underlying common stock exceeded the respective stock option exercise price. Other information concerning stock options are as follows: For the Year Ended December 31, 2021 2020 2019 (in thousands, except for per share information) Weighted average fair value of stock options granted $ 0.93 $ 1.21 $ 1.56 Aggregate intrinsic value of stock options exercised $ — $ 3.20 $ 161.00 The aggregate intrinsic value of stock options exercised in a period represents the pre-tax cumulative difference, for the stock options exercised during the period, between the fair market value of the underlying common stock and the stock option exercise prices. The following weighted-average assumptions were used to determine the fair value of options and purchases under ASC 718: Year Ended December 31, 2021 2020 2019 Expected term (years) 6.35 6.50 6.50 Risk free interest rate 0.72 % 0.62 % 2.54 % Volatility factor 49.97 % 41.62 % 37.73 % Dividend yield — — — Employee Stock Purchase Plan The following weighted-average assumptions were used to determine the fair value of ESPP and purchases under ASC 718: Year Ended December 31, 2021 2020 2019 Expected term (years) 0.50 0.00 0.00 Risk free interest rate 0.05 % — — Volatility factor 84.32 % — — Dividend yield — % — — Restricted Stock Awards The Company’s policy is to grant restricted stock awards at a fair value equal to 100% of the market value of a share of common stock at closing on the date of the grant. The Company’s restricted stock awards generally vest over one-year to three-year periods. The value of restricted stock awards that do not have market conditions is determined by the market value of the Company’s common stock at the date of grant. In 2021, restricted stock awards in the amount of 147,719 shares and 0 shares of restricted stock were granted to employees and non-employee directors, respectively. As of December 31, 2021, there was $1.4 million of total unrecognized stock-based compensation related to unvested restricted stock awards. That expense is expected to be recognized on a straight-line basis over a weighted-average period of 1.44 years. The following table summarizes information about unvested restricted stock awards as of December 31, 2021: Number of Weighted Unvested at January 1, 2021 1,897,196 $ 3.47 Granted 147,719 2.06 Vested (1,037,528) 3.68 Forfeited (353,133) 3.35 Unvested at December 31, 2021 654,254 $ 2.89 The fair market value of restricted stock awards vested in 2021, 2020, and 2019 was $1.9 million, $3.0 million and $2.36 million, respectively. Restricted Stock Units The Company’s policy is to grant restricted stock units at a fair value equal to 100% of the market value of a share of common stock at closing on the date of the grant. The Company’s restricted stock units generally vest over one-year to three-year periods. The value of restricted stock units is determined by the market value of the Company’s common stock at the date of grant. As of December 31, 2021, there was $5.5 million of total unrecognized stock-based compensation expense related to unvested restricted stock units. That expense is expected to be recognized on a straight-line basis over a weighted-average period of 1.92 years. The following table summarizes information about unvested restricted stock units as of December 31, 2021: Number of Weighted Unvested at January 1, 2021 89,935 $ 7.41 Granted 5,541,313 1.64 Vested (30,783) 1.73 Forfeited (800,102) 2.18 Unvested at December 31, 2021 4,800,363 $ 1.66 Inducement Grant President, Global Spine On November 29, 2019, the Company issued an inducement grant to its President of Global Spine, now CEO of the Company, Mr. Terry Rich. This grant was in the form of: (1) a restricted stock award agreement (the “Restricted Stock Agreement”); and (2) a stock option agreement. This inducement grant was made under the RTI Surgical Holdings, Inc., Terry Rich Reserve Compensation Plan. Under the Restricted Stock Agreement, the Company granted Mr. Rich 125,598 shares of restricted stock. On the first anniversary of the Grant Date, 41,866 shares will vest. The remaining shares will vest on the last day of each calendar quarter at a rate of 10,467 shares per calendar quarter commencing on the fifteen month following the Grant Date and continuing for two years year after. Vesting of these shares may accelerate upon the occurrence of certain conditions. Under the Option Agreement, the Company granted Mr. Rich the option to purchase 188,397 shares of common stock (the “Stock Options”), as of the grant date. The exercise price for the Stock Options is $2.09. On the first anniversary of the grant date, 62,799 vested The remaining shares vest on the last day of each calendar quarter at a rate of 15,700 shares per calendar quarter commencing on the fifteen month following the grant date and continuing for two years after. The vesting of the Stock Options is cumulative. Former Chief Financial and Administrative Officer On September 18, 2017, the Company issued an inducement grant to its former Chief Financial and Administrative Officer, Mr. Jonathon Singer. This grant was in the form of: (1) a restricted stock award agreement (the “Restricted Stock Agreement”); and (2) a stock option agreement. This inducement grant was made under the RTI Surgical, Inc. 2015 Incentive Compensation Plan, which was filed with the SEC on May 5, 2015. Under the Restricted Stock Agreement, the Company granted Mr. Singer 109,890 shares of restricted stock. All of the shares granted to Mr. Singer under the Restricted Stock Agreement have fully vested. Under the Option Agreement, the Company granted Mr. Singer the option to purchase 306,900 shares of common stock, as of the grant date. The exercise price for the stock options is $4.55 per share. The stock options will expire on September 18, 2027. The stock options will vest based on the Company’s attainment of three average stock price benchmarks. The first 102,300 shares will vest if the Company’s average publicly traded stock price is over $7.00 per share for a sixty-consecutive calendar day period. The next 102,300 shares will vest if the Company’s average publicly traded stock price is over $8.00 per share for a sixty-consecutive calendar day period. The final 102,300 shares will vest if the Company’s average publicly traded stock price is over $9.00 per share for a sixty-consecutive calendar day period. The vesting of the stock options is cumulative. Former President and Chief Executive Officer On January 26, 2017, the Company issued an inducement grant to its President and Chief Executive Officer, Mr. Camille Farhat. This grant was in the form of: (1) a restricted stock award agreement (the “Restricted Stock Agreement #1”); (2) another restricted stock award agreement (the “Restricted Stock Agreement #2”); and (3) a stock option agreement. Under the Restricted Stock Agreement #1, the Company granted Mr. Farhat 850,000 shares of restricted common stock. On December 4, 2017, the Company and Mr. Farhat entered into the First Amendment to the Restricted Stock Agreement #1 (the “Amendment”). The Amendment revised the vesting conditions for the Company’s common stock (the “Common Stock”), granted under the Restricted Stock Agreement #1. Under the Restricted Stock Agreement #2, the Company granted Mr. Farhat 150,000 shares of restricted common stock. All of the shares granted to Mr. Farhat under the Restricted Stock Agreement #1, as amended, and the Restricted Stock Agreement #2 have fully vested. Under the Option Agreement, the Company granted Mr. Farhat the option to purchase 1,950,000 shares of common stock. The exercise price for the stock options is $3.20. The stock options expired on January 26, 2022 with no further vesting.

Inventories

Inventories	12 Months Ended
	Dec. 31, 2021
Inventory Disclosure [Abstract]
Inventories	Inventories The inventory balances as of December 31, 2021 and 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 years ended December 31, 2021, 2020, and 2019, the Company recognized costs related to inventory write-downs of $9.1 million, $17.7 million, and $2.2 million, respectively, relating primarily to excess quantities and obsolescence (“E&O”) of inventories. The E&O write-downs are included in the cost of goods sold. The Company was made aware in December 2020 that its former OEM Businesses recalled the Cervalign ACP System (“Cervalign”). The Company received the official notice in January 2021 and recalled all of the inventory which was held at the distributors. The Company worked with the former OEM Business to address the issue and has relaunched the product as of the end of 2021. The Company fully reserved the entire Cervalign inventory as of December 31, 2020, resulting in a charge of $2.2 million in 2020 .

Prepaid and Other Current Asset

Prepaid and Other Current Assets	12 Months Ended
	Dec. 31, 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: For the Year Ended December 31, 2021 2020 Insurance Recovery Receivable $ 1,500 $ — Income tax receivable 4,116 4,836 Prepaid expenses 2,553 1,543 Other Receivable 815 3,905 Total Prepaid and Other Current Assets $ 8,984 $ 10,284

Property and equipment

Property and equipment	12 Months Ended
	Dec. 31, 2021
Property, Plant and Equipment [Abstract]
Property and equipment	Property and equipment Property and equipment are as follows: For the Year Ended December 31, 2021 2020 Processing equipment $ 346 $ 35 Surgical instruments 489 440 Office equipment, furniture and fixtures 15 34 Computer equipment and software 44 12 Construction in process $ 51 — Total Property and equipment $ 945 $ 521 For the years ended December 31, 2021, 2020, and 2019, the Company had depreciation expense in connection with property and equipment of $2.5 million, $3.6 million, and $7.7 million, respectively. For the year ended December 31, 2021, the Company recorded asset impairment and abandonment charges of $11.0 million for property and equipment. Refer to Note 14 for further information on impairment. The Company uses the straight-line method of depreciation. As of December 31, 2021 and December 31, 2020, the Company capitalized a total of $4.5 million and $0.0 million of internal software expense related to the implementation of a new Enterprise Resource Planning ("ERP") system. As part of the impairment analysis the company impaired $4.4 million of these costs as of December 31, 2021. This impairment is recorded within the "Asset impairment and abandonments" line on the consolidated statements of comprehensive loss. The impairment charges were triggered by continued negative operating cash flows. The net capitalized costs of $0.1 million is considered "Construction in process" as the Company was still within the application and development stage of the project as of December 31, 2021. These amounts are included within "Property and equipment - net" on the Consolidated Balance Sheet as of December 31, 2021. For the year end December 31, 2021, the company expensed $0.1 million for ERP implementation which were not capitalized as these costs were incurred prior to the application and development stage of the project. These non-capitalizable expenses are recorded in the “General and administrative” line on the consolidated statements of comprehensive loss.

Debt

Debt	12 Months Ended
	Dec. 31, 2021
Debt Disclosure [Abstract]
Debt	Debt On December 30, 2021, the Company issued $10.6 million aggregate principal amount of unsecured seller notes (“Seller Notes”) recorded at fair value of $10.0 million as it was issued in conjunction with the acquisition of the equity interest in INN. All principal and accrued interest due and payable on the earlier of December 30, 2024, or the date upon which a change in control occurs. Interest is paid in kind and capitalized into the principal amount of the Seller Notes on each anniversary of the issuance date at a rate of 6.8% per year. In the event of default, as defined in the agreement, any and all of the indebtedness may be immediately declared due and payable, and the interest would accrue at a 4.0% higher rate. There is no prepayment penalty or covenants related to the fixed rate notes. The Seller Notes were issued as deferred consideration in connection with the INN Purchase Agreement discussed at note 1, note 7 and note 26. Debt issuance costs were immaterial and were included within the overall costs of the acquisition of INN. Related costs were expensed under "Asset acquisition expenses" in our consolidated statements of comprehensive income/(loss). The fair value of the Seller Notes is $10.0 million at December 31, 2021. Carrying Value (In thousands) Seller Notes-P. Lewicki $ 5,306 Seller Notes-K. Siemionow 5,306 Less: fair value adjustment (630) Total Seller Notes - related party 9,982 Current portion of seller notes — Total long-term seller note, excluding current portion $ 9,982 As of December 31, 2021, the future maturities of long-term debt, excluding deferred financing costs, accrued interest and debt discount, were as follows (in thousands): 2022 $ — 2023 — 2024 10,612 2025 — 2026 — Thereafter — Total $ 10,612

Net Loss Per Common Share

Net Loss Per Common Share	12 Months Ended
	Dec. 31, 2021
Earnings Per Share [Abstract]
Net Loss Per Common Share	Net Loss Per Common Share The number of shares of common stock used in the calculation of basic and diluted net loss per common share is presented below: For the Year Ended December 31, 2021 2020 2019 Weighted average basic and dilutive shares 122,592,569 74,403,155 70,150,492 For the years ended December 31, 2021, 2020 and 2019, the Company 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 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 Year Ended December 31, 2021 2020 2019 Stock Option (1) — 271,351 345,154 RSU and RSA 3,202,888 1,099,018 821,888 Convertible Series A Preferred Stock — 8,400,512 15,152,761 Total 3,202,888 9,770,881 16,319,803 (1) The number of potential dilutive shares does not include out-of-the-money stock options as their exercise prices were above the average stock price during the period.

Fair Value Information

Fair Value Information	12 Months Ended
	Dec. 31, 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. Fair value is assessed each reporting period, or more frequently, if circumstances dictate the need to revalue amounts recorded. The carrying value of cash and cash equivalents, accounts receivable, inventories, prepaid and other current assets, accounts payable and accrued expenses are reasonable estimates of their fair values, due to the short-term nature of the accounts. Management has determined that the company's contingent consideration resulting from its acquisitions, property and equipment, definite-lived intangibles assets. other assets, and warrant liability are within the level 3 fair value hierarchy and are measured using Level 3 inputs as described below. Contingent Consideration Changes in the fair value of contingent consideration are recorded in the "Loss (gain) on acquisition contingency" line in the consolidated statements of 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. On October 23, 2020, the Company acquired Holo Surgical with $83.0 million (valued $51.9 million as of December 31, 2021) of the consideration being contingent upon the achievement of certain regulatory, commercial and utilization milestones (the "Holo Milestone Payment"). The Company determined the fair value of the Holo Milestone Payments to be the present value of each future payment amount estimated using a probability-weighted model, driven by the probability of success factor and expected payment date. The probability of success factor was used in the fair value calculation to reflect inherent regulatory, development and commercial risk of the Holo Milestone Payments. More specifically, the probability of expected achievement of the specific milestones, including risks associated with the uncertainty regarding the achievement and payment of milestones; obtaining regulatory approvals in the United States and Europe; the development of new features used with the product; the adaption of the new technology by surgeons; and the placement of the devices within the field. 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. Inputs used in estimating the fair value of the contingent consideration for Holo Surgical as of December 31, 2021 and 2020, are summarized below: Fair Value at December 31, 2021 Valuation Technique Unobservable Inputs Ranges $51,928 Earn-Out Valuation Probability of success factor 0% - 90% Discount rates 0.06% - 11.60% Fair Value at December 31, 2020 Valuation Technique Unobservable Inputs Ranges $56,515 Earn-Out Valuation Probability of success factor 60% - 90% Discount rates 0.11% - 16.86% On March 8, 2019, the Company acquired Paradigm as further explained in Note 7, which included a contingent liability related to the revenue based earnout ("Paradigm Earnout") of $72.2 million. The fair value of the contingent liability was measured using Level 3 inputs. Unobservable inputs for the probability-weighted model included weighted average cost of capital and company specific projected revenue and costs. During 2019 management reduced the contingency consideration to $0.0 million due to a revision in the milestone inputs and recorded a gain of $72.2 million which was recognized and is included in gain on acquisition contingency in the consolidated statement of comprehensive loss for the year ended December 31. 2019. There are no amounts recorded as contingent consideration as of December 31, 2021 or 2020. On January 4, 2018, the Company acquired Zyga Technology, Inc. ("Zyga"). As of December 31, 2019, based on a probability-weighted model. the Company estimated a contingent liability related to the clinical and revenue milestone ("Zyga Milestone Payments") of $1.1 million. The fair value of the contingent liability was measured using Level 3 inputs. Unobservable inputs for the probability-weighted model included weighted average cost of capital and company-specific projected revenue and costs. 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 Zyga Milestone Payment was reduced to zero and an additional gain of $1.0 million was recognized and is included in gain on acquisition contingency in the consolidated statement of comprehensive loss as of December 31, 2020, and the liability continues to be zero as of December 31, 2021. The following table provides a reconciliation of contingent consideration measured at fair value using significant unobservable inputs (Level 3) for the years ended December 31, 2021 and 2020, (in thousands): 2021 2020 Beginning balance as of January 1 $ 56,515 $ 1,130 Contingent consideration – Holo Milestone Payments — 50,632 (Gain) loss - Holo & Zyga (4,587) 4,883 Other — (130) Ending balance as of December 31 $ 51,928 $ 56,515 Property and Equipment, Definite-Lived Intangibles and Other Assets As further discussed in Note 11, as of December 31, 2021 and 2020, respectively, property and equipment with a carrying amount of $12.0 million and $12.2 million were written down to their estimated fair value of $0.9 million and $0.5 million using Level 3 inputs. The Level 3 fair value was measured based on orderly liquidation value and is evaluated on a quarterly basis. Unobservable inputs for the orderly liquidation value included replacement costs, physical deterioration estimates and market sales data for comparable assets. Definite-lived intangible and other assets subject to amortization were impaired and written down to their estimated fair values in 2021 and 2020. Fair value is measured as of the impairment date using Level 3 inputs. Definite-lived intangible assets and other assets’ fair value was measured based on the income approach and orderly liquidation value, respectively. Because the Company’s forecasted cash flow being negative, any intangible assets acquired during the year was immediately impaired. Unobservable inputs for the orderly liquidation value included replacement costs, physical deterioration estimates and market sales data for comparable assets. Unobservable inputs for the income approach included forecasted cash flows generated from use of the definite-lived intangible assets. As a result of impairments recognized, the following table summarizes the post impairment fair values of the corresponding assets subject to fair value measured using Level 3 inputs for the years ended December 31, 2021 and 2020, and the corresponding impairment charge during the respective year: For the Year Ended December 31, 2021 Impairment Fair Value Property and equipment - net $ 11,018 $ 945 Definite-lived intangible assets - net 782 — Other assets - net 395 6,970 Total $ 12,195 $ 7,915 For the Year Ended December 31, 2020 Impairment Fair Value Property and equipment - net $ 11,707 $ 521 Definite-lived intangible assets - net 2,621 — Other assets - net 445 10,145 Total $ 14,773 $ 10,666 As of December 31, 2021, 2020, and 2019, the Company concluded, through its ASC 360 impairment testing of long-lived assets classified as held and used, that factors existed indicating that finite-lived intangible assets were impaired. The factors considered by management include a history of net losses and negative cash flows in each of those periods to be able to support the assets. The Company tested the carrying amounts of the property and equipment, definite lived intangible assets, and other assets for impairment. As a result, we recorded an impairment charge of $12.2 million, $14.8 million, and $97.3 million for the years ended December 31, 2021, 2020, and 2019 recorded within the Asset impairment and abandonments line item on the consolidated statement of comprehensive loss. Warrant Liability Warrants are accounted for as liabilities in accordance with ASC 815-40 and are presented within "Warrant liability" in the Company’s consolidated balance sheets. The warrant liability is revalued each reporting period with the change in fair value recorded in the "Change in fair value of warrant liability" line item in the 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: December 31, 2021 December 31, 2020 Stock price $ 0.72 $ — Risk-free interest rate 0.84 % — % Dividend yield — % — % Volatility 130 % — % 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 year ended December 31, 2021: Warrant Liability Balance - January 1, 2021 $ — Fair value of warrants on date of issuance 26,749 Change in fair value (14,736) Balance - December 31, 2021 $ 12,013

Warrants

Warrants	12 Months Ended
	Dec. 31, 2021
Warrants and Rights Note Disclosure [Abstract]
Warrants	Warrants On June 14, 2021, the Company issued and sold an aggregate of 28,985,508 shares of its common stock, each share with a warrant exercisable for shares of the Company's common stock, at a combined purchase price of $1.725 per share and warrant in a registered direct offering. 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 warrants, the Company will pay the placement agent a cash fee equal to 7.0% of the aggregate gross proceeds from the exercise of the warrants and a management fee equal to 1.0% of the aggregate gross proceeds from the exercise of the 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 warrants are outstanding. The Company accounts for its warrants as derivative liabilities in accordance with ASC 815, (“ASC 815”), under which the warrants did not meet the criteria for the equity scope exception from derivative accounting and thus were recorded as liabilities. As derivatives, and in accordance with ASC 815, these warrants were measured at fair value at inception and will be remeasured at each reporting date with changes in fair value recognized in the consolidated statements of comprehensive loss in the period of change. See Note 14 for information about the fair value measurement of the warrants liability and Level 3 inputs used in the Black Scholes Option Pricing Model.

Accrued Expenses

Accrued Expenses	12 Months Ended
	Dec. 31, 2021
Payables and Accruals [Abstract]
Accrued Expenses	Accrued Expenses Accrued expenses are as follows: For the Year Ended December 31, 2021 2020 Accrued compensation $ 5,258 $ 2,268 Accrued securities class action settlement 1,500 — Accrued distributor commissions 2,957 4,113 Other 8,054 6,267 Total accrued expenses $ 17,769 $ 12,648

Other long-term liabilities

Other long-term liabilities	12 Months Ended
	Dec. 31, 2021
Other Liabilities, Noncurrent [Abstract]
Other long-term liabilities	Other long-term liabilities Other long-term liabilities are as follows: For the Year Ended December 31, 2021 2020 Acquisition contingencies $ 26,343 $ 47,519 Warrant Liability 12,013 — Lease obligations 947 1,200 Other 2,229 2,992 Total other long-term liabilities $ 41,532 $ 51,711

Income Taxes

Income Taxes	12 Months Ended
	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes The Company’s pre-tax loss consists of the following components: Year Ended December 31, 2021 2020 2019 Pre-tax loss: Domestic (U.S., state and local) $ (114,731) $ (191,455) $ (242,896) Foreign (loss) income (9,061) (6,226) 39 Total pre-tax loss (123,792) (197,681) (242,857) The Company’s income tax benefit (provision) consists of the following components: For the Year Ended December 31, 2021 2020 2019 Current: Federal $ 426 $ (3,671) $ (312) State (1,325) — 89 International 184 (13) 138 Total current (715) (3,684) (85) Deferred: Federal (25) (99) 2,456 State (4) — 169 International (142) 297 3,381 Total deferred (171) 198 6,006 Total income tax (benefit) provision $ (886) $ (3,486) $ 5,921 The Company’s deferred tax assets and liabilities consists of the following components: For the Year Ended December 31, 2021 For the Year Ended December 31, 2020 Assets Liabilities Assets Liabilities Accounts receivable $ 2,376 $ — $ 1,993 — Accrued liabilities 990 — 1,326 — Deferred compensation 1,876 — 1,281 — Fixed assets and intangibles 22,096 — 22,235 — Inventory 7,066 — 8,475 — Net operating losses 29,917 — 9,891 — Revenue — — — (129) Tax credits 265 — — — Lease Liability 318 — 446 — Right of Use Asset — (224) — (344) Other 408 — — (48) Valuation allowance (65,007) — (45,126) — Total $ 305 $ (224) $ 521 $ (521) On March 27, 2020, the Coronavirus Aid, Relief and Economic Security Act (the “CARES Act”) was enacted. As a result of the enactment of the CARES Act, net operating losses (“NOL’s”) can now be carried back for five years, which resulted in the Company recognizing a benefit during tax year 2020 of $3.5 million. On July 20, 2020, the Company completed the disposition of its OEM Businesses. The Company was able to partially offset the tax gain on the OEM sale with the utilization of tax attributes and year-to-date losses. The benefit for 2020 year-to-date U.S. losses from continuing operations is reported in discontinued operations pursuant to the Company’s adoption of ASU 2019-12. (See Note 5 “Discontinued Operations” for additional information). On October 23, 2020, the Company completed the acquisition of Holo Surgical pursuant to the Stock Purchase Agreement. The total consideration of the asset acquisition was determined to be $95.0 million, including an estimated fair value of $50.6 million related to the contingent consideration. The fair value of the liability was $56.5 million as of December 31, 2020, with a $5.9 million change in fair value since October 23, 2020 recognized in the loss (gain) on acquisition contingency line on the consolidated statements of comprehensive income/(loss). The Company treated the transaction as a non-taxable acquisition of stock for tax purposes and has reversed these acquisition costs and the revaluation of contingent consideration when calculating tax expense. (See Note 7 "Business Combinations and Acquisitions" for additional information). On December 30, 2021, the Company entered into a Stock Purchase Agreement to acquire interest in Inteneural Networks Inc. The total consideration of the asset acquisition was determined to be $72.3 million, with $10.3 million in forward contracts related to the three potential milestone payments and $41.7 million in non-controlling interest related to the 58% equity interest not purchased. The Company treated the transaction as a non-taxable acquisition of stock for tax purposes and has reversed the $72.1 million expense related to the purchased IPR&D, $0.4 million acquisition expenses, and $0.2 million impairment related to the assembled workforce when calculating tax expense. (See Note 7 "Business Combinations and Acquisitions" for additional information). As of December 31, 2021, the Company has U.S. federal net operating loss carryforwards of $81.9 million, of which, $9.1 million will expire in years 2037 through 2038, and approximately $72.8 million will carryforward indefinitely. As of December 31, 2021, the Company has U.S. state net operating loss carryforwards of approximately $85.9 million, of which, approximately $74.0 million will expire in the years 2023 through 2040, and approximately $11.9 million will carryforward indefinitely. As of December 31, 2021, the Company has non-U.S. net operating loss carryforwards of approximately $29.5 million, of which approximately $16.5 million will expire in years 2022 through 2027, and approximately $13.0 million will carryforward indefinitely. As of December 31, 2021, the Company has U.S. research and development credit carryforwards of approximately $0.3 million which will expire in the year 2041. U.S. income taxes have not been provided on the undistributed earnings of the Company’s foreign subsidiaries. It is not practicable to estimate the amount of tax that might be payable. The Company’s intention is to indefinitely reinvest earnings of its foreign subsidiaries outside of the U.S. 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 maintains a valuation allowance of $65.0 million on deferred tax assets in the United States as well as most foreign jurisdictions as of December 31, 2021. The Company maintained a full valuation allowance position of $45.1 million as of December 31, 2020. The Company’s unrecognized tax benefits are summarized as follows: For the Year Ended December 31, 2021 2020 2019 Opening balance $ 2,991 $ 1,088 $ 1,088 Additions based on tax positions related to the current year — 1,903 — Additions for tax positions of prior years 542 — — Reductions for tax positions of prior years (1,451) — — Reductions for expiration of statute of limitations — — — $ 2,082 $ 2,991 $ 1,088 The unrecognized tax benefits if recognized, would favorably impact the Company’s effective tax rate. It is reasonably possible that the unrecognized tax benefits will not significantly increase or decrease during the next twelve months. The unrecognized tax benefits of $2.1 million as of December 31, 2021 are presented with other long-term liabilities on the consolidated balance sheets. The Company’s policy is to recognize interest and penalties accrued related to unrecognized tax benefits in the provision for income taxes. As of December 31, 2021, the Company has accrued interest and penalties of $0.1 million. Interest and penalties recorded during 2019 through 2020, and accrued as of December 31, 2020 were inconsequential. As of December 31, 2021, we have had no ongoing audits in the U.S. or any foreign jurisdictions. The tax years that are open to examination are U.S. federal periods from 2018 to current and state taxes from 2017 to current. The Company's U.S. and foreign tax attribute carryforwards remain open to examination. The effective tax rate differs from the statutory federal income tax rate for the following reasons: For the Year Ended December 31, 2021 2020 2019 Statutory federal rate 21.00 % 21.00 % 21.00 % State income taxes—net of federal tax benefit 0.00 % (0.07) % (0.56) % Foreign rate differential 1.33 % 0.90 % 0.00 % Acquisition expenses (5.21) % (9.87) % 0.00 % Loss (Gain) on acquisition contingency 0.78 % (0.50) % 6.58 % Goodwill impairment and disposal 0.00 % 0.00 % (11.88) % Change in fair value of the warrant liability 2.50 % 0.00 % 0.00 % Noncontrolling interest (7.11 %) 0.00 % 0.00 % Tax attributes (0.22) % 0.28 % 0.04 % Tax legislation 0.19 % 0.95 % 0.00 % Valuation allowances (12.61) % (10.57) % (16.98) % Uncertain tax positions 0.95 % 0.00 % 0.00 % Other reconciling items, net (0.89) % (0.36) % (0.63) % Effective tax rate 0.71 % 1.76 % (2.43) % For the years ended December 31, 2021, 2020, and 2019, the Company had no individually significant other reconciling items. The other reconciling items line includes non-significant officer compensation and stock-based compensation for all years presented.

Preferred Stock

Preferred Stock	12 Months Ended
	Dec. 31, 2021
Equity [Abstract]
Preferred Stock	Preferred Stock Preferred stock is as follows: Preferred Stock Liquidation Value Preferred Stock Issuance Costs Net Total Balance at January 1, 2019 $ 66,519 $ (293) $ 66,226 Amortization of preferred stock issuance costs — 184 184 Balance at December 31, 2019 66,519 (109) 66,410 Amortization of preferred stock issuance costs — 109 109 Redemption of preferred stock (66,519) — (66,519) Balance at December 31, 2020 — — — Amortization of preferred stock issuance costs — — — Redemption of preferred stock — — — Balance at December 31, 2021 $ — $ — $ — On June 12, 2013, the Company and WSHP Biologics Holdings, LLC, an affiliate of Water Street Healthcare Partners, a leading healthcare-focused private equity firm (“Water Street”), entered into an investment agreement. Pursuant to the terms of the investment agreement, the Company issued $50.0 million of convertible preferred equity to Water Street in a private placement which closed on July 16, 2013, with preferred stock issuance costs of $1.3 million. The preferred stock accrues dividends at a rate of 6% per annum. To the extent dividends are not paid in cash in any quarter, the dividends which have accrued on each outstanding share of preferred stock during such three-month period will accumulate until paid in cash or converted to common stock. On July 17, 2020, the Company received a notification from 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 Certificate of Retirement was filed with the Delaware Secretary of State retiring the Series A Preferred Stock.

Stockholders' Equity

Stockholders' Equity	12 Months Ended
	Dec. 31, 2021
Equity [Abstract]
Stockholders' Equity	Stockholders’ Equity Preferred Stock —The Company has 5,000,000 shares of preferred stock authorized under its Certificate of Incorporation. These shares may be issued in one or more series having such terms as may be determined by the Company’s Board of Directors. As discussed in Note 19, the Company issued 50,000 shares of Series A Preferred Stock in 2013 and, subsequently, all shares outstanding were redeemed on July 24, 2020. As of December 31, 2021, the Company did not have any Preferred Stock outstanding. Common Stock —The Company has 300,000,000 shares of common stock authorized. The common stock’s voting, dividend, and liquidation rights presently are subject to or qualified by the rights of the holders of any outstanding shares of preferred stock. Holders of common stock are entitled to one vote for each share held at all stockholder meetings. Shares of common stock do not have redemption rights. The Company is, and may in the future become, party to agreements and instruments that restrict or prevent the payment of dividends on our capital stock.

Severance and Restructuring Cos

Severance and Restructuring Costs	12 Months Ended
	Dec. 31, 2021
Restructuring and Related Activities [Abstract]
Severance and Restructuring Costs	Severance and Restructuring Costs From time to time, management records and pays severance related expenses associated with transitions of certain employees from one facility to another or with certain strategic acquisitions. the related severance expenses are composed of payroll and related healthcare expenses. Severance and restructuring payments were made over periods ranging from one month to twelve months and did not have a material impact on cash flows of the Company in any quarterly period. The following table includes a rollforward of severance and restructuring costs included in accrued expenses on the consolidated balance sheets, see Note 16. Accrued severance and restructuring charges at January 1, 2019 $ 908 Severance and restructuring expenses accrued in 2019 626 Severance and restructuring cash payments (1,398) Accrued severance and restructuring charges at December 31, 2019 136 Severance and restructuring expenses accrued in 2020 — Severance and restructuring cash payments (136) Accrued severance and restructuring charges at December 31, 2020 — Severance and restructuring expenses accrued in 2021 208 Severance and restructuring cash payments (208) Accrued severance and restructuring charges at December 31, 2021 $ —

Retirement Benefits

Retirement Benefits	12 Months Ended
	Dec. 31, 2021
Retirement Benefits [Abstract]
Retirement Benefits	Retirement BenefitsThe Company has a qualified 401(k) plan available to all U.S. employees who meet certain eligibility requirements. The 401(k) plan allows each employee to contribute up to the annual maximum allowed under the Internal Revenue Code. The Company has the discretion to make matching contributions up to 6% of the employee’s earnings. For the years ended December 31, 2021, 2020, and 2019, the amounts expensed under the plan were $0.7 million, $1.4 million, and $2.9 million, respectively.

Commitments and Contingencies

Commitments and Contingencies	12 Months Ended
	Dec. 31, 2021
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	. Commitments and Contingencies Agreement to Acquire 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 on March 8, 2019, plus potential future milestone payments. Established in 2005, Paradigm’s primary product is the Coflex ® Interlaminar Stabilization ® device, a differentiated and 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. Within the Master Transaction Agreement, there is a clause that upon a change in control of the organization, the Company would owe any outstanding milestone payments to Paradigm, regardless if the milestone was probable of achievement. Acquisition of Zyga – On January 4, 2018, the Company acquired Zyga, a leading 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 December 31, 2021, the Company determined that Zyga was not expected to meet the clinical milestone to earn the contingent consideration and therefore has not recorded a liability related to this contingency. There are no further obligations related to the Zyga acquisition as of December 31, 2021. 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. 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 amount the shortfall in a given year. If a purchase order is submitted, it does not have to be satisfied over the following year (i.e., the Company can satisfy the orders over multiple years and until the minimum is achieved). For calendar years 2022 and beyond, if the Company does not satisfy the Shortfall Obligations using one of the methods specified in the Distribution Agreement, the Company can continue to market the ViBone implants on a non-exclusive basis. In January 2022, the Company issued a purchase order to Aziyo for $14.2 million relating to the 2021 Shortfall Obligation. The total purchase commitment as of December 31, 2021, is $21.8 million. Acquisition of Inteneural Networks Inc. (INN) – As part of the INN acquisition, the Company has the ability to acquire the remaining 58% equity interest in INN based on the achievement of three separate regulatory and revenue based milestones. When each of the milestones are achieved the Company will be obligated to pay $19.3 million for an additional 19.3% equity interest within INN. The total future commitment of the remaining three milestones is $57.9 million. As of December 31, 2021 the value of the future commitments were $10.0 million, and recorded within the mezzanine section of the balance sheet. Acquisition of Holo Surgical Inc. – As part of the Holo Surgical Acquisition, the Company may be required to pay up to $83.0 million in contingent consideration if certain regulatory, development, and revenue based milestones are achieved. There are eight different milestones which have achievement dates through October 23, 2026. These contingent considerations have a fair value $51.9 million as of December 31, 2021, with $25.6 million classified as current liabilities within "Accrued expenses," while $26.3 million is included as "Other long-term liabilities" in the accompanying consolidated balance sheets. The change in the fair value of the liability of $4.6 million since December 31, 2020, was recognized in the gain on acquisition contingency line of the consolidated statements of comprehensive loss. On January 12, 2022, the Company entered into a Second Amendment to the Stock Purchase Agreement with the sellers of Holo Surgical to amendment one of the regulatory milestones beyond December 31, 2021. This regulatory milestone was subsequently achieved on January 14, 2022, when the Company received 510(k) clearance for Holo. Upon achievement of this milestone the Company issued 8,650,000 shares in common stock at a value of $5.9 million and also paid the sellers $4.1 million in cash, for a total payment for achieving the milestone of $10.0 million pursuant to the terms of the agreement. These payments were made in 2022. See Note 7 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 (ii) 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 (July 2020 - June 2021): $24,201 • Year 2 (July 2021 - June 2022): $25,767 • Year 3 (July 202 - June 2023): $27,158 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 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. All minimum purchase agreements were achieved in 2021. In addition management previously prepaid 2024 royalties to OPM. Based on current sales performance management determined those royalties would not be paid and wrote off a portion of the prepayment in the amount of $3.0 million which was recorded within cost of goods sold on the consolidated statements of comprehensive loss/(gain). 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 that event hasn't occurred, no amounts were accrued as of December 31, 2021. Concurrent with the Company’s execution of the Lease, as a security deposit, the Company

Legal Actions

Legal Actions	12 Months Ended
	Dec. 31, 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 December 31, 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 relates to 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 December 31, 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 sale of the Company’s OEM Business, 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— The Company’s Investigation (as defined below) resulted in stockholder litigation. 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 (the “Court”) 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 in the amount of $10.5 million. The $10.5 million loss contingency and corresponding insurance recovery was recorded within the "General and administrative" expense line on the consolidated statements of comprehensive income/(loss) as of December 31, 2021. No amounts were outstanding at December 31, 2021. The Court entered an order approving the settlement on January 26, 2022. The matter is now concluded. 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), as well as a books and records demand under Section 220 of the Delaware General Corporate Law (the “Books and Records Demand”). The three derivative lawsuits have been consolidated into the first-filed Summers Action (together with the Books and Records Demand, the “Derivative Actions”). 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 agreed to pay $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 consolidated balance sheets as of December 31, 2021. On January 24, 2022, the court gave final approval to the Derivative Actions Settlement. The matter is now concluded. 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	12 Months Ended
	Dec. 31, 2021
Commitments and Contingencies Disclosure [Abstract]
Regulatory Actions	Regulatory Actions SEC Investigation — 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 is in discussions with the SEC regarding a potential settlement. We have determined a reasonable estimate of this liability and have recorded that estimate in Accrued Expenses on the consolidated balance sheets as of December 31, 2021. 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	12 Months Ended
	Dec. 31, 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) greater than five percent beneficial owner of the Company’s common stock; or iii) immediate family member of any of the foregoing. The following are the Company's related party transactions: The Holo Surgical Acquisition As discussed in Note 9, 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 $51.9 million as of December 31, 2021, 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. On January 12, 2022 the Company entered into a Second Amendment to the Stock Purchase Agreement with the sellers of Holo Surgical to amend one of the regulatory milestones beyond December 31, 2021. This regulatory milestone was subsequently achieved on January 14, 2022, when the Company received 510(k) clearance for Holo. Upon achievement of this milestone the Company issued 8,650,000 in common stock at a value of $5.9 million and also paid the sellers $4.1 million in cash for a total payment for achieving the milestone of $10.0 million pursuant to the terms of the agreement. 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. Krzysztof Siemionow, MD, PhD is the Company's Chief Medical Officer. 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 for the years ended December 31, 2021 and December 31, 2020 were approximately $0.3 million and $0.1 million respectively. No amounts were payable to Mr. Simpson as of December 31, 2021 and 2020. INN Acquisition

Subsequent Events

Subsequent Events	12 Months Ended
	Dec. 31, 2021
Subsequent Events [Abstract]
Subsequent Events	Subsequent Events The Company evaluated subsequent events as of the issuance date of the consolidated financial statements as defined by FASB ASC 855, Subsequent Events. Public offering On February 15, 2022, we issued and sold in an underwritten public offering 43,478,264 shares of its common stock (or pre-funded warrants to purchase common stock in lieu thereof) and warrants to purchase up to an aggregate of 32,608,698 shares of common stock at a combined effective public offering price of $0.46 per share of common stock (or pre-funded warrant) and invest warrants to purchase up to an aggregate of 32,608,698 at a strike price of $0.60 and exercisable over the next five years. The Company, also in connection with the offering, issued placement agent warrants to purchase an aggregate of up 2,608,696 shares of common stock at a strike price of $0.575 per share. We received net proceeds of $17.8 million from the offering after deducting investor and other filing fees of $2.2 million. Holo Surgical Second Amendment and FDA Clearance On January 12, 2022, the Company entered into a Second Amendment to the Stock Purchase Agreement with the sellers of Holo Surgical to amend one of the regulatory milestones beyond December 31, 2021. This regulatory milestone was subsequently achieved on January 14, 2022 when the Company received 510(k) clearance for its HOLO Portal TM surgical guidance system for use within lumbar spine procedures. The HOLO Portal TM system is the world’s first AI-driven AR guidance system for spine and the first clinical application of Surgalign’s HOLO TM AI digital health platform. Upon achievement of this milestone the Company issued 8,650,000 in common stock at a value of $5.9 million and also paid the sellers $4.1 million in cash for a total payment for achieving the milestone of $10.0 million pursuant to the terms of the agreement.

Schedule II - Valuation and Qua

Schedule II - Valuation and Qualifying Accounts	12 Months Ended
	Dec. 31, 2021
SEC Schedule, 12-09, Valuation and Qualifying Accounts [Abstract]
Schedule II - Valuation and Qualifying Accounts	Schedule II Valuation and Qualifying Accounts Years Ended December 31, 2021, 2020 and 2019 (Dollars in thousands) Description Balance at Charged to Deductions, Balance at For the year ended December 31, 2021: Allowance for doubtful accounts $ 8,203 $ 1,722 $ 653 $ 9,272 Allowance for product returns 105 — — 105 Deferred tax asset valuation allowance 45,126 20,459 578 65,007 For the year ended December 31, 2020: Allowance for doubtful accounts 4,803 3,584 $ 184 $ 8,203 Allowance for product returns 106 246 247 105 Deferred tax asset valuation allowance 48,115 (2,638) 351 45,126 For the year ended December 31, 2019: Allowance for doubtful accounts 1,865 2,541 (397) 4,803 Allowance for product returns 478 — 372 106 Deferred tax asset valuation allowance 3,093 45,022 — 48,115

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2021
Accounting Policies [Abstract]
Principles of Consolidation	Principles of Consolidation — The consolidated financial statements include the accounts of the Company and its wholly owned subsidiaries, Surgalign, Inc., Paradigm Spine, LLC (“Paradigm”), Pioneer Surgical Technology, Inc. (“Pioneer Surgical”), Zyga Technology, Inc. (“Zyga”) and Holo Surgical Inc. (“Holo Surgical”). The Company consolidates the accounts of Inteneural Networks, Inc. ("INN"), a 42% owned subsidiary as control is achieved through means other than voting rights ("variable interest entities" or "VIE") as the Company is deemed to be the primary beneficiary of INN . The financial positions and operating results of the disposed OEM Businesses have been reported as discontinued operations in the consolidated financial statements in the current as well as prior comparative periods. The consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“U.S. GAAP”). All intercompany balances and transactions have been eliminated in consolidation.
Reclassification	Reclassification —The Company reclassified certain amounts from prior periods to conform with current period presentation of certain consolidated financial statements with no effect on previously reported net income, equity, total assets, or total liabilities.
Use of Estimates	Use of Estimates—The preparation of consolidated financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosures of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Estimates and assumptions relating to inventories, receivables, long-lived assets, contingent considerations, and litigation are made at the end of each financial reporting period by management. Actual results could differ from those estimates.
Foreign Currency Translation	Foreign Currency Translation —The functional currency of the Company’s foreign subsidiaries is the Euro. Assets and liabilities of the foreign subsidiaries are translated at the period end exchange rate while revenues and expenses are translated at the average exchange rate for the period. The resulting translation adjustments, representing unrealized, noncash gains and losses are recorded and presented as a component of comprehensive loss. Gains and losses resulting from transactions of the Company and its subsidiaries, which are made in currencies different from their own, are included in income or loss as they occur and are included in other expenses in the consolidated statements of comprehensive loss.
Fair Value of Financial Instruments	Fair Value of Financial Instruments—The estimated fair value of financial instruments disclosed in the consolidated financial statements has been determined by using available market information and appropriate valuation methodologies. The carrying value of all current assets and current liabilities approximates fair value because of their short-term nature.
Cash and Cash Equivalents	Cash and Cash Equivalents— The Company considers all funds in banks and short-term highly liquid investments with an original maturity of three months or less to be cash and cash equivalents. Cash equivalents comprise overnight repurchase agreements. Cash balances are held at a few financial institutions and usually exceed insurable amounts. The Company mitigates this risk by depositing its uninsured cash in major well capitalized financial institutions.
Accounts Receivable Allowances	Accounts Receivable Allowances — The Company maintains the allowance for estimated losses resulting from the inability of its customers to make required payments. The allowance represents the current estimate of lifetime expected credit losses over the remaining duration of existing accounts receivable considering current market conditions and supportable forecasts when appropriate. The estimate is a result of the Company’s ongoing evaluation of collectability, customer creditworthiness, historical levels of credit losses, and future expectations. Write-off activity and recoveries for the years were not material.
Inventories	Inventories — Inventories are stated at lower of cost or net realizable value, with cost determined using the first-in, first-out method. Non-current inventory represents those the Company anticipates will not be sold within the next year. Non-current inventory is estimated by comparing historical and projected sales trends and inventory quantities on hand. Inventory is evaluated for obsolescence and excess quantities by analyzing inventory levels, historical loss trends, expected product lives, product at risk of expiration, sales levels by product and projections of future sales demand.
Property and equipment	Property and equipment —Property and equipment are stated at cost less accumulated depreciation. The cost of leasehold improvements is amortized on the straight-line method over the shorter of the lease term or the estimated useful life of the asset. Included in property and equipment are costs related to purchased software that are capitalized. Surgical instruments which are included in property and equipment are handheld devices used by surgeons during implant
Internal use Software	Internal use Software - The Company accounts for its costs to develop computer software for internal use in accordance with Accounting Standards (“ASC”) 350-40, Internal use Software . These costs are directly attributable to the development and implementation of the new ERP system. The Company capitalizes the costs incurred during the application development stage, which generally include costs to design the software configuration and interfaces, coding, installation, and testing.
Derivative Instruments	Derivative Instruments— The Company reviews debt agreements for embedded features. If these features are not clearly and closely related to the debt host, they meet the definition of a derivative and require bifurcation from the host contract. All derivative instruments, including embedded derivatives are recorded on the balance sheet at their respective fair values. The Company will adjust the carrying value of the derivative liability to fair value at each subsequent reporting date. The changes in the fair value of the derivatives are recorded in the period they occur. Warrant Financing— The Company accounts for its warrants as derivative liabilities as the warrants did not meet the criteria for the equity scope exception from derivative accounting. As derivatives, these warrants were measured at fair value at inception and will be remeasured at each reporting date with changes in fair value recognized in the consolidated statements of comprehensive loss in the period of change.
Debt Issuance Costs	Debt Issuance Costs—Debt issuance costs include costs incurred to obtain financing and are amortized using the straight-line method, which approximates the effective interest method, over the life of the related debt. Debt issuance costs related to a recognized debt liability are presented in the balance sheet as a direct deduction from the carrying amount of that debt liability.
Long-Lived Assets	Long-Lived Assets —The Company reviews its long-lived assets for impairment whenever events or changes in circumstances indicate the carrying value of an asset may not be recoverable. Recoverability is measured by a comparison of the carrying amount to the net undiscounted cash flows expected to be generated by the asset. An impairment loss would be recorded for the excess of net carrying value over the fair value of the asset impaired. The fair value is estimated based on expected discounted future cash flows. The results of impairment tests are subject to management’s estimates and assumptions of projected cash flows and operating results. Changes in assumptions or market conditions could result in a change in estimated future cash flows and the likelihood of materially different reported results. Because the Company’s forecasted cash flow is negative, Long-lived assets, including property and equipment and intangible assets subject to amortization were impaired and written down to their estimated fair values in 2021 and 2020.
Other Intangible Assets	Other Intangible Assets —Other intangible assets, which constitutes finite lives assets, generally consist of patents, acquired exclusivity rights, licensing rights, distribution agreements, and procurement contracts. Patents are amortized on the straight-line method over the shorter of the remaining protection period or estimated useful lives of between 8 and 16 years. Trade names, procurement contracts, customer lists, acquired exclusivity rights, and distribution agreements are amortized over estimated useful lives of between 5 to 25 years.
Revenue Recognition	Revenue Recognition — The Company recognizes revenue upon transfer of control of promised implants 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, respectively based on the terms of the contract. The Company’s performance obligations consist mainly of transferring control of implants identified in the contracts. The Company’s transaction price is generally fixed. Any discounts or rebates are estimated at the inception of the contract and recognized as a reduction of the revenue. We generally do not bill customers for shipping and handling of our
Stock-Based Compensation Plans	Stock-Based Compensation Plans —The Company accounts for its stock-based compensation plans in accordance with ASC 718, Accounting for Stock Compensation (“ASC 718”). ASC 718 requires the measurement and recognition of compensation expense for all stock-based awards made to employees and directors, including restricted stock awards, restricted stock units, stock options and the employee stock purchase plan ("ESPP") purchase rights (i.e., equity-classified awards). Under the provisions of ASC 718, stock-based compensation cost for equity-classified awards is measured at the grant date, based on the calculated fair value of the award, and is recognized as an expense on a straight-line basis over the requisite service period of the entire award (generally the vesting period of an option, including graded vesting schedules, or share award and the offering period of an ESPP purchase right award). The Company currently measures the grant date fair value of restricted stock awards and restricted stock units based on the market value of the Company’s stock on the grant date. Prior to 2021 the Company used a Monte Carlo simulation model to estimate the grant date fair value of certain restricted stock awards that contain a market condition. The Company uses the Black-Scholes model to value its stock option grants and ESPP purchase rights. The fair value of stock options and awards is determined on the grant date, and the fair value of the ESPP purchase rights is determined on the offering date using assumptions for the expected term, expected volatility, dividend yield, and the risk-free interest rate. The details of those assumptions, is as follows: • The term assumption for stock options is primarily based on the contractual vesting term and historic data related to exercise and post-vesting expiration history experienced by the Company. The Company uses the simplified method for estimating the expected term used to determine the fair value under ASC 718. The expected term is determined separately for the Company’s directors and employees. The term assumption for ESPP purchase is primarily based on the offering period. • The Company’s anticipated volatility level for both stock options and ESPP purchase rights are primarily based on the historic volatility of the Company’s common stock. • The Company’s models for stock options and ESPP purchase rights includes a 0% expected dividend yield assumption, as the Company has not historically paid, nor does it anticipate paying dividends on its common stock. • The risk-free interest rate approximates recent U.S. Treasury note auction results with a similar life to that of the option or ESPP purchase right. The Company’s model does not include a discount for post-vesting restrictions, as the Company has not issued awards with such restrictions. The compensation cost recognized for stock options is determined based on the grant date fair value of the options and the number of options granted, net of an estimated forfeiture rate. The Company’s estimate of pre-vesting forfeitures is primarily based on the recent historical experience of the Company and is adjusted to reflect actual forfeitures. The compensation cost recognized for restricted stock awards, restricted stock units, and ESPP purchase rights is determined based on the grant date fair value of the awards.
Research and Development Costs	Research and Development Costs —Research and development costs, including the cost of research and development conducted for others and the cost of contracted research and development, are expensed as incurred.
Income Taxes	Income Taxes—The Company uses the asset and liability method of accounting for income taxes. Deferred income taxes are recorded to reflect the tax consequences on future years for differences between the tax basis of assets and liabilities and their financial reporting amounts at each year-end based on enacted tax laws and statutory tax rates applicable to the periods in which the differences are expected to affect taxable income. Valuation allowances are established when necessary to reduce deferred tax assets to amounts which are more likely than not to be realized.
Contingent Consideration	Contingent Consideration — The Company accounts for the contingent consideration related to the Holo Surgical Acquisition as a liability in accordance with the guidance of ASC 480, Distinguishing Liabilities from Equity , because the contingent consideration represents a conditional obligation that has a fixed monetary value known at inception and we may settle by issuing a variable number of our equity shares. The liability is recorded at its fair value at inception and shall be marked to market subsequently at the end of each reporting period, with any change recognized in the current earnings. See Note 7 for further discussion related to the Holo Surgical Acquisition.
Noncontrolling Interest	Noncontrolling Interest— The Company's consolidated noncontrolling interest is comprised of its investment in INN. The Company evaluated whether noncontrolling interest is subject to redemption features outside of the Company's control. We evaluated noncontrolling interest to determine whether it is currently redeemable for cash or probable of being redeemable for cash in the future within the mezzanine section of the consolidated balance sheet. As the noncontrolling interest is not currently redeemable, and is only redeemable upon the occurrence of FDA approval, we will not remeasure at each reporting period until approval is obtained.
Treasury Stock	Treasury Stock — The Company may periodically repurchase shares of its common stock from employees for the satisfaction of their individual payroll tax withholding upon vesting of restricted stock awards in connection with the Company’s incentive plans. The Company’s repurchases of common stock are recorded at the stock price on the vesting date of the common stock.
Earnings Per Share	Earnings Per Share —Basic earnings per share (“EPS”) is computed by dividing earnings attributable to common stockholders by the weighted-average number of common shares outstanding for the periods. Diluted EPS reflects the incremental shares issuable upon the assumed exercise of securities that could share in earnings. Shares whose issuance is contingent upon the satisfaction of certain conditions shall be considered outstanding and included in the computation of diluted EPS as follows: a. If all necessary conditions have been satisfied by the end of the period (the events have occurred), those shares shall be included as of the beginning of the period in which the conditions were satisfied (or as of the date of the contingent stock agreement, if later). b. If all necessary conditions have not been satisfied by the end of the period, the number of contingently issuable shares included in diluted EPS shall be based on the number of shares, if any, that would be issuable if the end of the reporting period were the end of the contingency period (for example, the number of shares that would be issuable based on current period earnings or period-end market price) and if the result would be dilutive. Those contingently issuable shares shall be included in the denominator of diluted EPS as of the beginning of the period (or as of the date of the contingent stock agreement, if later).
Recently Issued and Adopted Accounting Standards	Recently Issued and Adopted Accounting Standards. 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

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Tables)	12 Months Ended
	Dec. 31, 2021
Accounting Policies [Abstract]
Schedule of Estimated Useful Lives of Assets	Depreciation is computed on the straight-line method over the following estimated useful lives of the assets: Processing equipment 7 to 10 years Office equipment, furniture and fixtures 5 to 7 years Computer equipment and software 3 to 7 years Surgical instruments 1 year Property and equipment are as follows: For the Year Ended December 31, 2021 2020 Processing equipment $ 346 $ 35 Surgical instruments 489 440 Office equipment, furniture and fixtures 15 34 Computer equipment and software 44 12 Construction in process $ 51 — Total Property and equipment $ 945 $ 521

Leases (Tables)

Leases (Tables)	12 Months Ended
	Dec. 31, 2021
Leases [Abstract]
Schedule of Components of Operating Lease Expense	The components of operating lease expense were as follows: For the Year Ended December 31, For the Year Ended December 31, For the Year Ended December 31, 2019 Operating lease cost $ 706 $ 1,179 $ 1,108 Short-term operating lease cost 335 — 36 Total operating lease cost $ 1,041 $ 1,179 $ 1,144 Supplemental cash flow information related to operating leases was as follows: For the Year Ended December 31, For the Year Ended December 31, Cash paid for amounts included in the measurement of lease liabilities $ 1,237 $ 1,313 ROU assets obtained in exchange for lease obligations 57 242
Schedule of Supplemental Balance Sheet Information Related to Leases	Supplemental balance sheet information related to operating leases was as follows: Balance Sheet Classification Balance at December 31, Balance at December 31, Assets: Right-of-use assets Other assets - net $ 876 $ 1,425 Liabilities: Current Accrued expenses $ 294 $ 650 Noncurrent Other long-term liabilities 947 1,200 Total operating lease liabilities $ 1,241 $ 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 Year Ended December 31, For the Year Ended December 31, Weighted-average remaining lease term (years) 6.3 5.5 Weighted-average discount rate 5.09 % 4.92 %
Schedule of Maturities of Operating Lease Liabilities	As of December 31, 2021, maturities of operating lease liabilities were as follows: Maturity of Operating Lease Liabilities Balance at December 31, 2022 $ 374 2023 217 2024 173 2025 161 2026 159 2027 and beyond 398 Total future minimum lease payments 1,482 Less imputed interest (241) Total $ 1,241

Discontinued Operations (Tables

Discontinued Operations (Tables)	12 Months Ended
	Dec. 31, 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: Year Ended December 31, Year Ended December 31, Year Ended December 31, 2021 2020 2019 Major classes of line items constituting net income from discontinued operations: Revenues $ — $ 87,192 $ 190,961 Costs of goods sold — 49,678 104,482 Gross profit — 37,514 86,479 Expenses: General and administrative — 12,889 22,279 Severance and restructuring costs — 604 — Transaction and integration expenses — 23,598 3,160 Total operating expenses — 37,091 25,439 Operating income — 423 61,040 Other expense (income): OEM working capital adjustment 6,316 — — Interest expense — 14,965 12,571 Loss on extinguishment of debt — 2,686 — Derivative loss — 12,641 — Foreign exchange (gain) loss — (3) 17 Total other expense - net 6,316 30,289 12,588 (Loss) income from discontinued operations (6,316) (29,866) 48,452 Gain on sale of net assets of discontinued operations — 209,800 — (Loss) Income from discontinued operations before income tax provision (6,316) 179,934 48,452 Income tax (benefit) provision (2,674) 19,522 11,316 Net (loss) income on discontinued operations $ (3,642) $ 160,412 $ 37,136 Year Ended December 31, Year Ended December 31, Year Ended December 31, 2021 2020 2019 Significant operating non-cash reconciliation items: Depreciation and amortization $ — $ 2,125 $ 4,466 Provision for bad debts and product returns $ — $ 456 $ 101 Provision for inventory write-downs $ — $ — $ 6,340 Revenue recognized due to change in deferred revenue $ — $ (2,618) $ (4,906) Deferred income tax (benefit) provision $ — $ (1,609) $ (3,989) Stock-based compensation $ — $ 792 $ 540 Gain on sale of discontinued assets, net $ — $ (209,800) $ — Paid in kind interest expense $ — $ — $ 4,408 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) $ (6,866) Patent and acquired intangible asset costs $ — $ (419) $ (578) Proceeds from sale of OEM Businesses $ — $ 437,097 $ —

Revenue from Contracts with C_2

Revenue from Contracts with Customers (Tables)	12 Months Ended
	Dec. 31, 2021
Revenue from Contract with Customer [Abstract]
Schedule of Total Revenue by Geographical Region	The following table represents total revenue by geographical region for the years ended December 31, 2021, 2020 and 2019: Year Ended December 31, 2021 Year Ended December 31, 2020 Year Ended December 31, 2019 Revenues: Domestic $ 77,927 $ 85,612 $ 97,703 International 12,573 16,137 19,720 Total revenues from contracts with customers $ 90,500 $ 101,749 $ 117,423

Business Combinations and Acq_2

Business Combinations and Acquisitions (Tables)	12 Months Ended
	Dec. 31, 2021
Business Combination and Asset Acquisition [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): Balance at April 30, 2021 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 Balance at March 8, Cash $ 307 Accounts receivable 5,220 Inventories 17,647 Other current assets 934 Property, plant and equipment 379 Other non-current assets 1,079 Current liabilities (6,169) Lease liabilities (1,079) Net tangible assets acquired 18,318 Other intangible assets 79,000 Goodwill 135,589 Total net assets acquired $ 232,907
Schedule of Acquisition Purchase Price	The purchase price was financed as follows: Cash proceeds from second lien credit agreement $ 100,000 Fair market value of securities issued 60,730 Fair market value of contingent earnout 72,177 Total purchase price $ 232,907
Schedule of Pro Forma Information of Operations	The following unaudited pro forma information shows the results of the Paradigm’s operations as though the acquisition had occurred as of the beginning of the prior comparable period, January 1, 2018, (in thousands): For the Year Ended December 31, 2019 Revenues $ 37,374 Net loss applicable to common shares (16,547)

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	12 Months Ended
	Dec. 31, 2021
Share-based Payment Arrangement [Abstract]
Schedule of Stock-Based Compensation Recognized	For the years ended December 31, 2021, 2020, and 2019, the Company recognized stock-based compensation related to equity-classified awards as follows: For the Year Ended December 31, 2021 2020 2019 Stock-based compensation: Costs of goods sold $ 21 $ 169 $ 144 General and administrative 4,839 3,980 3,623 Research and development 352 72 60 Transaction and integration expenses — 1,515 — Total $ 5,212 $ 5,736 $ 3,827
Schedule of Stock Options Outstanding, Exercisable and Available for Grant and Other Information	Stock options outstanding, exercisable and available for grant at December 31, 2021, are summarized as follows: Number of Weighted Weighted Aggregate (in thousands, except for share and per share information) Outstanding at January 1, 2021 4,979,180 $ 3.28 5.30 $ 142 Granted 776,564 1.82 Exercised (1,007) 2.69 Forfeited or expired (423,517) 3.29 Outstanding at December 31, 2021 5,331,220 $ 3.08 4.43 $ — Vested or expected to vest at December 31, 2021 5,331,220 $ 3.08 4.43 $ — Exercisable at December 31, 2021 3,487,657 $ 3.37 2.15 $ — Available for grant at December 31, 2021 5,777,619 Other information concerning stock options are as follows: For the Year Ended December 31, 2021 2020 2019 (in thousands, except for per share information) Weighted average fair value of stock options granted $ 0.93 $ 1.21 $ 1.56 Aggregate intrinsic value of stock options exercised $ — $ 3.20 $ 161.00
Schedule of Weighted-Average Assumptions Used to Determine Fair Value of Options	The following weighted-average assumptions were used to determine the fair value of options and purchases under ASC 718: Year Ended December 31, 2021 2020 2019 Expected term (years) 6.35 6.50 6.50 Risk free interest rate 0.72 % 0.62 % 2.54 % Volatility factor 49.97 % 41.62 % 37.73 % Dividend yield — — — The following weighted-average assumptions were used to determine the fair value of ESPP and purchases under ASC 718: Year Ended December 31, 2021 2020 2019 Expected term (years) 0.50 0.00 0.00 Risk free interest rate 0.05 % — — Volatility factor 84.32 % — — Dividend yield — % — —
Schedule of Nonvested Restricted Stock Shares Activity	The following table summarizes information about unvested restricted stock awards as of December 31, 2021: Number of Weighted Unvested at January 1, 2021 1,897,196 $ 3.47 Granted 147,719 2.06 Vested (1,037,528) 3.68 Forfeited (353,133) 3.35 Unvested at December 31, 2021 654,254 $ 2.89
Schedule of Unvested Restricted Stock Awards	The following table summarizes information about unvested restricted stock units as of December 31, 2021: Number of Weighted Unvested at January 1, 2021 89,935 $ 7.41 Granted 5,541,313 1.64 Vested (30,783) 1.73 Forfeited (800,102) 2.18 Unvested at December 31, 2021 4,800,363 $ 1.66

Prepaid and Other Current Ass_2

Prepaid and Other Current Assets (Tables)	12 Months Ended
	Dec. 31, 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: For the Year Ended December 31, 2021 2020 Insurance Recovery Receivable $ 1,500 $ — Income tax receivable 4,116 4,836 Prepaid expenses 2,553 1,543 Other Receivable 815 3,905 Total Prepaid and Other Current Assets $ 8,984 $ 10,284

Property and equipment (Tables)

Property and equipment (Tables)	12 Months Ended
	Dec. 31, 2021
Property, Plant and Equipment [Abstract]
Schedule of Components of Property and Equipment	Depreciation is computed on the straight-line method over the following estimated useful lives of the assets: Processing equipment 7 to 10 years Office equipment, furniture and fixtures 5 to 7 years Computer equipment and software 3 to 7 years Surgical instruments 1 year Property and equipment are as follows: For the Year Ended December 31, 2021 2020 Processing equipment $ 346 $ 35 Surgical instruments 489 440 Office equipment, furniture and fixtures 15 34 Computer equipment and software 44 12 Construction in process $ 51 — Total Property and equipment $ 945 $ 521

Debt (Tables)

Debt (Tables)	12 Months Ended
	Dec. 31, 2021
Debt Disclosure [Abstract]
Schedule of Long-term Debt Instruments	Carrying Value (In thousands) Seller Notes-P. Lewicki $ 5,306 Seller Notes-K. Siemionow 5,306 Less: fair value adjustment (630) Total Seller Notes - related party 9,982 Current portion of seller notes — Total long-term seller note, excluding current portion $ 9,982
Schedule of Future Maturities of Long-term Debt	As of December 31, 2021, the future maturities of long-term debt, excluding deferred financing costs, accrued interest and debt discount, were as follows (in thousands): 2022 $ — 2023 — 2024 10,612 2025 — 2026 — Thereafter — Total $ 10,612

Net Loss Per Common Share (Tabl

Net Loss Per Common Share (Tables)	12 Months Ended
	Dec. 31, 2021
Earnings Per Share [Abstract]
Schedule of Common Stock used in Calculation of Basic and Diluted Earnings Per Share	The number of shares of common stock used in the calculation of basic and diluted net loss per common share is presented below: For the Year Ended December 31, 2021 2020 2019 Weighted average basic and dilutive shares 122,592,569 74,403,155 70,150,492
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 Year Ended December 31, 2021 2020 2019 Stock Option (1) — 271,351 345,154 RSU and RSA 3,202,888 1,099,018 821,888 Convertible Series A Preferred Stock — 8,400,512 15,152,761 Total 3,202,888 9,770,881 16,319,803

Fair Value Information (Tables)

Fair Value Information (Tables)	12 Months Ended
	Dec. 31, 2021
Fair Value Disclosures [Abstract]
Schedule of Fair Value Measurement Inputs, Warrant Liability and Valuation Techniques	Inputs used in estimating the fair value of the contingent consideration for Holo Surgical as of December 31, 2021 and 2020, are summarized below: Fair Value at December 31, 2021 Valuation Technique Unobservable Inputs Ranges $51,928 Earn-Out Valuation Probability of success factor 0% - 90% Discount rates 0.06% - 11.60% Fair Value at December 31, 2020 Valuation Technique Unobservable Inputs Ranges $56,515 Earn-Out Valuation Probability of success factor 60% - 90% Discount rates 0.11% - 16.86% The fair value of the warrant liability is estimated using the Black-Scholes Option Pricing Model using the following valuation inputs: December 31, 2021 December 31, 2020 Stock price $ 0.72 $ — Risk-free interest rate 0.84 % — % Dividend yield — % — % Volatility 130 % — %
Schedule of Reconciliation of Acquisition Contingencies	The following table provides a reconciliation of contingent consideration measured at fair value using significant unobservable inputs (Level 3) for the years ended December 31, 2021 and 2020, (in thousands): 2021 2020 Beginning balance as of January 1 $ 56,515 $ 1,130 Contingent consideration – Holo Milestone Payments — 50,632 (Gain) loss - Holo & Zyga (4,587) 4,883 Other — (130) Ending balance as of December 31 $ 51,928 $ 56,515
Schedule of Impairments of Long-Lived Assets and Related Post Impairment Fair Values	As a result of impairments recognized, the following table summarizes the post impairment fair values of the corresponding assets subject to fair value measured using Level 3 inputs for the years ended December 31, 2021 and 2020, and the corresponding impairment charge during the respective year: For the Year Ended December 31, 2021 Impairment Fair Value Property and equipment - net $ 11,018 $ 945 Definite-lived intangible assets - net 782 — Other assets - net 395 6,970 Total $ 12,195 $ 7,915 For the Year Ended December 31, 2020 Impairment Fair Value Property and equipment - net $ 11,707 $ 521 Definite-lived intangible assets - net 2,621 — Other assets - net 445 10,145 Total $ 14,773 $ 10,666
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 year ended December 31, 2021: Warrant Liability Balance - January 1, 2021 $ — Fair value of warrants on date of issuance 26,749 Change in fair value (14,736) Balance - December 31, 2021 $ 12,013

Accrued Expenses (Tables)

Accrued Expenses (Tables)	12 Months Ended
	Dec. 31, 2021
Payables and Accruals [Abstract]
Schedule of Accrued Expenses	Accrued expenses are as follows: For the Year Ended December 31, 2021 2020 Accrued compensation $ 5,258 $ 2,268 Accrued securities class action settlement 1,500 — Accrued distributor commissions 2,957 4,113 Other 8,054 6,267 Total accrued expenses $ 17,769 $ 12,648

Other long-term liabilities (Ta

Other long-term liabilities (Tables)	12 Months Ended
	Dec. 31, 2021
Other Liabilities, Noncurrent [Abstract]
Schedule of Other Long-term Liabilities	Other long-term liabilities are as follows: For the Year Ended December 31, 2021 2020 Acquisition contingencies $ 26,343 $ 47,519 Warrant Liability 12,013 — Lease obligations 947 1,200 Other 2,229 2,992 Total other long-term liabilities $ 41,532 $ 51,711

Income Taxes (Tables)

Income Taxes (Tables)	12 Months Ended
	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Summary of Pre-Tax Loss	The Company’s pre-tax loss consists of the following components: Year Ended December 31, 2021 2020 2019 Pre-tax loss: Domestic (U.S., state and local) $ (114,731) $ (191,455) $ (242,896) Foreign (loss) income (9,061) (6,226) 39 Total pre-tax loss (123,792) (197,681) (242,857)
Schedule of Income Tax Benefit (Provision)	The Company’s income tax benefit (provision) consists of the following components: For the Year Ended December 31, 2021 2020 2019 Current: Federal $ 426 $ (3,671) $ (312) State (1,325) — 89 International 184 (13) 138 Total current (715) (3,684) (85) Deferred: Federal (25) (99) 2,456 State (4) — 169 International (142) 297 3,381 Total deferred (171) 198 6,006 Total income tax (benefit) provision $ (886) $ (3,486) $ 5,921
Schedule of Deferred Tax Assets and Liabilities	The Company’s deferred tax assets and liabilities consists of the following components: For the Year Ended December 31, 2021 For the Year Ended December 31, 2020 Assets Liabilities Assets Liabilities Accounts receivable $ 2,376 $ — $ 1,993 — Accrued liabilities 990 — 1,326 — Deferred compensation 1,876 — 1,281 — Fixed assets and intangibles 22,096 — 22,235 — Inventory 7,066 — 8,475 — Net operating losses 29,917 — 9,891 — Revenue — — — (129) Tax credits 265 — — — Lease Liability 318 — 446 — Right of Use Asset — (224) — (344) Other 408 — — (48) Valuation allowance (65,007) — (45,126) — Total $ 305 $ (224) $ 521 $ (521)
Summary of Unrecognized Tax Benefits	The Company’s unrecognized tax benefits are summarized as follows: For the Year Ended December 31, 2021 2020 2019 Opening balance $ 2,991 $ 1,088 $ 1,088 Additions based on tax positions related to the current year — 1,903 — Additions for tax positions of prior years 542 — — Reductions for tax positions of prior years (1,451) — — Reductions for expiration of statute of limitations — — — $ 2,082 $ 2,991 $ 1,088
Schedule of Effective Tax Rate	The effective tax rate differs from the statutory federal income tax rate for the following reasons: For the Year Ended December 31, 2021 2020 2019 Statutory federal rate 21.00 % 21.00 % 21.00 % State income taxes—net of federal tax benefit 0.00 % (0.07) % (0.56) % Foreign rate differential 1.33 % 0.90 % 0.00 % Acquisition expenses (5.21) % (9.87) % 0.00 % Loss (Gain) on acquisition contingency 0.78 % (0.50) % 6.58 % Goodwill impairment and disposal 0.00 % 0.00 % (11.88) % Change in fair value of the warrant liability 2.50 % 0.00 % 0.00 % Noncontrolling interest (7.11 %) 0.00 % 0.00 % Tax attributes (0.22) % 0.28 % 0.04 % Tax legislation 0.19 % 0.95 % 0.00 % Valuation allowances (12.61) % (10.57) % (16.98) % Uncertain tax positions 0.95 % 0.00 % 0.00 % Other reconciling items, net (0.89) % (0.36) % (0.63) % Effective tax rate 0.71 % 1.76 % (2.43) %

Preferred Stock (Tables)

Preferred Stock (Tables)	12 Months Ended
	Dec. 31, 2021
Equity [Abstract]
Schedule of Preferred Stock	Preferred stock is as follows: Preferred Stock Liquidation Value Preferred Stock Issuance Costs Net Total Balance at January 1, 2019 $ 66,519 $ (293) $ 66,226 Amortization of preferred stock issuance costs — 184 184 Balance at December 31, 2019 66,519 (109) 66,410 Amortization of preferred stock issuance costs — 109 109 Redemption of preferred stock (66,519) — (66,519) Balance at December 31, 2020 — — — Amortization of preferred stock issuance costs — — — Redemption of preferred stock — — — Balance at December 31, 2021 $ — $ — $ —

Severance and Restructuring C_2

Severance and Restructuring Costs (Tables)	12 Months Ended
	Dec. 31, 2021
Restructuring and Related Activities [Abstract]
Schedule of Restructuring Charges	The following table includes a rollforward of severance and restructuring costs included in accrued expenses on the consolidated balance sheets, see Note 16. Accrued severance and restructuring charges at January 1, 2019 $ 908 Severance and restructuring expenses accrued in 2019 626 Severance and restructuring cash payments (1,398) Accrued severance and restructuring charges at December 31, 2019 136 Severance and restructuring expenses accrued in 2020 — Severance and restructuring cash payments (136) Accrued severance and restructuring charges at December 31, 2020 — Severance and restructuring expenses accrued in 2021 208 Severance and restructuring cash payments (208) Accrued severance and restructuring charges at December 31, 2021 $ —

Business - Additional Informati

Business - Additional Information (Details)

Feb. 15, 2022USD ($)$ / sharesshares

Jan. 14, 2022USD ($)shares

Jan. 12, 2022USD ($)shares

Dec. 30, 2021USD ($)shares

Jun. 14, 2021USD ($)$ / sharesshares

Apr. 30, 2021USD ($)payment

Feb. 01, 2021USD ($)$ / sharesshares

Oct. 23, 2020USD ($)shares

Jul. 24, 2020USD ($)

Jul. 20, 2020USD ($)

Dec. 31, 2021USD ($)country

Dec. 31, 2020USD ($)

Dec. 31, 2019USD ($)

Dec. 31, 2021USD ($)country

Business [Line Items]

Countries in which we market and sell (more than) | country

50

50

Contingent liability

$ 51,928,000

$ 56,515,000

$ 1,130,000

$ 51,928,000

Payment on redemption of preferred stock

$ 66,500,000

0

66,519,000

0

Cash and cash equivalents

51,287,000

43,962,000

51,287,000

Accumulated deficit

(569,613,000)

(484,962,000)

(569,613,000)

Loss from continuing operations

(122,906,000)

(194,195,000)

(248,778,000)

Strike price of warrants (in dollars per share) | $ / shares

$ 1.725

Period of warrants exercisable expiration period

3 years

Current portion of accrued acquisition contingency - Holo

25,585,000

8,996,000

25,585,000

Placement Agent Warrants

Business [Line Items]

Strike price of warrants (in dollars per share) | $ / shares

$ 2.15625

Subsequent Event | Invest Warrants

Business [Line Items]

Period of warrants exercisable expiration period

5 years

Public Offering

Business [Line Items]

Common stock sold (in shares) | shares

29,000,000

28,700,000

Net proceeds from issuance of common stock

$ 45,800,000

$ 40,500,000

Investor and other filing fees

$ 4,200,000

Common stock price per share (in dollars per share) | $ / shares

$ 1.50

Underwriting discounts and commission

$ 4,000,000

Public Offering | Invest Warrants

Business [Line Items]

Strike price of warrants (in dollars per share) | $ / shares

$ 1.725

Public Offering | Placement Agent Warrants

Business [Line Items]

Strike price of warrants (in dollars per share) | $ / shares

$ 2.15625

Public Offering | Subsequent Event

Business [Line Items]

Common stock sold (in shares) | shares

43,478,264

Net proceeds from issuance of common stock

$ 17,800,000

Investor and other filing fees

$ 2,200,000

Public Offering | Subsequent Event | Pre-Funded Warrants

Business [Line Items]

Sale of Stock, Price Per Share | $ / shares

$ 0.46

Public Offering | Subsequent Event | Invest Warrants

Business [Line Items]

Strike price of warrants (in dollars per share) | $ / shares

0.60

Public Offering | Subsequent Event | Placement Agent Warrants

Business [Line Items]

Strike price of warrants (in dollars per share) | $ / shares

$ 0.575

Revolving Credit Facility | 2018 Loan Agreement

Business [Line Items]

Debt retirement

$ 80,000,000

Term Loans | 2019 Loan Agreement

Business [Line Items]

Debt retirement

100,000,000

Incremental Term Loan | 2019 Loan Agreement

Business [Line Items]

Debt retirement

30,000,000

Sold

Business [Line Items]

Purchase price

$ 440,000,000

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 | Invest Warrants

Business [Line Items]

Number of common stock shares issuable upon conversion of warrants (in shares) | shares

29,000,000

Maximum | Public Offering | Placement Agent Warrants

Business [Line Items]

Number of common stock shares issuable upon conversion of warrants (in shares) | shares

1,700,000

Maximum | Public Offering | Subsequent Event | Pre-Funded Warrants

Business [Line Items]

Number of common stock shares issuable upon conversion of warrants (in shares) | shares

32,608,698

Maximum | Public Offering | Subsequent Event | Invest Warrants

Business [Line Items]

Number of common stock shares issuable upon conversion of warrants (in shares) | shares

32,608,698

Maximum | Public Offering | Subsequent Event | Placement Agent Warrants

Business [Line Items]

Number of common stock shares issuable upon conversion of warrants (in shares) | shares

2,608,696

INN Acquisition

Business [Line Items]

Payments to acquire businesses

19,900,000

Cash consideration

$ 5,000,000

5,000,000

0

0

Contingent liability

10,000,000

Shares issued

$ 4,900,000

INN Acquisition | Common Stock

Business [Line Items]

Shares issuable at closing (in shares) | shares

6,820,792

INN Acquisition | INN Acquisition

Business [Line Items]

Percentage of voting interests acquired

42.00%

INN Acquisition | Consideration for remaining ownership, achievement of all milestones

Business [Line Items]

Payments to acquire businesses

$ 72,300,000

72,300,000

Contingent liability

10,600,000

Contingent consideration for future commitments

57,900,000

57,900,000

Contingent consideration (up to)

$ 10,300,000

10,300,000

$ 10,300,000

Prompt | Asset Purchase Agreement

Business [Line Items]

Payments to acquire businesses

$ 1,100,000

Cash consideration

300,000

Shares issued

200,000

Contingent consideration

$ 600,000

Number of payments | payment

2

First payment

18 months

Second payment

36 months

Holo Surgical Inc.

Business [Line Items]

Cash consideration

0

32,117,000

$ 0

Holo Surgical Inc. | Stock purchase agreement

Business [Line Items]

Payments to acquire businesses

$ 95,000,000

Cash consideration

$ 30,000,000

Shares issuable at closing (in shares) | shares

6,250,000

Shares issuable at closing

$ 12,300,000

Contingent liability

50,600,000

56,500,000

Shares issued

$ 12,300,000

Contingent consideration payable closing milestones, term

6 years

6 years

Current portion of accrued acquisition contingency - Holo

25,600,000

9,000,000

$ 25,600,000

Contingent consideration (up to)

$ 83,000,000

Holo Surgical Inc. | Stock purchase agreement | Subsequent Event

Business [Line Items]

Cash consideration

$ 4,100,000

$ 4,100,000

Contingent liability

$ 10,000,000

$ 10,000,000

Number of contingent consideration shares issued (in shares) | shares

8,650,000

Maximum shares to be issued including contingent shares (in shares) | shares

5,900,000

5,900,000

Trading days

5 days

Holo Surgical Inc. | Common Stock | Stock purchase agreement

Business [Line Items]

Shares issuable at closing (in shares) | shares

6,250,000

Shares issued

$ 12,300,000

Maximum shares to be issued including contingent shares (in shares) | shares

14,900,000

Holo Surgical Inc. | Common Stock | Stock purchase agreement | Subsequent Event

Business [Line Items]

Number of contingent consideration shares issued (in shares) | shares

8,650,000

Holo Surgical Inc. | Consideration for remaining ownership, achievement of all milestones | Level 3 | Earn-Out Valuation

Business [Line Items]

Contingent liability

51,928,000

$ 56,515,000

51,928,000

Holo Surgical Inc. | Consideration for remaining ownership, achievement of all milestones | Stock purchase agreement

Business [Line Items]

Contingent liability

51,900,000

51,900,000

Contingent consideration (up to)

83,000,000

83,000,000

Holo Surgical Inc. | Consideration for remaining ownership, achievement of all milestones | Stock purchase agreement | Expected to become due

Business [Line Items]

Current portion of accrued acquisition contingency - Holo

$ 25,600,000

$ 25,600,000

Summary of Significant Accoun_4

Summary of Significant Accounting Policies - Additional Information (Details) - USD ($)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019	Dec. 30, 2021
Summary Of Significant Accounting Policies [Line Items]
Cash equivalents	$ 0	$ 0
Debt issuance costs	0	0
Amortization expense of other intangible assets	$ 0	$ 900,000	$ 10,700,000
Dividend yield	0.00%	0.00%	0.00%
Repurchase of common stock (in shares)	109,018	159,354	64,044
Repurchase of common stock	$ 200,000	$ 500,000	$ 300,000
INN Acquisition | INN Acquisition
Summary Of Significant Accounting Policies [Line Items]
Percentage of voting interests acquired				42.00%
Patents | Minimum
Summary Of Significant Accounting Policies [Line Items]
Estimated useful lives of intangible assets	8 years
Patents | Maximum
Summary Of Significant Accounting Policies [Line Items]
Estimated useful lives of intangible assets	16 years
Tradenames | Minimum
Summary Of Significant Accounting Policies [Line Items]
Estimated useful lives of intangible assets	5 years
Tradenames | Maximum
Summary Of Significant Accounting Policies [Line Items]
Estimated useful lives of intangible assets	25 years
Procurement contracts | Minimum
Summary Of Significant Accounting Policies [Line Items]
Estimated useful lives of intangible assets	5 years
Procurement contracts | Maximum
Summary Of Significant Accounting Policies [Line Items]
Estimated useful lives of intangible assets	25 years
Customer lists | Minimum
Summary Of Significant Accounting Policies [Line Items]
Estimated useful lives of intangible assets	5 years
Customer lists | Maximum
Summary Of Significant Accounting Policies [Line Items]
Estimated useful lives of intangible assets	25 years
Acquired exclusivity rights | Minimum
Summary Of Significant Accounting Policies [Line Items]
Estimated useful lives of intangible assets	5 years
Acquired exclusivity rights | Maximum
Summary Of Significant Accounting Policies [Line Items]
Estimated useful lives of intangible assets	25 years
Distribution agreements | Minimum
Summary Of Significant Accounting Policies [Line Items]
Estimated useful lives of intangible assets	5 years
Distribution agreements | Maximum
Summary Of Significant Accounting Policies [Line Items]
Estimated useful lives of intangible assets	25 years

Summary of Significant Accoun_5

Summary of Significant Accounting Policies - Estimated Useful Lives of Assets (Details)	12 Months Ended
	Dec. 31, 2021
Processing equipment | Minimum
Property, Plant and Equipment [Line Items]
Estimated useful lives of the assets	7 years
Processing equipment | Maximum
Property, Plant and Equipment [Line Items]
Estimated useful lives of the assets	10 years
Office equipment, furniture and fixtures | Minimum
Property, Plant and Equipment [Line Items]
Estimated useful lives of the assets	5 years
Office equipment, furniture and fixtures | Maximum
Property, Plant and Equipment [Line Items]
Estimated useful lives of the assets	7 years
Computer equipment and software | Minimum
Property, Plant and Equipment [Line Items]
Estimated useful lives of the assets	3 years
Computer equipment and software | Maximum
Property, Plant and Equipment [Line Items]
Estimated useful lives of the assets	7 years
Surgical instruments
Property, Plant and Equipment [Line Items]
Estimated useful lives of the assets	1 year

Leases - Additional Information

Leases - Additional Information (Details)	Dec. 31, 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	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Leases [Abstract]
Operating lease cost	$ 706	$ 1,179	$ 1,108
Short-term operating lease cost	335	0	36
Total operating lease cost	$ 1,041	$ 1,179	$ 1,144

Leases - Schedule of Supplement

Leases - Schedule of Supplemental Cash Flow Information Related to Leases (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Leases [Abstract]
Cash paid for amounts included in the measurement of lease liabilities	$ 1,237	$ 1,313
ROU assets obtained in exchange for lease obligations	$ 57	$ 242

Leases - Schedule of Suppleme_2

Leases - Schedule of Supplemental Balance Sheet Information Related to Leases (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Assets:
Right-of-use assets	$ 876	$ 1,425
Liabilities:
Current	294	650
Noncurrent	947	1,200
Total operating lease liabilities	$ 1,241	$ 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)	Dec. 31, 2021	Dec. 31, 2020
Leases [Abstract]
Weighted-average remaining lease term (years)	6 years 3 months 18 days	5 years 6 months
Weighted-average discount rate	5.09%	4.92%

Leases - Schedule of Maturities

Leases - Schedule of Maturities of Operating Lease Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Leases [Abstract]
2022	$ 374
2023	217
2024	173
2025	161
2026	159
2027 and beyond	398
Total future minimum lease payments	1,482
Less imputed interest	(241)
Total	$ 1,241	$ 1,850

Discontinued Operations - Addit

Discontinued Operations - Additional Information (Details) - USD ($) $ in Millions	Jul. 20, 2020	Jun. 30, 2021	Jun. 03, 2021	Dec. 01, 2020
Revolving Credit Facility | 2018 Loan Agreement
Income Statement Balance Sheet And Additional Disclosures By Disposal Groups Including Discontinued Operations [Line Items]
Debt retirement	$ 80
Term Loans | 2019 Loan Agreement
Income Statement Balance Sheet And Additional Disclosures By Disposal Groups Including Discontinued Operations [Line Items]
Debt retirement	100
Incremental Term Loan | 2019 Loan Agreement
Income Statement Balance Sheet And Additional Disclosures By Disposal Groups Including Discontinued Operations [Line Items]
Debt retirement	30
OEM Business | Sold
Income Statement Balance Sheet And Additional Disclosures By Disposal Groups Including Discontinued Operations [Line Items]
Maximum working capital adjustment amount				$ 14
Disputed amount remaining			$ 5.8
Disputed amount paid		$ 5.8
OEM Business | Sold | Revolving Credit Facility | 2018 Loan Agreement
Income Statement Balance Sheet And Additional Disclosures By Disposal Groups Including Discontinued Operations [Line Items]
Debt retirement	80
OEM Business | Sold | Term Loans | 2019 Loan Agreement
Income Statement Balance Sheet And Additional Disclosures By Disposal Groups Including Discontinued Operations [Line Items]
Debt retirement	100
OEM Business | Sold | Incremental Term Loan | 2019 Loan Agreement
Income Statement Balance Sheet And Additional Disclosures By Disposal Groups Including Discontinued Operations [Line Items]
Debt retirement	$ 30

Discontinued Operations - Sched

Discontinued Operations - Schedule of Financial Results of Discontinued Operations (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Other Expense, Nonoperating [Abstract]
(Loss) Income from discontinued operations before income tax provision	$ (6,316)	$ 179,934	$ 48,452
Income tax (benefit) provision	(2,674)	19,522	11,316
OEM Business | Sold
Income Statement Balance Sheet And Additional Disclosures By Disposal Groups Including Discontinued Operations [Line Items]
Revenues	0	87,192	190,961
Costs of goods sold	0	49,678	104,482
Gross profit	0	37,514	86,479
Expenses:
General and administrative	0	12,889	22,279
Severance and restructuring costs	0	604	0
Transaction and integration expenses	0	23,598	3,160
Total operating expenses	0	37,091	25,439
Operating income	0	423	61,040
Other Expense, Nonoperating [Abstract]
OEM working capital adjustment	6,316	0	0
Interest expense	0	14,965	12,571
Loss on extinguishment of debt	0	2,686	0
Derivative loss	0	12,641	0
Foreign exchange (gain) loss	0	(3)	17
Total other expense - net	6,316	30,289	12,588
(Loss) income from discontinued operations	(6,316)	(29,866)	48,452
Gain on sale of net assets of discontinued operations	0	209,800	0
(Loss) Income from discontinued operations before income tax provision	(6,316)	179,934	48,452
Income tax (benefit) provision	(2,674)	19,522	11,316
Net (loss) income on discontinued operations	$ (3,642)	$ 160,412	$ 37,136

Discontinued Operations - Summa

Discontinued Operations - Summary of Operating and Investing Cash Flows of Discontinued Operations (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Significant operating non-cash reconciliation items:
Stock-based compensation	$ 5,212	$ 6,528	$ 4,367
Gain on sale of discontinued assets, net	6,316	(209,800)	0
Paid in kind interest expense	0	0	4,408
Loss on extinguishment of debt	0	2,686	0
Amortization of debt issuance costs	0	283	0
Amortization of debt discount	0	2,479	0
Significant investing items:
Payments for OEM working capital adjustment	(5,430)	0	0
Purchases of property and equipment	(195)	(750)	(1,468)
Proceeds from sale of OEM business	0	437,097	0
Sold | OEM Business
Significant operating non-cash reconciliation items:
Depreciation and amortization	0	2,125	4,466
Provision for bad debts and product returns	0	456	101
Provision for inventory write-downs	0	0	6,340
Revenue recognized due to change in deferred revenue	0	(2,618)	(4,906)
Deferred income tax (benefit) provision	0	(1,609)	(3,989)
Stock-based compensation	0	792	540
Gain on sale of discontinued assets, net	0	(209,800)	0
Paid in kind interest expense	0	0	4,408
Loss on extinguishment of debt	0	2,686	0
Amortization of debt issuance costs	0	283	0
Amortization of debt discount	0	2,479	0
Significant investing items:
Payments for OEM working capital adjustment	(5,430)	0	0
Purchases of property and equipment	0	(1,867)	(6,866)
Patent and acquired intangible asset costs	0	(419)	(578)
Proceeds from sale of OEM business	$ 0	$ 437,097	$ 0

Revenue from Contracts with C_3

Revenue from Contracts with Customers - Schedule of Total Revenue by Geographical Region (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Disaggregation Of Revenue [Line Items]
Revenues	$ 90,500	$ 101,749	$ 117,423
Recognized at a point in time
Disaggregation Of Revenue [Line Items]
Revenues	90,500	101,749	117,423
Domestic | Recognized at a point in time
Disaggregation Of Revenue [Line Items]
Revenues	77,927	85,612	97,703
International | Recognized at a point in time
Disaggregation Of Revenue [Line Items]
Revenues	$ 12,573	$ 16,137	$ 19,720

Business Combinations and Acq_3

Business Combinations and Acquisitions - Inteneural Networks, Inc. (Details) $ / shares in Units, $ in Thousands	Dec. 30, 2021USD ($)payment$ / sharesshares	Dec. 31, 2021USD ($)$ / shares	Dec. 31, 2021USD ($)$ / shares	Dec. 31, 2020USD ($)$ / shares	Dec. 31, 2019USD ($)
Business Acquisition [Line Items]
Common stock, par value (in dollars per share) | $ / shares		$ 0.001	$ 0.001	$ 0.001
Contingent liability		$ 51,928	$ 51,928	$ 56,515	$ 1,130
Asset acquisition expenses			72,100	94,999	0
Net loss			(84,651)	(33,783)	(211,642)
Net loss applicable to noncontrolling interests			(41,897)	0	0
INN Acquisition
Business Acquisition [Line Items]
Payments to acquire businesses			19,900
Cash consideration	$ 5,000		5,000	$ 0	$ 0
Shares issued	4,900
Contingent liability	$ 10,000
Contingent voting interests	19.30%
Contingent consideration for future equity acquisitions	$ 19,300
Noncontrolling interest not purchased	41,700
Asset acquisition expenses			72,087
Non controlling interest		52,000	52,000
Net loss			30,200
Net loss applicable to noncontrolling interests			41,900
INN Acquisition | Assembled Workforce
Business Acquisition [Line Items]
Asset acquisition expenses		200	200
INN Acquisition | Consideration for remaining ownership, achievement of all milestones
Business Acquisition [Line Items]
Payments to acquire businesses	72,300		72,300
Contingent liability	$ 10,600
Equity interest percentage	100.00%
Number of potential milestone payments | payment	3
Accrued acquisition and integration expenses	$ 400	400	400
Contingent consideration (up to)	$ 10,300	$ 10,300	$ 10,300
INN Acquisition | Common Stock
Business Acquisition [Line Items]
Shares issuable at closing (in shares) | shares	6,820,792
Common stock, par value (in dollars per share) | $ / shares	$ 0.001
INN Acquisition | INN Acquisition
Business Acquisition [Line Items]
Percentage of voting interests acquired	42.00%
Remaining equity interest	58.00%	58.00%	58.00%

Business Combinations and Acq_4

Business Combinations and Acquisitions - Prompt Prototypes Acquisition (Details) - Prompt - Asset Purchase Agreement $ in Millions	Apr. 30, 2021USD ($)payment	Dec. 31, 2021USD ($)
Business Acquisition [Line Items]
Payments to acquire businesses	$ 1.1
Cash consideration	0.3
Shares issued	0.2
Contingent consideration	$ 0.6
First payment	18 months
Second payment	36 months
Bargain purchase gain		$ 0.1
Number of payments | payment	2

Business Combinations and Acq_5

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

Business Combinations and Acq_6

Business Combinations and Acquisitions - Holo Surgical Acquisition (Details) - USD ($)	Jan. 14, 2022	Jan. 12, 2022	Oct. 23, 2020	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2021
Business Acquisition [Line Items]
Common stock, par value (in dollars per share)				$ 0.001	$ 0.001		$ 0.001
Contingent liability				$ 51,928,000	$ 56,515,000	$ 1,130,000	$ 51,928,000
Current portion of accrued acquisition contingency - Holo				25,585,000	8,996,000		25,585,000
Asset acquisition expenses				72,100,000	94,999,000	0
Change in fair value				(4,587,000)	4,753,000	(76,033,000)
Holo Surgical Inc.
Business Acquisition [Line Items]
Cash consideration				0	32,117,000	$ 0
Holo Surgical Inc. | Earn-Out Valuation | Consideration for remaining ownership, achievement of all milestones | Level 3
Business Acquisition [Line Items]
Contingent liability				51,928,000	56,515,000		$ 51,928,000
Holo Surgical Inc. | Stock purchase agreement
Business Acquisition [Line Items]
Cash consideration			$ 30,000,000
Shares issuable at closing (in shares)			6,250,000
Common stock, par value (in dollars per share)			$ 0.001
Contingent consideration (up to)			$ 83,000,000
Contingent consideration payable closing milestones, term			6 years				6 years
Payments to acquire businesses			$ 95,000,000
Shares issued			12,300,000
Acquisition related costs			2,100,000
Contingent liability			$ 50,600,000		56,500,000
Current portion of accrued acquisition contingency - Holo				25,600,000	9,000,000		$ 25,600,000
Noncurrent contingent consideration					47,500,000
IPR&D one-time expense					94,500,000
Asset acquisition expenses					500,000
Change in fair value				(4,600,000)	$ 4,700,000		5,900,000
Holo Surgical Inc. | Stock purchase agreement | Subsequent Event
Business Acquisition [Line Items]
Cash consideration	$ 4,100,000	$ 4,100,000
Maximum shares to be issued including contingent shares (in shares)	5,900,000	5,900,000
Contingent liability	$ 10,000,000	$ 10,000,000
Number of contingent consideration shares issued (in shares)		8,650,000
Holo Surgical Inc. | Stock purchase agreement | Consideration for remaining ownership, achievement of all milestones
Business Acquisition [Line Items]
Contingent consideration (up to)				83,000,000			83,000,000
Contingent liability				51,900,000			51,900,000
Holo Surgical Inc. | Stock purchase agreement | Recurring | Earn-Out Valuation | Consideration for remaining ownership, achievement of all milestones | Level 3
Business Acquisition [Line Items]
Contingent liability				51,900,000			51,900,000
Holo Surgical Inc. | Stock purchase agreement | Other long-term liabilities
Business Acquisition [Line Items]
Fair value of liability				$ 26,300,000			$ 26,300,000
Holo Surgical Inc. | Stock purchase agreement | Common Stock
Business Acquisition [Line Items]
Shares issuable at closing (in shares)			6,250,000
Maximum shares to be issued including contingent shares (in shares)			14,900,000
Shares issued			$ 12,300,000
Holo Surgical Inc. | Stock purchase agreement | Common Stock | Subsequent Event
Business Acquisition [Line Items]
Number of contingent consideration shares issued (in shares)	8,650,000

Business Combinations and Acq_7

Business Combinations and Acquisitions - Paradigm Spine Acquisition (Details) - USD ($)	Mar. 08, 2019	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Business Acquisition [Line Items]
Common stock, par value (in dollars per share)		$ 0.001	$ 0.001
Contingent liability		$ 51,928,000	$ 56,515,000	$ 1,130,000
Asset acquisition expenses		72,100,000	94,999,000	0
Paradigm
Business Acquisition [Line Items]
Cash consideration	$ 100,000,000	0	$ 0	99,692,000
Shares issuable at closing (in shares)	10,729,614
Consideration adjustment for working capital	$ 7,000,000
Contingent consideration (up to)	150,000,000
Contingent liability	72,200,000	0		$ 0
Inventory fair value, current	7,100,000
Inventory fair value, noncurrent	10,500,000
Goodwill	135,589,000
Paradigm | Stock purchase agreement
Business Acquisition [Line Items]
Contingent liability		$ 0
Paradigm | Shares of Company common stock
Business Acquisition [Line Items]
Contingent consideration (up to)	50,000,000
Paradigm | Cash and/or Company common stock
Business Acquisition [Line Items]
Contingent consideration (up to)	$ 100,000,000
Paradigm | Master Transaction Agreement | Common Stock
Business Acquisition [Line Items]
Common stock, par value (in dollars per share)	$ 0.001
Convertible preferred stock, fully paid and non-assessable (in share)	1
Paradigm | Master Transaction Agreement | Series A Preferred Stock
Business Acquisition [Line Items]
Convertible preferred stock, fully paid and non-assessable (in share)	1
Preferred stock, par value (in dollars per share)	$ 0.001
Paradigm | Master Transaction Agreement | Legacy RTI
Business Acquisition [Line Items]
Common stock, par value (in dollars per share)	0.001
Paradigm | Master Transaction Agreement | Legacy RTI | Series A Preferred Stock
Business Acquisition [Line Items]
Preferred stock, par value (in dollars per share)	$ 0.001

Business Combinations and Acq_8

Business Combinations and Acquisitions - Schedule of Acquisition Purchase Price (Details) - Paradigm $ in Thousands	Mar. 08, 2019USD ($)
Business Acquisition [Line Items]
Cash proceeds from second lien credit agreement	$ 100,000
Fair market value of securities issued	60,730
Fair market value of contingent earnout	72,177
Total purchase price	$ 232,907

Business Combinations and Acq_9

Business Combinations and Acquisitions - Schedule of Final Allocation of Total Consideration to Tangible and Intangible/ Identifiable Assets and Liabilities (Details) - Paradigm $ in Thousands	Mar. 08, 2019USD ($)
Business Acquisition [Line Items]
Cash	$ 307
Accounts receivable	5,220
Inventories	17,647
Other current assets	934
Property and equipment	379
Other non-current assets	1,079
Current liabilities	(6,169)
Lease liabilities	(1,079)
Net tangible assets acquired	18,318
Other intangible assets	79,000
Goodwill	135,589
Total net assets acquired	$ 232,907

Business Combinations and Ac_10

Business Combinations and Acquisitions - Pro Forma Information of Operations (Details) - Paradigm $ in Thousands	12 Months Ended
	Dec. 31, 2019USD ($)
Business Acquisition [Line Items]
Revenues	$ 37,374
Net loss applicable to common shares	$ (16,547)

Stock-Based Compensation - Addi

Stock-Based Compensation - Additional Information (Detail) $ / shares in Units, $ in Thousands	Jul. 01, 2021	May 07, 2021shares	Nov. 29, 2019$ / sharesshares	Dec. 04, 2017shares	Sep. 18, 2017reporting_unit$ / sharesshares	Jan. 26, 2017$ / sharesshares	Jan. 31, 2021	Dec. 31, 2021USD ($)planshares	Dec. 31, 2020USD ($)	Dec. 31, 2019USD ($)
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Number of stock based compensation plans | plan								4
Shares that will vest (in shares)								5,331,220
Options granted (in shares)								776,564
ESPP | Board of Directors
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares of common stock allowed to be issued (in shares)								667,399
Employee's compensation minimum percentage		1.00%
Employee's compensation maximum percentage		15.00%
ESPP Offering period	6 months						6 months
Look back period		6 months
Fair market value of common stock (in dollars per share)		85.00%
Number of stock issued value, employee stock purchase plan | $								$ 400
Number of shares reserved for issuance (in shares)								5,000,000
Number of shares issued (in shares)								4,332,601
Stock Option
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Exercise price percentage								100.00%
Total unrecognized stock-based compensation expense | $								$ 1,700
Expected weighted-average period of expense recognition								3 years
Stock Option | Minimum
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Contractual term of stock options granted								5 years
Vesting period								1 year
Stock Option | Maximum
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Contractual term of stock options granted								10 years
Vesting period								5 years
Stock Option | President of Global Spine, Mr. Terry Rich
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Options granted (in shares)			188,397
Exercise price (in dollars per share) | $ / shares			$ 2.09
Stock Option | President of Global Spine, Mr. Terry Rich | First vesting
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares that will vest (in shares)			62,799
Stock Option | President of Global Spine, Mr. Terry Rich | Second vesting
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares that will vest (in shares)			15,700
Stock Option | President of Global Spine, Mr. Terry Rich | Minimum | Second vesting
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Vesting period			15 months
Stock Option | President of Global Spine, Mr. Terry Rich | Maximum | Second vesting
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Vesting period			2 years
Restricted Stock Awards
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Exercise price percentage								100.00%
Total unrecognized stock-based compensation expense | $								$ 1,400
Expected weighted-average period of expense recognition								1 year 5 months 8 days
Shares granted (in shares)								147,719
Fair market value of restricted stock | $								$ 1,900	$ 3,000	$ 2,360
Restricted Stock Awards | Employees
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares granted (in shares)								147,719
Restricted Stock Awards | Non-employee directors
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares granted (in shares)								0
Restricted Stock Awards | Minimum
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Vesting period								1 year
Restricted Stock Awards | Maximum
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Vesting period								3 years
Restricted Stock Awards | President of Global Spine, Mr. Terry Rich
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares granted (in shares)			125,598
Restricted Stock Awards | President of Global Spine, Mr. Terry Rich | First vesting
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares that will vest (in shares)			41,866
Restricted Stock Awards | President of Global Spine, Mr. Terry Rich | Second vesting
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares that will vest (in shares)			10,467
Restricted Stock Awards | President of Global Spine, Mr. Terry Rich | Minimum | Second vesting
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Vesting period			15 months
Restricted Stock Awards | President of Global Spine, Mr. Terry Rich | Maximum | Second vesting
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Vesting period			2 years
Restricted Stock Units
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Exercise price percentage								100.00%
Total unrecognized stock-based compensation expense | $								$ 5,500
Expected weighted-average period of expense recognition								1 year 11 months 1 day
Shares granted (in shares)								5,541,313
Restricted Stock Units | Minimum
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Vesting period								1 year
Restricted Stock Units | Maximum
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Vesting period								3 years
2021 Incentive Compensation Plan
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares of common stock allowed to be issued (in shares)		5,842,608
2021 Inducement Compensation Plan
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares of common stock allowed to be issued (in shares)		4,500,000
2018 Plan
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares of common stock allowed to be issued (in shares)								5,726,035
Restricted Stock Agreement #1 | Restricted Stock Awards | Mr. Camille Farhat | Common Stock
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares granted (in shares)						850,000
Restricted Stock Agreement #2 | Restricted Stock Awards | Mr. Camille Farhat | Common Stock
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares granted (in shares)				150,000
Option Agreement | Stock Option | Mr. Camille Farhat
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Exercise price (in dollars per share) | $ / shares						$ 3.20
Option Agreement | Stock Option | Mr. Camille Farhat | Common Stock
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Options granted (in shares)						1,950,000
Option Agreement | Stock Option | Mr. Jonathon Singer
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Exercise price (in dollars per share) | $ / shares					$ 4.55
Option Agreement | Stock Option | Mr. Jonathon Singer | Common Stock
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Options granted (in shares)					306,900
Option Agreement | Stock Option | Mr. Jonathon Singer | First vesting
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Average stock price benchmark (in dollars per share) | $ / shares					$ 3
Options expected to vest (in shares)					102,300
Award vesting stock price (in dollars per share) | $ / shares					$ 7
Vesting, stock price, consecutive calendar days | reporting_unit					60
Option Agreement | Stock Option | Mr. Jonathon Singer | Second vesting
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Options expected to vest (in shares)					102,300
Award vesting stock price (in dollars per share) | $ / shares					$ 8
Vesting, stock price, consecutive calendar days | reporting_unit					60
Option Agreement | Stock Option | Mr. Jonathon Singer | Third vesting
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Options expected to vest (in shares)					102,300
Award vesting stock price (in dollars per share) | $ / shares					$ 9
Vesting, stock price, consecutive calendar days | reporting_unit					60
Restricted Stock Agreement | Restricted Stock Awards | Mr. Jonathon Singer
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares granted (in shares)					109,890

Stock-Based Compensation - Stoc

Stock-Based Compensation - Stock-Based Compensation Recognized (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation	$ 5,212	$ 5,736	$ 3,827
Costs of goods sold
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation	21	169	144
General and administrative
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation	4,839	3,980	3,623
Research and development
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation	352	72	60
Transaction and integration expenses
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation	$ 0	$ 1,515	$ 0

Stock-Based Compensation - St_2

Stock-Based Compensation - Stock Options Outstanding, Exercisable and Available for Grant (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Number of Options
Outstanding beginning balance (in shares)	4,979,180
Granted (in shares)	776,564
Exercised (in shares)	(1,007)
Forfeited or expired (in shares)	(423,517)
Outstanding ending balance (in shares)	5,331,220	4,979,180
Vested or expected to vest (in shares)	5,331,220
Exercisable (in shares)	3,487,657
Available for grant (in shares)	5,777,619
Weighted Average Exercise Price
Outstanding beginning balance (in dollars per share)	$ 3.28
Granted (in dollars per share)	1.82
Exercised (in dollars per share)	2.69
Forfeited or expired (in dollars per share)	3.29
Outstanding ending balance (in dollars per share)	3.08	$ 3.28
Vested or expected to vest (in dollars per share)	3.08
Exercisable (in dollars per share)	$ 3.37
Weighted Average Remaining Contractual Life (Years)
Outstanding at December 31, 2021	4 years 5 months 4 days	5 years 3 months 18 days
Vested or expected to vest	4 years 5 months 4 days
Exercisable at December 31, 2021	2 years 1 month 24 days
Aggregate Intrinsic Value, Outstanding	$ 0	$ 142
Aggregate Intrinsic Value, Vested or expected to vest	0
Aggregate Intrinsic Value, Exercisable	$ 0

Stock-Based Compensation - Othe

Stock-Based Compensation - Other Information Concerning Stock Options (Details) - USD ($)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Share-based Payment Arrangement [Abstract]
Weighted average fair value of stock options granted (in dollars per share)	$ 0.93	$ 1.21	$ 1.56
Aggregate intrinsic value of stock options exercised	$ 0	$ 3,200	$ 161,000

Stock-Based Compensation - Sche

Stock-Based Compensation - Schedule of Weighted-Average Assumptions Used to Determine Fair Value of Options (Details)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Employee Stock Ownership Plan (ESOP) Disclosures [Line Items]
Expected term (years)	6 years 4 months 6 days	6 years 6 months	6 years 6 months
Risk free interest rate	0.72%	0.62%	2.54%
Volatility factor	49.97%	41.62%	37.73%
Dividend yield	0.00%	0.00%	0.00%
ESPP
Employee Stock Ownership Plan (ESOP) Disclosures [Line Items]
Expected term (years)	6 months	0 years	0 years
Risk free interest rate	0.05%	0.00%	0.00%
Volatility factor	84.32%	0.00%	0.00%
Dividend yield	0.00%	0.00%	0.00%

Stock-Based Compensation - Unve

Stock-Based Compensation - Unvested Restricted Stock Awards (Details)	12 Months Ended
	Dec. 31, 2021$ / sharesshares
Restricted Stock Awards
Number of Shares
Beginning balance (in shares) | shares	1,897,196
Granted (in shares) | shares	147,719
Vested (in shares) | shares	(1,037,528)
Forfeited (in shares) | shares	(353,133)
Ending balance (in shares) | shares	654,254
Weighted Average Grant Date Fair Value
Beginning balance (in dollars per share) | $ / shares	$ 3.47
Granted (in dollars per share) | $ / shares	2.06
Vested (in dollars per share) | $ / shares	3.68
Forfeited (in dollars per share) | $ / shares	3.35
Ending balance (in dollars per share) | $ / shares	$ 2.89
Restricted Stock Units
Number of Shares
Beginning balance (in shares) | shares	89,935
Granted (in shares) | shares	5,541,313
Vested (in shares) | shares	(30,783)
Forfeited (in shares) | shares	(800,102)
Ending balance (in shares) | shares	4,800,363
Weighted Average Grant Date Fair Value
Beginning balance (in dollars per share) | $ / shares	$ 7.41
Granted (in dollars per share) | $ / shares	1.64
Vested (in dollars per share) | $ / shares	1.73
Forfeited (in dollars per share) | $ / shares	2.18
Ending balance (in dollars per share) | $ / shares	$ 1.66

Inventories (Details)

Inventories (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Inventory [Line Items]
Provision for inventory write-downs	$ 9,096	$ 17,691	$ 8,493
Cervalign inventory reserve charge		2,200
E&O
Inventory [Line Items]
Provision for inventory write-downs	$ 9,100	$ 17,700	2,200
Paradigm
Inventory [Line Items]
Acquisition-related inventory write-down			$ 500

Prepaid and Other Current Ass_3

Prepaid and Other Current Assets - Schedule of Prepaid and Other Current Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]
Insurance Recovery Receivable	$ 1,500	$ 0
Income tax receivable	4,116	4,836
Prepaid expenses	2,553	1,543
Other Receivable	815	3,905
Prepaid and other current assets	$ 8,984	$ 10,284

Property and equipment - Compon

Property and equipment - Components of Property and Equipment (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Property, Plant and Equipment [Line Items]
Property and equipment - net	$ 945	$ 521
Processing equipment
Property, Plant and Equipment [Line Items]
Property and equipment - net	346	35
Surgical instruments
Property, Plant and Equipment [Line Items]
Property and equipment - net	489	440
Office equipment, furniture and fixtures
Property, Plant and Equipment [Line Items]
Property and equipment - net	15	34
Computer equipment and software
Property, Plant and Equipment [Line Items]
Property and equipment - net	44	12
Construction in process
Property, Plant and Equipment [Line Items]
Property and equipment - net	$ 51	$ 0

Property and equipment - Additi

Property and equipment - Additional Information (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Property, Plant and Equipment [Line Items]
Depreciation expense	$ 2.5	$ 3.6	$ 7.7
ERP implementation expense	0.1
Property and equipment
Property, Plant and Equipment [Line Items]
Asset impairment and abandonment charges	11
Software Development
Property, Plant and Equipment [Line Items]
Asset impairment and abandonment charges	4.4
Capitalized cost of ERP system	4.5	$ 0
Construction in process	$ 0.1

Debt - Narrative (Details)

Debt - Narrative (Details) - USD ($)	Dec. 31, 2021	Dec. 30, 2021	Dec. 31, 2020	Dec. 31, 2019
Debt Instrument [Line Items]
Contingent liability	$ 51,928,000		$ 56,515,000	$ 1,130,000
INN Acquisition
Debt Instrument [Line Items]
Contingent liability		$ 10,000,000
INN Acquisition | Consideration for remaining ownership, achievement of all milestones
Debt Instrument [Line Items]
Contingent liability		10,600,000
Seller Notes | Unsecured Seller Notes
Debt Instrument [Line Items]
Debt issuance amount		$ 10,600,000
Stated rate		6.80%
Long -term debt default increase rate		4.00%

Debt - Schedule of Long-term De

Debt - Schedule of Long-term Debt Instruments (Details) $ in Thousands	Dec. 31, 2021USD ($)
Debt Instrument [Line Items]
Total Seller Notes - related party	$ 10,612
Seller Notes
Debt Instrument [Line Items]
Less: fair value adjustment	(630)
Total Seller Notes - related party	9,982
Current portion of seller notes	0
Total long-term seller note, excluding current portion	9,982
P. Lewicki | Seller Notes
Debt Instrument [Line Items]
2021 Fixed Rate Note	5,306
K. Siemionow | Seller Notes
Debt Instrument [Line Items]
2021 Fixed Rate Note	$ 5,306

Debt - Schedule of Future Matur

Debt - Schedule of Future Maturities of Long-term Debt (Details) $ in Thousands	Dec. 31, 2021USD ($)
Debt Disclosure [Abstract]
2022	$ 0
2023	0
2024	10,612
2025	0
2026	0
Thereafter	0
Total Seller Notes - related party	$ 10,612

Net Loss Per Common Share - Com

Net Loss Per Common Share - Common Stock Used in Calculation of Basic and Diluted Earnings Per Share (Details) - shares	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Earnings Per Share [Abstract]
Weighted average shares outstanding - basic (in shares)	122,592,569	74,403,155	70,150,492
Weighted average shares outstanding - diluted (in shares)	122,592,569	74,403,155	70,150,492

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	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Number of potential dilutive shares excluded due to anti-dilutive effect (in shares)	3,202,888	9,770,881	16,319,803
Stock option
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	271,351	345,154
RSU and RSA
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Number of potential dilutive shares excluded due to anti-dilutive effect (in shares)	3,202,888	1,099,018	821,888
Convertible 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	8,400,512	15,152,761

Net Loss Per Common Share - Add

Net Loss Per Common Share - Additional Information (Details) - shares	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Number of potential dilutive shares excluded due to anti-dilutive effect (in shares)	3,202,888	9,770,881	16,319,803
Stock option
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Number of potential dilutive shares excluded due to anti-dilutive effect (in shares)	5,306,938	265,282

Fair Value Information - Additi

Fair Value Information - Additional Information (Details) - USD ($)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019	Oct. 23, 2020	Mar. 08, 2019
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Contingent liability	$ 51,928,000	$ 56,515,000	$ 1,130,000
Property and equipment - net	945,000	521,000
Asset impairment and abandonments	12,195,000	14,773,000	97,341,000
Level 3
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Carrying amount of property and equipment	12,000,000
Property and equipment - net		12,200,000
Property and equipment - net	945,000	521,000
Definite-lived intangible assets - net	782,000	2,621,000
Holo Surgical Inc. | Stock purchase agreement
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Contingent consideration (up to)				$ 83,000,000
Contingent liability		56,500,000		$ 50,600,000
Holo Surgical Inc. | Consideration for remaining ownership, achievement of all milestones | Stock purchase agreement
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Contingent consideration (up to)	83,000,000
Contingent liability	51,900,000
Holo Surgical Inc. | Level 3 | Consideration for remaining ownership, achievement of all milestones | Earn-Out Valuation
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Contingent liability	51,928,000	56,515,000
Paradigm
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Contingent consideration (up to)					$ 150,000,000
Contingent liability	0		0		$ 72,200,000
Gain on acquisition contingency			72,200,000
Paradigm | Stock purchase agreement
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Contingent liability	0
Zyga | Clinical and revenue milestone
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Contingent liability	$ 0	0	$ 1,100,000
Gain on acquisition contingency		$ 1,000,000

Fair Value Information - Schedu

Fair Value Information - Schedule of Fair Value Measurement Inputs Valuation Technique (Details) $ in Thousands	Dec. 31, 2021USD ($)	Dec. 31, 2020USD ($)	Dec. 31, 2019USD ($)
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Contingent liability	$ 51,928	$ 56,515	$ 1,130
Earn-Out Valuation | Holo Surgical Inc. | Level 3 | Consideration for remaining ownership, achievement of all milestones
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Contingent liability	$ 51,928	$ 56,515
Earn-Out Valuation | Holo Surgical Inc. | Probability of success factor | Minimum | Level 3
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Unobservable Inputs	0	0.60
Earn-Out Valuation | Holo Surgical Inc. | Probability of success factor | Maximum | Level 3
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Unobservable Inputs	0.90	0.90
Earn-Out Valuation | Holo Surgical Inc. | Discount rates | Minimum | Level 3
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Unobservable Inputs	0.0006	0.0011
Earn-Out Valuation | Holo Surgical Inc. | Discount rates | Maximum | Level 3
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Unobservable Inputs	0.1160	0.1686

Fair Value Information - Reconc

Fair Value Information - Reconciliation of Acquisition Contingencies (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Business Combination, Contingent Consideration, Liability [Roll Forward]
Beginning balance as of January 1	$ 56,515	$ 1,130
Contingent consideration – Holo Milestone Payments	0	50,632
(Gain) loss - Holo & Zyga	4,587	(4,753)	$ 76,033
Other	0	(130)
Ending balance as of December 31	51,928	56,515	$ 1,130
Holo & Zyga
Business Combination, Contingent Consideration, Liability [Roll Forward]
(Gain) loss - Holo & Zyga	$ 4,587	$ (4,883)

Fair Value Information - Summar

Fair Value Information - Summary of Impairments of Long-Lived Assets and Related Post Impairment Fair Values (Details) - Level 3 - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Impaired Long-Lived Assets Held and Used [Line Items]
Property and equipment - net	$ 11,018	$ 11,707
Definite-lived intangible assets - net	782	2,621
Other assets - net	395	445
Impairment	12,195	14,773
Property and equipment - net	945	521
Definite-lived intangible assets - net	0	0
Other assets - net	6,970	10,145
Fair Value	$ 7,915	$ 10,666

Fair Value Information - Fair V

Fair Value Information - Fair Value of Warrant Liability Valuation Inputs (Details) - Black-Scholes Option Pricing Model - USD ($)	Dec. 31, 2021	Dec. 31, 2020
Stock price
Fair Value Disclosure, Asset and Liability, Not Measured at Fair Value [Line Items]
Measurement inputs	0.72	0
Risk-free interest rate
Fair Value Disclosure, Asset and Liability, Not Measured at Fair Value [Line Items]
Measurement inputs	0.0084	0
Dividend yield
Fair Value Disclosure, Asset and Liability, Not Measured at Fair Value [Line Items]
Measurement inputs	0	0
Volatility
Fair Value Disclosure, Asset and Liability, Not Measured at Fair Value [Line Items]
Measurement inputs	1.30	0

Fair Value Information - Sche_2

Fair Value Information - Schedule of Liabilities Measured at Fair Value on Recurring Basis (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Change in fair value	$ 14,736	$ 0	$ 0
Warrant Liability | Level 3
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance - January 1, 2021	0
Fair value of warrants on date of issuance	26,749
Change in fair value	(14,736)
Balance - December 31, 2021	$ 12,013	$ 0

Warrants (Details)

Warrants (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)	$ 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)	$ 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
Common stock price per share (in dollars per share)	$ 1.725
Net proceeds from the direct offering, after deducting investor and management fees | $	$ 45.8

Accrued Expenses - Schedule of

Accrued Expenses - Schedule of Accrued Expenses (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Payables and Accruals [Abstract]
Accrued compensation	$ 5,258	$ 2,268
Accrued securities class action settlement	1,500	0
Accrued distributor commissions	2,957	4,113
Other	8,054	6,267
Accrued expenses	$ 17,769	$ 12,648

Other long-term liabilities - S

Other long-term liabilities - Schedule of Other Long-term Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Other Liabilities, Noncurrent [Abstract]
Acquisition contingencies	$ 26,343	$ 47,519
Warrant Liability	12,013	0
Lease obligations	947	1,200
Other	2,229	2,992
Total other long-term liabilities	$ 41,532	$ 51,711

Income Taxes - Schedule of Pre-

Income Taxes - Schedule of Pre-Tax Loss (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Pre-tax loss:
Domestic (U.S., state and local)	$ (114,731)	$ (191,455)	$ (242,896)
Foreign (loss) income	(9,061)	(6,226)	39
Loss before income tax (benefit) provision	$ (123,792)	$ (197,681)	$ (242,857)

Income Taxes - Schedule of Inco

Income Taxes - Schedule of Income Tax Benefit (Provision) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Current:
Federal	$ 426	$ (3,671)	$ (312)
State	(1,325)	0	89
International	184	(13)	138
Total current	(715)	(3,684)	(85)
Deferred:
Federal	(25)	(99)	2,456
State	(4)	0	169
International	(142)	297	3,381
Total deferred	(171)	198	6,006
Total income tax (benefit) provision	$ (886)	$ (3,486)	$ 5,921

Income Taxes - Schedule of Defe

Income Taxes - Schedule of Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Assets
Accounts receivable	$ 2,376	$ 1,993
Accrued liabilities	990	1,326
Deferred compensation	1,876	1,281
Fixed assets and intangibles	22,096	22,235
Inventory	7,066	8,475
Net operating losses	29,917	9,891
Revenue	0	0
Tax credits	265	0
Lease Liability	318	446
Right of Use Asset	0	0
Other	408	0
Valuation allowance	(65,007)	(45,126)
Total	305	521
Liabilities
Revenue	0	(129)
Right of Use Asset	(224)	(344)
Other	0	(48)
Total	$ (224)	$ (521)

Income Taxes - Additional Infor

Income Taxes - Additional Information (Details)	Dec. 30, 2021USD ($)payment	Oct. 23, 2020USD ($)	Mar. 27, 2020	Dec. 31, 2021USD ($)	Dec. 31, 2021USD ($)	Dec. 31, 2020USD ($)	Dec. 31, 2019USD ($)	Dec. 31, 2021USD ($)	Dec. 31, 2018USD ($)
Income Tax [Line Items]
Net operating losses carried back period			5 years
CARES Act benefit						$ 3,500,000
Contingent liability				$ 51,928,000	$ 51,928,000	56,515,000	$ 1,130,000	$ 51,928,000
Change in fair value					(4,587,000)	4,753,000	(76,033,000)
Asset acquisition expenses					72,100,000	94,999,000	0
Net operating loss carryforwards				29,917,000	29,917,000	9,891,000		29,917,000
Net operating loss carryforwards, not subject to expiration				72,800,000	72,800,000			72,800,000
Research and development credit carryforwards				300,000	300,000			300,000
Valuation allowance				65,007,000	65,007,000	45,126,000		65,007,000
Unrecognized tax benefits				2,082,000	2,082,000	2,991,000	$ 1,088,000	2,082,000	$ 1,088,000
Accrued interest and penalties				100,000	100,000			100,000
U.S. State
Income Tax [Line Items]
Net operating loss carryforwards				85,900,000	85,900,000			85,900,000
Net operating loss carryforwards, subject to expiration				74,000,000	74,000,000			74,000,000
Net operating loss carryforwards, not subject to expiration				11,900,000	11,900,000			11,900,000
Non-U.S.
Income Tax [Line Items]
Net operating loss carryforwards				29,500,000	29,500,000			29,500,000
Net operating loss carryforwards, subject to expiration				16,500,000	16,500,000			16,500,000
Net operating loss carryforwards, not subject to expiration				13,000,000	13,000,000			13,000,000
U.S. Federal
Income Tax [Line Items]
Net operating loss carryforwards				81,900,000	81,900,000			81,900,000
Net operating loss carryforwards, subject to expiration				9,100,000	9,100,000			9,100,000
Holo Surgical Inc. | Stock purchase agreement
Income Tax [Line Items]
Payments to acquire businesses		$ 95,000,000
Contingent liability		50,600,000				56,500,000
Change in fair value					(4,600,000)	4,700,000		5,900,000
Contingent consideration (up to)		$ 83,000,000
Asset acquisition expenses						$ 500,000
Holo Surgical Inc. | Stock purchase agreement | Consideration for remaining ownership, achievement of all milestones
Income Tax [Line Items]
Contingent liability				51,900,000	51,900,000			51,900,000
Contingent consideration (up to)				83,000,000	83,000,000			$ 83,000,000
INN Acquisition
Income Tax [Line Items]
Payments to acquire businesses					19,900,000
Contingent liability	$ 10,000,000
Purchase of noncontrolling interest					41,700,000
Asset acquisition expenses					72,087,000
INN Acquisition | Assembled Workforce
Income Tax [Line Items]
Asset acquisition expenses				$ 200,000	$ 200,000
INN Acquisition | INN Acquisition
Income Tax [Line Items]
Remaining equity interest	58.00%			58.00%	58.00%			58.00%
INN Acquisition | Consideration for remaining ownership, achievement of all milestones
Income Tax [Line Items]
Payments to acquire businesses	$ 72,300,000				$ 72,300,000
Contingent liability	10,600,000
Contingent consideration (up to)	10,300,000			$ 10,300,000	10,300,000			$ 10,300,000
Accrued acquisition and integration expenses	$ 400,000			$ 400,000	$ 400,000			$ 400,000
Number of potential milestone payments | payment	3

Income Taxes - Summary of Unrec

Income Taxes - Summary of Unrecognized Tax Benefits (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns [Roll Forward]
Opening balance	$ 2,991	$ 1,088	$ 1,088
Additions based on tax positions related to the current year	0	1,903	0
Additions for tax positions of prior years	542	0	0
Reductions for tax positions of prior years	(1,451)	0	0
Reductions for expiration of statute of limitations	0	0	0
Closing balance	$ 2,082	$ 2,991	$ 1,088

Income Taxes - Schedule of Effe

Income Taxes - Schedule of Effective Tax Rate (Details)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Income Tax Disclosure [Abstract]
Statutory federal rate	21.00%	21.00%	21.00%
State income taxes—net of federal tax benefit	0.00%	(0.07%)	(0.56%)
Foreign rate differential	1.33%	0.90%	0.00%
Acquisition expenses	(5.21%)	(9.87%)	0.00%
Loss (Gain) on acquisition contingency	0.78%	(0.50%)	6.58%
Goodwill impairment and disposal	0.00%	0.00%	(11.88%)
Change in fair value of the warrant liability	2.50%	0.00%	0.00%
Noncontrolling interest	(7.11%)	0.00%	0.00%
Tax attributes	(0.22%)	0.28%	0.04%
Tax legislation	0.19%	0.95%	0.00%
Valuation allowances	(12.61%)	(10.57%)	(16.98%)
Uncertain tax positions	0.95%	0.00%	0.00%
Other reconciling items, net	(0.89%)	(0.36%)	(0.63%)
Effective tax rate	0.71%	1.76%	(2.43%)

Preferred Stock - Schedule of P

Preferred Stock - Schedule of Preferred Stock (Details) - USD ($) $ in Thousands	Jul. 24, 2020	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Temporary Equity [Line Items]
Net total, beginning balance		$ 0
Redemption of preferred stock	$ (66,500)	0	$ (66,519)	$ 0
Net total, ending balance		10,006	0
Convertible preferred equity
Temporary Equity [Line Items]
Preferred stock liquidation value, beginning balance		0	66,519	66,519
Preferred stock issuance costs, beginning balance		0	(109)	(293)
Net total, beginning balance		0	66,410	66,226
Amortization of preferred stock issuance costs		0	109	184
Redemption of preferred stock		0	(66,519)
Preferred stock liquidation value, ending balance		0	0	66,519
Preferred stock issuance costs, ending balance		0	0	(109)
Net total, ending balance		$ 0	$ 0	$ 66,410

Preferred Stock - Additional In

Preferred Stock - Additional Information (Details) - USD ($) $ in Thousands	Jul. 24, 2020	Jun. 12, 2013	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2018	Jul. 16, 2013
Temporary Equity [Line Items]
Payment on redemption of preferred stock	$ 66,500		$ 0	$ 66,519	$ 0
Convertible preferred equity
Temporary Equity [Line Items]
Preferred stock issuance cost			0	0	$ 109	$ 293
Payment on redemption of preferred stock			$ 0	$ 66,519
WHSP
Temporary Equity [Line Items]
Payment on redemption of preferred stock	$ 66,500
Private Placement | WHSP
Temporary Equity [Line Items]
Preferred stock dividend rate (as a percent)		6.00%
Private Placement | WHSP | Convertible preferred equity
Temporary Equity [Line Items]
Convertible preferred stock issued		$ 50,000
Preferred stock issuance cost							$ 1,300

Stockholders' Equity (Details)

Stockholders' Equity (Details)	12 Months Ended
	Dec. 31, 2021voteshares	Dec. 31, 2020shares	Dec. 31, 2013shares
Stockholders Equity [Line Items]
Preferred stock, shares authorized (in shares)	5,000,000
Preferred stock, shares outstanding (in shares)	0
Common stock, shares authorized (in shares)	300,000,000	300,000,000
Vote for each share held | vote	1
Series A Preferred Stock
Stockholders Equity [Line Items]
Preferred stock, shares issued (in shares)			50,000

Severance and Restructuring C_3

Severance and Restructuring Costs - Additional Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Employee Severance
Restructuring Cost and Reserve [Line Items]
Severance and restructuring costs	$ 208	$ 0	$ 626
Minimum
Restructuring Cost and Reserve [Line Items]
Severance and restructuring payment period	1 month
Maximum
Restructuring Cost and Reserve [Line Items]
Severance and restructuring payment period	12 months

Severance and Restructuring C_4

Severance and Restructuring Costs - Schedule of Restructuring Charges (Details) - Employee Severance - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Restructuring Reserve [Roll Forward]
Accrued severance and restructuring charges, beginning balance	$ 0	$ 136	$ 908
Severance and restructuring expenses accrued	208	0	626
Severance and restructuring cash payments	(208)	(136)	(1,398)
Accrued severance and restructuring charges, ending balance	$ 0	$ 0	$ 136

Retirement Benefits (Details)

Retirement Benefits (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Retirement Benefits [Abstract]
Employer matching contribution, percent of match (up to)	6.00%
Amounts expensed	$ 0.7	$ 1.4	$ 2.9

Commitments and Contingencies (

Commitments and Contingencies (Details)	Jan. 14, 2022USD ($)shares	Jan. 12, 2022USD ($)shares	Dec. 30, 2021USD ($)payment	Mar. 12, 2021USD ($)ft²claim	Jan. 20, 2021USD ($)	Oct. 23, 2020USD ($)shares	Jul. 20, 2020USD ($)agreement	Mar. 08, 2019USD ($)shares	Jan. 04, 2018USD ($)	Dec. 31, 2021USD ($)payment	Dec. 31, 2020USD ($)	Dec. 31, 2019USD ($)	Dec. 31, 2021USD ($)
Commitment And Contingencies [Line Items]
Contingent liability										$ 51,928,000	$ 56,515,000	$ 1,130,000	$ 51,928,000
Current portion of accrued acquisition contingency - Holo										25,585,000	8,996,000		25,585,000
Change in fair value										(4,587,000)	4,753,000	(76,033,000)
Operating lease cost										706,000	1,179,000	1,108,000
Cash paid for amounts included in the measurement of lease liabilities										1,237,000	1,313,000
OEM Distribution Agreements
Commitment And Contingencies [Line Items]
Number of manufacturing and distribution agreements | agreement							3
Year 1							$ 24,201,000
Year 2							25,767,000
Year 3							27,158,000
Design and Development Agreement
Commitment And Contingencies [Line Items]
Direct labor costs							$ 1,700,000
Collaborative agreement term							2 years
Oxford Supply Agreement
Commitment And Contingencies [Line Items]
Quarterly binding purchase orders					$ 200,000
Binding purchase orders					$ 600,000
Prepayment write off										3,000,000
Minimum purchase obligations beyond 2021										0			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 | San Diego Lease
Commitment And Contingencies [Line Items]
Lease rentable area (square feet) | ft²				94,457
Lease improvement term				12 months
Operating lease cost				$ 64,600,000
Rent abatement term				13 months
San Diego Lease | Other assets – net | San Diego Lease
Commitment And Contingencies [Line Items]
Cash paid for amounts included in the measurement of lease liabilities				$ 2,500,000
Paradigm
Commitment And Contingencies [Line Items]
Total considerations including acquisition contingencies								$ 300,000,000
Cash to be paid at closing								150,000,000
Cash payment								$ 100,000,000		0	0	99,692,000
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
Contingent consideration (up to)								150,000,000
Estimated contingent liability								0
Payments to acquire businesses								232,907,000
Cash proceeds from second lien credit agreement								100,000,000
Contingent liability								$ 72,200,000		0		0	0
Paradigm | Stock purchase agreement
Commitment And Contingencies [Line Items]
Contingent liability										0			0
Zyga Technology
Commitment And Contingencies [Line Items]
Cash payment									$ 3,000,000
Payments to acquire businesses									21,000,000
Zyga Technology | Revolving Credit Facility
Commitment And Contingencies [Line Items]
Cash proceeds from second lien credit agreement									18,000,000
Zyga Technology | Revenue earnout consideration
Commitment And Contingencies [Line Items]
Contingent consideration (up to)									35,000,000
Zyga Technology | Clinical milestone
Commitment And Contingencies [Line Items]
Contingent liability									$ 1,000,000	0			0
Aziyo
Commitment And Contingencies [Line Items]
Shortfall obligation										14,200,000
Purchase obligation										21,800,000			$ 21,800,000
INN Acquisition
Commitment And Contingencies [Line Items]
Cash payment			$ 5,000,000							5,000,000	0	0
Payments to acquire businesses										$ 19,900,000
Contingent liability			$ 10,000,000
Contingent voting interests			19.30%
Contingent consideration for future equity acquisitions			$ 19,300,000
INN Acquisition | INN Acquisition
Commitment And Contingencies [Line Items]
Remaining equity interest			58.00%							58.00%			58.00%
INN Acquisition | Consideration for remaining ownership, achievement of all milestones
Commitment And Contingencies [Line Items]
Contingent consideration (up to)			$ 10,300,000							$ 10,300,000			$ 10,300,000
Payments to acquire businesses			72,300,000							72,300,000
Contingent liability			$ 10,600,000
Number of potential milestone payments | payment			3
Contingent consideration for future commitments										57,900,000			57,900,000
Mezzanine equity										10,000,000			10,000,000
Holo Surgical Inc.
Commitment And Contingencies [Line Items]
Cash payment										0	32,117,000	$ 0
Holo Surgical Inc. | Stock purchase agreement
Commitment And Contingencies [Line Items]
Cash payment						$ 30,000,000
Shares issuable at closing (in shares) | shares						6,250,000
Contingent consideration (up to)						$ 83,000,000
Payments to acquire businesses						95,000,000
Contingent liability						$ 50,600,000					56,500,000
Current portion of accrued acquisition contingency - Holo										25,600,000	9,000,000		25,600,000
Change in fair value										(4,600,000)	4,700,000		5,900,000
Holo Surgical Inc. | Stock purchase agreement | Subsequent Event
Commitment And Contingencies [Line Items]
Cash payment	$ 4,100,000	$ 4,100,000
Trading days	5 days
Contingent liability	$ 10,000,000	$ 10,000,000
Number of contingent consideration shares issued (in shares) | shares		8,650,000
Maximum shares to be issued including contingent shares (in shares) | shares	5,900,000	5,900,000
Holo Surgical Inc. | Stock purchase agreement | Other long-term liabilities
Commitment And Contingencies [Line Items]
Fair value of liability										26,300,000			26,300,000
Holo Surgical Inc. | Consideration for remaining ownership, achievement of all milestones | Level 3 | Earn-Out Valuation
Commitment And Contingencies [Line Items]
Contingent liability										51,928,000	$ 56,515,000		51,928,000
Holo Surgical Inc. | Consideration for remaining ownership, achievement of all milestones | Stock purchase agreement
Commitment And Contingencies [Line Items]
Contingent consideration (up to)										83,000,000			83,000,000
Contingent liability										$ 51,900,000			51,900,000
Milestones | payment										8
Holo Surgical Inc. | Consideration for remaining ownership, achievement of all milestones | Stock purchase agreement | Level 3 | Recurring | Earn-Out Valuation
Commitment And Contingencies [Line Items]
Contingent liability										$ 51,900,000			$ 51,900,000

Legal Actions (Details)

Legal Actions (Details) $ in Thousands	Jul. 27, 2021USD ($)	Jul. 27, 2018patent	Dec. 31, 2021USD ($)claim	Oct. 31, 2021USD ($)	Dec. 31, 2020USD ($)
Loss Contingencies [Line Items]
Insurance recovery receivable			$ 1,500		$ 0
Indemnified Claims
Loss Contingencies [Line Items]
Number of pending claims | claim			1,157
Securities Class Action | Judicial Ruling
Loss Contingencies [Line Items]
Litigation settlement to other party	$ 10,500
Insurance recovery receivable				$ 10,500
Loss contingency			$ 10,500
Insurance recovery			$ 10,500
Derivative Actions
Loss Contingencies [Line Items]
Number of pending claims | claim			3
Damages sought value, liability			$ 1,500
Derivative Actions | Prepaid Expenses and Other Current Assets
Loss Contingencies [Line Items]
Insurance recovery receivable			1,500
Derivative Actions | Accrued Liabilities, Current
Loss Contingencies [Line Items]
Liability			$ 1,500
LifeNet Health, Inc., Patent Infringement
Loss Contingencies [Line Items]
Number of patents claims | patent		5

Related Party Transactions (Det

Related Party Transactions (Details) - USD ($) $ in Thousands	Dec. 30, 2021	Oct. 23, 2020	Jul. 20, 2020	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019	Dec. 31, 2021
Related Party Transaction [Line Items]
Percent of beneficial owner of common stock				5.00%			5.00%
Contingent liability				$ 51,928	$ 56,515	$ 1,130	$ 51,928
Mr. Simpson | Consulting Agreement
Related Party Transaction [Line Items]
Agreement initial term period			3 years
Former Board of Directors Chairman | Consulting Agreement | Simpson
Related Party Transaction [Line Items]
Related party transaction amounts				300	100
Holo Surgical Inc.
Related Party Transaction [Line Items]
Cash consideration				0	32,117	0
Holo Surgical Inc. | Stock purchase agreement
Related Party Transaction [Line Items]
Cash consideration		$ 30,000
Shares issuable at closing (in shares)		6,250,000
Shares issued		$ 12,300
Contingent liability		$ 50,600			56,500
Maximum shares to be issued (in shares)		8,650,000
Contingent consideration payable closing milestones, term		6 years					6 years
Holo Surgical Inc. | Stock purchase agreement | Dr. Pawel Lewicki
Related Party Transaction [Line Items]
Indirect outstanding ownership percent		57.50%
INN Acquisition
Related Party Transaction [Line Items]
Cash consideration	$ 5,000			$ 5,000	$ 0	$ 0
Shares issued	4,900
Contingent liability	$ 10,000
INN Acquisition | INN Acquisition
Related Party Transaction [Line Items]
Remaining equity interest	58.00%			58.00%			58.00%

Subsequent Events - Additional

Subsequent Events - Additional Information (Details) - USD ($) $ / shares in Units, $ in Thousands	Feb. 15, 2022	Jan. 14, 2022	Jan. 12, 2022	Jun. 14, 2021	Feb. 01, 2021	Oct. 23, 2020	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Subsequent Event [Line Items]
Strike price of warrants (in dollars per share)				$ 1.725
Period of warrants exercisable expiration period				3 years
Contingent liability							$ 51,928	$ 56,515	$ 1,130
Holo Surgical Inc.
Subsequent Event [Line Items]
Cash consideration							$ 0	32,117	$ 0
Holo Surgical Inc. | Stock purchase agreement
Subsequent Event [Line Items]
Cash consideration						$ 30,000
Contingent liability						$ 50,600		$ 56,500
Placement Agent Warrants
Subsequent Event [Line Items]
Strike price of warrants (in dollars per share)				$ 2.15625
Placement Agent Warrants | Maximum
Subsequent Event [Line Items]
Number of common stock shares issuable upon conversion of warrants (in shares)				1,739,130
Public Offering
Subsequent Event [Line Items]
Common stock sold (in shares)				29,000,000	28,700,000
Net proceeds from issuance of common stock				$ 45,800	$ 40,500
Investor and other filing fees				$ 4,200
Public Offering | Invest Warrants
Subsequent Event [Line Items]
Strike price of warrants (in dollars per share)				$ 1.725
Public Offering | Invest Warrants | Maximum
Subsequent Event [Line Items]
Number of common stock shares issuable upon conversion of warrants (in shares)				29,000,000
Public Offering | Placement Agent Warrants
Subsequent Event [Line Items]
Strike price of warrants (in dollars per share)				$ 2.15625
Public Offering | Placement Agent Warrants | Maximum
Subsequent Event [Line Items]
Number of common stock shares issuable upon conversion of warrants (in shares)				1,700,000
Subsequent Event | Holo Surgical Inc. | Stock purchase agreement
Subsequent Event [Line Items]
Number of contingent consideration shares issued (in shares)			8,650,000
Maximum shares to be issued including contingent shares (in shares)		5,900,000	5,900,000
Cash consideration		$ 4,100	$ 4,100
Contingent liability		$ 10,000	$ 10,000
Subsequent Event | Invest Warrants
Subsequent Event [Line Items]
Period of warrants exercisable expiration period	5 years
Subsequent Event | Public Offering
Subsequent Event [Line Items]
Common stock sold (in shares)	43,478,264
Net proceeds from issuance of common stock	$ 17,800
Investor and other filing fees	$ 2,200
Subsequent Event | Public Offering | Pre-Funded Warrants
Subsequent Event [Line Items]
Sale of Stock, Price Per Share	$ 0.46
Subsequent Event | Public Offering | Pre-Funded Warrants | Maximum
Subsequent Event [Line Items]
Number of common stock shares issuable upon conversion of warrants (in shares)	32,608,698
Subsequent Event | Public Offering | Invest Warrants
Subsequent Event [Line Items]
Strike price of warrants (in dollars per share)	$ 0.60
Subsequent Event | Public Offering | Invest Warrants | Maximum
Subsequent Event [Line Items]
Number of common stock shares issuable upon conversion of warrants (in shares)	32,608,698
Subsequent Event | Public Offering | Placement Agent Warrants
Subsequent Event [Line Items]
Strike price of warrants (in dollars per share)	$ 0.575
Subsequent Event | Public Offering | Placement Agent Warrants | Maximum
Subsequent Event [Line Items]
Number of common stock shares issuable upon conversion of warrants (in shares)	2,608,696

Schedule II - Valuation and Q_2

Schedule II - Valuation and Qualifying Accounts (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Dec. 31, 2019
Allowance for doubtful accounts
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Balance at Beginning of Period	$ 8,203	$ 4,803	$ 1,865
Charged to Costs and Expenses	1,722	3,584	2,541
Deductions, Write-offs, or Payments	653	184	(397)
Balance at End of Period	9,272	8,203	4,803
Allowance for product returns
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Balance at Beginning of Period	105	106	478
Charged to Costs and Expenses	0	246	0
Deductions, Write-offs, or Payments	0	247	372
Balance at End of Period	105	105	106
Deferred tax asset valuation allowance
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Balance at Beginning of Period	45,126	48,115	3,093
Charged to Costs and Expenses	20,459	(2,638)	45,022
Deductions, Write-offs, or Payments	578	351	0
Balance at End of Period	$ 65,007	$ 45,126	$ 48,115