Surgalign (SRGAQ) 10-Q 10 May 22 2022 Q1 Quarterly report Financial data

Cover

Cover - shares	3 Months Ended
	Mar. 31, 2022	May 05, 2022
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Mar. 31, 2022
Document Transition Report	false
Entity File Number	001-38832
Entity Registrant Name	SURGALIGN HOLDINGS, INC.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	83-2540607
Entity Address, Address Line One	520 Lake Cook Road
Entity Address, Address Line Two	Suite 315
Entity Address, City or Town	Deerfield
Entity Address, State or Province	IL
Entity Address, Postal Zip Code	60015
City Area Code	224
Local Phone Number	303-4651
Title of 12(b) Security	common stock, $0.001 par value
Trading Symbol	SRGA
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		198,720,219
Amendment Flag	false
Document Fiscal Year Focus	2022
Document Fiscal Period Focus	Q1
Entity Central Index Key	0001760173
Current Fiscal Year End Date	--12-31

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Current Assets:
Cash and cash equivalents	$ 44,677	$ 51,287
Accounts receivable - less allowances of $10,185 at March 31, 2022 and $9,272 at December 31, 2021	20,458	19,197
Inventories - current	22,980	26,204
Prepaid and other current assets	13,191	8,984
Total current assets	101,306	105,672
Non-current inventories	12,225	10,212
Property and equipment - net	900	945
Other assets - net	7,114	6,970
Total assets	121,545	123,799
Current Liabilities:
Accounts payable	12,089	10,204
Current portion of acquisition contingency - Holo	0	25,585
Accrued expenses	15,813	17,769
Accrued income taxes	444	484
Total current liabilities	28,346	54,042
Acquisition contingencies - Holo	33,425	26,343
Warrant liability	10,678	12,013
Notes payable - related party	10,034	9,982
Other long-term liabilities	3,376	3,176
Total liabilities	85,859	105,556
Commitments and contingencies (Note 17)
Mezzanine equity	10,006	10,006
Stockholders' equity:
Common stock, $.001 par value: 300,000,000 shares authorized; 198,734,928 and 146,640,069 shares issued and outstanding, as of March 31, 2022 and December 31, 2021, respectively	199	147
Additional paid-in capital	602,853	585,375
Accumulated other comprehensive loss	(1,929)	(1,820)
Accumulated deficit	(569,586)	(569,613)
Less treasury stock, 1,578,186 and 1,543,446 shares, as of March 31, 2022 and December 31, 2021, respectively, at cost	(5,857)	(5,852)
Total stockholders' equity	25,680	8,237
Total liabilities Mezzanine Equity and stockholders' equity	$ 121,545	$ 123,799

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Statement of Financial Position [Abstract]
Accounts receivable allowances	$ 10,185	$ 9,272
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)	198,734,928	146,640,069
Common stock, shares outstanding (in shares)	198,734,928	146,640,069
Treasury stock (in shares)	1,578,186	1,543,446

Condensed Consolidated Statemen

Condensed Consolidated Statements of Comprehensive Income / (Loss) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Income Statement [Abstract]
Revenues	$ 20,605	$ 23,291
Cost of goods sold	6,410	6,238
Gross profit	14,195	17,053
Operating Expenses:
General and administrative	25,317	26,161
Research and development	4,447	2,875
Gain on acquisition contingency	(8,503)	(51)
Asset impairment and abandonments	939	2,176
Transaction and integration expenses	916	322
Total operating expenses	23,116	31,483
Operating loss	(8,921)	(14,430)
Other (income) expense - net:
Other (income) expense - net	28	(4)
Interest expense	252	0
Foreign exchange loss	353	545
Change in fair value of warrant liability	(9,743)	0
Total other (income) expense - net	(9,110)	541
Income (Loss) before income tax provision	189	(14,971)
Income tax provision	162	219
Net income (loss) from operations	27	(15,190)
Noncontrolling interests
Net income applicable to noncontrolling interests	0	0
Net income (loss) applicable to Surgalign Holdings, Inc.	27	(15,190)
Other comprehensive income (loss)
Unrealized foreign currency translation gain	(109)	(71)
Total other comprehensive income (loss)	$ 136	$ (15,119)
Net loss from operations per share - basic (in dollars per share)	$ 0	$ (0.15)
Net loss per share applicable to Surgalign Holdings, Inc.- basic (in dollars per share)	0	(0.15)
Net loss from operations per share - diluted (in dollars per share)	0	(0.15)
Net loss per share applicable to Surgalign Holdings, Inc.- diluted (in dollars per share)	$ 0	$ (0.15)
Weighted average basic shares (in shares)	172,009,259	98,109,900
Weighted average diluted shares (in shares)	177,328,099	98,109,900

Condensed Consolidated Statem_2

Condensed Consolidated Statement of Stockholders' Equity - USD ($) $ in Thousands	Total	Total	Common Stock	Additional Paid-In Capital	Accumulated Other Comprehensive Loss	Accumulated Deficit	Treasury Stock
Beginning Balance at Dec. 31, 2020		$ 24,170	$ 81	$ 517,123	$ (2,416)	$ (484,962)	$ (5,656)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net Income	$ (15,190)	(15,190)				(15,190)
Foreign currency translation adjustment		71			71
Share offering		36,484	29	36,455
Exercise of common stock options		23		23
Stock-based compensation		936		936
Purchase of treasury stock		(110)					(110)
Ending Balance at Mar. 31, 2021		46,384	110	554,537	(2,345)	(500,152)	(5,766)
Beginning Balance at Dec. 31, 2021		8,237	147	585,375	(1,820)	(569,613)	(5,852)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net Income	27	27				27
Foreign currency translation adjustment		(109)			(109)
Share offering	8,488		39	8,449
Prefunded warrant execution	1,749		4	1,745
Equity instruments issued in connection with the Holo acquisition		5,919	9	5,910
Stock-based compensation		1,374		1,374
Purchase of treasury stock		(5)					(5)
Ending Balance at Mar. 31, 2022		$ 25,680	$ 199	$ 602,853	$ (1,929)	$ (569,586)	$ (5,857)
Mezzanine equity, beginning balance at Dec. 31, 2021	10,006
Mezzanine equity, ending balance at Mar. 31, 2022	$ 10,006

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Cash flows from operating activities:
Net income (loss)	$ 27	$ (15,190)
Adjustments to reconcile net income (loss) to net cash used in operating activities:
Depreciation and amortization expense	562	520
Provision for bad debts and product returns	913	1,978
Investor fee	916	0
Change in fair value of warrant liability	(9,743)	0
Provision for inventory write-downs	3,044	2,754
Stock-based compensation	1,374	936
Asset impairment and abandonments	939	2,176
Gain on acquisition contingency	(8,503)	(51)
Other	(3)	58
Change in assets and liabilities:
Accounts receivable	(2,235)	(4,280)
Inventories	(2,122)	(5,636)
Accounts payable	1,771	(238)
Accrued expenses	(17,492)	9,659
Right-of-use asset and lease liability	(2)	0
Other operating assets and liabilities	11,416	(7,212)
Net cash used in operating activities	(19,138)	(14,526)
Cash flows from investing activities:
Purchases of property and equipment	(1,261)	(2,321)
Patent and acquired intangible asset costs	(81)	(161)
Net cash used in provided by investing activities	(1,342)	(2,482)
Cash flows from financing activities:
Share offering proceeds including prefunded warrant exercised, net	17,729	36,484
Proceeds from exercise of common stock options	0	23
Payment of Holo Milestones - contingent consideration	(4,081)	0
Payments for treasury stock	(5)	(110)
Net cash provided by financing activities	13,643	36,397
Effect of exchange rate changes on cash and cash equivalents	227	412
Net (decrease) increase in cash and cash equivalents	(6,610)	19,801
Cash and cash equivalents, beginning of period	51,287	43,962
Cash and cash equivalents, end of period	44,677	63,763
Supplemental cash flow disclosure:
Net income tax payments, net of refunds	22	7
Non-cash acquisition of property and equipment	105	397
Non-cash common stock issuance - Holo Milestones contingent considerations	$ 5,919	$ 0

Business

Business	3 Months Ended
	Mar. 31, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Business	Business Surgalign Holdings, Inc. (the “Company”), is a global medical technology company focused on elevating the standard of care by driving the evolution of digital surgery. We are developing an augmented reality (AR) and artificial intelligence (AI) technology platform called HOLO™ AI to enable digital spine surgery, which we believe is one of the most advanced AI technologies being applied to surgery. Our HOLO Portal™ surgical guidance system, a component of our HOLO™ AI technology platform, is designed to automatically recognize, identify, and segment patient anatomy to autonomously assist the surgeon throughout the surgical procedure. This proprietary AI-based system is an intelligent anatomical mapping technology designed to assist surgeons by allowing them to remain in safe anatomical zones and to enhance surgical performance. We plan to leverage our HOLO AI platform to improve patient outcomes and drive adoption of our spinal hardware implants and biomaterials products. We are developing a pipeline of new innovative technologies that we plan to integrate with our HOLO AI platform. We also 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. Accompanying the hardware portfolio are our advanced and traditional orthobiologics, or biomaterials, products. 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, CA; Wurmlingen, Germany; Poznan, Poland; and Warsaw, Poland. The Company operates one reportable segment: Spine. Acquisition of equity interest in INN On December 30, 2021, we completed a Stock Purchase Agreement (“Purchase Agreement”) to acquire 42% of Inteneural Networks Inc. ("INN") for a non-exclusive license to use INN's proprietary artificial intelligence ("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% stake in INN, we paid total consideration of $19.9 million which consisted of $5.0 million in cash, 6,820,792 shares of our common stock with a fair value of $4.9 million and issued 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 and subject to certain contingencies, the Company must purchase up to 100% of the equity of INN in three 19.3% tranches for $19.3 million for each on the achievement of the three additional clinical, regulatory, and revenue milestones. Prompt Prototypes LLC Acquisition On April 30, 2021, The Company, entered into an Asset Purchase Agreement with Prompt Prototype LLC ("Prompt") a California limited liability company, and Peter Kopley, an individual residing in the State of California (the "Sellers"). The Company purchased the assets of Prompt to expand its research and development capabilities and create the capacity to produce certain medical prototypes. Pursuant to the terms of the Agreement, the Company purchased specific assets and assumed certain liabilities of Prompt for a purchase price of $1.1 million. At the closing, the Company paid $0.3 million of cash and issued restricted shares with an aggregate fair market value of $0.2 million to the seller. The remaining $0.6 million of the purchase price will be paid contingent on Mr. Kopley's 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. COVID-19 The COVID-19 pandemic continues to materially impact our business and results of operations and financial condition. Although vaccines have 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 depends on future developments that are highly uncertain and cannot be accurately predicted. Many government agencies in conjunction with hospitals and healthcare systems have, to varying degrees, deferred, reduced, or suspended elective surgical procedures due to COVID-19. We have seen and may continue to see a significant reduction in procedural volumes as hospital systems and/or patients elect to defer spine surgery procedures. Despite the impact COVID-19 has had on our business, we continued to invest in our digital health strategy, invest in our teams, improve operating processes through building strong foundations, and taking steps to position ourselves for long-term success by improving patient outcomes while maintaining adequate cash levels. 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 condensed consolidated financial statements of the Company have been prepared assuming the Company will continue as a going concern and in accordance with generally accepted accounting principles in the United States of America. The going concern basis of presentation assumes that we will continue in operation one year after the date these 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 March 31, 2022, the company had cash and cash equivalent of $44.7 million and an accumulated deficit of $569.6 million. For the three months ended March 31, 2022, the company had an income from continuing operations of $0.0 million and net income applicable to Surgalign Holdings, Inc. of $0.0 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 or for the three months ended March 31, 2022. The Company expects net operating losses for the full year 2022. On February 15, 2022, we issued and sold in an underwritten public offering 38,565,220 shares of common stock and 4,913,044 of pre-funded warrants to purchase common stock with gross proceeds of $20.0 million at an effective offering price of $0.46 and $0.4599 per share respectively. In addition, the Company issued warrants to purchase up to an aggregate of 32,608,698 shares of common stock at a strike price of $0.60 that are exercisable over the next five years. Also in connection with the offering, the Company 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 that are exercisable over the next five years. Finally, the Company granted the underwriters the option for a period of 30 days from February 15, 2022 to purchase up to 6,521,736 additional shares of the Company's common stock at the public offering price of $0.4599 per share and/or warrants to purchase up to 4,891,302 shares of the Company's common stock at a public offering price of $0.0001 per warrant. The Underwriters did not exercise the option to purchase the common shares from the Company, but they did exercise the option to purchase the warrants which have not been converted to common shares as of March 31, 2022. We received net proceeds of $17.7 million from the offering. On June 14, 2021, we issued and sold in a registered direct offering an aggregate of 28,985,508 shares of our common stock and investor warrants to purchase up to an aggregate of 28,985,508 million shares at a strike price of $1.725. The Company, also in connection with the direct offering, issued placement agent warrants to purchase an aggregate of up to 1,739,130 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 and recent market volatility; ii) negative cash flows that are projected over the next 12-month period; iii) potential milestone payments related to the Holo Surgical Inc. ("Holo Surgical") and INN acquisitions should any of the milestones be achieved; iv) seller notes with a fair value amount of $10.0 million due to the seller of INN on December 31, 2024; and v) various supplier minimum requirements. 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 and geopolitical 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 condensed consolidated financial statements are issued. Management continually evaluates plans to raise additional debt and/or equity financing and will attempt to curtail discretionary expenditures in the future, if necessary; however, in consideration of the risks and uncertainties mentioned, such plans cannot be considered probable of occurring at this time. The recoverability of a major portion of the recorded asset amounts shown in the Company’s accompanying condensed consolidated balance sheets is dependent upon continued operations of the Company, which in turn is dependent upon the Company’s ability to meet its funding requirements on a continuous basis to maintain existing financing to succeed in its future operations. The Company’s condensed consolidated financial statements do not include any adjustment relating to the recoverability and classification of recorded asset amounts and classification of liabilities that might be necessary should the Company be unable to continue in existence.

Basis of Presentation

Basis of Presentation	3 Months Ended
	Mar. 31, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Presentation	Basis of Presentation The accompanying condensed consolidated financial statements include all adjustments, consisting of normal recurring accruals, which the Company considers necessary for a fair presentation of the results of operations for the periods shown. The condensed consolidated financial statements have been prepared in accordance with the instructions to Form 10-Q and Rule 10-01 of Regulation S-X, and, therefore, do not include all information and footnotes necessary for a fair presentation of the condensed consolidated financial position, results of operations, comprehensive loss and cash flows in conformity with accounting principles generally accepted in the United States of America (“GAAP”). The preparation of our condensed consolidated financial statements in accordance with GAAP often requires us to make estimates and judgments that affect reported amounts. These estimates and judgments are based on historical experience and assumptions that we believe to be reasonable under the circumstances. Assumptions and judgments based on historical experience may provide reported results, which differ from actual results; however, these assumptions and judgments historically have not varied significantly from actual experience, and we therefore do not expect them to vary significantly in the future. All intercompany balances and transactions have been eliminated in consolidation. The results of operations for any interim period are not necessarily indicative of the results to be expected for the full year. The Company includes acquisition, disposal, integration and separation related costs, which are predominantly composed of legal, consulting, and advisor fee expenses, within the “Transaction and integration expense” line on the condensed consolidated statements of comprehensive income/(loss). The condensed consolidated financial statements include the accounts of the Company and its wholly owned subsidiaries, Surgalign Spine Technologies, Inc., Paradigm Spine, LLC (“Paradigm”), Pioneer Surgical Technology, Inc. (“Pioneer Surgical”) and Holo Surgical Inc. (“Holo Surgical”). The Company consolidates the accounts of Inteneural Networks, Inc. ("INN"), a 42% owned subsidiary as control was achieved through means other than voting rights ("variable interest entities" or "VIE") as the Company is deemed to be the primary beneficiary of INN. For further information, refer to the consolidated financial statements and notes thereto included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2021 filed with the Securities and Exchange Commission (“SEC”) on March 15, 2022 . Accounting Standards Issued But Not Yet Adopted To date, there have been no recent accounting pronouncements not yet effective that have a material, or potential material, impact to our consolidated financial statements. Significant New Accounting Policies

Leases

Leases	3 Months Ended
	Mar. 31, 2022
Leases [Abstract]
Leases	Leases The Company’s leases are classified as operating leases that include office space, automobiles, and copiers. The Company does not have any finance leases and the Company’s operating leases do not have any residual value guarantees, restrictions, or covenants. As of March 31, 2022 the only lease that has yet to commence is for our San Diego and Design Center, which is expected to open in the second half of 2022. The Company’s leases have remaining lease terms of 1 to 8 years, some of which include options to extend or terminate the leases. The option to extend is only included in the lease term if the Company is reasonably certain of exercising that option. Operating lease right-of-use ("ROU") assets are presented within "Other assets-net" on the condensed consolidated balance sheets. The current portion of operating lease liabilities are presented within "Accrued expenses", and the non-current portion of operating lease liabilities are presented within "Other long-term liabilities" on the condensed consolidated balance sheets. The Company’s lease agreements do not provide a readily determinable implicit rate nor is it available to the Company from its lessors. Instead, the Company estimates its incremental borrowing rate based on information available at lease commencement in order to discount lease payments to present value. 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 Three Months Ended 2022 2021 Operating lease cost $ 125 $ 183 Short-term operating lease cost 221 37 Total operating lease cost $ 346 $ 220 Supplemental cash flow information related to operating leases was as follows: For the Three Months Ended 2022 2021 Cash paid for amounts included in the measurement of lease liabilities $ 347 $ 244 Supplemental balance sheet information related to operating leases was as follows: Balance Sheet Classification Balance at March 31, 2022 Balance at December 31, 2021 Assets: Right-of-use assets Other assets - net $ 881 $ 876 Liabilities: Current Accrued expenses $ 346 $ 294 Noncurrent Other long-term liabilities 892 947 Total operating lease liabilities $ 1,238 $ 1,241 The weighted-average remaining lease terms and discount rates were as follows: For the Three Months Ended 2022 2021 Weighted-average remaining lease term (years) 5.9 5.8 Weighted-average discount rate 5.1 % 4.9 % As of March 31, 2022, maturities of operating lease liabilities were as follows: Balance at March 31, 2022 (remaining) $ 353 2023 198 2024 172 2025 161 2026 159 2027 and beyond 398 Total future minimum lease payments 1,441 Less imputed interest (203) Total $ 1,238

Revenue from Contracts with Cus

Revenue from Contracts with Customers	3 Months Ended
	Mar. 31, 2022
Revenue from Contract with Customer [Abstract]
Revenue from Contracts with Customers	Revenue from Contracts with Customers The Company recognizes revenue upon transfer of control of promised products in an amount that reflects the consideration it expects to receive in exchange for those products. The Company typically transfers control at a point in time upon shipment or delivery of the implants for direct sales, or upon implantation for sales of consigned inventory. The customer is able to direct the use of and obtain substantially all of the benefits from the implant at the time the implant is shipped, delivered, or implanted, based on the terms of the contract. Disaggregation of Revenue The Company’s entire revenue for the three months ended March 31, 2022 and 2021 was recognized at a point in time. The following table represents total revenue by geographical region for the three months ended March 31, 2022 and 2021, respectively: For the Three Months Ended 2022 2021 Revenues: Domestic $ 17,170 $ 19,849 International 3,435 3,442 Total revenues from contracts with customers $ 20,605 $ 23,291

Business Combinations

Business Combinations	3 Months Ended
	Mar. 31, 2022
Business Combination and Asset Acquisition [Abstract]
Business Combinations	Business Combinations 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 former member of the Board of Directors (the “Board”). 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 AI 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. These milestones have not been achieved as of March 31, 2022 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 was fully consolidated into the consolidated financial statements as of March 31, 2022 . INN does not have any assets or liabilities as of March 31, 2022 . Additionally, there was no income statement activity within INN for the three month period ended March 31, 2022. 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. As the forward contracts are redeemable upon a future event, FDA approval and as the event is not probable under the accounting guidance, the forward contracts are not remeasured to fair value at March 31, 2022. 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 noncontrolling 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 as of the transaction date. 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 during the fourth quarter for the year ended December 31, 2021 . This loss had 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”), a California limited liability company, and Peter Kopley, an individual residing in the State of California (the “Sellers”). The Company purchased the assets of Prompt to expand its research and development capabilities and create the capacity to produce certain medical prototypes. Pursuant to the terms of the Agreement, the Company purchased specific assets and assumed certain liabilities of Prompt for a purchase price of $1.1 million. At the closing, the Company paid $0.3 million of cash and issued restricted shares with an aggregate fair market value of $0.2 million to the sellers. The remaining $0.6 million of the purchase price will be paid to Mr. Kopley, contingent on the continued employment with the Company, in the form of cash and restricted shares in two equal amounts on the 18 th and 36 th month anniversary of the closing date. These payments are considered future compensation. The following table summarizes the fair value of the identifiable assets acquired and liabilities assumed from the acquisition of Prompt as of April 30, 2021 (in thousands): Inventories $ 140 Right-of-use assets 78 Property and equipment 528 Operating lease liabilities (78) Deferred tax liability (28) Net assets acquired $ 640 Bargain purchase gain (90) Total purchase price $ 550 Based on the preliminary purchase price, the fair value of the assets acquired and liabilities assumed exceeded the purchase price consideration resulting in a bargain purchase gain of $0.1 million and was recorded in "Other (income) expense – net" during the second quarter ended June 30, 2021. The bargain purchase was primarily driven by the potential future compensation expense in lieu of an increased purchase price.

Stock-Based Compensation

Stock-Based Compensation	3 Months Ended
	Mar. 31, 2022
Share-based Payment Arrangement [Abstract]
Stock-Based Compensation	Stock-Based Compensation The following tables summarize our stock option and stock grant awards by plan: For the three months ended March 31, 2022: Plan Stock Options Restricted Stock Awards Restricted Stock Units Total 2021 Incentive Inducement Plan — — 2,340,316 2,340,316 2021 Incentive Compensation Plan — — 24,899 24,899 Total — — 2,365,215 2,365,215 For the three months ended March 31, 2021: Plan Stock Options Restricted Stock Awards Restricted Stock Units Total 2018 Incentive Compensation Plan 173,683 78,084 — 251,767 Total 173,683 78,084 — 251,767 The Company recognized stock-based compensation as follows: For the Three Months Ended 2022 2021 Stock-based compensation: Costs of goods sold $ — $ 21 General and administrative 1,271 889 Research and development 103 26 Total $ 1,374 $ 936

Net Income Per Common Share

Net Income Per Common Share	3 Months Ended
	Mar. 31, 2022
Earnings Per Share [Abstract]
Net Income Per Common Share	Net Income Per Common Share A reconciliation of the number of shares of common stock used in the calculation of basic and diluted net income per common share is presented below: For the Three Months Ended 2022 2021 Weighted average basic shares 172,009,259 98,109,900 Stock Options — — Restricted Stock Units and Restricted Stock Awards 5,318,840 — Weighted average diluted shares 177,328,099 98,109,900 For the three months ended March 31, 2021, the Company has recorded a net loss from operations. As a result, the Company has excluded all potential dilutive shares from the computation of the diluted net loss per common share to avoid the anti-dilutive effect. The following table includes the number of potential dilutive shares that were excluded due to the anti-dilutive effect: For the Three Months Ended 2022 2021 Stock Options — 781,144 Restricted Stock Units and Restricted Stock Awards — 886,434 Total — 1,667,578 For the three months ended March 31, 2022 and 2021, the company excluded 3,541,328 and 4,264,055 of issued stock options in the computation of diluted net income per share and diluted net loss per share, respectively, because their exercise price exceeded the average market price during the respective periods. The Company’s outstanding warrants were also excluded from the computation of diluted net loss per common share as they were considered “out-of-the-money” as of March 31, 2022.

Inventories

Inventories	3 Months Ended
	Mar. 31, 2022
Inventory Disclosure [Abstract]
Inventories	Inventories The inventory balances as of March 31, 2022 and December 31, 2021 consist entirely of finished goods. The Company values its inventories at the lower of net realizable value or cost using first-in, first-out ("FIFO"). For the three months ended March 31, 2022 and 2021, the Company had inventory write-downs of $3.0 million and $2.8 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 on the condensed consolidated statements of comprehensive income/(loss).

Prepaid and Other Current Asset

Prepaid and Other Current Assets	3 Months Ended
	Mar. 31, 2022
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: March 31, December 31, Income tax receivable $ 3,913 $ 4,116 Leasehold improvement reimbursement $ 3,410 $ — Prepaid expenses $ 2,952 $ 2,553 Payroll tax receivable $ 1,695 $ — Insurance recovery receivable $ — $ 1,500 Other receivables 1,221 815 $ 13,191 $ 8,984

Property and Equipment

Property and Equipment	3 Months Ended
	Mar. 31, 2022
Property, Plant and Equipment [Abstract]
Property and Equipment	Property and Equipment The net book value of property and equipment after accumulated depreciation and all impairment is as follows: March 31, 2022 December 31, 2021 Processing equipment $ 273 $ 346 Surgical instruments 449 489 Office equipment, furniture and fixtures 10 15 Computer equipment and software 163 44 Construction in process 5 51 $ 900 $ 945 For the three months ended March 31, 2022 and 2021, the Company recorded depreciation expense in connection with property and equipment of $0.5 million and $0.5 million, respectively. The Company uses the straight-line method of depreciation. For the three months ended March 31, 2022 and 2021, the Company recorded asset impairment and abandonment charges of $0.9 million and $2.2 million, respectively. The fair value of property and equipment was measured utilizing an orderly liquidation value of each of the underlying assets. For the three months ended March 31, 2022 and 2021, the Company capitalized a total of $0.0 million and $0.3 million of internal software expense related to the implementation of a new Enterprise Resource Planning ("ERP") system. The ERP system was implemented in January 2022 and related capitalized expenses were transferred from "Construction in process to "Comput er equipment and software" to coincide with implementation. Impairment of the ERP costs was $0.0 million and $0.3 million for the three months ended March 31, 2022 and 2021, respectively. The impairment charges were triggered by continued negative operating cash flows.

Warrants

Warrants	3 Months Ended
	Mar. 31, 2022
Warrants and Rights Note Disclosure [Abstract]
Warrants	Warrants On February 15, 2022, we issued and sold in an underwritten public offering 38,565,220 shares of common stock and 4,913,044 of pre-funded warrants to purchase common stock with gross proceeds of $20.0 million at an effective offering price of $0.46 and $0.4599 per share respectively. In addition, the Company issued warrants to purchase up to an aggregate of 32,608,698 shares of common stock at a strike price of $0.60 that are exercisable over the next five years. Also in connection with the offering, the Company issued placement agent warrants to purchase an aggregate of up to 2,608,696 shares of common stock at a strike price of $0.575 per share that are exercisable over the next five years. Finally, the Company granted the underwriters the option for a period of 30 days from February 15, 2022 to purchase up to 6,521,736 additional shares of our common stock at the public offering price of $0.4599 per share and/or warrants to purchase up to 4,891,302 shares of the Company's common stock at a public offering price of $0.0001 per warrant. The Underwriters did not exercise the option to purchase the common shares from the Company, but they did exercise the option to purchase the warrants which have not been converted to common shares as of March 31, 2022. We received net proceeds of $17.7 million from the offering. The Company incurred issuance costs related to the offering of $2.3 million which has been allocated between the value of the warrant liability and the amounts recorded within the Statement of Shareholders Equity. Fees allocated to the warrant liabilities were $0.9 million and is reflected in the "Transaction and integration expenses" line in the condensed consolidated statement of income/(loss). The remaining $1.4 million is allocated to common shares and is reflected in "Additional Paid-In Capital" and "Common Stock" sections of the Company’s condensed consolidated balance sheets On June 14, 2021, the Company issued and sold in a registered direct offering priced at-the-market an aggregate of 28,985,508 shares of its common stock and warrants exercisable for an aggregate of 28,985,508 shares of Company common stock, at a combined purchase price of $1.725 per share. The warrants have an exercise price equal to $1.725 per share, are exercisable immediately upon issuance and will expire three years from the issuance date. The net proceeds from the direct offering, after deducting investor and management fees, were $45.8 million. Upon any exercise of the offering warrants issued in the offering for cash, the Company agreed to pay the placement agent a total cash fee equal to 7.0% of the aggregate gross proceeds from the exercise of the offering warrants and a management fee equal to 1.0% of the aggregate gross proceeds from the exercise of the offering warrants. The Company, also in connection with the direct offering, issued the placement agent or its designees warrants to purchase an aggregate of up to 1,739,130 shares of its common stock. The placement agent warrants have substantially the same terms as the warrants described above, except that the placement agent warrants will have an exercise price of $2.15625 per share, and holders of the placement agent warrants are not entitled to receive cash dividends issued by the Company during such time as the placement agent warrant is outstanding. The Company accounts for its warrants in accordance with ASC 815-40, “Derivatives and Hedging—Contracts in Entity’s Own Equity” (“ASC 815”), under which the warrants did not meet the criteria for equity classification and thus were recorded as liabilities. Since the warrants met the definition of a derivative in accordance with ASC 815, these warrants were measured at fair value at inception and will be remeasured at each reporting date in accordance with ASC 820, Fair Value Measurement

Fair Value Information

Fair Value Information	3 Months Ended
	Mar. 31, 2022
Fair Value Disclosures [Abstract]
Fair Value Information	Fair Value Information Fair value is defined as the price that would be received upon the sale of an asset or paid to transfer a liability in an orderly transaction between market participants on the measurement date. Valuation techniques used to measure fair value maximize the use of observable inputs and minimize the use of unobservable inputs. The fair value hierarchy defines a three-level valuation hierarchy for classification and disclosure of fair value measurements as follows: Level 1 – Quoted prices in active markets for identical assets or liabilities. Level 2 – Inputs other than Level 1 that are observable, either directly or indirectly, such as quoted prices for similar assets or liabilities; quoted prices in markets that are not active; or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities. Level 3 – Unobservable inputs that are supported by little or no market activity and that are significant to the fair value of the assets or liabilities. Acquisition Contingencies Changes in the fair value of contingent consideration are recorded in the "Gain on acquisition contingency" line in the condensed consolidated statement of income/(loss). Significant changes in unobservable inputs, mainly the probability of success and projected cash flows, could result in material changes to the contingent consideration liability. Inteneural Networks Inc. On December 30, 2021, we completed a Stock Purchase Agreement (“Purchase Agreement”) to acquire 42% of Inteneural Networks Inc. ("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% stake in INN, we paid total consideration of $19.9 million which consisted of $5.0 million in cash, 6,820,792 shares of our common stock with a fair value of $4.9 million and issued 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 and subject to certain contingencies, the Company must purchase up to 100% of the equity of INN in three 19.3% tranches for $19.3 million for each of the achievement of the three additional clinical, regulatory, and revenue milestones. Holo Surgical On September 29, 2020, the Company entered into a Stock Purchase Agreement (the “Holo Purchase Agreement”), with Roboticine, Inc, a Delaware corporation (the “Seller”), Holo Surgical S.A., a Polish joint-stock company (“Holo S.A.”), Pawel Lewicki, PhD (“Lewicki”), and Krzysztof Siemionow, MD, PhD (“Siemionow”), which provides for the Company to acquire all of the issued and outstanding equity interests in Holo Surgical Inc., a Delaware corporation and a wholly owned subsidiary of the Seller (“Holo Surgical”). The Seller, Holo S.A., Lewicki and Siemionow are together referred to herein as the “Seller Group Members.” The Acquisition was closed on October 23, 2020. As consideration for the Holo Surgical acquisition, the Company paid to the Seller $30.0 million in cash and issued to the Seller 6,250,000 shares of common stock, par value $0.001 of the Company (“Common Stock”). In addition, the Seller is entitled to receive contingent consideration from the Company valued in an aggregate amount of up to $83.0 million, to be paid through the issuance of Common Stock or the payment of cash, contingent upon and following the achievement of certain regulatory, commercial and utilization milestones by specified time periods occurring up to the sixth (6 th ) anniversary of the closing. T he contingent consideration is evaluated quarterly, or more frequently, if circumstances dictate. Changes in the fair value of contingent consideration are recorded in the "Gain on acquisition contingency" line item in the condensed consolidated statements of comprehensive income/(loss). Significant changes in unobservable inputs, mainly the probability of success and cash flows projected, could result in material changes to the contingent consideration liabilities. The Purchase Agreement provides that the Company will issue Common Stock to satisfy any contingent consideration payable to the Seller, until the total number of shares of Common Stock issued to the Seller pursuant to the Purchase Agreement (including the 6,250,000 shares of Common Stock issued at closing) is equal to 14,900,000 shares of Common Stock. Following the attainment of that limitation, the post-closing contingent payments would be payable in cash. The number of shares of Common Stock issued as contingent consideration with respect to the achievement of a post-closing milestone, if any, will be calculated based on the volume weighted average price of the Common Stock for the five (5) day trading period commencing on the opening of trading on the third trading day following the achievement of the applicable milestone. 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 its HOLO Portal ™ surgical guidance system. 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 (the "Holo Milestone Payments"). 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 March 31, 2022 and December 31, 2021, are summarized below: Fair Value at March 31, 2022 Valuation Technique Unobservable Inputs Ranges $33,425 Earn-Out Valuation Probability of success factor 0% - 95% Discount rates 0.00% - 12.47% 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% The following table provides a reconciliation of contingent consideration measured at fair value using significant unobservable inputs (Level 3) as of March 31, 2022 and December 31, 2021 : March 31, December 31, Beginning balance as of January 1 $ 51,928 $ 56,515 Gain on acquisition contingency (8,503) (4,587) Milestone payments (10,000) — Ending balance as of March 31 $ 33,425 $ 51,928 Paradigm On March 8, 2019, the Company acquired Paradigm, 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 during 2019. There are no amounts recorded as contingent consideration as of March 31, 2022 and December 31, 2021 as management has determined that the milestones will not be met. The last milestones will expire on December 31, 2022. Property and Equipment, Intangibles and Other Assets As of March 31, 2022, and December 31, 2021, respectively, property and equipment with a carrying amount of $1.7 million and $12.0 million were written down to their estimated fair value of $0.9 million and $0.9 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 2022 and 2021. 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. Due to the Company’s forecasted cash flow being negative, any intangible assets acquired during the period were 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 as of March 31, 2022 and December 31, 2021: Fair value March 31, December 31, Property and equipment – net $ 900 $ 945 Definite-lived intangible assets - net — Other assets – net 7,114 6,970 $ 8,014 $ 7,915 Property and equipment was impaired and written down to their estimated fair values during the three months ended March 31, 2022 and 2021. Other intangible assets and other assets were impaired and written down to their estimated fair values during the three months ended March 31, 2022. The following table summarizes the corresponding impairment charge during the three months ended March 31, 2022 and 2021: For the Three Months Ended Impairment 2022 2021 Property and equipment – net $ 789 $ 1,778 Definite-lived intangible assets - net 101 161 Other assets – net 49 237 $ 939 $ 2,176 During the three months ended March 31, 2022 and 2021, 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 intangibles, and other assets for impairment. As a result, we recorded an impairment charge of $0.9 million and $2.2 million for the three months ended March 31, 2022 and 2021 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 condensed consolidated balance sheets. The following table presents information about the Company’s liabilities that are measured at fair value: Level March 31, 2022 December 31, 2021 Warrant liability 3 $ 10,678 $ 12,013 June 15, 2021 Warrants The table presented below is a summary of changes in the fair value of the Company’s Level 3 valuation for the June 15, 2021 warrant liability for the three months ended March 31, 2022, there were no warrants issued as of March 31, 2021: Warrant Liability December 31, 2021 $ 12,013 Change in fair value of warrant liability (7,600) March 31, 2022 $ 4,413 The warrant liability is revalued each reporting period with the change in fair value recorded in the accompanying condensed consolidated statements of comprehensive income/(loss) until the warrants are exercised or expire. The fair value of the warrant liability is estimated using the Black-Scholes Option Pricing Model using the following valuation inputs: March 31, December 31, Stock price $ 0.30 0.72 Risk-free interest rate 2.31 % 0.84 % Dividend yield — % — % Volatility 150 % 130 % February 15, 2022 Warrants The table presented below is a summary of changes in the fair value of the Company’s Level 3 valuation for the February 15, 2022 warrant liability for the three months ended March 31, 2022, there were no warrants issued as of March 31, 2021: Warrant Liability December 31, 2021 $ — Fair value of warrants on date of issuance 10,157 Execution of prefunded warrants (1,749) Change in fair value of warrant liability (2,143) March 31, 2022 $ 6,265 The warrant liability is revalued each reporting period with the change in fair value recorded in the accompanying condensed consolidated statements of comprehensive income/(loss) until the warrants are exercised or expire. The fair value of the warrant liability is estimated using the Black-Scholes Option Pricing Model using the following valuation inputs: March 31, Stock price $ 0.30 Risk-free interest rate 2.42 % Dividend yield — % Volatility 80 %

Accrued Expenses

Accrued Expenses	3 Months Ended
	Mar. 31, 2022
Payables and Accruals [Abstract]
Accrued Expenses	Accrued Expenses Accrued expenses are as follows: March 31, December 31, Accrued compensation $ 4,405 $ 5,258 Accrued distributor commissions $ 3,186 $ 2,957 Accrued securities class action settlement $ — $ 1,500 Other 8,222 8,054 Total accrued expenses $ 15,813 $ 17,769

Other Long-term Liabilities

Other Long-term Liabilities	3 Months Ended
	Mar. 31, 2022
Other Liabilities, Noncurrent [Abstract]
Other Long-term Liabilities	Other Long-term Liabilities Other long-term liabilities are as follows: March 31, 2022 December 31, 2021 Acquisition contingencies $ 33,425 $ 26,343 Warrant Liability 10,678 12,013 Lease obligations 892 947 Other 2,484 2,229 Total other long-term liabilities $ 47,479 $ 41,532

Income Taxes

Income Taxes	3 Months Ended
	Mar. 31, 2022
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes The Company evaluates the need for deferred tax asset valuation allowances based on a more likely than not standard. The ability to realize deferred tax assets depends on the ability to generate sufficient taxable income within the carryback or carryforward periods provided for in the tax law for each applicable tax jurisdiction. The Company has evaluated all evidence, both positive and negative, and maintains a valuation allowance on deferred tax assets in the United States as well as most foreign jurisdictions as of March 31, 2022. For the three months ended March 31, 2022 and 2021, the Company recorded income tax expense of $0.2 million and $0.2 million, respectively in continuing operations. The March 31, 2022 three-month income tax provision was primarily a result of federal tax notices received, non-U.S. income tax expense, and interest accrued on uncertain tax positions. The March 31, 2021 three-month income tax provision was primarily a result of federal interest associated with the timing of payments.

Debt

Debt	3 Months Ended
	Mar. 31, 2022
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 $10.0 million and $10.0 million as of March 31, 2022 and December 31, 2021 respectively. 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. For the three months ended March 31, 2022 management accrued $0.2 million in interest expense and accredited $0.1 million related to the seller notes for a total interest expense of $0.3 million. 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 5, and Note 20. Debt issuance costs were immaterial and were included within the overall costs of the acquisition of INN. The following table summarizes the debt recorded on the condensed consolidated balance sheet: Carrying Value (In thousands) March 31, 2022 December 31, 2021 Seller Notes-P. Lewicki $ 5,306 $ 5,306 Seller Notes-K. Siemionow 5,306 5,306 Less: fair value adjustment (578) (630) Total Seller Notes - related party 10,034 9,982 Current portion of seller notes — — Total long-term seller note, excluding current portion $ 10,034 $ 9,982 The fair value of the Seller Notes is $10.0 million at March 31, 2022 and December 31, 2021, respectively. The Company has determined that the Seller Notes is a level 2 financial instrument as there are other unobservable inputs. As of March 31, 2022, the future maturities of long-term debt, excluding deferred financing costs, accrued interest and debt discount, were as follows: 2022 $ — 2023 — 2024 10,612 2025 — 2026 — Thereafter — Total $ 10,612

Commitments and Contingencies

Commitments and Contingencies	3 Months Ended
	Mar. 31, 2022
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies Acquisition of Paradigm – On March 8, 2019, pursuant to a Master Transaction Agreement, the Company acquired Paradigm in a cash and stock transaction valued at up to $300.0 million consisting of $150.0 million of cash, plus potential future milestone payments. Paradigm’s primary product is the Coflex ® Interlaminar Stabilization ® device, a minimally invasive motion preserving stabilization implant that is FDA premarket approved for the treatment of moderate to severe lumbar spinal stenosis in conjunction with decompression. Under the terms of the agreement, the Company paid $100.0 million in cash and issued 10,729,614 shares of the Company’s common stock. The shares of Company common stock issued on March 8, 2019, were valued based on the volume weighted average closing trading price for the five utilizing a Monte-Carlo simulation model. A Monte-Carlo simulation is an analytical method used to estimate fair value by performing a large number of simulations or trial runs and thereby determining a value based on the possible outcomes. Accounted for as a liability to be revalued at each reporting period, the fair value of the contingent liability was measured using Level 3 inputs, which includes weighted average cost of capital and projected revenues and costs. There are no amounts recorded as contingent consideration as of March 31, 2022 and December 31, 2021 as management has determined that the milestones will not be met. The last milestones will expire on December 31, 2022. Aziyo – On August 1, 2018, the Company and Aziyo Biologics, Inc. ("Aziyo") entered into a Distribution Agreement which was subsequently amended on December 3, 2018, and November 15, 2020 (the “Distribution Agreement”). Pursuant to the Distribution Agreement, the Company has exclusive distribution rights to certain biologic implants manufactured by Aziyo and marketed under the ViBone trade name (“ViBone”). The Distribution Agreement provides for minimum purchases of ViBone implants on an annual basis through calendar 2025. For calendar years 2019-2021, if the minimum purchase obligations for a particular year are not fulfilled, the Distribution Agreement provides various options for the Company to satisfy such obligations (“Shortfall Obligations”) in subsequent years, including a combination of payments and/or providing purchase orders for the shortfall amount in a given year. If a purchase order is submitted, the contract does not provide that it needs to be satisfied during 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 minimum purchase obligations specified in the Distribution Agreement, the Company can continue to market the ViBone implants on a non-exclusive basis without any Shortfall Obligations. In January 2021, the Company issued a purchase order to Aziyo for $12.4 million relating to the 2020 Shortfall Obligation. In January 2022, the Company issued a purchase order to Aziyo for $14.2 million relating to the 2021 Shortfall Obligation. Acquisition of Holo Surgical – As part of the Holo Surgical acquisition, the Company issued contingent consideration which would be payable to the sellers upon the achievement of certain regulatory, commercial, and utilization milestones by specified time periods. On January 14, 2022 the Company received 510(k) clearance for the HOLO Portal TM surgical guidance system. 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. The fair value of the liability was $33.4 million as of March 31, 2022 all of which is being classified as a long-term liability in the accompanying condensed consolidated balance sheets, within "Acquisition contingencies - Holo." The fair value of the liability was $51.9 million on December 31, 2021 with $25.6 million classified as current liabilities within " Current portion of accrued acquisition contingency- Holo " while $26.3 million classified as " Acquisition contingencies - Holo ." The change in the fair value of the liability of $8.5 million since December 31, 2021 was recognized in the gain on acquisition contingency line of the condensed consolidated statements of comprehensive income/(loss). 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 would manufacture certain hardware implants for the Company; (ii) a Processing and Distribution Agreement with RTI Surgical, Inc. (“RTI”), an affiliate of Pioneer, pursuant to which RTI would process certain biologic implants for the Company (the “PDA”); and (iii) a Manufacture and Distribution Agreement (“NanOss”) pursuant to which Pioneer would manufacture certain synthetic implants for the Company (the “NanOss MDA”), and together with the Hardware MDA and the PDA, the “OEM Distribution Agreements.” The OEM Distribution Agreements contain aggregate minimum purchase obligations for each of the first three years of the agreements as follows: • Year 1: $24.2 million • Year 2: $25.8 million • Year 3: $27.2 million The OEM Distribution Agreements contain provisions whereby the minimum purchase obligations are reduced under certain circumstances, including certain force majeure events and termination of the agreements for certain specified reasons. In addition, on July 20, 2020, the Company entered into a Design and Development Agreement with Pioneer pursuant to which Pioneer will provide certain design and development services with respect to certain implants (the “Design and Development Agreement”). The Design and Development Agreement contains a provision whereby the Company will pay Pioneer a minimum of $1.7 million for direct labor costs and certain services with respect to maintaining design history files in each of the first two years under the Design and Development Agreement. Pioneer has filed a legal dispute with the Company regarding the Design and Development Agreement related certain disputed invoices. All amounts have been properly accrued related to the agreement within the condensed consolidated balance sheet as of March 31, 2022. 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 agreed to make improvements over the 12 month period after the execution of the leases, after which occupancy is expected to be delivered to the Company. Aggregate payments towards base rent for the Premises over the term of the lease will be approximately $64.6 million, including 13 months of rent abatement. The Company will recognize the lease assets and liabilities when the Landlord makes the underlying asset available to the Company and as such no amounts were accrued as of September 30, 2021. Concurrent with the Company’s execution of the Lease, as a security deposit, the Company delivered to the Landlord a payment in the amount of $2.5 million which is recorded within "Other assets – net" in our condensed consolidated balance sheets.

Legal Actions

Legal Actions	3 Months Ended
	Mar. 31, 2022
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, except as described below and in Note 19 the Company does not believe that any of these claims that were outstanding as of March 31, 2022 will have a material adverse impact on its financial position or results of operations. The Company’s accounting policy is to accrue for legal costs as they are incurred. Coloplast — RTI Surgical, Inc., as a predecessor to the Company, is presently named as co-defendant along with other companies in a small percentage of the transvaginal surgical mesh (“TSM”) mass tort claims being brought in various state and federal courts. The TSM litigation has as its catalyst various Public Health Notifications issued by the FDA with respect to the placement of certain TSM implants that were the subject of 510(k) regulatory clearance prior to their distribution. The Company does not process or otherwise manufacture for distribution in the U.S. any implants that were the subject of these FDA Public Health Notifications. The Company denies any allegations against it and intends to continue to vigorously defend itself. In addition to claims made directly against the Company, Coloplast, a distributor of TSM’s and certain allografts processed and private labeled for them under a contract with the Company, has also been named as a defendant in individual TSM cases in various federal and state courts. Coloplast requested that the Company indemnify or defend Coloplast in those claims which allege injuries caused by the Company’s allograft implants, and on April 24, 2014, Coloplast sued RTI Surgical, Inc. in the Fourth Judicial District of Minnesota for declaratory relief and breach of contract. On December 11, 2014, Coloplast entered into a settlement agreement with RTI Surgical, Inc. and Tutogen Medical, Inc. (the “Company Parties”) resulting in dismissal of the case. Under the terms of the settlement agreement, the Company Parties are responsible for the defense and indemnification of two categories of present and future claims: (1) tissue only (where Coloplast is solely the distributor of Company processed allograft tissue and no Coloplast-manufactured or distributed synthetic mesh is identified) (“Tissue Only Claims”), and (2) tissue plus non-Coloplast synthetic mesh (“Tissue-Non-Coloplast Claims”) (the Tissue Only Claims and the Tissue-Non-Coloplast Claims being collectively referred to as “Indemnified Claims”). As of March 31, 2022, there are a cumulative total of 1,028 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 Federal Circuit issued its written opinion regarding Surgalign's Appeal and LifeNet's Cross-appeal on April 11, 2022, affirming in-part, reversing in-part, and remanding one issue to the PTAB. In connection with the transactions, liabilities related to these claims remained a liability retained by the Company. The Company continues to believe the suit is without merit and will vigorously defend its position. Based on the current information available to the Company, the impact that current or any future litigation may have on the Company cannot be reasonably estimated. Securities Class Action— 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. No amounts were outstanding on March 31, 2022 and 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. The settlement amount was paid by the Company's insurers under its Directors' and Officers' insurance policies in January 2022 in the amount of $1.5 million. On January 24, 2022, the court gave final approval to the Derivative Actions Settlement. The matter is now concluded and no amounts were outstanding at March 31, 2022 . 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	3 Months Ended
	Mar. 31, 2022
Regulatory Actions [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 condensed consolidated financial statements for the quarterly periods within these years commencing with the first quarter of 2016, as well as the 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 March 31, 2022 and December 31, 2021 .

Related Party Transactions

Related Party Transactions	3 Months Ended
	Mar. 31, 2022
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 Company has not entered into any related part transaction in 2022. The following transactions were determined to be related parties at the time of the transaction: The Holo Surgical Acquisition As discussed in Note 5, on September 29, 2020, the Company entered into the Holo Purchase Agreement, pursuant to which, among other things, the Company consummated the Acquisition on October 23, 2020. As consideration for the Acquisition, the Company paid to Seller $30.0 million in cash and issued to Seller 6,250,000 shares of its common stock with a fair value of $12.3 million. In addition, the Seller will be entitled to receive contingent consideration from the Company valued at $50.6 million as of October 23, 2020, which must be first paid in shares of our common stock (in an amount up to 8,650,000 shares) and then paid in cash thereafter, contingent upon and following the achievement of certain regulatory, commercial and utilization milestones by specified time periods occurring up to the sixth (6th) anniversary of the Closing Date. Dr. Lewicki was appointed to the Company's board of directors on November 23, 2020. He will not be nominated to the Board of Directors following the May 10, 2022 shareholders meeting. Dr. Pawel Lewicki indirectly owns approximately 57.5% of the outstanding ownership interests in the Seller. 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 would provide consulting services to the Company. The Consulting Agreement had 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. For the three months ended March 31, 2022 and 2021, t otal cash compensation paid to Mr. Simpson for his services were $0.0 million and $0.1 million, respectively. INN Acquisition On December 30, 2021, we executed the INN Purchase Agreement with the related party Sellers, Siemionow and Lewicki who own the remaining 58% of INN evenly. See Note 1 , Note 5, and Note 16 for further discussion on amounts outstanding to them.

Subsequent Events

Subsequent Events	3 Months Ended
	Mar. 31, 2022
Subsequent Events [Abstract]
Subsequent Events	Subsequent Events The Company evaluated subsequent events as of the issuance date of the condensed consolidated financial statements as defined by FASB ASC 855, Subsequent Events.

Basis of Presentation (Policies

Basis of Presentation (Policies)	3 Months Ended
	Mar. 31, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Presentation	Basis of Presentation The accompanying condensed consolidated financial statements include all adjustments, consisting of normal recurring accruals, which the Company considers necessary for a fair presentation of the results of operations for the periods shown. The condensed consolidated financial statements have been prepared in accordance with the instructions to Form 10-Q and Rule 10-01 of Regulation S-X, and, therefore, do not include all information and footnotes necessary for a fair presentation of the condensed consolidated financial position, results of operations, comprehensive loss and cash flows in conformity with accounting principles generally accepted in the United States of America (“GAAP”). The preparation of our condensed consolidated financial statements in accordance with GAAP often requires us to make estimates and judgments that affect reported amounts. These estimates and judgments are based on historical experience and assumptions that we believe to be reasonable under the circumstances. Assumptions and judgments based on historical experience may provide reported results, which differ from actual results; however, these assumptions and judgments historically have not varied significantly from actual experience, and we therefore do not expect them to vary significantly in the future. All intercompany balances and transactions have been eliminated in consolidation. The results of operations for any interim period are not necessarily indicative of the results to be expected for the full year. The Company includes acquisition, disposal, integration and separation related costs, which are predominantly composed of legal, consulting, and advisor fee expenses, within the “Transaction and integration expense” line on the condensed consolidated statements of comprehensive income/(loss).The condensed consolidated financial statements include the accounts of the Company and its wholly owned subsidiaries, Surgalign Spine Technologies, Inc., Paradigm Spine, LLC (“Paradigm”), Pioneer Surgical Technology, Inc. (“Pioneer Surgical”) and Holo Surgical Inc. (“Holo Surgical”). The Company consolidates the accounts of Inteneural Networks, Inc. ("INN"), a 42% owned subsidiary as control was achieved through means other than voting rights ("variable interest entities" or "VIE") as the Company is deemed to be the primary beneficiary of INN.
Accounting Standards Issued But Not Yet Adopted and Significant New Accounting Policies	Accounting Standards Issued But Not Yet Adopted To date, there have been no recent accounting pronouncements not yet effective that have a material, or potential material, impact to our consolidated financial statements. Significant New Accounting Policies

Leases (Tables)

Leases (Tables)	3 Months Ended
	Mar. 31, 2022
Leases [Abstract]
Schedule of Components of Operating Lease Expense	The components of operating lease expense were as follows: For the Three Months Ended 2022 2021 Operating lease cost $ 125 $ 183 Short-term operating lease cost 221 37 Total operating lease cost $ 346 $ 220 Supplemental cash flow information related to operating leases was as follows: For the Three Months Ended 2022 2021 Cash paid for amounts included in the measurement of lease liabilities $ 347 $ 244
Schedule of Supplemental Balance Sheet Information Related to Operating Leases	Supplemental balance sheet information related to operating leases was as follows: Balance Sheet Classification Balance at March 31, 2022 Balance at December 31, 2021 Assets: Right-of-use assets Other assets - net $ 881 $ 876 Liabilities: Current Accrued expenses $ 346 $ 294 Noncurrent Other long-term liabilities 892 947 Total operating lease liabilities $ 1,238 $ 1,241
Schedule of Weighted-Average Remaining Lease Terms and Discount Rates	The weighted-average remaining lease terms and discount rates were as follows: For the Three Months Ended 2022 2021 Weighted-average remaining lease term (years) 5.9 5.8 Weighted-average discount rate 5.1 % 4.9 %
Schedule of Maturities of Operating Lease Liabilities	As of March 31, 2022, maturities of operating lease liabilities were as follows: Balance at March 31, 2022 (remaining) $ 353 2023 198 2024 172 2025 161 2026 159 2027 and beyond 398 Total future minimum lease payments 1,441 Less imputed interest (203) Total $ 1,238

Revenue from Contracts with C_2

Revenue from Contracts with Customers (Tables)	3 Months Ended
	Mar. 31, 2022
Revenue from Contract with Customer [Abstract]
Schedule of Total Revenue by Geographical Region	The Company’s entire revenue for the three months ended March 31, 2022 and 2021 was recognized at a point in time. The following table represents total revenue by geographical region for the three months ended March 31, 2022 and 2021, respectively: For the Three Months Ended 2022 2021 Revenues: Domestic $ 17,170 $ 19,849 International 3,435 3,442 Total revenues from contracts with customers $ 20,605 $ 23,291

Business Combinations (Tables)

Business Combinations (Tables)	3 Months Ended
	Mar. 31, 2022
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): Inventories $ 140 Right-of-use assets 78 Property and equipment 528 Operating lease liabilities (78) Deferred tax liability (28) Net assets acquired $ 640 Bargain purchase gain (90) Total purchase price $ 550

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	3 Months Ended
	Mar. 31, 2022
Share-based Payment Arrangement [Abstract]
Schedule of Stock Option And Stock Grant Awards By Plan	The following tables summarize our stock option and stock grant awards by plan: For the three months ended March 31, 2022: Plan Stock Options Restricted Stock Awards Restricted Stock Units Total 2021 Incentive Inducement Plan — — 2,340,316 2,340,316 2021 Incentive Compensation Plan — — 24,899 24,899 Total — — 2,365,215 2,365,215 For the three months ended March 31, 2021: Plan Stock Options Restricted Stock Awards Restricted Stock Units Total 2018 Incentive Compensation Plan 173,683 78,084 — 251,767 Total 173,683 78,084 — 251,767
Schedule of Stock-Based Compensation Recognized	The Company recognized stock-based compensation as follows: For the Three Months Ended 2022 2021 Stock-based compensation: Costs of goods sold $ — $ 21 General and administrative 1,271 889 Research and development 103 26 Total $ 1,374 $ 936

Net Income Per Common Share (Ta

Net Income Per Common Share (Tables)	3 Months Ended
	Mar. 31, 2022
Earnings Per Share [Abstract]
Schedule of Common Stock used in Calculation of Basic and Diluted Earnings Per Share	A reconciliation of the number of shares of common stock used in the calculation of basic and diluted net income per common share is presented below: For the Three Months Ended 2022 2021 Weighted average basic shares 172,009,259 98,109,900 Stock Options — — Restricted Stock Units and Restricted Stock Awards 5,318,840 — Weighted average diluted shares 177,328,099 98,109,900
Schedule of Number of Potential Dilutive Shares that Excluded Due to Anti-dilutive Effect	The following table includes the number of potential dilutive shares that were excluded due to the anti-dilutive effect: For the Three Months Ended 2022 2021 Stock Options — 781,144 Restricted Stock Units and Restricted Stock Awards — 886,434 Total — 1,667,578

Prepaid and Other Current Ass_2

Prepaid and Other Current Assets (Tables)	3 Months Ended
	Mar. 31, 2022
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]
Schedule of Prepaid and Other Current Assets	Prepaid and other current assets are as follows: March 31, December 31, Income tax receivable $ 3,913 $ 4,116 Leasehold improvement reimbursement $ 3,410 $ — Prepaid expenses $ 2,952 $ 2,553 Payroll tax receivable $ 1,695 $ — Insurance recovery receivable $ — $ 1,500 Other receivables 1,221 815 $ 13,191 $ 8,984

Property and Equipment (Tables)

Property and Equipment (Tables)	3 Months Ended
	Mar. 31, 2022
Property, Plant and Equipment [Abstract]
Schedule of Property and Equipment	The net book value of property and equipment after accumulated depreciation and all impairment is as follows: March 31, 2022 December 31, 2021 Processing equipment $ 273 $ 346 Surgical instruments 449 489 Office equipment, furniture and fixtures 10 15 Computer equipment and software 163 44 Construction in process 5 51 $ 900 $ 945

Fair Value Information (Tables)

Fair Value Information (Tables)	3 Months Ended
	Mar. 31, 2022
Fair Value Disclosures [Abstract]
Schedule of Fair Value of Warrant Liability Valuation Inputs	Inputs used in estimating the fair value of the contingent consideration for Holo Surgical as of March 31, 2022 and December 31, 2021, are summarized below: Fair Value at March 31, 2022 Valuation Technique Unobservable Inputs Ranges $33,425 Earn-Out Valuation Probability of success factor 0% - 95% Discount rates 0.00% - 12.47% 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% value of the warrant liability is estimated using the Black-Scholes Option Pricing Model using the following valuation inputs: March 31, December 31, Stock price $ 0.30 0.72 Risk-free interest rate 2.31 % 0.84 % Dividend yield — % — % Volatility 150 % 130 % The warrant liability is revalued each reporting period with the change in fair value recorded in the accompanying condensed consolidated statements of comprehensive income/(loss) until the warrants are exercised or expire. The fair value of the warrant liability is estimated using the Black-Scholes Option Pricing Model using the following valuation inputs: March 31, Stock price $ 0.30 Risk-free interest rate 2.42 % Dividend yield — % Volatility 80 %
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) as of March 31, 2022 and December 31, 2021 : March 31, December 31, Beginning balance as of January 1 $ 51,928 $ 56,515 Gain on acquisition contingency (8,503) (4,587) Milestone payments (10,000) — Ending balance as of March 31 $ 33,425 $ 51,928
Schedule of Fair Value Assets Subject to Fair Value Measured Using Level 3 Inputs	As a result of impairments recognized, the following table summarizes the post impairment fair values of the corresponding assets subject to fair value measured using Level 3 inputs as of March 31, 2022 and December 31, 2021: Fair value March 31, December 31, Property and equipment – net $ 900 $ 945 Definite-lived intangible assets - net — Other assets – net 7,114 6,970 $ 8,014 $ 7,915
Schedule of Impairments of Assets Subject to Fair Value Measured Using Level 3 Inputs	The following table summarizes the corresponding impairment charge during the three months ended March 31, 2022 and 2021: For the Three Months Ended Impairment 2022 2021 Property and equipment – net $ 789 $ 1,778 Definite-lived intangible assets - net 101 161 Other assets – net 49 237 $ 939 $ 2,176
Schedule of Liabilities Measured at Fair Value on Recurring Basis	The following table presents information about the Company’s liabilities that are measured at fair value: Level March 31, 2022 December 31, 2021 Warrant liability 3 $ 10,678 $ 12,013
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 June 15, 2021 warrant liability for the three months ended March 31, 2022, there were no warrants issued as of March 31, 2021: Warrant Liability December 31, 2021 $ 12,013 Change in fair value of warrant liability (7,600) March 31, 2022 $ 4,413 The table presented below is a summary of changes in the fair value of the Company’s Level 3 valuation for the February 15, 2022 warrant liability for the three months ended March 31, 2022, there were no warrants issued as of March 31, 2021: Warrant Liability December 31, 2021 $ — Fair value of warrants on date of issuance 10,157 Execution of prefunded warrants (1,749) Change in fair value of warrant liability (2,143) March 31, 2022 $ 6,265

Accrued Expenses (Tables)

Accrued Expenses (Tables)	3 Months Ended
	Mar. 31, 2022
Payables and Accruals [Abstract]
Schedule of Accrued Expenses	Accrued expenses are as follows: March 31, December 31, Accrued compensation $ 4,405 $ 5,258 Accrued distributor commissions $ 3,186 $ 2,957 Accrued securities class action settlement $ — $ 1,500 Other 8,222 8,054 Total accrued expenses $ 15,813 $ 17,769

Other Long-term Liabilities (Ta

Other Long-term Liabilities (Tables)	3 Months Ended
	Mar. 31, 2022
Other Liabilities, Noncurrent [Abstract]
Schedule of Other long-term liabilities	Other long-term liabilities are as follows: March 31, 2022 December 31, 2021 Acquisition contingencies $ 33,425 $ 26,343 Warrant Liability 10,678 12,013 Lease obligations 892 947 Other 2,484 2,229 Total other long-term liabilities $ 47,479 $ 41,532

Debt (Tables)

Debt (Tables)	3 Months Ended
	Mar. 31, 2022
Debt Disclosure [Abstract]
Schedule of Long-term Debt Instruments	Carrying Value (In thousands) March 31, 2022 December 31, 2021 Seller Notes-P. Lewicki $ 5,306 $ 5,306 Seller Notes-K. Siemionow 5,306 5,306 Less: fair value adjustment (578) (630) Total Seller Notes - related party 10,034 9,982 Current portion of seller notes — — Total long-term seller note, excluding current portion $ 10,034 $ 9,982
Schedule of Maturities of Long-term Debt	As of March 31, 2022, the future maturities of long-term debt, excluding deferred financing costs, accrued interest and debt discount, were as follows: 2022 $ — 2023 — 2024 10,612 2025 — 2026 — Thereafter — Total $ 10,612

Business (Details)

Business (Details) $ / shares in Units, $ in Thousands	Feb. 15, 2022USD ($)$ / sharesshares	Dec. 30, 2021USD ($)	Dec. 30, 2021USD ($)tranche	Dec. 30, 2021USD ($)payment	Dec. 30, 2021USD ($)shares	Jun. 14, 2021USD ($)$ / sharesshares	Apr. 30, 2021USD ($)payment	Feb. 01, 2021USD ($)$ / sharesshares	Mar. 31, 2022USD ($)countrysegment	Mar. 31, 2021USD ($)	Dec. 31, 2021USD ($)
Business [Line Items]
Countries in which we market and sell (more than) | country									50
Number of reportable segments | segment									1
Cash and cash equivalents									$ 44,677		$ 51,287
Accumulated deficit									(569,586)		(569,613)
Net loss from continuing operations									0
Net Income									$ 27	$ (15,190)
Strike price of warrants (in dollars per share) | $ / shares						$ 1.725
Period of warrants exercisable expiration period (in years)						3 years
Warrants
Business [Line Items]
Period of warrants exercisable expiration period (in years)	5 years
Placement Agent Warrants
Business [Line Items]
Strike price of warrants (in dollars per share) | $ / shares						$ 2.15625
Period of warrants exercisable expiration period (in years)	5 years
Public Offering Warrants
Business [Line Items]
Warrants issued (in shares) | shares	4,891,302
Strike price of warrants (in dollars per share) | $ / shares	$ 0.0001
Public Offering
Business [Line Items]
Common stock sold (in shares) | shares	38,565,220							28,700,000
Net proceeds from issuance of common stock	$ 20,000
Sale of stock price (in dollars per share) | $ / shares	$ 0.46
Underwriters option	30 days
Net proceeds from the direct offering, after deducting investor and management fees	$ 17,700					$ 45,800		$ 40,500
Common stock sold (in shares) | shares						28,985,508
Investors fees						$ 4,200		$ 4,000
Common stock price per share (in dollars per share) | $ / shares								$ 1.50
Public Offering | Pre-Funded Warrants
Business [Line Items]
Warrants issued (in shares) | shares	4,913,044
Sale of warrants price (in dollars per share) | $ / shares	$ 0.4599
Public Offering | Warrants
Business [Line Items]
Warrants issued (in shares) | shares						28,985,508
Strike price of warrants (in dollars per share) | $ / shares	$ 0.60
Public Offering | Warrants | Maximum
Business [Line Items]
Warrants issued (in shares) | shares	32,608,698
Public Offering | Placement Agent Warrants
Business [Line Items]
Warrants issued (in shares) | shares						1,739,130
Strike price of warrants (in dollars per share) | $ / shares	$ 0.575					$ 2.15625
Public Offering | Placement Agent Warrants | Maximum
Business [Line Items]
Warrants issued (in shares) | shares	2,608,696
Public Offering | Invest Warrants
Business [Line Items]
Warrants issued (in shares) | shares						28,985,508
Strike price of warrants (in dollars per share) | $ / shares						$ 1.725
Over-Allotment Option
Business [Line Items]
Common stock sold (in shares) | shares	6,521,736
Sale of stock price (in dollars per share) | $ / shares	$ 0.4599
INN Acquisition
Business [Line Items]
Payments to acquire businesses		$ 19,900
Cash consideration		5,000
Shares issued		4,900
Net Income											$ 30,200
INN Acquisition | Achievement of all milestones
Business [Line Items]
Payments to acquire businesses		72,300
Aggregate principal amount		$ 10,600
Equity interest acquired (up to)		100.00%	100.00%	100.00%	100.00%
Number of payments			3	3
Fair value		$ 10,000	$ 10,000	$ 10,000	$ 10,000
INN Acquisition | Tranche One
Business [Line Items]
Percentage of additional voting interests acquired (as a percent)		19.30%	19.30%	19.30%	19.30%
Equity interests issued and issuable		$ 19,300
INN Acquisition | Tranche Two
Business [Line Items]
Percentage of additional voting interests acquired (as a percent)		19.30%	19.30%	19.30%	19.30%
Equity interests issued and issuable		$ 19,300
INN Acquisition | Tranche Three
Business [Line Items]
Percentage of additional voting interests acquired (as a percent)		19.30%	19.30%	19.30%	19.30%
Equity interests issued and issuable		$ 19,300
INN Acquisition | Common Stock
Business [Line Items]
Shares issuable at closing (in shares) | shares					6,820,792
Prompt | Agreement
Business [Line Items]
Payments to acquire businesses							$ 1,100
Cash consideration							300
Shares issued							200
Contingent consideration							$ 600
Number of payments | payment							2
First payment							18 months
Second payment							36 months
INN Acquisition | INN Acquisition
Business [Line Items]
Percentage of voting interests acquired (as a percent)		42.00%	42.00%	42.00%	42.00%

Basis of Presentation (Details)

Basis of Presentation (Details)	Dec. 30, 2021
INN Acquisition | INN Acquisition
Business Combinations [Line Items]
Percentage of voting interests acquired (as a percent)	42.00%

Leases - Additional Information

Leases - Additional Information (Details)	Mar. 31, 2022
Minimum
Lessee, Lease, Description [Line Items]
Remaining lease term (in years)	1 year
Maximum
Lessee, Lease, Description [Line Items]
Remaining lease term (in years)	8 years

Leases - Schedule of Operating

Leases - Schedule of Operating Leases (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Leases [Abstract]
Operating lease cost	$ 125	$ 183
Short-term operating lease cost	221	37
Total operating lease cost	$ 346	$ 220

Leases - Schedule of Supplement

Leases - Schedule of Supplemental Cash Flow Information Related to Leases (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Leases [Abstract]
Cash paid for amounts included in the measurement of lease liabilities	$ 347	$ 244

Leases - Schedule of Suppleme_2

Leases - Schedule of Supplemental Balance Sheet Information Related to Leases (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Leases [Abstract]
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
Assets:
Right-of-use assets	$ 881	$ 876
Liabilities:
Current	346	294
Noncurrent	892	947
Total operating lease liabilities	$ 1,238	$ 1,241

Leases - Schedule of Weighted-A

Leases - Schedule of Weighted-Average Remaining Lease Terms and Discount Rates (Details)	Mar. 31, 2022	Mar. 31, 2021
Leases [Abstract]
Weighted-average remaining lease term (years)	5 years 10 months 24 days	5 years 9 months 18 days
Weighted-average discount rate	5.10%	4.90%

Leases - Schedule of Maturities

Leases - Schedule of Maturities of Operating Lease Liabilities (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Leases [Abstract]
2022 (remaining)	$ 353
2023	198
2024	172
2025	161
2026	159
2027 and beyond	398
Total future minimum lease payments	1,441
Less imputed interest	(203)
Total operating lease liabilities	$ 1,238	$ 1,241

Revenue from Contracts with C_3

Revenue from Contracts with Customers - Schedule of Total Revenue by Geographical Region (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Disaggregation Of Revenue [Line Items]
Total revenues from contracts with customers	$ 20,605	$ 23,291
Point In Time
Disaggregation Of Revenue [Line Items]
Total revenues from contracts with customers	20,605	23,291
Point In Time | Domestic
Disaggregation Of Revenue [Line Items]
Total revenues from contracts with customers	17,170	19,849
Point In Time | International
Disaggregation Of Revenue [Line Items]
Total revenues from contracts with customers	$ 3,435	$ 3,442

Business Combinations - Inteneu

Business Combinations - Inteneural Networks Inc. (Details) $ / shares in Units, $ in Thousands	Dec. 30, 2021USD ($)$ / shares	Dec. 30, 2021USD ($)tranche$ / shares	Dec. 30, 2021USD ($)payment$ / shares	Dec. 30, 2021USD ($)$ / sharesshares	Mar. 31, 2022USD ($)$ / shares	Dec. 31, 2021USD ($)$ / shares	Mar. 31, 2021USD ($)	Dec. 31, 2021USD ($)$ / shares
Business Combinations [Line Items]
Common stock, par value (in dollars per share) | $ / shares					$ 0.001	$ 0.001		$ 0.001
Net Income					$ 27		$ (15,190)
Net income applicable to noncontrolling interests					$ 0		$ 0
INN Acquisition
Business Combinations [Line Items]
Payments to acquire businesses	$ 19,900
Cash consideration	5,000
Shares issued	4,900
Direct and incremental costs	400	$ 400	$ 400	$ 400
Acquisition of additional voting interests	41,700
Acquisition related costs								$ 72,100
Fair value of noncontrolling interests	52,000	$ 52,000	$ 52,000	$ 52,000
Net Income								30,200
Net income applicable to noncontrolling interests								$ 41,900
INN Acquisition | Assembled Workforce
Business Combinations [Line Items]
Acquisition related costs						$ 200
INN Acquisition | Achievement of all milestones
Business Combinations [Line Items]
Payments to acquire businesses	$ 72,300
Equity interest acquired (up to)	100.00%	100.00%	100.00%	100.00%
Number of payments		3	3
Revenue based earnout consideration	$ 10,300	$ 10,300	$ 10,300	$ 10,300
INN Acquisition | Common Stock
Business Combinations [Line Items]
Shares issuable at closing (in shares) | shares				6,820,792
Common stock, par value (in dollars per share) | $ / shares	$ 0.001	$ 0.001	$ 0.001	$ 0.001
INN Acquisition | INN Acquisition
Business Combinations [Line Items]
Percentage of voting interests acquired (as a percent)	42.00%	42.00%	42.00%	42.00%
Ownership percentage by noncontrolling owners (as a percent)	58.00%	58.00%	58.00%	58.00%

Business Combinations - Prompt

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

Business Combinations - Schedul

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

Stock-Based Compensation - Sche

Stock-Based Compensation - Schedule of Stock Option And Stock Grant Awards By Plan (Details) - shares	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Total, granted (in shares)	2,365,215	251,767
Stock Options
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock Options, granted (in shares)	0	173,683
Restricted Stock Awards
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Restricted Stock Awards and Units, granted (in shares)	0	78,084
Restricted Stock Units
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Restricted Stock Awards and Units, granted (in shares)	2,365,215	0
2021 Incentive Inducement Plan
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Total, granted (in shares)	2,340,316
2021 Incentive Inducement Plan | Stock Options
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock Options, granted (in shares)	0
2021 Incentive Inducement Plan | Restricted Stock Awards
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Restricted Stock Awards and Units, granted (in shares)	0
2021 Incentive Inducement Plan | Restricted Stock Units
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Restricted Stock Awards and Units, granted (in shares)	2,340,316
2021 Incentive Compensation Plan
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Total, granted (in shares)	24,899
2021 Incentive Compensation Plan | Stock Options
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock Options, granted (in shares)	0
2021 Incentive Compensation Plan | Restricted Stock Awards
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Restricted Stock Awards and Units, granted (in shares)	0
2021 Incentive Compensation Plan | Restricted Stock Units
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Restricted Stock Awards and Units, granted (in shares)	24,899
2018 Incentive Compensation Plan
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Total, granted (in shares)		251,767
2018 Incentive Compensation Plan | Stock Options
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock Options, granted (in shares)		173,683
2018 Incentive Compensation Plan | Restricted Stock Awards
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Restricted Stock Awards and Units, granted (in shares)		78,084
2018 Incentive Compensation Plan | Restricted Stock Units
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Restricted Stock Awards and Units, granted (in shares)		0

Stock-Based Compensation - Stoc

Stock-Based Compensation - Stock-Based Compensation Recognized (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation	$ 1,374	$ 936
Costs of goods sold
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation	0	21
General and administrative
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation	1,271	889
Research and development
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation	$ 103	$ 26

Net Income Per Common Share - R

Net Income Per Common Share - Reconciliation of Common Stock Used in Calculation of Basic and Diluted Earnings Per Share (Details) - shares	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Earnings Per Share [Abstract]
Weighted average basic shares (in shares)	172,009,259	98,109,900
Stock Options (in shares)	0	0
Restricted Stock Units and Restricted Stock Awards (in shares)	5,318,840	0
Weighted average diluted shares (in shares)	177,328,099	98,109,900

Net Income Per Common Share - S

Net Income Per Common Share - Schedule of Number of Potential Dilutive Shares that Excluded Due to Anti-dilutive Effect (Details) - shares	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
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	1,667,578
Stock Options
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Number of potential dilutive shares excluded due to anti-dilutive effect (in shares)	0	781,144
Restricted Stock Units and Restricted Stock Awards
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Number of potential dilutive shares excluded due to anti-dilutive effect (in shares)	0	886,434

Net Income Per Common Share - A

Net Income Per Common Share - Additional Information (Details) - shares	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Anti-dilutive stock excluded from the computation of diluted EPS (in shares)	0	1,667,578
Stock Options
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Anti-dilutive stock excluded from the computation of diluted EPS (in shares)	3,541,328	4,264,055

Inventories - Additional Inform

Inventories - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Inventory Disclosure [Abstract]
Inventory write-downs	$ 3,044	$ 2,754

Prepaid and Other Current Ass_3

Prepaid and Other Current Assets - Schedule of Prepaid and Other Current Assets (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]
Income tax receivable	$ 3,913	$ 4,116
Leasehold improvement reimbursement	3,410	0
Prepaid expenses	2,952	2,553
Payroll tax receivable	1,695	0
Insurance recovery receivable	0	1,500
Other receivables	1,221	815
Prepaid and other current assets	$ 13,191	$ 8,984

Property and Equipment - Schedu

Property and Equipment - Schedule of Net Book Value of Property and Equipment after Accumulated Depreciation and Impairment (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Property, Plant and Equipment [Line Items]
Property and equipment - net	$ 900	$ 945
Processing equipment
Property, Plant and Equipment [Line Items]
Property and equipment - net	273	346
Surgical instruments
Property, Plant and Equipment [Line Items]
Property and equipment - net	449	489
Office equipment, furniture and fixtures
Property, Plant and Equipment [Line Items]
Property and equipment - net	10	15
Computer equipment and software
Property, Plant and Equipment [Line Items]
Property and equipment - net	163	44
Construction in process
Property, Plant and Equipment [Line Items]
Property and equipment - net	$ 5	$ 51

Property and Equipment - Additi

Property and Equipment - Additional Information (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Property, Plant and Equipment [Line Items]
Depreciation expense	$ 0.5	$ 0.5
Asset impairment and abandonment charges	0.9	2.2
ERP
Property, Plant and Equipment [Line Items]
Asset impairment and abandonment charges	0	0.3
Capitalized cost of internal software expense related to new ERP system	0	0.3
ERP implementation expense	$ 0.6	$ 0.1

Warrants - Additional Informati

Warrants - Additional Information (Details) - USD ($) $ / shares in Units, $ in Millions	Feb. 15, 2022	Jun. 14, 2021	Feb. 01, 2021	Mar. 31, 2022
Class Of Warrant Or Right [Line Items]
Strike price of warrants (in dollars per share)		$ 1.725
Period of warrants exercisable expiration period (in years)		3 years
Percentage of placement agent sash fee equal to gross proceeds from warrants (as a percent)		7.00%
Management fee equal to aggregate of gross proceeds of warrants (as a percent)		1.00%
Additional Paid-In Capital
Class Of Warrant Or Right [Line Items]
Stock issuance costs				$ 1.4
Common Stock
Class Of Warrant Or Right [Line Items]
Stock issuance costs				1.4
Warrants
Class Of Warrant Or Right [Line Items]
Period of warrants exercisable expiration period (in years)	5 years
Warrants | Transaction and integration expenses
Class Of Warrant Or Right [Line Items]
Warrant issuance costs				0.9
Placement Agent Warrants
Class Of Warrant Or Right [Line Items]
Strike price of warrants (in dollars per share)		$ 2.15625
Period of warrants exercisable expiration period (in years)	5 years
Placement Agent Warrants | Maximum
Class Of Warrant Or Right [Line Items]
Number of common stock shares issuable upon conversion of warrants (in shares)		1,739,130
Public Offering Warrants
Class Of Warrant Or Right [Line Items]
Warrants issued (in shares)	4,891,302
Strike price of warrants (in dollars per share)	$ 0.0001
Public Offering
Class Of Warrant Or Right [Line Items]
Common stock sold (in shares)	38,565,220		28,700,000
Net proceeds from issuance of common stock	$ 20
Sale of stock price (in dollars per share)	$ 0.46
Net proceeds from the direct offering, after deducting investor and management fees	$ 17.7	$ 45.8	$ 40.5
Common stock sold (in shares)		28,985,508
Stock issuance costs		$ 4.2	$ 4
Common stock price per share (in dollars per share)			$ 1.50
Issuance costs				$ 2.3
Public Offering | Pre-Funded Warrants
Class Of Warrant Or Right [Line Items]
Warrants issued (in shares)	4,913,044
Public Offering | Warrants
Class Of Warrant Or Right [Line Items]
Warrants issued (in shares)		28,985,508
Strike price of warrants (in dollars per share)	$ 0.60
Public Offering | Warrants | Maximum
Class Of Warrant Or Right [Line Items]
Warrants issued (in shares)	32,608,698
Public Offering | Placement Agent Warrants
Class Of Warrant Or Right [Line Items]
Warrants issued (in shares)		1,739,130
Strike price of warrants (in dollars per share)	$ 0.575	$ 2.15625
Public Offering | Placement Agent Warrants | Maximum
Class Of Warrant Or Right [Line Items]
Warrants issued (in shares)	2,608,696
Public Offering | Invest Warrants
Class Of Warrant Or Right [Line Items]
Warrants issued (in shares)		28,985,508
Strike price of warrants (in dollars per share)		$ 1.725
Over-Allotment Option
Class Of Warrant Or Right [Line Items]
Common stock sold (in shares)	6,521,736
Sale of stock price (in dollars per share)	$ 0.4599
At-the-Market Offering
Class Of Warrant Or Right [Line Items]
Net proceeds from the direct offering, after deducting investor and management fees		$ 45.8
Common stock sold (in shares)		28,985,508
Common stock price per share (in dollars per share)		$ 1.725

Fair Value Information - Additi

Fair Value Information - Additional Information (Details)	Jan. 14, 2022USD ($)shares	Dec. 30, 2021USD ($)$ / shares	Dec. 30, 2021USD ($)tranche$ / shares	Dec. 30, 2021USD ($)payment$ / shares	Dec. 30, 2021USD ($)$ / sharesshares	Oct. 23, 2020USD ($)shares	Sep. 29, 2020USD ($)$ / sharesshares	Mar. 08, 2019USD ($)shares	Dec. 31, 2019USD ($)	Mar. 31, 2022USD ($)$ / shares	Dec. 31, 2021USD ($)$ / shares	Mar. 31, 2021USD ($)	Dec. 31, 2020USD ($)
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Common stock, par value (in dollars per share) | $ / shares										$ 0.001	$ 0.001
Property and equipment - net										$ 900,000	$ 945,000
Property And Equipment Written Down To Estimated Fair Value
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Property and equipment - net										1,700,000	12,000,000
Level 3 | Property And Equipment Written Down To Estimated Fair Value
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Property and equipment – net, Fair Value										900,000	945,000
INN Acquisition
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Payments to acquire businesses		$ 19,900,000
Cash consideration		5,000,000
Shares issued		4,900,000
INN Acquisition | Achievement of all milestones
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Payments to acquire businesses		72,300,000
Aggregate principal amount		10,600,000
Fair value		$ 10,000,000	$ 10,000,000	$ 10,000,000	$ 10,000,000
Equity interest acquired (up to)		100.00%	100.00%	100.00%	100.00%
Number of payments			3	3
Revenue based earnout consideration		$ 10,300,000	$ 10,300,000	$ 10,300,000	$ 10,300,000
INN Acquisition | Common Stock
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Shares issuable at closing (in shares) | shares					6,820,792
Common stock, par value (in dollars per share) | $ / shares		$ 0.001	$ 0.001	$ 0.001	$ 0.001
Holo Surgical | Holo Purchase Agreement
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Cash consideration	$ 4,100,000					$ 30,000,000	$ 30,000,000
Shares issuable at closing (in shares) | shares						6,250,000
Shares issued						$ 12,300,000
Common stock, par value (in dollars per share) | $ / shares							$ 0.001
Revenue based earnout consideration							$ 83,000,000
Contingent consideration payable closing milestones, term (in years)						6 years	6 years
Equity interest issued or issuable, number of shares (in shares) | shares	5,900,000
Trading days (in days)							5 days
Number of contingent consideration shares issued (in shares) | shares	8,650,000
Contingent liability	$ 10,000,000									33,400,000	51,900,000
Holo Surgical | Achievement of all milestones | Level 3
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Contingent liability										33,425,000	51,928,000	$ 51,928,000	$ 56,515,000
Holo Surgical | Achievement of all milestones | Holo Purchase Agreement
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Contingent liability						$ 50,600,000
Holo Surgical | Common Stock | Holo Purchase Agreement
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Shares issuable at closing (in shares) | shares							6,250,000
Equity interest issued or issuable, number of shares (in shares) | shares							14,900,000
Paradigm Spine Acquisition
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Cash consideration								$ 100,000,000
Shares issuable at closing (in shares) | shares								10,729,614
Revenue based earnout consideration								$ 150,000,000
Trading days (in days)								5 days
Contingent liability								$ 72,200,000	$ 0	$ 0	$ 0
Gain on acquisition contingency									$ 72,200,000
INN Acquisition | INN Acquisition
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Percentage of voting interests acquired (as a percent)		42.00%	42.00%	42.00%	42.00%

Fair Value Information - Schedu

Fair Value Information - Schedule of Fair Value Measurement Inputs Valuation Technique (Details) - Holo Surgical - Level 3 $ in Thousands	Mar. 31, 2022USD ($)	Dec. 31, 2021USD ($)	Mar. 31, 2021USD ($)	Dec. 31, 2020USD ($)
Achievement of all milestones
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis Valuation Techniques [Line Items]
Contingent liability	$ 33,425	$ 51,928	$ 51,928	$ 56,515
Earn-Out Valuation | Minimum | Probability of success factor
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis Valuation Techniques [Line Items]
Unobservable Inputs	0	0
Earn-Out Valuation | Minimum | Discount rates
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis Valuation Techniques [Line Items]
Unobservable Inputs	0	0.0006
Earn-Out Valuation | Maximum | Probability of success factor
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis Valuation Techniques [Line Items]
Unobservable Inputs	0.95	0.90
Earn-Out Valuation | Maximum | Discount rates
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis Valuation Techniques [Line Items]
Unobservable Inputs	0.1247	0.1160
Earn-Out Valuation | Achievement of all milestones
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis Valuation Techniques [Line Items]
Contingent liability		$ 51,928

Fair Value Information - Sche_2

Fair Value Information - Schedule of Reconciliation of Acquisition Contingencies (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Fair Value, Assets Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Gain on acquisition contingency	$ (8,503)	$ (51)
Holo Surgical | Achievement of all milestones | Level 3
Fair Value, Assets Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items]
Beginning balance	51,928	56,515
Gain on acquisition contingency	(8,503)	(4,587)
Milestone payments	(10,000)	0
Ending balance	$ 33,425	$ 51,928

Fair Value Information - Sche_3

Fair Value Information - Schedule of Fair Value Assets Subject to Fair Value Measured Using Level 3 Inputs (Details) - Level 3 - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Impaired Long Lived Assets Held And Used [Line Items]
Definite-lived intangible assets - net	$ 0
Other assets – net	7,114	6,970
Long lived assets	$ 8,014	$ 7,915

Fair Value Information - Sche_4

Fair Value Information - Schedule of Impairments of Assets Subject to Fair Value Measured Using Level 3 Inputs (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Impaired Long Lived Assets Held And Used [Line Items]
Asset impairment and abandonment charges	$ 900	$ 2,200
Level 3
Impaired Long Lived Assets Held And Used [Line Items]
Property and equipment – net	789	1,778
Definite-lived intangible assets - net	101	161
Other assets – net	49	237
Asset impairment and abandonment charges	$ 939	$ 2,176

Fair Value Information - Sche_5

Fair Value Information - Schedule of Liabilities Measured at Fair Value on Recurring Basis (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Level 3 | Warrant liability
Fair Value Liabilities Measured On Recurring Basis [Line Items]
Warrant liability	$ 10,678	$ 12,013

Fair Value Information - Sche_6

Fair Value Information - Schedule of Changes in Fair Value of Level 3 Valuation for the Warrant Liability (Details) - Level 3 $ in Thousands	3 Months Ended
	Mar. 31, 2022USD ($)
Warrant Liability June 15 2021
Business Combination, Contingent Consideration, Liability [Roll Forward]
Beginning balance	$ 12,013
Change in fair value of warrant liability	(7,600)
Ending balance	4,413
Warrant Liability February 15 2022
Business Combination, Contingent Consideration, Liability [Roll Forward]
Beginning balance	0
Fair value of warrants on date of issuance	10,157
Execution of prefunded warrants	(1,749)
Change in fair value of warrant liability	(2,143)
Ending balance	$ 6,265

Fair Value Information - Fair V

Fair Value Information - Fair Value of Warrant Liability Valuation Inputs (Details) - Black-Scholes Option Pricing Model - USD ($)	Mar. 31, 2022	Dec. 31, 2021
Stock price | Warrant Liability June 15 2021
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis Valuation Techniques [Line Items]
Measurement inputs	0.30	0.72
Stock price | Warrant Liability February 15 2022
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis Valuation Techniques [Line Items]
Measurement inputs	0.30
Risk-free interest rate | Warrant Liability June 15 2021
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis Valuation Techniques [Line Items]
Measurement inputs	0.0231	0.0084
Risk-free interest rate | Warrant Liability February 15 2022
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis Valuation Techniques [Line Items]
Measurement inputs	0.0242
Dividend yield | Warrant Liability June 15 2021
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis Valuation Techniques [Line Items]
Measurement inputs	0	0
Dividend yield | Warrant Liability February 15 2022
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis Valuation Techniques [Line Items]
Measurement inputs	0
Volatility | Warrant Liability June 15 2021
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis Valuation Techniques [Line Items]
Measurement inputs	1.50	1.30
Volatility | Warrant Liability February 15 2022
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis Valuation Techniques [Line Items]
Measurement inputs	0.80

Accrued Expenses - Accrued Expe

Accrued Expenses - Accrued Expenses (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Payables and Accruals [Abstract]
Accrued compensation	$ 4,405	$ 5,258
Accrued distributor commissions	3,186	2,957
Accrued securities class action settlement	0	1,500
Other	8,222	8,054
Total accrued expenses	$ 15,813	$ 17,769

Other Long-term Liabilities - S

Other Long-term Liabilities - Schedule of Other Long-term Liabilities (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Other Liabilities, Noncurrent [Abstract]
Acquisition contingencies	$ 33,425	$ 26,343
Warrant Liability	10,678	12,013
Lease obligations	892	947
Other	2,484	2,229
Total other long-term liabilities	$ 47,479	$ 41,532

Income Taxes - Additional Infor

Income Taxes - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2022	Mar. 31, 2021
Income Tax Disclosure [Abstract]
Income tax provision	$ 162	$ 219

Debt - Additional Information (

Debt - Additional Information (Details) - Seller Notes - USD ($)	3 Months Ended
	Mar. 31, 2022	Dec. 31, 2021	Dec. 30, 2021
Debt Instrument [Line Items]
Accrued interest expense	$ 200,000
Amortization of debt discount	100,000
Interest expense	300,000
Unsecured Debt
Debt Instrument [Line Items]
Debt issuance amount			$ 10,600,000
Contingent liability	10,000,000	$ 10,000,000
Stated rate (as a percent)			6.80%
Long -term debt default rate			4.00%
Unsecured Debt | Level 2
Debt Instrument [Line Items]
Fair value	$ 10,000,000	$ 10,000,000

Debt - Schedule of Long-term De

Debt - Schedule of Long-term Debt Instruments (Details) - USD ($) $ in Thousands	Mar. 31, 2022	Dec. 31, 2021
Debt Instrument [Line Items]
Total Seller Notes - related party	$ 10,612
Unsecured Debt | Seller Notes
Debt Instrument [Line Items]
Less: fair value adjustment	(578)	$ (630)
Total Seller Notes - related party	10,034	9,982
Current portion of seller notes	0	0
Total long-term seller note, excluding current portion	10,034	9,982
Unsecured Debt | Seller Notes | P. Lewicki
Debt Instrument [Line Items]
2021 Fixed Rate Note	5,306	5,306
Unsecured Debt | Seller Notes | K. Siemionow
Debt Instrument [Line Items]
2021 Fixed Rate Note	$ 5,306	$ 5,306

Debt - Schedule of Future Matur

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

Commitments and Contingencies (

Commitments and Contingencies (Details)

Jan. 14, 2022USD ($)shares

Mar. 12, 2021USD ($)ft²claim

Oct. 23, 2020USD ($)shares

Sep. 29, 2020USD ($)

Jul. 20, 2020USD ($)agreement

Mar. 08, 2019USD ($)shares

Jan. 31, 2022USD ($)

Jan. 31, 2021USD ($)

Mar. 31, 2022USD ($)

Mar. 31, 2021USD ($)

Dec. 31, 2020USD ($)

Dec. 31, 2021USD ($)

Dec. 31, 2019USD ($)

Commitment And Contingencies [Line Items]

Current portion of acquisition contingency - Holo

$ 0

$ 25,585,000

Change in fair value of liability

(8,503,000)

$ (51,000)

Operating lease cost

125,000

183,000

Cash paid for amounts included in the measurement of lease liabilities

347,000

$ 244,000

Manufacturing and Distribution Agreements with Affiliates of Montague Private Equity

Commitment And Contingencies [Line Items]

Number of manufacturing and distribution agreements | agreement

3

Purchase obligation, year one

$ 24,200,000

Purchase obligation, year two

25,800,000

Purchase obligation, year three

27,200,000

Design and Development Agreement with Pioneer

Commitment And Contingencies [Line Items]

Direct labor costs

$ 1,700,000

Collaborative arrangement term (in years)

2 years

San Diego Lease | Premises

Commitment And Contingencies [Line Items]

Operating lease term of contract (in years)

12 years

Number of lease extension options (in years) | claim

1

Lease extension term (in years)

7 years

Lease rentable area (in square feet) | ft²

94,457

Lease improvement term (in months)

12 months

Operating lease cost

$ 64,600,000

Rent abatement term (in months)

13 months

San Diego Lease | Other assets - net | Premises

Commitment And Contingencies [Line Items]

Cash paid for amounts included in the measurement of lease liabilities

$ 2,500,000

Paradigm Spine Acquisition

Commitment And Contingencies [Line Items]

Total considerations including acquisition contingencies

$ 300,000,000

Cash to be paid at closing

150,000,000

Cash consideration

$ 100,000,000

Shares issuable at closing (in shares) | shares

10,729,614

Trading days (in days)

5 days

Number of common stock to be issued at closing, value

$ 50,000,000

Revenue based earnout consideration

150,000,000

First potential earnout payment

$ 20,000,000

Estimated contingent liability

0

Contingent liability

$ 72,200,000

0

0

$ 0

Aziyo Biologics, Inc.

Commitment And Contingencies [Line Items]

Shortfall obligation

$ 14,200,000

$ 12,400,000

Holo Surgical | Holo Purchase Agreement

Commitment And Contingencies [Line Items]

Cash consideration

$ 4,100,000

$ 30,000,000

$ 30,000,000

Shares issuable at closing (in shares) | shares

6,250,000

Trading days (in days)

5 days

Revenue based earnout consideration

$ 83,000,000

Contingent liability

$ 10,000,000

33,400,000

51,900,000

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

8,650,000

Equity interest issued or issuable, number of shares (in shares) | shares

5,900,000

Change in fair value of liability

$ 8,500,000

Holo Surgical | Holo Purchase Agreement | Accrued expenses

Commitment And Contingencies [Line Items]

Current portion of acquisition contingency - Holo

25,600,000

Holo Surgical | Holo Purchase Agreement | Acquisition contingencies - Holo

Commitment And Contingencies [Line Items]

Contingent liability, included as Acquisition contingencies - Holo

$ 26,300,000

Legal Actions - Additional Info

Legal Actions - Additional Information (Details) $ in Thousands	Jul. 27, 2021USD ($)	Jul. 27, 2018patent	Jan. 31, 2022USD ($)	Mar. 31, 2022USD ($)claim	Dec. 31, 2021USD ($)	Oct. 31, 2021USD ($)
Loss Contingencies [Line Items]
Insurance recovery receivable				$ 0	$ 1,500
Indemnified Claims
Loss Contingencies [Line Items]
Number of pending claims | claim				1,028
LifeNet
Loss Contingencies [Line Items]
Number of patents claims | patent		5
Securities Class Action | Judicial Ruling
Loss Contingencies [Line Items]
Litigation settlement to other party	$ 10,500
Insurance recovery receivable						$ 10,500
Derivative Actions
Loss Contingencies [Line Items]
Number of pending claims | claim				3
Damages sought value, liability				$ 1,500
Settlement paid by insurers			$ 1,500
Derivative Actions | Prepaid and other current assets
Loss Contingencies [Line Items]
Insurance recovery receivable				1,500
Derivative Actions | Accrued expenses
Loss Contingencies [Line Items]
Liability				$ 1,500

Related Party Transactions - Ad

Related Party Transactions - Additional Information (Details) - USD ($) $ in Millions	Jan. 14, 2022	Dec. 30, 2021	Oct. 23, 2020	Sep. 29, 2020	Jul. 20, 2020	Mar. 31, 2022	Mar. 31, 2021	Dec. 31, 2021
Related Party Transaction [Line Items]
Percent of beneficial owner of common stock (as a percent)						5.00%
Mr. Simpson, former Chairman of the Board | Consulting Agreement
Related Party Transaction [Line Items]
Agreement initial term period (in years)					3 years
Total cash compensation						$ 0.1	$ 0
Holo Surgical | Holo Purchase Agreement
Related Party Transaction [Line Items]
Cash consideration	$ 4.1		$ 30	$ 30
Shares issuable at closing (in shares)			6,250,000
Shares issued			$ 12.3
Contingent liability	$ 10					$ 33.4		$ 51.9
Maximum shares to be issued (in shares)			8,650,000
Contingent consideration payable closing milestones, term (in years)			6 years	6 years
Holo Surgical | Holo Purchase Agreement | Dr. Pawel Lewicki
Related Party Transaction [Line Items]
Indirect outstanding ownership (as a percent)			57.50%
Holo Surgical | Holo Purchase Agreement | Achievement of all milestones
Related Party Transaction [Line Items]
Contingent liability			$ 50.6
INN Acquisition
Related Party Transaction [Line Items]
Cash consideration		$ 5
Shares issued		$ 4.9
INN Acquisition | INN Acquisition
Related Party Transaction [Line Items]
Ownership percentage by noncontrolling owners (as a percent)		58.00%