Surgalign (SRGAQ) 10-K 30 Mar 23 2022 FY Annual report Financial data

Cover

Cover - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2022	Mar. 24, 2023	Jun. 30, 2022
Cover [Abstract]
Document Type	10-K
Document Annual Report	true
Document Period End Date	Dec. 31, 2022
Current Fiscal Year End Date	--12-31
Document Transition Report	false
Entity File Number	001-38832
Entity Registrant Name	Surgalign Holdings, Inc.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	83-2540607
Entity Address, Address Line One	520 Lake Cook Road
Entity Address, Address Line Two	Suite 315
Entity Address, City or Town	Deerfield
Entity Address, State or Province	IL
Entity Address, Postal Zip Code	60015
City Area Code	224
Local Phone Number	303-4651
Title of 12(b) Security	common stock, $0.001 par value
Trading Symbol	SRGA
Security Exchange Name	NASDAQ
Entity Well-known Seasoned Issuer	No
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Non-accelerated Filer
Entity Small Business	true
Entity Emerging Growth Company	false
ICFR Auditor Attestation Flag	false
Entity Shell Company	false
Entity Public Float			$ 22.1
Entity Common Stock, Shares Outstanding		8,408,123
Documents Incorporated by Reference	As stated in Part III of this Annual Report on Form 10-K, portions of the registrant’s definitive proxy statement to be filed for the registrant’s 2023 Annual Meeting of Stockholders are incorporated by reference in Part III of this Annual Report on Form 10-K.
Amendment Flag	false
Document Fiscal Year Focus	2022
Document Fiscal Period Focus	FY
Entity Central Index Key	0001760173

Audit Information

Audit Information	12 Months Ended
	Dec. 31, 2022
Auditor Information [Abstract]
Auditor Name	GRANT THORNTON LLP
Auditor Location	Chicago, Illinois
Auditor Firm ID	248

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Current Assets:
Cash and cash equivalents	$ 16,295	$ 51,287
Accounts receivable - less allowances of $9,861 at December 31, 2022 and $9,272 at December 31, 2021	16,057	19,197
Inventories - current	17,710	26,204
Prepaid and other current assets	6,649	9,984
Total current assets	56,711	106,672
Non-current inventories	5,947	10,212
Property and equipment - net	2,057	945
Other assets - net	5,527	5,970
Total assets	70,242	123,799
Current Liabilities:
Accounts payable	7,705	10,204
Current portion of accrued acquisition contingency - Holo	0	25,585
Accrued expenses	13,146	17,769
Accrued income taxes	296	484
Total current liabilities	21,147	54,042
Acquisition contingencies - Holo	24,061	26,343
Warrant liability	22,982	12,013
Notes payable - related party	10,192	9,982
Other long-term liabilities	7,583	3,176
Total liabilities	85,965	105,556
Commitments and contingencies (Note 22)
Mezzanine equity	10,006	10,006
Stockholders' equity:
Common stock, $.001 par value: 300,000,000 shares authorized; 7,860,369 and 4,887,982 shares issued and outstanding, as of December 31, 2022 and 2021, respectively	7	5
Additional paid-in capital	607,245	585,517
Accumulated other comprehensive loss	(2,840)	(1,820)
Accumulated deficit	(624,218)	(569,613)
Less treasury stock, 66,641 and 51,448 shares, as of December 31, 2022 and 2021, respectively, at cost	(5,923)	(5,852)
Total stockholders' equity	(25,729)	8,237
Total liabilities, mezzanine equity and stockholders' equity	$ 70,242	$ 123,799

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Statement of Financial Position [Abstract]
Accounts receivable, allowances	$ 9,861	$ 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)	7,860,369	4,887,982
Common stock, shares outstanding (in shares)	7,860,369	4,887,982
Treasury stock, shares (in shares)	66,641	51,448

Consolidated Statements of Comp

Consolidated Statements of Comprehensive Loss - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Income Statement [Abstract]
Revenues	$ 81,979	$ 90,500
Costs of goods sold	41,691	29,775
Gross profit	40,288	60,725
Operating Expenses:
General and administrative	95,888	104,460
Severance and restructuring costs	1,148	208
Research and development	15,736	13,888
Gain on acquisition contingency	(17,867)	(4,587)
Asset acquisition expenses	0	72,087
Asset impairment and abandonments	5,352	12,195
Transaction and financing expenses	19,391	3,689
Total operating expenses	119,648	201,940
Other operating income, net	(898)	(3,932)
Operating loss	(78,462)	(137,283)
Other expense (income) - net
Other expense (income) - net	26	(202)
Interest expense	1,009	0
Foreign exchange loss	978	1,447
Change in fair value of warrant liability	(24,827)	(14,736)
Total other income - net	(22,814)	(13,491)
Loss before income tax provision	(55,648)	(123,792)
Income tax benefit	(1,043)	(886)
Net loss from continuing operations	(54,605)	(122,906)
Discontinued operations (Note 5)
Loss from operations of discontinued operations	0	(6,316)
Income tax benefit	0	(2,674)
Net loss from discontinued operations	0	(3,642)
Net loss	(54,605)	(126,548)
Net loss applicable to noncontrolling interests	0	41,897
Net loss applicable to Surgalign Holdings, Inc.	(54,605)	(84,651)
Other comprehensive loss:
Unrealized foreign currency translation gain	(1,020)	(596)
Total other comprehensive loss	$ (53,585)	$ (84,055)
Net loss from continuing operations per share applicable to Surgalign Holdings, Inc. - basic (in dollars per share)	$ (8.33)	$ (30.08)
Net loss from discontinued operations per share applicable to Surgalign Holdings, Inc. - basic (in dollars per share)	0	(0.89)
Net loss per share applicable to Surgalign Holdings, Inc. - basic (in dollars per share)	(8.33)	(20.72)
Net loss from continuing operations per share applicable to Surgalign Holdings, Inc. - diluted (in dollars per share)	(8.33)	(30.08)
Net loss from discontinued operations per share applicable to Surgalign Holdings, Inc. - diluted (in dollars per share)	0	(0.89)
Net loss per share applicable to Surgalign Holdings, Inc. - diluted (in dollars per share)	$ (8.33)	$ (20.72)
Weighted average shares outstanding - basic (in shares)	6,555,207	4,086,409
Weighted average shares outstanding - diluted (in shares)	6,555,207	4,086,409

Consolidated Statements of Stoc

Consolidated Statements of Stockholders' Equity - USD ($) $ in Thousands	Total	Total Stockholders' Equity	Total Stockholders' Equity Prompt	Total Stockholders' Equity INN Acquisition	Common Stock	Additional Paid-in Capital	Additional Paid-in Capital Prompt	Additional Paid-in Capital INN Acquisition	Accumulated Other Comprehensive Loss	Accumulated Deficit	Treasury Stock
Beginning Balance at Dec. 31, 2020		$ 24,170			$ 3	$ 517,201			$ (2,416)	$ (484,962)	$ (5,656)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss	$ (126,548)	(84,651)								(84,651)
Foreign currency translation adjustment		596							596
Exercise of common stock options		23				23
Stock-based compensation		5,212				5,212
Purchase of treasury stock	(200)	(196)									(196)
Share offering		57,528			2	57,526
Equity instruments issued in connection with acquisition			$ 221	$ 4,927			$ 221	$ 4,927
Purchases of stock in the ESPP plan		407				407
Ending Balance at Dec. 31, 2021		8,237			5	585,517			(1,820)	(569,613)	(5,852)
Mezzanine equity, beginning balance at Dec. 31, 2020	0
Mezzanine Equity
Net loss	(41,897)
Purchase of noncontrolling interest	51,903
Mezzanine equity, ending balance at Dec. 31, 2021	10,006
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss	(54,605)	(54,605)								(54,605)
Foreign currency translation adjustment		(1,020)							(1,020)
Exercise of common stock options		0				0
Stock-based compensation		4,689				4,689
Purchase of treasury stock	(100)	(71)									(71)
Share offering		8,488			1	8,487
Pre-funded warrant execution		2,236				2,236
Equity instruments issued in connection with acquisition		5,919			1	5,918
Other		152				152
Purchases of stock in the ESPP plan		246				246
Ending Balance at Dec. 31, 2022		$ (25,729)			$ 7	$ 607,245			$ (2,840)	$ (624,218)	$ (5,923)
Mezzanine Equity
Net loss	0
Mezzanine equity, ending balance at Dec. 31, 2022	$ 10,006

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Cash flows from operating activities:
Net loss	$ (54,605)	$ (126,548)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation and amortization expense	2,183	2,479
Provision for bad debts and product returns	1,895	2,064
Change in fair value of warrant liability	(24,827)	(14,736)
Provision for inventory write-downs	19,972	9,096
Investor fee for warrant financing	916	2,119
Financing fee for warrant financing	17,042	0
Deferred income tax provision	(1,251)	(171)
Stock-based compensation	4,634	5,212
Asset impairment and abandonments	5,352	12,195
Asset acquisition expenses	0	72,087
Gain on acquisition contingency	(17,867)	(4,587)
Bargain purchase gain	0	(90)
Loss on sale of OEM business (discontinued operations)	0	6,316
Other	(3)	24
Change in assets and liabilities:
Accounts receivable	1,182	5,701
Inventories	(7,858)	(15,480)
Accounts payable	(2,442)	(3,112)
Accrued expenses and income taxes payable	(20,317)	10,542
Right-of-use asset and lease liability	(174)	(2,542)
Other operating assets and liabilities	24,059	(12,361)
Net cash used in operating activities	(52,109)	(51,792)
Cash flows from investing activities:
Payments for OEM working capital adjustment	0	(5,430)
Purchases of property and equipment	(6,781)	(13,423)
Patent and acquired intangible asset costs	(475)	(649)
Net cash used in investing activities	(7,256)	(24,832)
Cash flows from financing activities:
Share offering proceeds, net	28,563	82,326
Pre-funded warrant execution	1	0
Proceeds from exercise of common stock options	0	23
Repayment of Holo milestones	(4,081)	0
Proceeds from Employee Stock Purchase Program (ESPP)	246	407
Payments for treasury stock	(71)	(196)
Net cash provided by financing activities	24,658	82,560
Effect of exchange rate changes on cash and cash equivalents	(285)	1,389
Net (decrease) increase in cash and cash equivalents	(34,992)	7,325
Cash and cash equivalents, beginning of period	51,287	43,962
Cash and cash equivalents, end of period	16,295	51,287
Supplemental cash flow disclosure:
Cash paid for income taxes, net of refunds	(2,497)	7,990
Non-cash acquisition of property and equipment	396	195
Non-cash acquisition of INN	0	14,909
INN Acquisition
Cash flows from investing activities:
Acquisition of INN	0	(5,000)
Prompt
Cash flows from investing activities:
Acquisition of Prompt Prototype, net of cash acquired	0	(330)
Supplemental cash flow disclosure:
Non-cash common stock issuance	0	221
Holo Surgical Inc.
Supplemental cash flow disclosure:
Non-cash common stock issuance	$ 5,919	$ 0

Business

Business	12 Months Ended
	Dec. 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 health. W e have developed an artificial intelligence (“AI”) and augmented reality ( “ AR ” ) technology platform called HOLO™ AI, which we view as a powerful suite of AI software technology which connects the continuum of care from the pre-op and clinical stage through post-op care, and is designed to achieve better surgical outcomes, reduce complications, and improve patient satisfaction. We believe HOLO AI is one of the most advanced AI technologies with applications beyond the spine and operating room. 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 platform was developed to be 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 have launched several new products and are developing a pipeline of new innovative technologies that we plan to integrate with our HOLO AI platform. In addition to our digital health solutions, w e have a broad portfolio of spinal hardware implants, including solutions for fusion procedures in the lumbar, thoracic, and cervical spine, and a minimally invasive surgical implant system for fusion of the sacroiliac joint. We also have a portfolio of advanced and traditional orthobiologics, or biomaterials, products. We currently market and sell products to hospitals, ambulatory surgery centers, and healthcare providers in the United States and in approximately 40 countries worldwide. We are headquartered in Deerfield, Illinois, with commercial, innovation and design centers in San Diego, California; Wurmlingen, Germany; and Warsaw, Poland. Reverse Stock Split On May 10, 2022, the stockholders of the Company approved the proposal to authorize the Company’s Board of Directors (the “Board”) to amend the Company’s Amended and Restated Certificate of Incorporation to affect a reverse stock split of the Company’s common stock (the “Reverse Stock Split”). Following Board approval on May 11, 2022, the Reverse Stock Split became effective on May 16, 2022 at a 1-for-30 ratio. The Reverse Stock Split did not modify any rights or preferences of the shares of the Company’s common stock. Proportionate adjustments were made to the exercise prices and the number of shares underlying the Company’s outstanding equity awards, as applicable, and warrants, as well as to the number of shares issued and issuable under the Company’s equity incentive plans. The Reverse Stock Split did not affect the number of authorized shares of common stock or the par value of the common stock. Unless we indicate otherwise, all per share amounts and references to common shares and common share amounts in this Annual Report on Form 10-K (this “Report”) reflect the Reverse Stock Split, and the accompanying financial statements and notes to the financial statements give effect to the Reverse Stock Split and have been retroactively applied. Acquisition of equity interest in INN On December 30, 2021, we completed a Stock Purchase Agreement (“INN 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 in order to advance our digital health strategy. At the time of acquisition, INN was a private technology company engaged in the development of technology to harness machine learning ("ML") and AI with the goal of 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. The acquisition of INN propels our AI capabilities and our future growth. As consideration for the 42% ownership, we paid total consideration of $19.9 million which consisted of $5.0 million in cash, issuance to the sellers 227,359 shares of our common stock with a fair value of $4.9 million and issuance of two unsecured promissory notes to the Sellers in an aggregate principal amount of $10.6 million. Pursuant to the INN Purchase Agreement, subject to certain contingencies, we are obligated to purchase up to 100% of the equity of INN if the three additional clinical, regulatory, and revenue milestones are met. With the achievement of each milestone and the satisfaction of the related contingencies, we project to acquire an additional 19.3% equity interest in INN for $19.3 million. Prompt Prototypes LLC Acquisition On April 30, 2021, the Company entered into an Asset Purchase Agreement with Prompt Prototypes LLC ("Prompt"). The Company purchased the assets of Prompt to expand its research and development capabilities and create the capacity to produce certain medical prototypes. Pursuant to the terms of the Agreement, the Company purchased specific assets and assumed certain liabilities of Prompt for a purchase price of $1.1 million. At the closing, the Company paid $0.3 million in cash and issued restricted shares with an aggregate fair market value of $0.2 million to the seller. The remaining $0.6 million of the purchase price will be paid to the seller, contingent on the continued employment with the Company, in the form of cash and restricted shares in two equal amounts on the 18th and 36th month anniversary of the closing date. On October 30, 2022, the Company issued its first payment to coincide with the 18-month anniversary from the closing date which consisted of $0.2 million of cash and issuance of restricted shares with an aggregate fair market value of $0.1 million. The second payment is considered future compensation and will be paid on the 36th month anniversary of the closing date. COVID-19 The COVID-19 pandemic significantly impacted our business results of operations and financial condition in fiscal years 2021 and 2022. At the height of the COVID-19 pandemic, governments implemented extraordinary measures to slow the spread of the virus, which included the mandatory closure of businesses, restrictions on travel and gatherings, quarantine and physical distancing requirements, and vaccine mandates. While market conditions have improved throughout the country and on a global scale, many government agencies in conjunction with hospitals and healthcare systems continue to defer, reduce or suspend certain elective surgical procedures. The COVID-19 pandemic has also adversely impacted supply chains and hospitals’ staffing and administrative functions, resulting in several delays. We may continue to see delays on this front and both delays and reductions in procedural volumes as hospital systems and/or patients elect to defer spine surgery procedures, and the unpredictability of emerging variants may create unforeseen impacts on business operations. During 2021 and 2022, we raised additional capital to solidify our financial foundation and we continue to invest in our digital health strategy, invest in our teams, and improve operating processes, while taking steps to position the Company for long-term success and improve patient outcomes notwithstanding the COVID-19 pandemic and/or additional variants. Liquidity As of December 31, 2022, we had approximately $16.3 million in cash and $20.9 million in trade accounts payable and accrued expense liabilities, all of which were current. We plan to use our existing cash to fund our general corporate needs. In December 2022, we implemented a restructuring plan based on a thorough review of our organizational structure, processes, costs, and product portfolio, which we expect will lower operating expenses and reduce our overall cash burden. We believe this corporate realignment program will streamline the organization, improve processes and result in a significant reduction in operating expenses, significantly decrease our current operating cash flow, and leading to a lower cost basis to operate in 2023. In addition, to continue to increase our overall cash position, we sold our U.S. Coflex business in the first quarter of 2023 for total consideration of $17.0 million which provided net cash of $14.8 million to the Company following transaction costs. Based on the current execution of the strategy and our current cash flow forecast, we expect our current net working capital available will be sufficient to satisfy our needs into the fourth quarter of 2023. We are currently executing on our overall corporate strategy which includes the possibility of further corporate alignment programs, additional financing events through debt or equity, the potential sale of certain or substantially all assets, a sale of the Company or a potential merger with another entity. There is no assurance that we will be successful in further implementing these initiatives. A bsent receipt of additional funding, based on our current cash flow forecast, we do not expect to have adequate capital resources to meet our anticipated cash needs and our current obligations as they become due into the fourth quarter of 2023, which could require the Company to seek protection through a bankruptcy filing. In the interim, if we seek to raise additional capital through debt or equity or other financial instruments, there is no assurance that we will be able to obtain financing in a timely manner or on acceptable terms to meet any liquidity needs. If we are unable to secure additional funding and successfully implement our planned corporate realignment programs designed to significantly reduce expenses, we may be required to seek protection under applicable bankruptcy laws and/or liquidate or reorganize our assets, which could cause us to be delisted from the NASDAQ, further limiting our ability to obtain financing. Going Concern The accompanying consolidated financial statements of the Company have been prepared assuming the Company will continue as a going concern and in accordance with generally accepted accounting principles in the United States of America. The going concern basis of presentation assumes that we will continue in operation one year after the date these financial statements are issued, and we will be able to realize our assets and discharge our liabilities and commitments in the normal course of business. However, as discussed below, management has concluded that substantial doubt exists with respect to the Company’s ability to continue as a going concern within one year after the date the consolidated financial statements are issued. As of December 31, 2022, the Company had cash of $16.3 million and an accumulated deficit of $624.2 million. For the year ended December 31, 2022, the Company had a loss from continuing operations of $54.6 million and a net loss applicable to Surgalign Holdings, Inc. of $54.6 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 2022 nor in 2021. The Company expects net operating losses for the full year 2023 as it works to commercialize its HOLO Portal™ surgical guidance system and further develop its HOLO™ AI platform and spinal device product lines. On November 13, 2022, we entered into a securities purchase agreement with a single institutional investor pursuant to which we agreed to sell, in a registered direct offering (the “2022 Registered Direct Offering”), 740,000 shares of our common stock, pre-funded warrants exercisable for up to an aggregate of 5,260,000 shares of common stock, Series A warrants to purchase an aggregate of up to 6,000,000 shares of common stock that are exercisable through November 13, 2027, and Series B warrants to purchase an aggregate of up to 1,500,000 shares of common stock that are exercisable through November 13, 2025. We received gross proceeds of $12.0 million associated with the purchase agreement. Also in connection with the 2022 Registered Direct Offering, we issued placement agent warrants to purchase an aggregate of up to 360,000 of common stock that are exercisable through November 13, 2027. On February 15, 2022, we issued and sold in an underwritten public offering 1,285,507 shares of our common stock and 163,768 of pre-funded warrants to purchase common stock. In addition, the Company issued warrants to purchase up to an aggregate of 1,086,956 shares of common stock that are exercisable through February 15, 2027. Also in connection with the offering, the Company issued placement agent warrants to purchase an aggregate of up to 86,956 shares of common stock that are exercisable through February 15, 2027. Finally, the Company granted the underwriters the option for a period of 30 days from February 15, 2022 to purchase up to 217,391 additional shares of the Company’s common stock and/or warrants to purchase up to 163,043 shares of the Company’s common stock. 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 December 31, 2022. We received gross proceeds of $20.0 million from the offering. On June 14, 2021, we issued and sold in a registered direct offering an aggregate of 966,183 shares of our common stock and investor warrants to purchase up to an aggregate of 966,183 shares of common stock. The Company, also in connection with the direct offering, issued placement agent warrants to purchase an aggregate of up to 57,971 shares of our common stock that are exercisable through June 14, 2024. We received gross proceeds of $50.0 million from the offering. On February 1, 2021, we closed a public offering and sold a total of 956,666 shares of our common stock at a price of $45.0000 per share, less the underwriter discounts and commissions. We received gross proceeds of $44.5 million from the offering. 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) supply chain and labor issues, potential of a COVID-19 or related variant resurgence, inflation, and recent market volatility; ii) negative cash flows that are projected over the next 12-month period; iii) probability of payment of potential milestone payments related to the Holo Surgical and INN acquisitions should any of the milestones be achieved; iv) INN seller notes with an aggregate amount of $10.6 million due to the seller of INN on December 31, 2024; and v) various supplier minimum purchase agreements. The Company’s operating plan for the next 12-month period also includes continued investments in its product pipeline that require additional financings, including digital health, its digital health products, and certain hardware assets. Historically, the Company has successfully funded its cash requirements with capital raised through financings and/or asset sales and intends to continue to pursue those paths to address cash shortfalls. We completed the Coflex Transaction for $17.0 million gross funds and net cash of $14.8 million to the Company. Even with this sale, absent receipt of additional third-party funding and based on our current cash flow forecast, the Company does not expect to have adequate capital resources to meet its current obligations as they become due into the fourth quarter of 2023. The Company’s ability to meet its current obligations as they become due over the next twelve months and to be able to continue with its operations will depend on obtaining additional capital and executing its current corporate strategy. No assurance can be given that any of these actions will be completed. If the Company is unable to secure additional funding and successfully implement its planned corporate realignment programs designed to significantly reduce expenses, the Company may be required to seek protection under applicable bankruptcy laws and/or liquidate or reorganize its assets, which could cause us to be delisted from the NASDAQ, further limiting our ability to obtain financing. In consideration of the inherent risks and uncertainties and the Company’s forecasted negative cash flows as described above, management has concluded that substantial doubt exists with respect to the Company’s ability to continue as a going concern within one year after the date the consolidated financial statements are issued. Management continually evaluates plans to raise additional debt and/or equity financing and will continue to attempt to curtail discretionary expenditures in the future; however, in consideration of the risks and uncertainties mentioned, such plans cannot be considered probable of occurring at this time. The recoverability of a major portion of the recorded asset amounts shown in the Company’s accompanying consolidated balance sheets is dependent upon continued operations of the Company, which in turn is dependent upon the Company’s ability to meet its funding requirements on a continuous basis to maintain existing financing to succeed in its future operations. The Company’s consolidated financial statements do not include any adjustments relating to the recoverability and classification of recorded asset amounts and classification of liabilities that might be necessary should the Company be unable to continue in existence.

Summary of Significant Accounti

Summary of Significant Accounting Policies	12 Months Ended
	Dec. 31, 2022
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	Summary of Significant Accounting Policies Principles of Consolidation — The consolidated financial statements include the accounts of the Company and its wholly owned subsidiaries, Surgalign, Inc., Paradigm Spine, LLC (“Paradigm”), Pioneer Surgical Technology, Inc. (“Pioneer Surgical”), Zyga Technology, Inc. (“Zyga”) and Holo Surgical Inc. (“Holo Surgical”). The Company consolidates the accounts of Inteneural Networks, Inc. ("INN"), a 42% owned subsidiary as control is achieved through means other than voting rights ("variable interest entities" or "VIE") as the Company is deemed to be the primary beneficiary of INN. The consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“U.S. GAAP”). All intercompany balances and transactions have been eliminated in consolidation. Reclassification —The Company reclassified certain amounts from prior periods to conform with current period presentation of certain consolidated financial statements with no effect on previously reported net income, equity, total assets, or total liabilities. Use of Estimates —The preparation of consolidated financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosures of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Estimates and assumptions relating to inventories, receivables, long-lived assets, contingent considerations, and litigation are made at the end of each financial reporting period by management. Actual results could differ from those estimates. Foreign Currency Translation —The functional currency of the Company’s foreign subsidiaries is the Euro. Assets and liabilities of the foreign subsidiaries are translated at the period end exchange rate while revenues and expenses are translated at the average exchange rate for the period. The resulting translation adjustments, representing unrealized, noncash gains and losses are recorded and presented as a component of comprehensive loss. Gains and losses resulting from transactions of the Company and its subsidiaries, which are made in currencies different from their own, are included in income or loss as they occur and are included in other expenses in the consolidated statements of comprehensive loss. Fair Value of Financial Instruments —The estimated fair value of financial instruments disclosed in the consolidated financial statements has been determined by using available market information and appropriate valuation methodologies. The carrying value of all current assets and current liabilities approximates fair value because of their short-term nature. Cash and Cash Equivalents — The Company considers all funds in banks and short-term highly liquid investments with an original maturity of three months or less to be cash and cash equivalents. Cash equivalents comprise overnight repurchase agreements. Cash balances are held at a few financial institutions and usually exceed insurable amounts. The Company mitigates this risk by depositing its uninsured cash in major well capitalized financial institutions. At December 31, 2022 and 2021, the Company had no cash equivalents. Accounts Receivable Allowances — The Company maintains the allowance for estimated losses resulting from the inability of its customers to make required payments. The allowance represents the current estimate of lifetime expected credit losses over the remaining duration of existing accounts receivable considering current market conditions and supportable forecasts when appropriate. The estimate is a result of the Company’s ongoing evaluation of collectability, customer creditworthiness, historical levels of credit losses, and future expectations. At times, it is determined that invoices are uncollectible and need to be written off. This occurs after extensive attempts by the Company to obtain payment, set up payment plans or send to debt collectors. When the Company determines the amount of the actual write-offs for the period, a credit is made to the accounts receivable account to reduce the amount of outstanding accounts receivable with a debit to the allowance account. Write-off activity for the years ended December 31, 2022 and 2021 were $1.4 million and $0.7 million, respectively. Recoveries for the years were not material. Inventories — Inventories are stated at lower of cost or net realizable value, with cost determined using the first-in, first-out method (“FIFO”) applied on a consistent basis. Non-current inventory represents those the Company anticipates will not be sold within the next year. Non-current inventory is estimated by comparing historical and projected sales trends and inventory quantities on hand. Inventory is evaluated for obsolescence and excess quantities by analyzing inventory levels, historical loss trends, expected product lives, product at risk of expiration, sales levels by product and projections of future sales demand. The announced product rationalization was also evaluated in the Company’s obsolescence and excess quantity reserve. The Company’s calculation of the amount of inventory that is excess, obsolete, or will expire prior to sale has the following components: 1) a consumption based component that compares historical sales to inventory quantities on hand for our United States calculation and projected sales to quantities on hand for our international calculation given its wind down; 2) for expiring inventory we assess the risk related to inventory that is near expiration by analyzing historical expiration trends to project inventory that will expire prior to being sold; and 3) identifying product lines that will be rationalized in the near future. The Company’s demand-based consumption model assumes that inventory will be sold on a first-in-first-out basis. The Company’s metal inventory does not expire and can be re-sterilized and sold; however, the Company assesses quantities on hand, historical sales, projected sales, projected consumption, the number of forecasted years, wind down timing for rationalized product lines when calculating the estimate. Property and Equipment —Property and equipment are stated at cost less accumulated depreciation. The cost of leasehold improvements is amortized on the straight-line method over the shorter of the lease term or the estimated useful life of the asset. Included in property and equipment are costs related to purchased software that are capitalized. Surgical instruments which are included in property and equipment are handheld devices used by surgeons during implant procedures. The Company retains title to the surgical instruments. Depreciation for surgical instruments is included in general and administrative expenses in the accompanying consolidated statements of comprehensive loss. Depreciation is computed on the straight-line method over the following estimated useful lives of the assets: Processing equipment 7 to 10 years Office equipment, furniture and fixtures 5 to 7 years Computer equipment and software 3 to 7 years Surgical instruments 1 year Internal Use Software - The Company accounts for its costs to develop computer software for internal use in accordance with Accounting Standards (“ASC”) 350-40, Internal use Software, specifically for its development and implementation of its new ERP system in January 2022, and for continued enhancements to its HOLO™ AI software technology platform. The Company capitalizes the costs incurred during the application development stage, which generally include costs to design the software configuration and interfaces, coding, installation, and testing, in addition to enhancement costs when determined to result in additional functionality. Costs associated with these developments are maintained as construction in process until either a 510(k) application has been submitted or the software has gone live. When this occurs the costs are subsequently transferred into property and equipment account with depreciation commencing thereafter. Derivative Instruments— The Company reviews debt agreements for embedded features. If these features are not clearly and closely related to the debt host, they meet the definition of a derivative and require bifurcation from the host contract. All derivative instruments, including embedded derivatives are recorded on the balance sheet at their respective fair values. The Company will adjust the carrying value of the derivative liability to fair value at each subsequent reporting date. The changes in the fair value of the derivatives are recorded in the period they occur. Warrant Financing— The Company accounts for its warrants as derivative liabilities as the warrants did not meet the criteria for the equity scope exception from derivative accounting. As derivatives, these warrants were measured at fair value at inception and will be remeasured at each reporting date with changes in fair value recognized in the consolidated statements of comprehensive loss in the period of change. Debt Issuance Costs— Debt issuance costs include costs incurred to obtain financing and are amortized using the straight-line method, which approximates the effective interest method, over the life of the related debt. Debt issuance costs related to a recognized debt liability are presented in the balance sheet as a direct deduction from the carrying amount of that debt liability. No amounts are recorded as debt issuance costs for December 31, 2022 and 2021, as any incurred amounts were immaterial. Long-Lived Assets —The Company reviews its long-lived assets for impairment whenever events or changes in circumstances indicate the carrying value of an asset may not be recoverable. Recoverability is measured by a comparison of the carrying amount to the net undiscounted cash flows expected to be generated by the asset. An impairment loss would be recorded for the excess of net carrying value over the fair value of the asset impaired. The fair value is estimated based on expected discounted future cash flows. The results of impairment tests are subject to management’s estimates and assumptions of projected cash flows and operating results. Changes in assumptions or market conditions could result in a change in estimated future cash flows and the likelihood of materially different reported results. Because the Company’s forecasted cash flow is negative, long-lived assets, including property and equipment and intangible assets subject to amortization were impaired and written down to their estimated fair values in 2022 and 2021. Other Intangible Assets —Other intangible assets, which constitutes finite lived assets, generally consist of patents, acquired exclusivity rights, licensing rights, distribution agreements, and procurement contracts. Patents are amortized on the straight-line method over the shorter of the remaining protection period or estimated useful lives of between 8 and 16 years. Trade names, procurement contracts, customer lists, acquired exclusivity rights, and distribution agreements are amortized over estimated useful lives of between 5 to 25 years. Because the Company’s forecasted cash flow is negative, any intangible assets acquired during the year were immediately impaired, and as such, there was no amortization expense f or the years ended December 31, 2022 and 2021. Revenue Recognition — The Company recognizes revenue upon transfer of control of promised implants in an amount that reflects the consideration it expects to receive in exchange for those products. The Company typically transfers control at a point in time upon shipment or delivery of the implants for direct sales, or upon implantation for sales of consigned inventory. The customer is able to direct the use of, and obtain substantially all of the benefits from, the implant at the time the implant is shipped, delivered, or implanted, respectively based on the terms of the contract. The Company’s performance obligations consist mainly of transferring control of implants identified in the contracts. The Company’s transaction price is generally fixed. Payment terms vary but are generally due within 30 days of transferring control. Any discounts or rebates are estimated at the inception of the contract and recognized as a reduction of the revenue. We generally do not bill customers for shipping and handling of our products. We treat shipping and handling costs performed after a customer obtains control of the good as a fulfillment cost and record these costs as a selling expense when incurred. Some of the Company’s contracts offer assurance-type warranties in connection with the sale of a product to a customer. Assurance-type warranties provide a customer with assurance that the related product will function as the parties intended because it complies with agreed-upon specifications. Such warranties do not represent a separate performance obligation and are not material to the consolidated financial statements. Stock-Based Compensation Plans —The Company accounts for its stock-based compensation plans in accordance with ASC 718, Accounting for Stock Compensation (“ASC 718”). ASC 718 requires the measurement and recognition of compensation expense for all stock-based awards made to employees and directors, including restricted stock awards, restricted stock units, stock options and the employee stock purchase plan ("ESPP") purchase rights (i.e., equity-classified awards). Under the provisions of ASC 718, stock-based compensation cost for equity-classified awards is measured at the grant date, based on the calculated fair value of the award, and is recognized as an expense on a straight-line basis over the requisite service period of the entire award (generally the vesting period of an option, including graded vesting schedules, or share award and the offering period of an ESPP purchase right award). The Company currently measures the grant date fair value of restricted stock awards and restricted stock units based on the market value of the Company’s stock on the grant date. The Company uses the Black-Scholes model to value its stock option grants and ESPP purchase rights. The fair value of stock options and awards is determined on the grant date, and the fair value of the ESPP purchase rights is determined on the offering date using assumptions for the expected term, expected volatility, dividend yield, and the risk-free interest rate. The details of those assumptions, is as follows: • The term assumption for stock options is primarily based on the contractual vesting term and historic data related to exercise and post-vesting expiration history experienced by the Company. The Company uses the simplified method for estimating the expected term used to determine the fair value under ASC 718. The expected term is determined separately for the Company’s directors and employees. The term assumption for ESPP purchase is primarily based on the offering period. • The Company’s anticipated volatility level for both stock options and ESPP purchase rights are primarily based on the historic volatility of the Company’s common stock. • The Company’s models for stock options and ESPP purchase rights includes a 0% expected dividend yield assumption, as the Company has not historically paid, nor does it anticipate paying dividends on its common stock. • The risk-free interest rate approximates recent U.S. Treasury note auction results with a similar life to that of the option or ESPP purchase right. The Company’s model does not include a discount for post-vesting restrictions, as the Company has not issued awards with such restrictions. The compensation cost recognized for stock options is determined based on the grant date fair value of the options and the number of options granted. The compensation cost recognized for restricted stock awards, restricted stock units, and ESPP purchase rights is determined based on the grant date fair value of the awards. The Company accounts for forfeitures as they occur. Research and Development Costs —Research and development costs, including the cost of research and development conducted for others and the cost of contracted research and development, are expensed as incurred. Transaction and Integration Costs —Transaction and integration costs, including fees associated with strategic initiatives, issuance costs for potential debt and equity offerings, and costs associated with potential M&A activity, are expensed as incurred. The Company incurred related expenses of $19.4 million and $3.7 million, for the years ended December 31, 2022 and 2021, respectively. Income Taxes —The Company uses the asset and liability method of accounting for income taxes. Deferred income taxes are recorded to reflect the tax consequences on future years for differences between the tax basis of assets and liabilities and their financial reporting amounts at each year-end based on enacted tax laws and statutory tax rates applicable to the periods in which the differences are expected to affect taxable income. Valuation allowances are established when necessary to reduce deferred tax assets to amounts which are more likely than not to be realized. Employee Retention Credit —Pursuant to the Coronavirus Aid, Relief and Economic Security Act (the “CARES Act”), the Company is eligible for an employee retention credit subject to certain criteria. The Company has accounted for funds received under the CARES Act in accordance with International Accounting Standards (IAS) 20, Accounting for Government Grants and Disclosure of Government Assistance , of International Financial Reporting Standards (“IFRS”). Under an IAS 20 analogy, a business entity would recognize the employee retention credit on a systematic basis over the periods in which the entity recognizes the payroll expenses for which the grant (i.e., tax credit) is intended to compensate when there is reasonable assurance (i.e., it is probable) that the entity will comply with any conditions attached to the grant and the grant (i.e., tax credit) will be received. The Company applied for the Employee Retention Credit during 2022 and received a reimbursement from the government in the amount of $3.2 million during the fourth quarter of 2022. Due to the uncertainty in the government program and the changing legislation, the Company could not determine that the conditions of the program have been substantially met and therefore have recorded a reserve in the amount of $3.2 million in “Other long-term liabilities” on the consolidated balance sheet. Contingent Consideration — The Company accounts for the contingent consideration related to the Holo Surgical Acquisition as a liability in accordance with the guidance of ASC 480, Distinguishing Liabilities from Equity , because the contingent consideration represents a conditional obligation that has a fixed monetary value known at inception and we may settle by issuing a variable number of our equity shares. The liability is recorded at its fair value at inception and shall be marked to market subsequently at the end of each reporting period, with any change recognized in the current earnings. See Note 7 for further discussion related to the Holo Surgical Acquisition. Noncontrolling Interest — The Company's consolidated noncontrolling interest is comprised of its investment in INN. The Company evaluated whether noncontrolling interest is subject to redemption features outside of the Company's control. We evaluated noncontrolling interest to determine whether it is currently redeemable for cash or probable of being redeemable for cash in the future within the mezzanine section of the consolidated balance sheet. As the noncontrolling interest is not currently redeemable, and is only redeemable upon the occurrence of FDA approval, we will not remeasure at each reporting period until approval is obtained. Treasury Stock — The Company may periodically repurchase shares of its common stock from employees for the satisfaction of their individual payroll tax withholding upon vesting of restricted stock awards in connection with the Company’s incentive plans. The Company’s repurchases of common stock are recorded at the stock price on the vesting date of the common stock. The Company repurchased 14,921 and 3,633 shares of its common stock for $0.1 million and $0.2 million, for the years ended December 31, 2022 and 2021, respectively . Earnings Per Share —Basic earnings per share (“EPS”) is computed by dividing earnings attributable to common stockholders by the weighted-average number of common shares outstanding for the periods. Diluted EPS reflects the incremental shares issuable upon the assumed exercise of securities that could share in earnings. Shares whose issuance is contingent upon the satisfaction of certain conditions shall be considered outstanding and included in the computation of diluted EPS as follows: a. If all necessary conditions have been satisfied by the end of the period (the events have occurred), those shares shall be included as of the beginning of the period in which the conditions were satisfied (or as of the date of the contingent stock agreement, if later). b. If all necessary conditions have not been satisfied by the end of the period, the number of contingently issuable shares included in diluted EPS shall be based on the number of shares, if any, that would be issuable if the end of the reporting period were the end of the contingency period (for example, the number of shares that would be issuable based on current period earnings or period-end market price) and if the result would be dilutive. Those contingently issuable shares shall be included in the denominator of diluted EPS as of the beginning of the period (or as of the date of the contingent stock agreement, if later). Other Operating Income — Included within "Other operating income, net" for the years ended December 31, 2022 and 2021 is $0.9 million and $3.9 million, respectively, related to the settlement received by the Company from OEM related to inventory purchased during the year that was also paid for by the Company at the date of acquisition.

Recently Issued and Adopted Acc

Recently Issued and Adopted Accounting Standards.	12 Months Ended
	Dec. 31, 2022
Accounting Changes and Error Corrections [Abstract]
Recently Issued and Adopted Accounting Standards.	Recently Issued and Adopted Accounting Standards.To date, there have been no recent accounting pronouncements not yet effective that the Company expects will have a material, or potentially material, impact to our consolidated financial statements.

Leases

Leases	12 Months Ended
	Dec. 31, 2022
Leases [Abstract]
Leases	LeasesThe Company’s leases are classified as operating leases and includes office space, automobiles, and copiers. The Company does not have any finance leases and the Company’s operating leases do not have any residual value guarantees, restrictions or covenants. As of December 31, 2022 the only lease that has yet to commence is for our San Diego Design Center, which is expected to open in mid-2023. Therefore, no lease obligation or right-of-use (“ROU”) asset has been recorded as of December 31, 2022 . All other obligations associated with the lease are reflected as of December 31, 2022 . The Company’s leases have remaining lease terms of 1 to 7 years, some of which include options to extend or terminate the leases. The option to extend or terminate is only included in the lease term if the Company is reasonably certain of exercising that option. Operating lease ROU assets are presented within “Other assets-net” on the consolidated balance 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 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 sheets. A subset of the Company’s automobile and copier leases contain variable payments. The variable lease payments for such automobile leases are based on actual mileage incurred at the standard contractual rate. The variable lease payments for such copier leases are based on actual copies incurred at the standard contractual rate. The variable lease costs for all leases are immaterial. The components of operating lease expense were as follows: For the Year Ended December 31, For the Year Ended December 31, Operating lease cost $ 462 $ 706 Short-term operating lease cost 916 335 Total operating lease cost $ 1,378 $ 1,041 Supplemental cash flow information related to operating leases was as follows: For the Year Ended December 31, For the Year Ended December 31, Cash paid for amounts included in the measurement of lease liabilities $ 1,405 $ 1,237 ROU assets obtained in exchange for lease obligations 381 57 Supplemental balance sheet information related to operating leases was as follows: Balance Sheet Classification Balance at December 31, Balance at December 31, Assets: Right-of-use assets Other assets - net $ 967 $ 876 Liabilities: Current Accrued expenses $ 182 $ 294 Noncurrent Other long-term liabilities 1,142 947 Total operating lease liabilities $ 1,324 $ 1,241 The weighted-average remaining lease terms and discount rates were as follows: For the Year Ended December 31, For the Year Ended December 31, Weighted-average remaining lease term (years) 6.0 6.3 Weighted-average discount rate 4.97 % 5.09 % As of December 31, 2022, maturities of operating lease liabilities (excluding San Diego Design Center lease) were as follows: Maturity of Operating Lease Liabilities Balance at December 31, 2023 $ 384 2024 402 2025 391 2026 389 2027 and beyond 806 Total future minimum lease payments 2,372 Less imputed interest (1,048) Total $ 1,324

Discontinued Operations

Discontinued Operations	12 Months Ended
	Dec. 31, 2022
Discontinued Operations and Disposal Groups [Abstract]
Discontinued Operations	Discontinued Operations On July 20, 2020, the Company completed the disposition of its former original equipment manufacturing business and business related to processing donated human musculoskeletal and other tissue and bovine and porcine animal tissue in producing allograft and xenograft implants using sing BIOCLEANSE ® , TUTOPLAST ® and CANCELLE ® SP sterilization processes (collectively, the “OEM Businesses”). Accordingly, the OEM Businesses are reported as discontinued operations in accordance with ASC 205-20, Discontinued Operations (“ASC 205-20”). The results of operations from the OEM Businesses are classified as discontinued operations in the consolidated statements of comprehensive loss. The Company applied the “Intraperiod Tax Allocation” rules under ASC 740, which requires the allocation of an entity’s total annual income tax provision among continuing operations and, in the Company’s case, discontinued operations. There were no assets or liabilities of the OEM Business as of years ended December 31, 2022 or December 31, 2021, due to the transaction occurring on July 20, 2020. Applicable amounts in prior years have been recast to conform to this discontinued operations presentation. The following table presents the financial results of the discontinued operations: Year Ended December 31, Year Ended December 31, 2022 2021 Major classes of line items constituting net income from discontinued operations: Revenues $ — $ — Costs of goods sold — — Gross profit — — Expenses: General and administrative — — Severance and restructuring costs — — Transaction and financing expenses — — Total operating expenses — — Operating income — — Other expense (income): OEM working capital adjustment — 6,316 Interest expense — — Loss on extinguishment of debt — — Derivative loss — — Foreign exchange (gain) loss — — Total other expense - net — 6,316 (Loss) income from discontinued operations — (6,316) Gain on sale of net assets of discontinued operations — — (Loss) Income from discontinued operations before income tax provision — (6,316) Income tax (benefit) provision — (2,674) Net (loss) income on discontinued operations $ — $ (3,642) On December 1, 2020, pursuant to the OEM Purchase Agreement dated as of January 13, 2020 (as amended from time to time, the “OEM Purchase Agreement”), by and between the Company and Ardi Bidco Ltd. (the “Buyer”), the Company received a notice from the Buyer indicating that a post-closing adjustment in an amount of up to $14.0 million may be owed in respect of the working capital adjustment paid at closing. On June 3, 2021, the firm engaged to resolve the dispute issued a binding, non-appealable resolution whereby it was determined the Company was liable for $5.8 million of the disputed amount, which was finalized and paid during the second quarter of 2021. The final settlement was expensed under "Loss from operations of discontinued operations " in our consolidated statements of comprehensive loss. There were no operating cash flows of discontinued operations for the years ended December 31, 2022 and 2021. Investing cash flows used in discontinuing operations were comprised of $0.0 million and $5.4 million for the years ended December 31, 2022 and 2021, respectively, related to payments made for the OEM working capital adjustment less agreed upon fees. All amounts exclude the effect of income taxes.

Revenue from Contracts with Cus

Revenue from Contracts with Customers	12 Months Ended
	Dec. 31, 2022
Revenue from Contract with Customer [Abstract]
Revenue from Contracts with Customers	Revenue from Contracts with Customers Disaggregation of Revenue The Company’s entire revenue for the years ended December 31, 2022 and 2021 were recognized at a point in time. The following table represents total revenue by geographical region for the years ended December 31, 2022 and 2021: Year Ended December 31, 2022 Year Ended December 31, 2021 Revenues: Domestic $ 68,647 $ 77,927 International 13,332 12,573 Total revenues from contracts with customers $ 81,979 $ 90,500

Business Combinations and Acqui

Business Combinations and Acquisitions	12 Months Ended
	Dec. 31, 2022
Business Combination and Asset Acquisition [Abstract]
Business Combinations and Acquisitions	Business Combinations and Acquisitions Inteneural Networks Inc. On December 30, 2021, the Company entered into a Stock Purchase Agreement with Dearborn Capital Management LLC, and Neva, LLC, a Delaware limited liability company (collectively the sellers of INN), that are owned by Krzysztof Siemionow, MD, PhD (“Siemionow”), Pawel Lewicki, PhD ("Lewicki") respectively to acquire a 42% equity interest in the issued and outstanding shares of INN for a non-exclusive right to use their proprietary technology. On the date of the Stock Purchase Agreement, Lewicki was as a member of the Board of Directors (the “Board”). INN is a medical technology company specializing in AI and big data learning analysis of brain imaging. INN has a proprietary AI technology that seeks to autonomously segment and identify neural structures in medical images to help identify possible pathological states. This technology has potential future applications in neurosurgery as well as 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 may position the Company as a leader in intelligent digital health; ii) by bringing INN’s intercranial capabilities to the HOLO TM AI platform, the Company seeks to expand the applicability of HOLO AI technology into significant segments beyond spine and in particular, neurosurgery; iii) the expected 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 is expected to materially contribute to the Company’s mission to improve patient 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 227,359 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 is obligated to purchase up to 100% of the equity of INN if 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. None of the milestones have been achieved as of December 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 has fully consolidated INN into the consolidated financial statements. INN does not have any assets or liabilities as of December 31, 2022 and December 31, 2021. Additionally, there was no income statement activity within INN for the years ended December 31, 2022 and 2021. As such, the amounts recorded in the “Mezzanine equity” section of the consolidated balance sheets has not changed. 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 a noncontrolling interest related to the 58% equity interest not purchased. As the forward contracts are redeemable upon a future event (FDA approval) it is determined that this event is not probable under the accounting guidance. As a result, the forward contracts are not remeasured to fair value for the years ended December 31, 2022 and 2021. 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. Management determined that because the IPR&D asset did not have technological feasibility, it was immediately expensed. As a result of the transaction, the company recorded a $72.1 million loss within the consolidated statements of comprehensive loss for the year ended December 31, 2021. This loss has a net impact of $30.2 million to Surgalign, and $41.9 million impact to INN. These adjustments were made as it relates to the amounts recorded within the transaction. Prompt Prototypes Acquisition On April 30, 2021, the Company entered into an Asset Purchase Agreement (the “Agreement”) with Prompt Prototypes LLC (“Prompt”). The Company purchased the assets of Prompt to expand its research and development capabilities and create the capacity to produce certain medical prototypes. Pursuant to the terms of the Agreement, the Company purchased specific assets and assumed certain liabilities of Prompt for a purchase agreement price of $1.1 million . At the closing, the Company paid $0.3 million of cash and issued restricted shares with an aggregate fair market value of $0.2 million to the sellers. The remaining $0.6 million of the purchase price will be paid to the seller, contingent on the continued employment with the Company, in the form of cash and restricted shares in two equal amounts on the 18th and 36th month anniversary of the closing date. On October 30, 2022, the Company issued its first payment to coincide with the 18 month anniversary from the closing date which consisted of $0.2 million of cash and issuance of restricted shares with an aggregate fair market value of $0.1 million. The outstanding second payment is considered future compensation. The following table summarizes the fair value of the identifiable assets acquired and liabilities assumed from the acquisition of Prompt as of April 30, 2021 (in thousands): Balance at April 30, 2021 Inventories $ 140 Right-of-use assets 78 Property and equipment 528 Operating lease liabilities (78) Deferred tax liability (28) Net assets acquired $ 640 Bargain purchase gain (90) Total purchase price $ 550 Based on the final 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 expense (income) - net

Stock-Based Compensation

Stock-Based Compensation	12 Months Ended
	Dec. 31, 2022
Share-Based Payment Arrangement [Abstract]
Stock-Based Compensation	Stock-Based Compensation The Company has three active stock-based compensation plans: the 2021 Incentive Compensation Plan, the 2021 Inducement Plan, and the 2021 Employee Stock Purchase Plan ("ESPP"). The Company accounts for its stock-based compensation plans in accordance with ASC 718. The Company grants stock-based awards to its employees, including officers and directors, comprised of restricted stock, restricted stock units, stock options and ESPP purchase rights. Employee Equity Plans 2021 Incentive Compensation Plan On May 7, 2021, the Company’s stockholders approved and adopted the 2021 Incentive Compensation Plan (the "Incentive Plan"). The Incentive Plan permits the grant of stock options, stock appreciation rights, restricted stock, restricted stock units and performance shares to our officers, directors, employees, and consultants of the Company. The plan allows for up to 666,666 shares of common stock to be issued with respect to awards granted. 2021 Inducement Compensation Plan On May 7, 2021, the Company’s stockholders approved and adopted the 2021 Inducement Plan (the "Inducement Plan"). The Inducement Plan purpose is to advance the interests of the Company by providing a material inducement for the best available individuals to join the Company and its subsidiaries as employees by affording such individuals an opportunity to acquire a proprietary interest in the Company. The Inducement Plan permits the grant of stock appreciation rights, restricted stock, restricted stock units and performance shares to our officers, directors, employees, and consultants of the Company. The plan allows for up to 300,000 shares of common stock to be issued with respect to awards granted. Employee Stock Purchase Plan On May 7, 2021, our board of directors adopted the ESPP, which became effective July 1, 2021. Under our ESPP, employees can purchase shares of our common stock based equal to no less than 1% of the employee's compensation, up to a maximum of 15%, subject to certain limits. The offering period is every six-month period beginning January 1st and July 1st of each year. The ESPP offers a six-month look-back feature. The purchase price per share is equal to the lower of 85% of the fair market value of our common stock on the offering date or the purchase date. ESPP purchases are settled with common stock from the ESPP’s previously authorized and available pool of shares. A total of 166,666 shares of common stock have been authorized for issuance under the ESPP plan. During 2022, 99,428 shares were issued under the ESPP for $0.2 million and in 2021, 22,220 shares were issued for $0.4 million. There were 45,018 shares available for issuance under the ESPP plan as of December 31, 2022. Impact on Net Loss For the years ended December 31, 2022 and 2021, the Company recognized stock-based compensation related to equity-classified awards as follows: For the Year Ended December 31, 2022 2021 Stock-based compensation: Costs of goods sold $ — $ 21 General and administrative 4,289 4,839 Research and development 345 352 Total $ 4,634 $ 5,212 Stock Options The Company’s policy is to grant stock options at an exercise price equal to 100% of the market value of a share of common stock at closing on the date of the grant. The Company’s stock options generally have five one As of December 31, 2022, there was $0.5 million of total unrecognized stock-based compensation expense related to nonvested stock options. That expense is expected to be recognized over a weighted-average period of 2.47 years. Stock options outstanding, exercisable and available for grant at December 31, 2022, are summarized as follows: Number of Weighted Weighted Aggregate Outstanding at January 1, 2022 177,665 $ 92.26 3.96 $ — Granted — — Exercised — — Forfeited or expired (101,512) 99.26 Outstanding at December 31, 2022 76,153 $ 82.94 6.77 $ — Vested or expected to vest at December 31, 2022 76,153 $ 82.94 6.77 $ — Exercisable at December 31, 2022 52,562 $ 88.02 6.32 $ — Available for grant at December 31, 2022 288,585 The aggregate intrinsic value in the table above represents the total pre-tax intrinsic value of stock options for which the fair market value of the underlying common stock exceeded the respective stock option exercise price. Other information concerning stock options are as follows: For the Year Ended December 31, (in thousands, except for per share information) 2022 2021 Weighted average fair value of stock options granted $ — $ 0.93 Aggregate intrinsic value of stock options exercised $ — $ — The aggregate intrinsic value of stock options exercised in a period represents the pre-tax cumulative difference, for the stock options exercised during the period, between the fair market value of the underlying common stock and the stock option exercise prices. The following weighted-average assumptions were used to determine the fair value of options and purchases under ASC 718. Please note there were no stock options granted in 2022, so no valuation metrics are provided: Year Ended December 31, 2022 2021 Expected term (years) 0.00 6.35 Risk free interest rate — % 0.72 % Volatility factor — % 49.97 % Dividend yield — — Employee Stock Purchase Plan The following weighted-average assumptions were used to determine the fair value of ESPP and purchases under ASC 718: Year Ended December 31, 2022 2021 Expected term (years) 0.50 0.50 Risk free interest rate 1.03 % 0.05 % Volatility factor 91.99 % 84.32 % Dividend yield — — Restricted Stock Awards The Company’s policy is to grant restricted stock awards at a fair value equal to 100% of the market value of a share of common stock at closing on the date of the grant. The Company’s restricted stock awards generally vest over one-year to three-year periods. The value of restricted stock awards that do not have market conditions is determined by the market value of the Company’s common stock at the date of grant. In 2022, no restricted stock awards were granted to employees and non-employee directors. As of December 31, 2022, there was $0.2 million of total unrecognized stock-based compensation related to unvested restricted stock awards. That expense is expected to be recognized on a straight-line basis over a weighted-average period of 0.70 years. The following table summarizes information about unvested restricted stock awards as of December 31, 2022: Number of Weighted Unvested at January 1, 2022 21,788 $ 86.65 Granted — — Vested (10,833) 94.42 Forfeited (4,496) 83.49 Unvested at December 31, 2022 6,459 $ 75.81 The fair market value of restricted stock awards vested in 2022 and 2021 was $0.1 million and $1.9 million, respectively. Restricted Stock Units The Company’s policy is to grant restricted stock units at a fair value equal to 100% of the market value of a share of common stock at closing on the date of the grant. The Company’s restricted stock units generally vest over one-year to three-year periods. The value of restricted stock units is determined by the market value of the Company’s common stock at the date of grant. In 2022, restricted stock units in the amount of 565,118 shares and 114,285 shares of restricted stock were granted to employees and non-employee directors, respectively. As of December 31, 2022, there was $4.6 million of total unrecognized stock-based compensation expense related to unvested restricted stock units. That expense is expected to be recognized on a straight-line basis over a weighted-average period of 1.46 years. The following table summarizes information about unvested restricted stock units as of December 31, 2022: Number of Weighted Unvested at January 1, 2022 158,972 $ 48.83 Granted 679,403 5.88 Vested (75,970) 50.19 Forfeited (66,314) 29.13 Unvested at December 31, 2022 696,091 $ 8.64 The fair market value of restricted stock units vested in 2022 and 2021 was $0.4 million and $0.0 million, respectively.

Inventories

Inventories	12 Months Ended
	Dec. 31, 2022
Inventory Disclosure [Abstract]
Inventories	Inventories The inventory balances as of December 31, 2022 and 2021, consist entirely of finished goods. The Company values its inventories at the lower of net realizable value or cost using FIFO. For the years ended December 31, 2022 and 2021, the Company recognized costs related to inventory write-downs of $20.0 million and $9.1 million, respectively. Of the $20.0 million incurred in 2022, $13.8 million related to costs associated with the product portfolio rationalization initiatives and the wind down of the international location, which led to increases in our excess quantities and obsolescence (“E&O”) reserve. In addition, we incurred an additional $3.2 million of an E&O charge related to a decrease in 2022 sales as compared to forecasted. The E&O write-downs are included within "Costs of goods sold" on the consolidated statements of comprehensive loss. Please see Note 20 for further discussion. The Company received a settlement from OEM of $0.9 million and $3.9 million, respectively, for the years ended December 31, 2022 and 2021 related to inventory that was purchased during the period that was also paid for during the split of the OEM Businesses. These amounts are recorded in “Other operating income, net ” in our consolidated statements of comprehensive loss. On January 20, 2021, the Company and Oxford Performance Materials, Inc. (“Oxford”) entered into an Amended and Restated License and Supply Agreement (the “Oxford Supply Agreement”) pursuant to which Oxford licenses certain intellectual property to the Company and supplies the Company on a non-exclusive basis in the United States with PEKK material for use in spinal implants. The Company previously prepaid 2024 royalties to Oxford. Based on current sales performance management determined those royalties would not be paid and wrote off a portion of the prepayment in the amount of $0.2 million and $3.0 million for the years ended December 31, 2022 and 2021, respectively. These amounts are recorded within "Costs of goods sold" on the consolidated statements of comprehensive loss.

Prepaid and Other Current Asset

Prepaid and Other Current Assets	12 Months Ended
	Dec. 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: For the Year Ended December 31, 2022 2021 Leasehold improvement reimbursement $ 2,885 $ — Income tax receivable 958 4,116 OEM Safety Stock receivable 900 1,000 Prepaid expenses 941 2,553 Other receivable 965 815 Insurance recovery receivable — 1,500 Total Prepaid and Other Current Assets $ 6,649 $ 9,984

Property and Equipment

Property and Equipment	12 Months Ended
	Dec. 31, 2022
Property, Plant and Equipment [Abstract]
Property and Equipment	Property and Equipment Property and equipment are as follows: For the Year Ended December 31, 2022 2021 Processing equipment $ 266 $ 346 Surgical instruments 543 489 Office equipment, furniture and fixtures 1 15 Computer equipment and software 40 44 Construction in process 1,207 51 Total Property and equipment $ 2,057 $ 945 For the years ended December 31, 2022 and 2021, the Company had depreciation expense in connection with property and equipment of $2.0 million and $2.5 million, respectively. The Company uses the straight-line method of depreciation. For the years ended December 31, 2022 and 2021, the Company recorded asset impairment and abandonment charges of $3.7 million and $11.0 million, respectively, for property and equipment as a result of negative forecasted cash flows. The fair value of property and equipment was measured utilizing an orderly liquidation value of each of the underlying assets. Refer to Note 14 for further information on impairment. Construction in process is further presented below: For the Year Ended December 31, 2022 2021 Beginning balance as of January 1 $ 51 $ — Capitalized 1,207 5,015 Impairment — (4,964) Assets transferred into service (51) — Ending balance as of December 31 $ 1,207 $ 51 For the years ended December 31, 2022 and 2021, the Company capitalized a total of $1.2 million and $0.0 million of employee costs related to enhancements for the HOLO™ Portal surgical guidance system, including stock-based compensation expense of $0.1 million and $0.0 million for the respective periods. No impairment has been taken as the Company has determined cost incurred will result in additional functionality for the system. These costs are recorded within “Construction in Process” on the consolidated balance sheet as of December 31, 2022 as the enhancements to the system are still being developed and have not been submitted to the FDA. We expect this to happen in the first half of 2023. For the years ended December 31, 2022 and 2021, the Company capitalized a total of $0.0 million and $4.5 million of internal software expense related to activities associated to the Enterprise Resource Planning (“ERP”) system implementation. 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. The Company subsequently impaired the costs in the quarter they were capitalized due to our continued negative operating cash flows. We recorded impairment charges of $0.0 million and $4.4 million, respectively and recorded those charges within the "Asset impairment and abandonments" line on the consolidated statements of comprehensive loss. Note 14 further discusses impairment methods applied for the ERP system. For the years ended December 31, 2022 and 2021, the company expensed $0.7 million and $0.1 million, respectively, related to the ERP implementation as they were not associated to the design and development phase of the

Debt

Debt	12 Months Ended
	Dec. 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 $10.2 million and $10.0 million as of December 31, 2022 and 2021, respectively, as it was issued in conjunction with the acquisition of the equity interest in INN. All principal and accrued interest due and payable on the earlier of December 30, 2024, or the date upon which a change in control occurs. A change of control occurs when (i) the current shareholders of the Company will no longer own a majority of the outstanding voting shares of the Company due to a transaction or series of related transactions, or (ii) a sale or transfer of Holo Surgical Inc and Inteneural Networks Inc or all or substantially all of their assets. 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 years ended December 31, 2022 and 2021, management accrued $0.2 million and $0.0 million, respectively, in interest expense and accredited, $0.8 million and $0.0 million, respectively, related to the seller notes for a total interest expense of $1.0 million and $0.0 million, respectively. In the event of default, as defined in the agreement, any and all of the indebtedness may be immediately declared due and payable, and the interest would accrue at a 4.0% higher rate. There is no prepayment penalty or covenants related to the fixed rate notes. The Seller Notes were issued as deferred consideration in connection with the INN Purchase Agreement discussed at Note 1, Note 7 and Note 25. Debt issuance costs were immaterial and were included within the overall costs of the acquisition of INN. Related costs were expensed under "Asset acquisition expenses" in our consolidated statements of comprehensive loss. The following table summarizes the debt recorded on the consolidated balance sheet: Carrying Value (In thousands) 2022 2021 Seller Notes-P. Lewicki $ 5,306 $ 5,306 Seller Notes-K. Siemionow 5,306 5,306 Less: accretion of acquisition adjustment (420) (630) Total Seller Notes - related party 10,192 9,982 Current portion of seller notes — — Total long-term seller notes, excluding current portion $ 10,192 $ 9,982 As of December 31, 2022 and 2021, the fair value of the Seller Notes is $10.2 million and $10.0 million, respectively. The Company has determined that the Seller Notes is a Level 2 financial instrument as there are other unobservable inputs. As of December 31, 2022, the future maturities of long-term debt, excluding deferred financing costs, accrued interest and debt discount, were as follows (in thousands): 2023 $ — 2024 10,612 2025 — 2026 — 2027 — Thereafter — Total $ 10,612

Net Loss Per Common Share

Net Loss Per Common Share	12 Months Ended
	Dec. 31, 2022
Earnings Per Share [Abstract]
Net Loss Per Common Share	Net Loss Per Common Share The number of shares of common stock used in the calculation of basic and diluted net loss per common share is presented below: For the Year Ended December 31, 2022 2021 Weighted average basic and dilutive shares 6,555,207 4,086,409 For the years ended December 31, 2022 and 2021, the Company recorded a net loss from its continuing operations. As a result, the Company has excluded all potential dilutive shares for stock options, restricted stock units, and restricted stock awards, pre-funded warrants, and outstanding warrants from the computation of the diluted net loss per share to avoid the anti-dilutive effect. The following table includes the number of potential dilutive shares that were excluded due to the anti-dilutive effect: For the Year Ended December 31, 2022 2021 Stock Options — — Restricted Stock Units and Restricted Stock Awards 268,502 106,607 Pre-funded warrants 4,926,498 — Warrants 675,747 — Total 5,870,747 106,607 For the year end December 31, 2022 and December 31, 2021, the company excluded 92,358 and 176,856 respectively, of issued stock options in the computation of diluted net loss per common share because their exercise price exceeded the average market price during the respective periods. Also, for the year ended December 31, 2022 and December 31, 2021, 1,601,545 and 1,024,154 of the Company’s outstanding warrants were excluded from the computation of diluted net loss per common share as they were considered “out-of-the-money.”

Fair Value Information

Fair Value Information	12 Months Ended
	Dec. 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. Fair value is assessed each reporting period, or more frequently, if circumstances dictate the need to revalue amounts recorded. The carrying value of cash and cash equivalents, accounts receivable, inventories, prepaid and other current assets, accounts payable and accrued expenses are reasonable estimates of their fair values, due to the short-term nature of the accounts. Management has determined that the company's contingent consideration resulting from its acquisitions, property and equipment, definite-lived intangibles assets, other assets, and warrant liability are within the Level 3 fair value hierarchy and are measured using Level 3 inputs as described below. Contingent Consideration Changes in the fair value of contingent consideration are recorded in the "Gain on acquisition contingency" line in the consolidated statements of 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. 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 208,333 shares of common stock, par value $0.001 of the Company (“Common Stock”). In addition, following the closing, the Seller will be entitled to receive contingent consideration from the Company valued in an aggregate amount of up to $83.0 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. 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 208,333 shares of Common Stock issued at closing) is equal to 496,666 shares of Common Stock (or otherwise, to the extent a lower number, the maximum number of shares of Common Stock that would not require obtaining stockholder approval under the applicable rules of the Nasdaq Stock Market). Following the attainment of that limitation, the post-closing contingent payments would be payable in cash. The number of shares of Common Stock issued as contingent consideration with respect to the achievement of a post-closing milestone, if any, will be calculated base d 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 amend one of the regulatory milestones beyond December 31, 2021. This first 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 288,333 in common stock at a value of $5.9 million, and also paid the Seller Group Members $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 second regulatory milestone within the Purchase Agreement had an achievement date of December 31, 2022, which was not achieved. This was reflected within the valuation of the milestones as of December 31, 2022. The Company determined the fair value of the Holo Milestone Payments to be the present value of each future payment amount estimated using a probability-weighted model, driven by the probability of success factor and expected payment date. The probability of success factor was used in the fair value calculation to reflect inherent regulatory, development and commercial risk of the Holo Milestone Payments. More specifically, the probability of expected achievement of the specific milestones, including risks associated with the uncertainty regarding the achievement and payment of milestones; obtaining regulatory approvals in the United States and Europe; the development of new features used with the product; the adaption of the new technology by surgeons; and the placement of the devices within the field. This fair value measurement is based on significant unobservable inputs in the market and thus represents a Level 3 measurement within the fair value hierarchy. Inputs used in estimating the fair value of the contingent consideration for Holo Surgical as of December 31, 2022 and 2021, are summarized below: Fair Value at December 31, 2022 Valuation Technique Unobservable Inputs Ranges $24,061 Earn-Out Valuation Probability of success factor 0% - 95% Discount rates 13.09% - 13.80% 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) for the years ended December 31, 2022 and 2021, (in thousands): For the Year Ended December 31, 2022 2021 Beginning balance as of January 1 $ 51,928 $ 56,515 Contingent consideration – Holo Milestone Payments (10,000) — Gain on acquisition contingency (17,867) (4,587) Ending balance as of December 31 $ 24,061 $ 51,928 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 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 357,653 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 There are no amounts recorded as contingent consideration as of December 31, 2022 or 2021, with the last milestones expiring on December 31, 2022. Property and Equipment, Definite-Lived Intangibles and Other Assets As further discussed in Note 11, as of December 31, 2022 and 2021, respectively, property and equipment with a carrying amount of $6.0 million and $12.0 million were written down to their estimated fair value of $2.3 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. Because the Company’s forecasted cash flow being negative, any intangible assets acquired during the year was immediately impaired. Unobservable inputs for the orderly liquidation value included replacement costs, physical deterioration estimates and market sales data for comparable assets. Unobservable inputs for the income approach included forecasted cash flows generated from use of the definite-lived intangible assets. As a result of impairments recognized, the following table summarizes the post impairment fair values of the corresponding assets subject to fair value measured using Level 3 inputs for the years ended December 31, 2022 and 2021, and the corresponding impairment charge during the respective year: For the Year Ended December 31, 2022 Impairment Net Book Value Property and equipment - net $ 3,684 $ 2,316 Definite-lived intangible assets - net 492 — Other assets - net 1,176 5,527 Total $ 5,352 $ 7,843 For the Year Ended December 31, 2021 Impairment Net Book Value Property and equipment - net $ 11,018 $ 945 Definite-lived intangible assets - net 782 — Other assets - net 395 5,970 Total $ 12,195 $ 6,915 As of December 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 intangible assets, and other assets for impairment. As a result, we recorded an impairment charge of $5.4 million and $12.2 million for the years ended December 31, 2022 and 2021, respectively, within the “Asset impairment and abandonments” line item on the consolidated statement of comprehensive loss. Warrant Liability Warrants are accounted for as liabilities in accordance with ASC 815-40 and are presented within "Warrant liability" in the Company’s consolidated balance sheets. The warrant liability is revalued each reporting period with the change in fair value recorded in the "Change in fair value of warrant liability" line item in the consolidated statements of comprehensive loss until the warrants are exercised or expire. The following table presents information about the Company’s liabilities that are measured at fair value: Level December 31, 2022 December 31, 2021 Warrant liability 3 $ 22,982 $ 12,013 June 14, 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 14, 2021 warrant liability including investor warrants and placement agent warrants for the years ended December 31, 2022 and 2021 (in thousands): For the Year Ended December 31, 2022 2021 Beginning balance as of January 1 $ 12,013 $ — Fair value of warrants on date of issuance — 26,749 Change in fair value of restriked warrants (1) 866 — Transfer of warrants (2) (929) — Change in fair value of warrant liability (11,937) (14,736) Ending balance as of December 31 $ 13 $ 12,013 (1) The following relates to the changes in fair value of the amended warrants from September 30, 2022 to November 16, 2022 related to the warrants which were restriked as part of the November Financing transaction. This change in fair value is recorded within the “Transaction and financing expenses” line item on the consolidated statement of comprehensive loss. Refer to footnote 15 for further explanation. (2) As the restriked warrants have the same assumptions and valuation inputs, the value was analyzed as part of the November 2022 financing. The warrant liability is revalued each reporting period with the change in fair value recorded in the accompanying consolidated statements of comprehensive loss until the warrants are exercised or expire. The fair value of the warrant liability is estimated using the Black-Scholes Option Pricing Model using the following valuation inputs: December 31, 2022 December 31, 2021 Stock price $ 1.99 $ 0.72 Risk-free interest rate 4.53 % 0.84 % Dividend yield — — Volatility 110 % 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 including investor warrants and underwriter warrants for the year ended December 31, 2022 (in thousands): Warrant Liability Beginning balance as of January 1 $ — Fair value of warrants on date of issuance 10,157 Change in fair value of restriked warrants (1) 448 Transfer of warrants (2) (1,064) Redemption of shares (1,749) Change in fair value of warrant liability (7,350) Ending balance as of December 31 $ 442 (1) The following relates to the changes in fair value of the amended warrants from September 30, 2022 to November 16, 2022 related to the warrants which were restriked as part of the November Financing transaction. This change in fair value is recorded within the “Transaction and financing expenses” line item on the consolidated statement of comprehensive loss. Refer to footnote 15 for further explanation. (2) As the restriked warrants have the same assumptions and valuation inputs, the value was analyzed as part of the November 2022 financing. The warrant liability is revalued each reporting period with the change in fair value recorded in the accompanying consolidated statements of comprehensive loss until the warrants are exercised or expire. The fair value of the warrant liability is estimated using the Black-Scholes Option Pricing Model using the following valuation inputs: December 31, 2022 Stock price $ 1.99 Risk-free interest rate 4.05 % Dividend yield — Volatility 95 % November 13, 2022 Warrants The table presented below is a summary of changes in the fair value of the Company’s Level 3 valuation for the November 13, 2022 warrant liability for the year ended December 31, 2022 (in thousands) : Warrant Liability Pre-funded Warrants Series A Warrants Series B Warrants Placement Agent Warrants Beginning balance as of January 1 $ — $ — $ — $ — Fair value of warrants on date of issuance 12,724 10,671 2,570 596 Transfer of warrants — 1,993 — — Redemption of shares (487) — — — Change in fair value of warrant liability (2,434) (2,421) (570) (115) Ending balance as of December 31 $ 9,803 $ 10,243 $ 2,000 $ 481 The warrant liability is revalued each reporting period with the change in fair value recorded in the accompanying consolidated statements of comprehensive loss until the warrants are exercised or expire. The fair value of the warrant liability is estimated using the Black-Scholes Option Pricing Model using the following valuation inputs: December 31, 2022 Pre-funded Warrants (1) Series A Warrants Series B Warrants Placement Agent Warrants Stock price $ 1.99 $ 1.99 $ 1.99 $ 1.99 Risk-free interest rate N/A 3.96 % 4.20 % 3.97 % Dividend yield N/A — — — Volatility N/A 90 % 105 % 90 % (1) The fair value of the pre-funded warrants has been calculated as the difference between the stock price and exercise price. No other inputs are applicable.

Share Offering and Warrants

Share Offering and Warrants	12 Months Ended
	Dec. 31, 2022
Warrants and Rights Note Disclosure [Abstract]
Share Offering and Warrants	Share Offering and Warrants On November 13, 2022, we entered into a securities purchase agreement (the “Purchase Agreement”) with a single institutional investor pursuant to which we agreed to sell, in a registered direct offering 740,000 shares of our common stock, pre-funded warrants exercisable for up to an aggregate of 5,260,000 shares of common stock, Series A warrants to purchase an aggregate of up to 6,000,000 shares of common stock, and Series B warrants to purchase an aggregate of up to 1,500,000 shares of common stock with gross proceeds of $12.0 million . The offering price for each share of common stock and accompanying warrants is $2.0000 and the offering price for each pre-funded warrant and accompanying warrants is $1.9990. Series A warrants are exercisable through November 13, 2027, Series B warrants are exercisable through November 13, 2025, and pre-funded warrants will expire when exercised in full. We received net proceeds of $10.8 million from the offering after deducting investor and other filing fees of $1.2 million, which is reflected in the “Transaction and financing expenses” line in the consolidated statement of comprehensive loss. 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. As all the warrants were determined to be liability classified, the proceeds are first allocated to the warrant based on the fair value on the November 16, 2022 transaction closing date. As the fair value of the warrants exceeded the net proceeds of the offering, the remaining fair value of the warrants was recorded through a charge to the consolidated statement of comprehensive loss. The total charge to the consolidated statement of comprehensive loss was $15.7 million as of December 31, 2022 and recorded within the “Transaction and financing expenses” line. As there were no remaining proceeds to allocate to equity, no amounts were recorded within the consolidated statement of Stockholders’ Equity. as of December 31, 2022 related to this transaction. During the fourth quarter of 2022, 331,000 shares of the pre-funded warrants were exercised, leading to 4,929,000 pre-funded warrants still outstanding as of December 31, 2022. As a result of the exercise, the associated warrant liability was reduced and offset against the “Additional Paid-In Capital” and “Common Stock” sections of the Company’s consolidated balance sheets. The Company, also in connection with the 2022 registered direct offering, entered into a warrant amendment agreement (“Warrant Amendment Agreement”) with the purchaser party to the Purchase Agreement pursuant to which the Company agreed to amend the purchaser’s existing warrants to purchase up to 521,739 shares of Common Stock at an exercise price of $51.7500 per share issued in June 2021 and warrants to purchase up to 597,826 shares of Common stock at an exercise price of $18.0000 per share issued in February 2022 (the “Existing Warrants”), and lowered the exercise price of the Existing Warrants to $1.8150 per share and extended the termination date of the Existing Warrants to November 16, 2027. As a result of the amendment, we included the warrants in the November 13, 2022 Series A outstanding warrants valuation as of December 31, 2022 as these warrants have the same assumptions and valuation inputs. Fair value changes of $1.3 million associated with the transfer are reflected in the “Transaction and financing expenses” line in the consolidated statement of comprehensive loss. The total impact on the “Transaction and financing expenses” line associated with the November 13, 2022 warrant financing was $17.0 million . The Company, also in connection with the 2022 registered direct offering, issued the placement agent or its designees warrants to purchase an aggregate of up to 360,000 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 $2.5000 per share and will expire on November 13, 2027. On February 15, 2022, we issued and sold in an underwritten public offering 1,285,507 shares of common stock and 163,768 of pre-funded warrants to purchase common stock with gross proceeds of $20.0 million at an effective offering price of $13.8000 and $13.7970 per share respectively. In addition, the Company issued warrants to purchase up to an aggregate of 1,086,956 shares of common stock at a strike price of $18.0000 that are exercisable through February 15, 2027. Finally, the Company granted the underwriters the option for a period of 30 days from February 15, 2022 to purchase up to 217,391 additional shares of our common stock at the public offering price of $13.7970 per share and/or warrants to purchase up to 163,043 shares of the Company’s common stock at a public offering price of $0.0030 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 December 31, 2022. We received net proceeds of $17.7 million after deducting investor fees of $2.3 million. Investor fees have been allocated between the value of the warrant liability and the amounts recorded within the Consolidated Statement of Shareholders' Equity. Fees allocated to the warrant liabilities were $0.9 million and is reflected in the “Transaction and financing expenses” line in the consolidated statement of comprehensive 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 consolidated balance sheets. Upon any exercise of the offering warrants issued in the offering for cash, the Company agreed to pay the underwriter 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 underwriter or its designees warrants to purchase an aggregate of up to 86,956 shares of its common stock. The underwriter warrants have substantially the same terms as the warrants described above, except that the underwriter warrants will have an exercise price of $17.2500 per share, and holders of the underwriter warrants are not entitled to receive cash dividends issued by the Company during such time as the underwriter warrant is outstanding. On June 14, 2021, the Company issued and sold in a registered direct offering priced at-the-market an aggregate of 966,183 shares of its common stock and warrants exercisable for an aggregate of 966,183 shares of Company common stock with gross proceeds of $50.0 million at a combined purchase price of $51.7500 per share. The warrants have an exercise price equal to $51.7500 per share, are exercisable immediately upon issuance and are exercisable through June 14, 2024. The net proceeds from the direct offering, after deducting investor and management fees, were $45.8 million after deducting investor fees of $4.2 million . Investor fees have been allocated between the value of the warrant liability and the amounts recorded within the Consolidated Statement of Shareholders’ Equity. Fees allocated to the warrant liabilities were $2.1 million and is reflected in the “Transaction and financing expenses” line in the consolidated statement of comprehensive loss. The remaining $2.1 million is allocated to common shares and is reflected in “Additional Paid-In Capital” and “Common Stock” sections of the Company’s consolidated balance sheets. 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 2021 registered direct offering, issued the placement agent or its designees warrants to purchase an aggregate of up to 57,971 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 $64.6875 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 as derivative liabilities in accordance with ASC 815, (“ASC 815”), under which the warrants did not meet the criteria for the equity scope exception from derivative accounting and thus were recorded as liabilities. As derivatives, and in accordance with ASC 815, these warrants were measured at fair value at inception and will be remeasured at each reporting date with changes in fair value recognized in the consolidated statements of comprehensive loss in the period of change. See Note 14 for information about the fair value measurement of the warrants liability and Level 3 inputs used in the Black Scholes Option Pricing Model. On February 1, 2021, we closed a public offering and sold a total of 956,666 shares of our common stock at a price of $45.0000 per share, less the underwriter discounts and commissions. We received gross proceeds of $44.5 million

Accrued Expenses

Accrued Expenses	12 Months Ended
	Dec. 31, 2022
Payables and Accruals [Abstract]
Accrued Expenses	Accrued Expenses Accrued expenses are as follows: For the Year Ended December 31, 2022 2021 Accrued compensation $ 3,614 $ 5,258 Accrued distributor commissions 3,801 2,957 Accrued severance and restructuring costs 1,041 — Accrued securities class action settlement — 1,500 Other 4,690 8,054 Total accrued expenses $ 13,146 $ 17,769

Other Long-term liabilities

Other Long-term liabilities	12 Months Ended
	Dec. 31, 2022
Other Liabilities, Noncurrent [Abstract]
Other Long-term liabilities	Other Long-term liabilities Other long-term liabilities are as follows: For the Year Ended December 31, 2022 2021 Acquisition contingencies $ 24,061 $ 26,343 Warrant liability 22,982 12,013 Lease obligations 1,142 947 Retention credit 3,222 — Other 3,219 2,229 Total other long-term liabilities $ 54,626 $ 41,532

Income Taxes

Income Taxes	12 Months Ended
	Dec. 31, 2022
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes The Company’s pre-tax loss consists of the following components: Year Ended December 31, 2022 2021 Pre-tax loss: Domestic (U.S., state and local) $ (42,987) $ (114,731) Foreign (loss) income (12,661) (9,061) Total pre-tax loss $ (55,648) $ (123,792) The Company’s income tax provision (benefit) consists of the following components: Year Ended December 31, 2022 2021 Current: Federal $ 151 $ 426 State 23 (1,325) International 34 184 Total current 208 (715) Deferred: Federal — (25) State — (4) International (1,251) (142) Total deferred (1,251) (171) Total income tax (benefit) provision $ (1,043) $ (886) The Company’s deferred tax assets and liabilities consists of the following components: For the Year Ended December 31, 2022 For the Year Ended December 31, 2021 Assets Liabilities Assets Liabilities Accounts receivable $ 2,385 $ — $ 2,376 — Accrued liabilities 1,951 — 720 — Deferred compensation 943 — 1,876 — Fixed assets and intangibles 19,128 — 22,096 — Inventory 11,845 — 7,066 — Net operating losses and other carryforwards 36,382 — 30,187 — Tax credits 1,406 — 265 — Lease Liability 230 — 318 — Right of Use Asset — (143) — (224) Capitalized Research and Development 4,326 — — — Other 14 — 408 — Valuation allowance (77,123) — (65,007) — Total $ 1,487 $ (143) $ 305 $ (224) On December 30, 2021, the Company entered into a Stock Purchase Agreement to acquire interest in Inteneural Networks Inc. The total consideration of the asset acquisition was determined to be $72.3 million, with $10.3 million in forward contracts related to the three potential milestone payments and $41.7 million in non-controlling interest related to the 58% equity interest not purchased. The Company treated the transaction as a non-taxable acquisition of stock for tax purposes and reversed the $72.1 million expense related to the purchased IPR&D, $0.4 million acquisition expenses, and $0.2 million impairment related to the assembled workforce when calculating 2021 tax expense. (See Note 7 "Business Combinations and Acquisitions" for additional information). The Tax Cuts and Jobs Act (TCJA) requires taxpayers to capitalize and subsequently amortize research and experimental (R&D) expenditures that fall within the scope of Internal Revenue Code Section 174 for tax years starting after December 31, 2021. This rule became effective for the Company during the year and resulted in the estimated deferred tax asset for capitalization of R&D costs of $4.3 million, based on interpretation of the law as currently enacted. The Company will amortize these costs for tax purposes over 5 years if the R&D was performed in the U.S. and over 15 years if the R&D was performed outside the U.S, rather than deducting such costs in the year incurred for tax purposes. As of December 31, 2022, the Company has U.S. federal net operating loss carryforwards of $24.9 million, of which, $1.5 million will expire in years 2037 through 2038, and approximately $23.4 million will carryforward indefinitely. As of December 31, 2022, the Company has U.S. state net operating loss carryforwards of approximately $4.6 million, of which, $3.7 million will expire in the years 2023 through 2042, and approximately $0.9 million will carryforward indefinitely. As of December 31, 2022, the Company has non-U.S. net operating loss carryforwards of approximately $6.6 million, which will carryforward indefinitely. The Company has offset all of the U.S. federal and state net operating loss carryforwards and approximately $5.4 million of the non-U.S. net operating loss carryforwards by a valuation allowance based on management’s judgment that it is more likely than not that the benefits of those deferred tax assets will not be realized in the future. As of December 31, 2022, the Company has U.S. research and development credit carryforwards of approximately $1.4 million which will expire in the years 2041 through 2042. As of December 31, 2022, the Company has disallowed U.S. interest expense net of tax of approximately $0.5 million subject to Internal Revenue Code Section 163(j) limitations, which may be carried forward indefinitely. The Company has offset all of the research and development credit and disallowed U.S. interest carryforwards by a valuation allowance. U.S. income taxes have not been provided on the undistributed earnings of the Company’s foreign subsidiaries. It is not practicable to estimate the amount of tax that might be payable. The Company’s intention is to indefinitely reinvest earnings of its foreign subsidiaries outside of the U.S. The Company evaluates the need for a valuation allowance against its deferred tax assets 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 income tax benefit for the year ended December 31, 2022 includes a $1.5 million income tax benefit for the release of valuation allowances. The Company has evaluated all evidence, both positive and negative and maintains a valuation allowance of $77.1 million on U.S. deferred tax assets and certain non-U.S. jurisdictions as of December 31, 2022 . The Company maintained a full valuation allowance of $65.0 million in the United States as well as most foreign jurisdictions as of December 31, 2021. The Company’s unrecognized tax benefits are summarized as follows: For the Year Ended December 31, 2022 2021 Opening balance $ 2,082 $ 2,991 Additions based on tax positions related to the current year — — Additions for tax positions of prior years — 542 Reductions for tax positions of prior years — (1,451) Reductions for expiration of statute of limitations — — $ 2,082 $ 2,082 The unrecognized tax benefits if recognized, would favorably impact the Company’s effective tax rate. It is reasonably possible that the unrecognized tax benefits will not significantly increase or decrease during the next twelve months. The unrecognized tax benefits of $2.1 million as of December 31, 2022 are presented with other long-term liabilities. The Company’s policy is to recognize interest and penalties accrued related to unrecognized tax benefits in the provision for income taxes. As of December 31, 2022, the Company has accrued interest and penalties of $0.2 million. As of December 31, 2021, the Company has accrued interest and penalties of $0.1 million. As of December 31, 2022, we have had no ongoing audits in the U.S. or any major non-U.S. jurisdictions. The tax years that are open to examination are U.S. federal periods from 2019 to current and state taxes from 2017 to current. The Company's U.S. and foreign tax attribute carryforwards remain open to examination. The effective tax rate differs from the statutory federal income tax rate for the following reasons: For the Year Ended December 31, 2022 2021 Statutory federal rate 21.00 % 21.00 % State income taxes—net of federal tax benefit 0.03 % 0.00 % Foreign rate differential 6.03 % 1.33 % Acquisition expenses 0.00 % (5.21) % Loss on acquisition contingency 6.74 % 0.78 % Change in fair value of the warrant liability 9.37 % 2.50 % Non-deductible items (11.58) % (0.99) % Noncontrolling interest 0.00 % (7.11) % Tax attributes 1.26 % (0.22) % Valuation allowances (24.90) % (12.61) % Uncertain tax positions (0.18) % 0.95 % Tax filings & account adjustments (5.74 %) 0.04 % Other reconciling items, net (0.16) % 0.25 % Effective tax rate 1.87 % 0.71 % For the years ended December 31, 2022 and 2021, the Company had no individually significant other reconciling items. The other reconciling items line includes non-significant officer compensation and stock-based compensation for all years presented.

Stockholders' Equity

Stockholders' Equity	12 Months Ended
	Dec. 31, 2022
Equity [Abstract]
Stockholders' Equity	Stockholders’ Equity Common Stock —The Company has 300,000,000 shares of common stock authorized. Holders of common stock are entitled to one vote for each share held at all stockholder meetings. Shares of common stock do not have redemption rights. The Company is, and may in the future become, party to agreements and instruments that restrict or prevent the payment of dividends on our capital stock.

Severance and Restructuring Cos

Severance and Restructuring Costs	12 Months Ended
	Dec. 31, 2022
Restructuring and Related Activities [Abstract]
Severance and Restructuring Costs	Severance and Restructuring Costs On November 8, 2022, the Board approved a restructuring plan intended to help the Company drive growth in what it views to be the most valuable and profitable parts of its business (Digital Health and core hardware assets). Throughout 2022, the Company has focused on bringing new products to market and the commercialization of new technologies, improving operational efficiencies, and lowering its working capital requirements. The Board-approved restructuring plan includes brand and product portfolio rationalization in the domestic markets, a scaled-down international business with operations winding down throughout 2023, a reduction in workforce and reduced non-essential spending. The Company began executing on the restructuring plan in December 2022 and plans to continue its efforts through the first half of 2023. The Company also expects to incur approximately $5.5 - $7.5 million in costs related severance and reduction in non-essential spending. In addition the Company recorded $13.8 million related to inventory write downs associated to the product rationalization as of December 31, 2022. With this restructuring plan the Company anticipates estimated cash savings in 2023 of approximately $30.0 - $35.0 million as compared to 2022. Management has recorded $1.2 million in employee related severance costs as of December 31, 2022. The severance costs recorded are comprised of payroll and related healthcare expenses and is reflected in the “Severance and restructuring costs” section of the consolidated statements of comprehensive loss. Severance and restructuring payments have and will be made over periods ranging from one month to three months. Amounts paid during the year did not have a material impact on cash flows of the Company. We expect all of these severance payments to be paid by the second quarter of 2023. In addition to these severance costs, management expects to incur other exit and disposal costs during the first half of 2023 of approximately $2.5 - $3.5 million related to inventory management and the product rationalization. With regards to product portfolio rationalization, the Company wrote down inventory by $13.8 million for the product lines it discontinued and rationalized. These charges were recorded as of December 31, 2022 and are reflected within the “Cost of goods sold” line on the consolidated statements of comprehensive loss. Of this inventory write down, $6.9 million was associated to domestic inventory with the main driver of this write down being the product rationalization. The remaining charge of $6.9 million relates to inventory held internationally. This inventory was written down as the Company has decided to wind down the international business and does not expect to sell through the related inventory. A summary of the total restructuring costs by major component recognized for the fiscal year ending December 31, 2022 is as follows: Employee-Related Product Rationalization Total Year ended December 31, 2022 $ 1,148 $ 13,822 $ 14,970 The following table summarizes the restructuring activities by major component as of December 31, 2022: Employee-Related Product Rationalization Total Incurred during 2022 $ 1,148 $ 13,822 $ 14,970 Paid during 2022 (107) — (107) Non-cash adjustment (1) — (13,822) (13,822) Balance as of December 31, 2022 $ 1,041 $ — $ 1,041

Retirement Benefits

Retirement Benefits	12 Months Ended
	Dec. 31, 2022
Retirement Benefits [Abstract]
Retirement Benefits	Retirement BenefitsThe Company has a qualified 401(k) plan available to all U.S. employees who meet certain eligibility requirements. The 401(k) plan allows each employee to contribute up to the annual maximum allowed under the Internal Revenue Code. The Company has the discretion to make matching contributions up to 6% of the employee’s earnings. For the years ended December 31, 2022 and 2021, the amounts expensed under the plan were $1.3 million and $0.7 million, respectively.

Commitment and Contingencies

Commitment and Contingencies	12 Months Ended
	Dec. 31, 2022
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	. Commitments and Contingencies Acquisition of Paradigm – As discussed in Note 14, on March 8, 2019, the Company acquired Paradigm. Under the terms of the agreement, the Company may have been required to pay up to an additional $150.0 million in a combination of cash and Company common stock based on a revenue earnout consideration. Related to this acquisition, there were three earnout payments based on revenues achieved during periods ending December 31, 2020, December 31, 2021, and December 31, 2022. None of these milestones were achieved including the revenue earnout as of December 31, 2022. There are no outstanding milestones beyond 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 Shortfall Obligations using one of the methods specified in the Distribution Agreement, the Company can continue to market the ViBone implants on a non-exclusive basis. We did not obtain the 2022 minimum purchase obligation; as such we will revert to a non-exclusive distribution agreement for Vibone. As it relates to the prior year minimums, we had previously issued a purchase order for the 2020 and 2021 minimums. The remaining amount on the purchase order for both years combined is $16.4 million. Acquisition of Inteneural Networks Inc. (INN) – As part of the INN acquisition, the Company has the ability to acquire the remaining 58% equity interest in INN based on the achievement of three separate regulatory and revenue based milestones. When each of the milestones are achieved the Company will pay $19.3 million for an additional 19.3% equity interest within INN. The total future commitment of the remaining three milestones is $57.9 million. As of December 31, 2022 the value of the future commitments were $10.0 million and recorded within the mezzanine section of the consolidated balance sheets. Acquisition of Holo Surgical Inc. – 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 288,333 in common stock at a value of $5.9 million, and also paid the sellers $4.1 million in cash for a total payment for achieving the milestone of $10.0 million pursuant to the terms of the agreement. These contingent considerations have a fair value $24.1 million as of December 31, 2022, with $0.0 million classified as current liabilities within “C urrent portion of acquisition contingency – Holo ,” while $24.1 million is included as “ Acquisition contingencies – Holo” in the accompanying consolidated balance sheets. 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 acquisition contingency – Holo” while $26.3 million classified as “ Acquisition contingencies – Holo .” The change in the fair value of the liability of $17.9 million since December 31, 2021, was recognized in the "Gain on acquisition contingency" line of the consolidated statements of comprehensive 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.” On August 5, 2022 , the Company amended the OEM distribution agreement to reduce the Contract Year 3 minimum to $17.9 million and released the Company of any obligation to cure any purchase shortfall in Contract Year 2. In connection with the amendment the Company agreed to pay RTI $2.1 million in relation to any Year 1, Year 2 or Design and Development Agreement shortfall previously incurred. There is no outstanding liability associated with the agreement as of December 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 has made improvements and will continue to do so until occupancy has been 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 from the Lease entry date. The Company will recognize the lease assets and liabilities when the Landlord makes the underlying asset available to the Company and because that event has not occurred, no amounts were accrued as of December 31, 2022. 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 consolidated balance sheets. In addition, the Company maintains a prepaid reimbursement balance of $2.9 million which is recorded within “Prepaid and other current assets” in our consolidated balance sheets. License and Royalty Commitments As of December 31, 2022 and 2021, the Company has entered into product development and fee for service agreements based on contributions to the development and commercialization of certain products. Each royalty agreement: (i) confirms the irrevocable transfer to the Company of all pertinent intellectual property rights; (ii) sets the applicable royalty rate; (iii) sets the period of time during which royalties are payable; (iv) sets the parameters for which the agreement may be terminated by either party; and (v) prohibits the payment of royalties on products sold to entities and/or individuals with whom the surgeon advisor or any other surgeon advisor entitled to royalties is affiliated. As of December 31, 2022 and 2021, the Company’s royalty agreements provide for (i) royalty payments for 7 years from first commercial sale of the relevant product and (ii) a royalty rate for each such agreement ranging from 1.0% to 10.0% of net sales for the particular product to which the surgeon contributed. Related royalty expenses are recorded within "Costs of goods sold" on the consolidated statements of comprehensive loss.

Legal Actions

Legal Actions	12 Months Ended
	Dec. 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, the Company does not believe that any of these claims that were outstanding as of December 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 December 31, 2022, there are a cumulative total of 1,026 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 a Written Opinion on April 11, 2022 affirming in part and remanding in part. The PTAB canceled all challenged claims of the patent on remand on December 1, 2022. LifeNet filed a Notice of Appeal with the Federal Circuit on January 12, 2023. The Court lifted the stay for counts related to 4 of the 5 patents on January 20, 2023 and severed the count relating to the patent claims canceled by the PTAB on December 1, 2022. A trial date has been set for July 22, 2024. In connection with the sale of the Company’s OEM Business, liabilities related to these claims remained a liability retained by the Company. The Company continues to believe the suit is without merit and will vigorously defend its position. However, the Company has entered into preliminary settlement discussions with LifeNet, but at this time an estimate of the settlement cannot be estimated and therefore no amounts have been recorded as of December 31, 2022. Additionally 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 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) of the Securities Exchange Act of 1934 (the “Exchange Act”). On June 30, 2021, the parties to the Lowry Action conducted a mediation session and on July 27, 2021, a binding term sheet settling the Lowry Action was entered into whereby the defendants agreed to pay $10.5 million (inclusive of attorneys’ fees and administrative costs) in exchange for the dismissal with prejudice of all claims. On September 22, 2021, the court granted preliminary approval to the settlement, and the amount was paid by the Company’s insurers under its Directors’ and Officers’ insurance policies. The Court entered an order approving the settlement on January 26, 2022 and no amounts were outstanding on December 31, 2022. The matter is now concluded. Derivative Lawsuits —Three derivative lawsuits have also been filed on behalf of the Company, naming it as a nominal defendant, and demanding a jury trial. On June 5, 2020, David Summers filed a shareholder derivative lawsuit (the “Summers Action”) against certain current and former directors and officers of the Company (as well as the Company as a nominal defendant), in the United States District Court for the Northern District of Illinois asserting statutory claims under Sections 10(b), 14(a), and 20(a) of the Exchange Act, as well as common law claims for breach of fiduciary duty, unjust enrichment and corporate waste. Thereafter, two similar shareholder derivative lawsuits asserting many of the same claims were filed in the same court against the same current and former directors and officers of the Company (as well as the Company as a nominal defendant), as well as a books and records demand under Section 220 of the Delaware General Corporate Law (the “Books and Records Demand”). The three derivative lawsuits have been consolidated into the first-filed Summers Action (together with the Books and Records Demand, the “Derivative Actions”). On September 6, 2020, the court entered an order staying the Summers Action pending resolution of the motions to dismiss in the Lowry Action. On September 30, 2021, the court granted preliminary approval of a proposed settlement of the Derivative Actions (the “Derivative Actions Settlement”). Pursuant to the Derivative Actions Settlement, the Company has agreed to adopt or revise certain corporate governance policies and procedures, and the Company’s insurers agreed to pay $1.5 million to plaintiffs’ counsel. Based on this a corresponding receivable and liability of $1.5 million was recorded within “Prepaid and other current assets,” and “Accrued expenses” on the consolidated balance sheets as of December 31, 2021. On January 24, 2022, the court gave final approval to the Derivative Actions Settlement. The matter is now concluded and no amounts were outstanding on December 31, 2022. GPV I FIZN and StartVenture Poland Sp. z.o.o. ASI SKA — The Company is presently named as a co-defendant along with other companies and individuals, including Dr. Siemionow and Dr. Lewicki, our former Chief Medical Officer and former Director respectively, by former stockholders of Holo Surgical, S.A. (“Holo SA”), individually and/or collectively, for common law fraud, constructive fraud, fraudulent inducement, conspiracy to defraud, and unjust enrichment, unlawful taking and conversion based on illegal and fraudulent actions related to (i) the sale of shares in Holo Surgical, Inc. to Roboticine, (ii) the purchase of Plaintiffs’ ownership interests in Holo SA by Roboticine, and (iii) the subsequent sale of Holo Surgical, Inc. to the Company. The Company does not believe that any of the claims relate to its action with regards to the negotiations nor the purchase of Holo SA and on May 27, 2022, moved to dismiss. On February 7, 2023, the court granted the Company’s motion to dismiss and the deadline for appeal has passed. The matter is now concluded. In the future, we may become subject to additional litigation or governmental proceedings or investigations that could result in additional unanticipated legal costs regardless of the outcome of the litigation. If we are not successful in any such litigation, we may be required to pay substantial damages or settlement costs. Based on the current information

Regulatory Actions

Regulatory Actions	12 Months Ended
	Dec. 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.

Related Party Transactions

Related Party Transactions	12 Months Ended
	Dec. 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 did not enter into any related party transactions in 2022. The following transactions were determined to be with related parties at the time of the transaction: The Holo Surgical Acquisition As discussed in Note 7, 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 the Seller $30.0 million in cash and issued to the Seller 208,333 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 $24.1 million as of December 31, 2022, which must be first paid in shares of our common stock (in an amount up to 288,333 shares) and then paid in cash thereafter, contingent upon and following the achievement of certain regulatory, commercial and utilization milestones by specified time periods occurring up to the sixth (6th) anniversary of the Closing Date. Dr. Pawel Lewicki was appointed to the Company's board of directors on November 23, 2020 and served through May 10, 2022 and Dr. Krzysztof Siemionow was the Company's former Chief Medical Officer. Lewicki and Siemionow indirectly owned approximately 57.5% and 42.5%, respectively, of the outstanding ownership interests in the Seller prior to the acquisition being executed. INN Acquisition

Subsequent Events

Subsequent Events	12 Months Ended
	Dec. 31, 2022
Subsequent Events [Abstract]
Subsequent Events	Subsequent Events The Company evaluated subsequent events as of the issuance date of the consolidated financial statements as defined by FASB ASC 855, Subsequent Events. Coflex Purchase Agreement On February 28, 2023, the Company’s indirect subsidiary Surgalign SPV, Inc., a Delaware corporation (“Surgalign SPV”) formed in February 2023, Surgalign Spine Technologies, Inc, a Delaware corporation and sole stockholder of Surgalign SPV (“Seller”), the Company and Xtant Medical Holdings, Inc., a Delaware corporation (“Xtant” or “Buyer”) entered into an Equity Purchase Agreement (the “Coflex Purchase Agreement”), pursuant to which, among other things and concurrently with execution thereof, Xtant acquired 100% of the issued and outstanding equity of Surgalign SPV, from Seller (the “Coflex Transaction”). No material relationship exists between Xtant and the other parties, other than with respect to the material definitive agreements. The aggregate consideration paid in the Coflex Transaction for 100% of Surgalign SPV’s equity securities was $17.0 million in cash. As a result of the Coflex Transaction, Xtant acquired the Company’s Coflex and Cofix product lines in the United States and worldwide intellectual property rights therein. Seller, Surgalign SPV and Xtant also entered into a Transition Services Agreement, dated as of February 28, 2023 (the “Transition Services Agreement”), in connection with the Coflex Transaction pursuant to which Seller has agreed to provide certain transition services to Xtant immediately after the closing for an agreed upon transition period. Pre-funded warrant exercise

Schedule II - Valuation and Qua

Schedule II - Valuation and Qualifying Accounts	12 Months Ended
	Dec. 31, 2022
SEC Schedule, 12-09, Valuation and Qualifying Accounts [Abstract]
Schedule II - Valuation and Qualifying Accounts	Schedule II Valuation and Qualifying Accounts Years Ended December 31, 2022 and 2021 (Dollars in thousands) Description Balance at Charged to Deductions, Balance at For the year ended December 31, 2022: Allowance for doubtful accounts $ 9,272 $ 1,982 $ 1,393 $ 9,861 Allowance for product returns 105 — 50 55 Deferred tax asset valuation allowance 65,007 12,600 484 77,123 For the year ended December 31, 2021: Allowance for doubtful accounts 8,203 1,722 $ 653 $ 9,272 Allowance for product returns 105 — — 105 Deferred tax asset valuation allowance 45,126 20,459 578 65,007

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	12 Months Ended
	Dec. 31, 2022
Accounting Policies [Abstract]
Principles of Consolidation	Principles of Consolidation — The consolidated financial statements include the accounts of the Company and its wholly owned subsidiaries, Surgalign, Inc., Paradigm Spine, LLC (“Paradigm”), Pioneer Surgical Technology, Inc. (“Pioneer Surgical”), Zyga Technology, Inc. (“Zyga”) and Holo Surgical Inc. (“Holo Surgical”). The Company consolidates the accounts of Inteneural Networks, Inc. ("INN"), a 42% owned subsidiary as control is achieved through means other than voting rights ("variable interest entities" or "VIE") as the Company is deemed to be the primary beneficiary of INN. The consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“U.S. GAAP”). All intercompany balances and transactions have been eliminated in consolidation.
Reclassification	Reclassification —The Company reclassified certain amounts from prior periods to conform with current period presentation of certain consolidated financial statements with no effect on previously reported net income, equity, total assets, or total liabilities.
Use of Estimates	Use of Estimates—The preparation of consolidated financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosures of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Estimates and assumptions relating to inventories, receivables, long-lived assets, contingent considerations, and litigation are made at the end of each financial reporting period by management. Actual results could differ from those estimates.
Foreign Currency Translation	Foreign Currency Translation —The functional currency of the Company’s foreign subsidiaries is the Euro. Assets and liabilities of the foreign subsidiaries are translated at the period end exchange rate while revenues and expenses are translated at the average exchange rate for the period. The resulting translation adjustments, representing unrealized, noncash gains and losses are recorded and presented as a component of comprehensive loss. Gains and losses resulting from transactions of the Company and its subsidiaries, which are made in currencies different from their own, are included in income or loss as they occur and are included in other expenses in the consolidated statements of comprehensive loss.
Fair Value of Financial Instruments	Fair Value of Financial Instruments —The estimated fair value of financial instruments disclosed in the consolidated financial statements has been determined by using available market information and appropriate valuation
Cash and Cash Equivalents	Cash and Cash Equivalents— The Company considers all funds in banks and short-term highly liquid investments with an original maturity of three months or less to be cash and cash equivalents. Cash equivalents comprise overnight repurchase agreements. Cash balances are held at a few financial institutions and usually exceed insurable amounts. The Company mitigates this risk by depositing its uninsured cash in major well capitalized financial institutions.
Accounts Receivable Allowances	Accounts Receivable Allowances — The Company maintains the allowance for estimated losses resulting from the inability of its customers to make required payments. The allowance represents the current estimate of lifetime expected credit losses over the remaining duration of existing accounts receivable considering current market conditions and supportable forecasts when appropriate. The estimate is a result of the Company’s ongoing evaluation of collectability, customer creditworthiness, historical levels of credit losses, and future expectations. At times, it is determined that invoices are uncollectible and need to be written off. This occurs after extensive attempts by the Company to obtain payment, set up payment plans or send to debt collectors. When the Company determines the amount of the actual write-offs for the period, a credit is made to the accounts receivable account to reduce the amount of outstanding accounts receivable with a debit to the allowance account. Write-off activity for the years ended December 31, 2022 and 2021 were $1.4 million and $0.7 million, respectively. Recoveries for the years were not material.
Inventories	Inventories — Inventories are stated at lower of cost or net realizable value, with cost determined using the first-in, first-out method (“FIFO”) applied on a consistent basis. Non-current inventory represents those the Company anticipates will not be sold within the next year. Non-current inventory is estimated by comparing historical and projected sales trends and inventory quantities on hand. Inventory is evaluated for obsolescence and excess quantities by analyzing inventory levels, historical loss trends, expected product lives, product at risk of expiration, sales levels by product and projections of future sales demand. The announced product rationalization was also evaluated in the Company’s obsolescence and excess quantity reserve.
Property and Equipment	Property and Equipment—Property and equipment are stated at cost less accumulated depreciation. The cost of leasehold improvements is amortized on the straight-line method over the shorter of the lease term or the estimated useful life of the asset. Included in property and equipment are costs related to purchased software that are capitalized. Surgical instruments which are included in property and equipment are handheld devices used by surgeons during implant procedures. The Company retains title to the surgical instruments. Depreciation for surgical instruments is included in general and administrative expenses in the accompanying consolidated statements of comprehensive loss.
Internal Use Software	Internal Use Software - The Company accounts for its costs to develop computer software for internal use in accordance with Accounting Standards (“ASC”) 350-40, Internal use Software, specifically for its development and implementation of its new ERP system in January 2022, and for continued enhancements to its HOLO™ AI software technology platform. The Company capitalizes the costs incurred during the application development stage, which generally include costs to design the software configuration and interfaces, coding, installation, and testing, in addition to enhancement costs when determined to result in additional functionality. Costs associated with these developments are
Derivative Instruments & Warrant Financing	Derivative Instruments— The Company reviews debt agreements for embedded features. If these features are not clearly and closely related to the debt host, they meet the definition of a derivative and require bifurcation from the host contract. All derivative instruments, including embedded derivatives are recorded on the balance sheet at their respective fair values. The Company will adjust the carrying value of the derivative liability to fair value at each subsequent reporting date. The changes in the fair value of the derivatives are recorded in the period they occur. Warrant Financing— The Company accounts for its warrants as derivative liabilities as the warrants did not meet the criteria for the equity scope exception from derivative accounting. As derivatives, these warrants were measured at fair value at inception and will be remeasured at each reporting date with changes in fair value recognized in the consolidated statements of comprehensive loss in the period of change.
Debt Issuance Costs	Debt Issuance Costs—Debt issuance costs include costs incurred to obtain financing and are amortized using the straight-line method, which approximates the effective interest method, over the life of the related debt. Debt issuance costs related to a recognized debt liability are presented in the balance sheet as a direct deduction from the carrying amount of that debt liability.
Long-Lived Assets	Long-Lived Assets —The Company reviews its long-lived assets for impairment whenever events or changes in circumstances indicate the carrying value of an asset may not be recoverable. Recoverability is measured by a comparison of the carrying amount to the net undiscounted cash flows expected to be generated by the asset. An impairment loss would be recorded for the excess of net carrying value over the fair value of the asset impaired. The fair value is estimated based on expected discounted future cash flows. The results of impairment tests are subject to management’s estimates and assumptions of projected cash flows and operating results. Changes in assumptions or market conditions could result in a change in estimated future cash flows and the likelihood of materially different reported results. Because the Company’s forecasted cash flow is negative, long-lived assets, including property and equipment and intangible assets subject to amortization were impaired and written down to their estimated fair values in 2022 and 2021.
Other Intangible Assets	Other Intangible Assets —Other intangible assets, which constitutes finite lived assets, generally consist of patents, acquired exclusivity rights, licensing rights, distribution agreements, and procurement contracts. Patents are amortized on the straight-line method over the shorter of the remaining protection period or estimated useful lives of between 8 and 16 years. Trade names, procurement contracts, customer lists, acquired exclusivity rights, and distribution agreements are amortized over estimated useful lives of between 5 to 25 years.
Revenue Recognition	Revenue Recognition — The Company recognizes revenue upon transfer of control of promised implants in an amount that reflects the consideration it expects to receive in exchange for those products. The Company typically transfers control at a point in time upon shipment or delivery of the implants for direct sales, or upon implantation for sales of consigned inventory. The customer is able to direct the use of, and obtain substantially all of the benefits from, the implant at the time the implant is shipped, delivered, or implanted, respectively based on the terms of the contract. The Company’s performance obligations consist mainly of transferring control of implants identified in the contracts. The Company’s transaction price is generally fixed. Payment terms vary but are generally due within 30 days of transferring control. Any discounts or rebates are estimated at the inception of the contract and recognized as a reduction of the revenue. We generally do not bill customers for shipping and handling of our products. We treat shipping and handling costs performed after a customer obtains control of the good as a fulfillment cost and record these costs as a selling expense when incurred. Some of the Company’s contracts offer assurance-type warranties in connection with the sale of a product to a customer. Assurance-type warranties provide a customer with assurance that the related product will function as the parties intended because it complies with agreed-upon specifications. Such warranties do not represent a separate performance obligation and are not material to the consolidated financial statements.
Stock-Based Compensation Plans	Stock-Based Compensation Plans —The Company accounts for its stock-based compensation plans in accordance with ASC 718, Accounting for Stock Compensation (“ASC 718”). ASC 718 requires the measurement and recognition of compensation expense for all stock-based awards made to employees and directors, including restricted stock awards, restricted stock units, stock options and the employee stock purchase plan ("ESPP") purchase rights (i.e., equity-classified awards). Under the provisions of ASC 718, stock-based compensation cost for equity-classified awards is measured at the grant date, based on the calculated fair value of the award, and is recognized as an expense on a straight-line basis over the requisite service period of the entire award (generally the vesting period of an option, including graded vesting schedules, or share award and the offering period of an ESPP purchase right award). The Company currently measures the grant date fair value of restricted stock awards and restricted stock units based on the market value of the Company’s stock on the grant date. The Company uses the Black-Scholes model to value its stock option grants and ESPP purchase rights. The fair value of stock options and awards is determined on the grant date, and the fair value of the ESPP purchase rights is determined on the offering date using assumptions for the expected term, expected volatility, dividend yield, and the risk-free interest rate. The details of those assumptions, is as follows: • The term assumption for stock options is primarily based on the contractual vesting term and historic data related to exercise and post-vesting expiration history experienced by the Company. The Company uses the simplified method for estimating the expected term used to determine the fair value under ASC 718. The expected term is determined separately for the Company’s directors and employees. The term assumption for ESPP purchase is primarily based on the offering period. • The Company’s anticipated volatility level for both stock options and ESPP purchase rights are primarily based on the historic volatility of the Company’s common stock. • The Company’s models for stock options and ESPP purchase rights includes a 0% expected dividend yield assumption, as the Company has not historically paid, nor does it anticipate paying dividends on its common stock. • The risk-free interest rate approximates recent U.S. Treasury note auction results with a similar life to that of the option or ESPP purchase right. The Company’s model does not include a discount for post-vesting restrictions, as the Company has not issued awards with such restrictions.
Research and Development Costs	Research and Development Costs —Research and development costs, including the cost of research and development conducted for others and the cost of contracted research and development, are expensed as incurred.
Transaction and Integration Costs	Transaction and Integration Costs—Transaction and integration costs, including fees associated with strategic initiatives, issuance costs for potential debt and equity offerings, and costs associated with potential M&A activity, are expensed as incurred.
Income Taxes	Income Taxes—The Company uses the asset and liability method of accounting for income taxes. Deferred income taxes are recorded to reflect the tax consequences on future years for differences between the tax basis of assets and liabilities and their financial reporting amounts at each year-end based on enacted tax laws and statutory tax rates applicable to the periods in which the differences are expected to affect taxable income. Valuation allowances are established when necessary to reduce deferred tax assets to amounts which are more likely than not to be realized.
Employee Retention Credit	Employee Retention Credit —Pursuant to the Coronavirus Aid, Relief and Economic Security Act (the “CARES Act”), the Company is eligible for an employee retention credit subject to certain criteria. The Company has accounted for funds received under the CARES Act in accordance with International Accounting Standards (IAS) 20, Accounting for Government Grants and Disclosure of Government Assistance , of International Financial Reporting Standards (“IFRS”). Under an IAS 20 analogy, a business entity would recognize the employee retention credit on a systematic basis over the periods in which the entity recognizes the payroll expenses for which the grant (i.e., tax credit) is intended to
Contingent Consideration	Contingent Consideration — The Company accounts for the contingent consideration related to the Holo Surgical Acquisition as a liability in accordance with the guidance of ASC 480, Distinguishing Liabilities from Equity , because the contingent consideration represents a conditional obligation that has a fixed monetary value known at inception and we may settle by issuing a variable number of our equity shares. The liability is recorded at its fair value at inception and shall be marked to market subsequently at the end of each reporting period, with any change recognized in the current earnings. See Note 7 for further discussion related to the Holo Surgical Acquisition.
Noncontrolling Interest	Noncontrolling Interest— The Company's consolidated noncontrolling interest is comprised of its investment in INN. The Company evaluated whether noncontrolling interest is subject to redemption features outside of the Company's control. We evaluated noncontrolling interest to determine whether it is currently redeemable for cash or probable of being redeemable for cash in the future within the mezzanine section of the consolidated balance sheet. As the noncontrolling interest is not currently redeemable, and is only redeemable upon the occurrence of FDA approval, we will not remeasure at each reporting period until approval is obtained.
Treasury Stock	Treasury Stock — The Company may periodically repurchase shares of its common stock from employees for the satisfaction of their individual payroll tax withholding upon vesting of restricted stock awards in connection with the Company’s incentive plans. The Company’s repurchases of common stock are recorded at the stock price on the vesting date of the common stock.
Earnings Per Share	Earnings Per Share —Basic earnings per share (“EPS”) is computed by dividing earnings attributable to common stockholders by the weighted-average number of common shares outstanding for the periods. Diluted EPS reflects the incremental shares issuable upon the assumed exercise of securities that could share in earnings. Shares whose issuance is contingent upon the satisfaction of certain conditions shall be considered outstanding and included in the computation of diluted EPS as follows: a. If all necessary conditions have been satisfied by the end of the period (the events have occurred), those shares shall be included as of the beginning of the period in which the conditions were satisfied (or as of the date of the contingent stock agreement, if later). b. If all necessary conditions have not been satisfied by the end of the period, the number of contingently issuable shares included in diluted EPS shall be based on the number of shares, if any, that would be issuable if the end of the reporting period were the end of the contingency period (for example, the number of shares that would be issuable based on current period earnings or period-end market price) and if the result would be dilutive. Those contingently issuable shares shall be included in the denominator of diluted EPS as of the beginning of the period (or as of the date of the contingent stock agreement, if later).
Recently Issued and Adopted Accounting Standards	Recently Issued and Adopted Accounting Standards.To date, there have been no recent accounting pronouncements not yet effective that the Company expects will have a material, or potentially material, impact to our consolidated financial statements.

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Tables)	12 Months Ended
	Dec. 31, 2022
Accounting Policies [Abstract]
Schedule of Estimated Useful Lives of Assets	Depreciation is computed on the straight-line method over the following estimated useful lives of the assets: Processing equipment 7 to 10 years Office equipment, furniture and fixtures 5 to 7 years Computer equipment and software 3 to 7 years Surgical instruments 1 year Property and equipment are as follows: For the Year Ended December 31, 2022 2021 Processing equipment $ 266 $ 346 Surgical instruments 543 489 Office equipment, furniture and fixtures 1 15 Computer equipment and software 40 44 Construction in process 1,207 51 Total Property and equipment $ 2,057 $ 945

Leases (Tables)

Leases (Tables)	12 Months Ended
	Dec. 31, 2022
Leases [Abstract]
Schedule of Components of Operating Lease Expense	The components of operating lease expense were as follows: For the Year Ended December 31, For the Year Ended December 31, Operating lease cost $ 462 $ 706 Short-term operating lease cost 916 335 Total operating lease cost $ 1,378 $ 1,041 Supplemental cash flow information related to operating leases was as follows: For the Year Ended December 31, For the Year Ended December 31, Cash paid for amounts included in the measurement of lease liabilities $ 1,405 $ 1,237 ROU assets obtained in exchange for lease obligations 381 57
Schedule of Supplemental Balance Sheet Information Related to Leases	Supplemental balance sheet information related to operating leases was as follows: Balance Sheet Classification Balance at December 31, Balance at December 31, Assets: Right-of-use assets Other assets - net $ 967 $ 876 Liabilities: Current Accrued expenses $ 182 $ 294 Noncurrent Other long-term liabilities 1,142 947 Total operating lease liabilities $ 1,324 $ 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 Year Ended December 31, For the Year Ended December 31, Weighted-average remaining lease term (years) 6.0 6.3 Weighted-average discount rate 4.97 % 5.09 %
Schedule of Maturities of Operating Lease Liabilities (Excluding San Diego Design Center Lease)	As of December 31, 2022, maturities of operating lease liabilities (excluding San Diego Design Center lease) were as follows: Maturity of Operating Lease Liabilities Balance at December 31, 2023 $ 384 2024 402 2025 391 2026 389 2027 and beyond 806 Total future minimum lease payments 2,372 Less imputed interest (1,048) Total $ 1,324

Discontinued Operations (Tables

Discontinued Operations (Tables)	12 Months Ended
	Dec. 31, 2022
Discontinued Operations and Disposal Groups [Abstract]
Schedule of Financial Results and Operating and Investing Cash Flows of Discontinued Operations	The following table presents the financial results of the discontinued operations: Year Ended December 31, Year Ended December 31, 2022 2021 Major classes of line items constituting net income from discontinued operations: Revenues $ — $ — Costs of goods sold — — Gross profit — — Expenses: General and administrative — — Severance and restructuring costs — — Transaction and financing expenses — — Total operating expenses — — Operating income — — Other expense (income): OEM working capital adjustment — 6,316 Interest expense — — Loss on extinguishment of debt — — Derivative loss — — Foreign exchange (gain) loss — — Total other expense - net — 6,316 (Loss) income from discontinued operations — (6,316) Gain on sale of net assets of discontinued operations — — (Loss) Income from discontinued operations before income tax provision — (6,316) Income tax (benefit) provision — (2,674) Net (loss) income on discontinued operations $ — $ (3,642)

Revenue from Contracts with C_2

Revenue from Contracts with Customers (Tables)	12 Months Ended
	Dec. 31, 2022
Revenue from Contract with Customer [Abstract]
Schedule of Total Revenue by Geographical Region	The following table represents total revenue by geographical region for the years ended December 31, 2022 and 2021: Year Ended December 31, 2022 Year Ended December 31, 2021 Revenues: Domestic $ 68,647 $ 77,927 International 13,332 12,573 Total revenues from contracts with customers $ 81,979 $ 90,500

Business Combinations and Acq_2

Business Combinations and Acquisitions (Tables)	12 Months Ended
	Dec. 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): Balance at April 30, 2021 Inventories $ 140 Right-of-use assets 78 Property and equipment 528 Operating lease liabilities (78) Deferred tax liability (28) Net assets acquired $ 640 Bargain purchase gain (90) Total purchase price $ 550

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	12 Months Ended
	Dec. 31, 2022
Share-Based Payment Arrangement [Abstract]
Schedule of Stock-Based Compensation Recognized	For the years ended December 31, 2022 and 2021, the Company recognized stock-based compensation related to equity-classified awards as follows: For the Year Ended December 31, 2022 2021 Stock-based compensation: Costs of goods sold $ — $ 21 General and administrative 4,289 4,839 Research and development 345 352 Total $ 4,634 $ 5,212
Schedule of Stock Options Outstanding, Exercisable and Available for Grant and Other Information	Stock options outstanding, exercisable and available for grant at December 31, 2022, are summarized as follows: Number of Weighted Weighted Aggregate Outstanding at January 1, 2022 177,665 $ 92.26 3.96 $ — Granted — — Exercised — — Forfeited or expired (101,512) 99.26 Outstanding at December 31, 2022 76,153 $ 82.94 6.77 $ — Vested or expected to vest at December 31, 2022 76,153 $ 82.94 6.77 $ — Exercisable at December 31, 2022 52,562 $ 88.02 6.32 $ — Available for grant at December 31, 2022 288,585 Other information concerning stock options are as follows: For the Year Ended December 31, (in thousands, except for per share information) 2022 2021 Weighted average fair value of stock options granted $ — $ 0.93 Aggregate intrinsic value of stock options exercised $ — $ —
Schedule of Weighted-Average Assumptions Used to Determine Fair Value of Options	The following weighted-average assumptions were used to determine the fair value of options and purchases under ASC 718. Please note there were no stock options granted in 2022, so no valuation metrics are provided: Year Ended December 31, 2022 2021 Expected term (years) 0.00 6.35 Risk free interest rate — % 0.72 % Volatility factor — % 49.97 % Dividend yield — — The following weighted-average assumptions were used to determine the fair value of ESPP and purchases under ASC 718: Year Ended December 31, 2022 2021 Expected term (years) 0.50 0.50 Risk free interest rate 1.03 % 0.05 % Volatility factor 91.99 % 84.32 % Dividend yield — —
Schedule of Nonvested Restricted Stock Shares Activity	The following table summarizes information about unvested restricted stock awards as of December 31, 2022: Number of Weighted Unvested at January 1, 2022 21,788 $ 86.65 Granted — — Vested (10,833) 94.42 Forfeited (4,496) 83.49 Unvested at December 31, 2022 6,459 $ 75.81
Schedule of Unvested Restricted Stock Awards	The following table summarizes information about unvested restricted stock units as of December 31, 2022: Number of Weighted Unvested at January 1, 2022 158,972 $ 48.83 Granted 679,403 5.88 Vested (75,970) 50.19 Forfeited (66,314) 29.13 Unvested at December 31, 2022 696,091 $ 8.64

Prepaid and Other Current Ass_2

Prepaid and Other Current Assets (Tables)	12 Months Ended
	Dec. 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: For the Year Ended December 31, 2022 2021 Leasehold improvement reimbursement $ 2,885 $ — Income tax receivable 958 4,116 OEM Safety Stock receivable 900 1,000 Prepaid expenses 941 2,553 Other receivable 965 815 Insurance recovery receivable — 1,500 Total Prepaid and Other Current Assets $ 6,649 $ 9,984

Property and Equipment (Tables)

Property and Equipment (Tables)	12 Months Ended
	Dec. 31, 2022
Property, Plant and Equipment [Abstract]
Schedule of Components of Property and Equipment	Depreciation is computed on the straight-line method over the following estimated useful lives of the assets: Processing equipment 7 to 10 years Office equipment, furniture and fixtures 5 to 7 years Computer equipment and software 3 to 7 years Surgical instruments 1 year Property and equipment are as follows: For the Year Ended December 31, 2022 2021 Processing equipment $ 266 $ 346 Surgical instruments 543 489 Office equipment, furniture and fixtures 1 15 Computer equipment and software 40 44 Construction in process 1,207 51 Total Property and equipment $ 2,057 $ 945
Schedule of Construction in Progress Rollforward	Construction in process is further presented below: For the Year Ended December 31, 2022 2021 Beginning balance as of January 1 $ 51 $ — Capitalized 1,207 5,015 Impairment — (4,964) Assets transferred into service (51) — Ending balance as of December 31 $ 1,207 $ 51

Debt (Tables)

Debt (Tables)	12 Months Ended
	Dec. 31, 2022
Debt Disclosure [Abstract]
Schedule of Long-term Debt Instruments	The following table summarizes the debt recorded on the consolidated balance sheet: Carrying Value (In thousands) 2022 2021 Seller Notes-P. Lewicki $ 5,306 $ 5,306 Seller Notes-K. Siemionow 5,306 5,306 Less: accretion of acquisition adjustment (420) (630) Total Seller Notes - related party 10,192 9,982 Current portion of seller notes — — Total long-term seller notes, excluding current portion $ 10,192 $ 9,982
Schedule of Future Maturities of Long-term Debt	As of December 31, 2022, the future maturities of long-term debt, excluding deferred financing costs, accrued interest and debt discount, were as follows (in thousands): 2023 $ — 2024 10,612 2025 — 2026 — 2027 — Thereafter — Total $ 10,612

Net Loss Per Common Share (Tabl

Net Loss Per Common Share (Tables)	12 Months Ended
	Dec. 31, 2022
Earnings Per Share [Abstract]
Schedule of Common Stock used in Calculation of Basic and Diluted Earnings Per Share	The number of shares of common stock used in the calculation of basic and diluted net loss per common share is presented below: For the Year Ended December 31, 2022 2021 Weighted average basic and dilutive shares 6,555,207 4,086,409
Schedule of Number of Potential Dilutive Shares that Excluded Due to Anti-dilutive Effect	The following table includes the number of potential dilutive shares that were excluded due to the anti-dilutive effect: For the Year Ended December 31, 2022 2021 Stock Options — — Restricted Stock Units and Restricted Stock Awards 268,502 106,607 Pre-funded warrants 4,926,498 — Warrants 675,747 — Total 5,870,747 106,607

Fair Value Information (Tables)

Fair Value Information (Tables)	12 Months Ended
	Dec. 31, 2022
Fair Value Disclosures [Abstract]
Schedule of Fair Value Measurement Inputs, Warrant Liability and Valuation Techniques	Inputs used in estimating the fair value of the contingent consideration for Holo Surgical as of December 31, 2022 and 2021, are summarized below: Fair Value at December 31, 2022 Valuation Technique Unobservable Inputs Ranges $24,061 Earn-Out Valuation Probability of success factor 0% - 95% Discount rates 13.09% - 13.80% 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 warrant liability is revalued each reporting period with the change in fair value recorded in the accompanying consolidated statements of comprehensive loss until the warrants are exercised or expire. The fair value of the warrant liability is estimated using the Black-Scholes Option Pricing Model using the following valuation inputs: December 31, 2022 December 31, 2021 Stock price $ 1.99 $ 0.72 Risk-free interest rate 4.53 % 0.84 % Dividend yield — — Volatility 110 % 130 % The warrant liability is revalued each reporting period with the change in fair value recorded in the accompanying consolidated statements of comprehensive loss until the warrants are exercised or expire. The fair value of the warrant liability is estimated using the Black-Scholes Option Pricing Model using the following valuation inputs: December 31, 2022 Stock price $ 1.99 Risk-free interest rate 4.05 % Dividend yield — Volatility 95 % The warrant liability is revalued each reporting period with the change in fair value recorded in the accompanying consolidated statements of comprehensive loss until the warrants are exercised or expire. The fair value of the warrant liability is estimated using the Black-Scholes Option Pricing Model using the following valuation inputs: December 31, 2022 Pre-funded Warrants (1) Series A Warrants Series B Warrants Placement Agent Warrants Stock price $ 1.99 $ 1.99 $ 1.99 $ 1.99 Risk-free interest rate N/A 3.96 % 4.20 % 3.97 % Dividend yield N/A — — — Volatility N/A 90 % 105 % 90 % (1) The fair value of the pre-funded warrants has been calculated as the difference between the stock price and exercise price. No other inputs are applicable.
Schedule of Reconciliation of Acquisition Contingencies	The following table provides a reconciliation of contingent consideration measured at fair value using significant unobservable inputs (Level 3) for the years ended December 31, 2022 and 2021, (in thousands): For the Year Ended December 31, 2022 2021 Beginning balance as of January 1 $ 51,928 $ 56,515 Contingent consideration – Holo Milestone Payments (10,000) — Gain on acquisition contingency (17,867) (4,587) Ending balance as of December 31 $ 24,061 $ 51,928
Schedule of Impairments of Long-Lived Assets and Related Post Impairment Fair Values	As a result of impairments recognized, the following table summarizes the post impairment fair values of the corresponding assets subject to fair value measured using Level 3 inputs for the years ended December 31, 2022 and 2021, and the corresponding impairment charge during the respective year: For the Year Ended December 31, 2022 Impairment Net Book Value Property and equipment - net $ 3,684 $ 2,316 Definite-lived intangible assets - net 492 — Other assets - net 1,176 5,527 Total $ 5,352 $ 7,843 For the Year Ended December 31, 2021 Impairment Net Book Value Property and equipment - net $ 11,018 $ 945 Definite-lived intangible assets - net 782 — Other assets - net 395 5,970 Total $ 12,195 $ 6,915
Schedule of Liabilities Measured at Fair Value	The following table presents information about the Company’s liabilities that are measured at fair value: Level December 31, 2022 December 31, 2021 Warrant liability 3 $ 22,982 $ 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 14, 2021 warrant liability including investor warrants and placement agent warrants for the years ended December 31, 2022 and 2021 (in thousands): For the Year Ended December 31, 2022 2021 Beginning balance as of January 1 $ 12,013 $ — Fair value of warrants on date of issuance — 26,749 Change in fair value of restriked warrants (1) 866 — Transfer of warrants (2) (929) — Change in fair value of warrant liability (11,937) (14,736) Ending balance as of December 31 $ 13 $ 12,013 (1) The following relates to the changes in fair value of the amended warrants from September 30, 2022 to November 16, 2022 related to the warrants which were restriked as part of the November Financing transaction. This change in fair value is recorded within the “Transaction and financing expenses” line item on the consolidated statement of comprehensive loss. Refer to footnote 15 for further explanation. (2) As the restriked warrants have the same assumptions and valuation inputs, the value was analyzed as part of the November 2022 financing. 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 including investor warrants and underwriter warrants for the year ended December 31, 2022 (in thousands): Warrant Liability Beginning balance as of January 1 $ — Fair value of warrants on date of issuance 10,157 Change in fair value of restriked warrants (1) 448 Transfer of warrants (2) (1,064) Redemption of shares (1,749) Change in fair value of warrant liability (7,350) Ending balance as of December 31 $ 442 (1) The following relates to the changes in fair value of the amended warrants from September 30, 2022 to November 16, 2022 related to the warrants which were restriked as part of the November Financing transaction. This change in fair value is recorded within the “Transaction and financing expenses” line item on the consolidated statement of comprehensive loss. Refer to footnote 15 for further explanation. (2) As the restriked warrants have the same assumptions and valuation inputs, the value was analyzed as part of the November 2022 financing. The table presented below is a summary of changes in the fair value of the Company’s Level 3 valuation for the November 13, 2022 warrant liability for the year ended December 31, 2022 (in thousands) : Warrant Liability Pre-funded Warrants Series A Warrants Series B Warrants Placement Agent Warrants Beginning balance as of January 1 $ — $ — $ — $ — Fair value of warrants on date of issuance 12,724 10,671 2,570 596 Transfer of warrants — 1,993 — — Redemption of shares (487) — — — Change in fair value of warrant liability (2,434) (2,421) (570) (115) Ending balance as of December 31 $ 9,803 $ 10,243 $ 2,000 $ 481

Accrued Expenses (Tables)

Accrued Expenses (Tables)	12 Months Ended
	Dec. 31, 2022
Payables and Accruals [Abstract]
Schedule of Accrued Expenses	Accrued expenses are as follows: For the Year Ended December 31, 2022 2021 Accrued compensation $ 3,614 $ 5,258 Accrued distributor commissions 3,801 2,957 Accrued severance and restructuring costs 1,041 — Accrued securities class action settlement — 1,500 Other 4,690 8,054 Total accrued expenses $ 13,146 $ 17,769

Other Long-term liabilities (Ta

Other Long-term liabilities (Tables)	12 Months Ended
	Dec. 31, 2022
Other Liabilities, Noncurrent [Abstract]
Schedule of Other Long-term Liabilities	Other long-term liabilities are as follows: For the Year Ended December 31, 2022 2021 Acquisition contingencies $ 24,061 $ 26,343 Warrant liability 22,982 12,013 Lease obligations 1,142 947 Retention credit 3,222 — Other 3,219 2,229 Total other long-term liabilities $ 54,626 $ 41,532

Income Taxes (Tables)

Income Taxes (Tables)	12 Months Ended
	Dec. 31, 2022
Income Tax Disclosure [Abstract]
Schedule of Pre-Tax Loss	The Company’s pre-tax loss consists of the following components: Year Ended December 31, 2022 2021 Pre-tax loss: Domestic (U.S., state and local) $ (42,987) $ (114,731) Foreign (loss) income (12,661) (9,061) Total pre-tax loss $ (55,648) $ (123,792)
Schedule of Income Tax Benefit (Provision)	The Company’s income tax provision (benefit) consists of the following components: Year Ended December 31, 2022 2021 Current: Federal $ 151 $ 426 State 23 (1,325) International 34 184 Total current 208 (715) Deferred: Federal — (25) State — (4) International (1,251) (142) Total deferred (1,251) (171) Total income tax (benefit) provision $ (1,043) $ (886)
Schedule of Deferred Tax Assets and Liabilities	The Company’s deferred tax assets and liabilities consists of the following components: For the Year Ended December 31, 2022 For the Year Ended December 31, 2021 Assets Liabilities Assets Liabilities Accounts receivable $ 2,385 $ — $ 2,376 — Accrued liabilities 1,951 — 720 — Deferred compensation 943 — 1,876 — Fixed assets and intangibles 19,128 — 22,096 — Inventory 11,845 — 7,066 — Net operating losses and other carryforwards 36,382 — 30,187 — Tax credits 1,406 — 265 — Lease Liability 230 — 318 — Right of Use Asset — (143) — (224) Capitalized Research and Development 4,326 — — — Other 14 — 408 — Valuation allowance (77,123) — (65,007) — Total $ 1,487 $ (143) $ 305 $ (224)
Schedule of Unrecognized Tax Benefits	The Company’s unrecognized tax benefits are summarized as follows: For the Year Ended December 31, 2022 2021 Opening balance $ 2,082 $ 2,991 Additions based on tax positions related to the current year — — Additions for tax positions of prior years — 542 Reductions for tax positions of prior years — (1,451) Reductions for expiration of statute of limitations — — $ 2,082 $ 2,082
Schedule of Effective Tax Rate	The effective tax rate differs from the statutory federal income tax rate for the following reasons: For the Year Ended December 31, 2022 2021 Statutory federal rate 21.00 % 21.00 % State income taxes—net of federal tax benefit 0.03 % 0.00 % Foreign rate differential 6.03 % 1.33 % Acquisition expenses 0.00 % (5.21) % Loss on acquisition contingency 6.74 % 0.78 % Change in fair value of the warrant liability 9.37 % 2.50 % Non-deductible items (11.58) % (0.99) % Noncontrolling interest 0.00 % (7.11) % Tax attributes 1.26 % (0.22) % Valuation allowances (24.90) % (12.61) % Uncertain tax positions (0.18) % 0.95 % Tax filings & account adjustments (5.74 %) 0.04 % Other reconciling items, net (0.16) % 0.25 % Effective tax rate 1.87 % 0.71 %

Severance and Restructuring C_2

Severance and Restructuring Costs (Tables)	12 Months Ended
	Dec. 31, 2022
Restructuring and Related Activities [Abstract]
Summary of Restructuring Cost and Activities	A summary of the total restructuring costs by major component recognized for the fiscal year ending December 31, 2022 is as follows: Employee-Related Product Rationalization Total Year ended December 31, 2022 $ 1,148 $ 13,822 $ 14,970 The following table summarizes the restructuring activities by major component as of December 31, 2022: Employee-Related Product Rationalization Total Incurred during 2022 $ 1,148 $ 13,822 $ 14,970 Paid during 2022 (107) — (107) Non-cash adjustment (1) — (13,822) (13,822) Balance as of December 31, 2022 $ 1,041 $ — $ 1,041

Business (Details)

Business (Details) $ / shares in Units, $ in Thousands										12 Months Ended
	Feb. 28, 2023 USD ($)	Nov. 13, 2022 USD ($) shares	Oct. 30, 2022 USD ($)	May 16, 2022	Feb. 15, 2022 USD ($) shares	Dec. 30, 2021 USD ($) payment note shares	Jun. 14, 2021 USD ($) shares	Apr. 30, 2021 USD ($) payment	Feb. 01, 2021 USD ($) $ / shares shares	Dec. 31, 2022 USD ($) country shares	Dec. 31, 2021 USD ($)
Business [Line Items]
Countries in which we market and sell (more than) | country										40
Stock split, conversion ratio				0.03333
Cash and cash equivalents										$ 16,295	$ 51,287
Trade accounts payable and accrued expense liabilities										20,900
Accumulated deficit										(624,218)	(569,613)
Net loss from continuing operations										(54,605)	(122,906)
Net loss applicable to Surgalign Holdings, Inc.										$ (54,605)	(84,651)
Sold | Coflex and Cofix product lines | Subsequent Event
Business [Line Items]
Total consideration	$ 17,000
Net cash	$ 14,800
Pre-funded Warrants
Business [Line Items]
Warrants (in shares) | shares										331,000
Public Offering Warrants
Business [Line Items]
Warrants (in shares) | shares					163,043
Purchase Agreement
Business [Line Items]
Common stock sold (in shares) | shares		740,000			1,285,507				956,666
Warrants (in shares) | shares		360,000
Proceeds from issuance of common stock		$ 12,000			$ 20,000
Underwriters options					30 days
Common stock price per share (in dollars per share) | $ / shares									$ 45
Net proceeds, after deduction		$ 10,800
Purchase Agreement | Pre-funded Warrants
Business [Line Items]
Warrants (in shares) | shares		5,260,000			163,768
Purchase Agreement | Series A Warrants
Business [Line Items]
Warrants (in shares) | shares		6,000,000
Purchase Agreement | Series B Warrants
Business [Line Items]
Warrants (in shares) | shares		1,500,000
Purchase Agreement | February 2022 Warrants
Business [Line Items]
Warrants (in shares) | shares		597,826
Purchase Agreement | Placement Agent Warrants
Business [Line Items]
Warrants (in shares) | shares		360,000
Over-Allotment Option
Business [Line Items]
Common stock sold (in shares) | shares					217,391
Over-Allotment Option | Public Offering Warrants
Business [Line Items]
Warrants (in shares) | shares					163,043
Public Offering
Business [Line Items]
Common stock sold (in shares) | shares					1,285,507
Proceeds from issuance of common stock					$ 20,000
Common stock sold (in shares) | shares							966,183
Net proceeds, after deduction					$ 17,700				$ 44,500
Public Offering | Pre-funded Warrants
Business [Line Items]
Warrants (in shares) | shares					163,768
Public Offering | February 2022 Warrants
Business [Line Items]
Warrants (in shares) | shares					1,086,956
Public Offering | Placement Agent Warrants
Business [Line Items]
Warrants (in shares) | shares					86,956		57,971
Public Offering | Investor Warrants
Business [Line Items]
Warrants (in shares) | shares							966,183
Proceeds from issuance of common stock							$ 50,000
Maximum | Purchase Agreement | February 2022 Warrants
Business [Line Items]
Warrants (in shares) | shares					1,086,956
Maximum | Purchase Agreement | Placement Agent Warrants
Business [Line Items]
Warrants (in shares) | shares					86,956
INN Acquisition
Business [Line Items]
Payments to acquire businesses						$ 19,900
Cash consideration						$ 5,000				$ 0	$ 5,000
Shares issuable at closing (in shares) | shares						227,359
Shares issued						$ 4,900
Number of unsecured promissory notes | note						2
Percentage of additional voting interests acquired (as a percent)						19.30%
Equity interests issued and issuable						$ 19,300
INN Acquisition | INN Acquisition
Business [Line Items]
Percentage of voting interests acquired						42%
INN Acquisition | Consideration for remaining ownership, achievement of all milestones
Business [Line Items]
Payments to acquire businesses						$ 72,300
Aggregate principal amount						$ 10,600
Equity interest percentage						100%
Number of milestone payments | payment						3
Contingent liability						$ 10,600
Prompt | Asset Purchase Agreement
Business [Line Items]
Payments to acquire businesses								$ 1,100
Cash consideration			$ 200					300
Shares issued			$ 100					200
Contingent consideration								$ 600
Number of payments | payment								2
First payment								18 months
Second payment								36 months

Summary of Significant Accoun_4

Summary of Significant Accounting Policies - Additional Information (Details) - USD ($)	3 Months Ended	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2022	Dec. 31, 2021	Dec. 30, 2021
Summary Of Significant Accounting Policies [Line Items]
Cash equivalents	$ 0	$ 0	$ 0
Accounts receivable allowances, write-off activity		1,400,000	700,000
Debt issuance costs	0	$ 0	$ 0
Dividend yield		0%	0%
Transaction and integration, related expenses	19,400,000	$ 19,400,000	$ 3,700,000
Employee Retention Credit	$ 3,200,000
Shares acquired (in shares)		14,921	3,633
Repurchase of common stock		$ 100,000	$ 200,000
Other operating income, net		$ 898,000	$ 3,932,000
INN Acquisition | INN Acquisition
Summary Of Significant Accounting Policies [Line Items]
Percentage of voting interests acquired				42%
Patents | Minimum
Summary Of Significant Accounting Policies [Line Items]
Estimated useful lives of intangible assets		8 years
Patents | Maximum
Summary Of Significant Accounting Policies [Line Items]
Estimated useful lives of intangible assets		16 years
Tradenames | Minimum
Summary Of Significant Accounting Policies [Line Items]
Estimated useful lives of intangible assets		5 years
Tradenames | Maximum
Summary Of Significant Accounting Policies [Line Items]
Estimated useful lives of intangible assets		25 years
Procurement contracts | Minimum
Summary Of Significant Accounting Policies [Line Items]
Estimated useful lives of intangible assets		5 years
Procurement contracts | Maximum
Summary Of Significant Accounting Policies [Line Items]
Estimated useful lives of intangible assets		25 years
Customer lists | Minimum
Summary Of Significant Accounting Policies [Line Items]
Estimated useful lives of intangible assets		5 years
Customer lists | Maximum
Summary Of Significant Accounting Policies [Line Items]
Estimated useful lives of intangible assets		25 years
Acquired exclusivity rights | Minimum
Summary Of Significant Accounting Policies [Line Items]
Estimated useful lives of intangible assets		5 years
Acquired exclusivity rights | Maximum
Summary Of Significant Accounting Policies [Line Items]
Estimated useful lives of intangible assets		25 years
Distribution agreements | Minimum
Summary Of Significant Accounting Policies [Line Items]
Estimated useful lives of intangible assets		5 years
Distribution agreements | Maximum
Summary Of Significant Accounting Policies [Line Items]
Estimated useful lives of intangible assets		25 years

Summary of Significant Accoun_5

Summary of Significant Accounting Policies - Estimated Useful Lives of Assets (Details)	12 Months Ended
	Dec. 31, 2022
Processing equipment | Minimum
Property, Plant and Equipment [Line Items]
Estimated useful lives of the assets	7 years
Processing equipment | Maximum
Property, Plant and Equipment [Line Items]
Estimated useful lives of the assets	10 years
Office equipment, furniture and fixtures | Minimum
Property, Plant and Equipment [Line Items]
Estimated useful lives of the assets	5 years
Office equipment, furniture and fixtures | Maximum
Property, Plant and Equipment [Line Items]
Estimated useful lives of the assets	7 years
Computer equipment and software | Minimum
Property, Plant and Equipment [Line Items]
Estimated useful lives of the assets	3 years
Computer equipment and software | Maximum
Property, Plant and Equipment [Line Items]
Estimated useful lives of the assets	7 years
Surgical instruments
Property, Plant and Equipment [Line Items]
Estimated useful lives of the assets	1 year

Leases - Additional Information

Leases - Additional Information (Details)	Dec. 31, 2022
Minimum
Lessee, Lease, Description [Line Items]
Remaining lease term	1 year
Maximum
Lessee, Lease, Description [Line Items]
Remaining lease term	7 years

Leases - Schedule of Operating

Leases - Schedule of Operating Leases (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Leases [Abstract]
Operating lease cost	$ 462	$ 706
Short-term operating lease cost	916	335
Total operating lease cost	$ 1,378	$ 1,041

Leases - Schedule of Supplement

Leases - Schedule of Supplemental Cash Flow Information Related to Leases (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Leases [Abstract]
Cash paid for amounts included in the measurement of lease liabilities	$ 1,405	$ 1,237
ROU assets obtained in exchange for lease obligations	$ 381	$ 57

Leases - Schedule of Suppleme_2

Leases - Schedule of Supplemental Balance Sheet Information Related to Leases (Details) - USD ($) $ in Thousands	Dec. 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	$ 967	$ 876
Liabilities:
Current	182	294
Noncurrent	1,142	947
Total operating lease liabilities	$ 1,324	$ 1,241

Leases - Schedule of Weighted-A

Leases - Schedule of Weighted-Average Remaining Lease Terms and Discount Rates (Details)	Dec. 31, 2022	Dec. 31, 2021
Leases [Abstract]
Weighted-average remaining lease term (years)	6 years	6 years 3 months 18 days
Weighted-average discount rate	4.97%	5.09%

Leases - Schedule of Maturities

Leases - Schedule of Maturities of Operating Lease Liabilities (Excluding San Diego Design Center Lease) (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Leases [Abstract]
2023	$ 384
2024	402
2025	391
2026	389
2027 and beyond	806
Total future minimum lease payments	2,372
Less imputed interest	(1,048)
Total	$ 1,324	$ 1,241

Discontinued Operations - Sched

Discontinued Operations - Schedule of Financial Results of Discontinued Operations (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Other expense (income):
(Loss) Income from discontinued operations before income tax provision	$ 0	$ (6,316)
Income tax (benefit) provision	0	(2,674)
OEM Business | Sold
Income Statement Balance Sheet And Additional Disclosures By Disposal Groups Including Discontinued Operations [Line Items]
Revenues	0	0
Costs of goods sold	0	0
Gross profit	0	0
Expenses:
General and administrative	0	0
Severance and restructuring costs	0	0
Transaction and financing expenses	0	0
Total operating expenses	0	0
Operating income	0	0
Other expense (income):
OEM working capital adjustment	0	6,316
Interest expense	0	0
Loss on extinguishment of debt	0	0
Derivative loss	0	0
Foreign exchange (gain) loss	0	0
Total other expense - net	0	6,316
(Loss) income from discontinued operations	0	(6,316)
Gain on sale of net assets of discontinued operations	0	0
(Loss) Income from discontinued operations before income tax provision	0	(6,316)
Income tax (benefit) provision	0	(2,674)
Net (loss) income on discontinued operations	$ 0	$ (3,642)

Discontinued Operations - Addit

Discontinued Operations - Additional Information (Details) - USD ($)	3 Months Ended	12 Months Ended
	Jun. 30, 2021	Dec. 31, 2022	Dec. 31, 2021	Jun. 03, 2021	Dec. 01, 2020
Income Statement Balance Sheet And Additional Disclosures By Disposal Groups Including Discontinued Operations [Line Items]
Operating cash flows of discontinued operations		$ 0	$ 0
Investing cash flows of discontinued operations		$ 0	$ (5,400,000)
OEM Business | Sold
Income Statement Balance Sheet And Additional Disclosures By Disposal Groups Including Discontinued Operations [Line Items]
Maximum working capital adjustment amount					$ 14,000,000
Disputed amount remaining				$ 5,800,000
Disputed amount paid	$ 5,800,000

Revenue from Contracts with C_3

Revenue from Contracts with Customers - Schedule of Total Revenue by Geographical Region (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Disaggregation Of Revenue [Line Items]
Revenues	$ 81,979	$ 90,500
Recognized at a point in time
Disaggregation Of Revenue [Line Items]
Revenues	81,979	90,500
Domestic | Recognized at a point in time
Disaggregation Of Revenue [Line Items]
Revenues	68,647	77,927
International | Recognized at a point in time
Disaggregation Of Revenue [Line Items]
Revenues	$ 13,332	$ 12,573

Business Combinations and Acq_3

Business Combinations and Acquisitions - Inteneural Networks, Inc. (Details) $ / shares in Units, $ in Thousands		3 Months Ended	12 Months Ended
	Dec. 30, 2021 USD ($) payment $ / shares shares	Dec. 31, 2021 USD ($) $ / shares	Dec. 31, 2022 USD ($) $ / shares	Dec. 31, 2021 USD ($) $ / shares
Business Acquisition [Line Items]
Common stock, par value (in dollars per share) | $ / shares		$ 0.001	$ 0.001	$ 0.001
Asset acquisition expenses			$ 0	$ 72,087
INN Acquisition
Business Acquisition [Line Items]
Payments to acquire businesses	$ 19,900
Cash consideration	$ 5,000		$ 0	5,000
Shares issuable at closing (in shares) | shares	227,359
Common stock, par value (in dollars per share) | $ / shares	$ 0.001
Shares issued	$ 4,900
Percentage of additional voting interests acquired (as a percent)	19.30%
Equity interests issued and issuable	$ 19,300
Noncontrolling interest not purchased	41,700
Asset acquisition expenses	72,100			72,100
Non controlling interest	52,000
Net impact due to transaction loss				30,200
INN Acquisition | INN Acquisition
Business Acquisition [Line Items]
Net impact due to transaction loss				$ 41,900
INN Acquisition | Assembled Workforce
Business Acquisition [Line Items]
Asset acquisition expenses	200	$ 200
INN Acquisition | Consideration for remaining ownership, achievement of all milestones
Business Acquisition [Line Items]
Payments to acquire businesses	72,300
Fair value	$ 10,000
Equity interest percentage	100%
Number of milestone payments | payment	3
Accrued acquisition and integration expenses	$ 400
Contingent consideration (up to)	$ 10,300
INN Acquisition | INN Acquisition
Business Acquisition [Line Items]
Percentage of voting interests acquired	42%
Remaining equity interest	58%

Business Combinations and Acq_4

Business Combinations and Acquisitions - Prompt Prototypes Acquisition (Details) - Prompt - Asset Purchase Agreement $ in Millions			12 Months Ended
	Oct. 30, 2022 USD ($)	Apr. 30, 2021 USD ($) payment	Dec. 31, 2021 USD ($)
Business Acquisition [Line Items]
Payments to acquire businesses		$ 1.1
Cash consideration	$ 0.2	0.3
Shares issued	$ 0.1	0.2
Contingent consideration		$ 0.6
Number of payments | payment		2
First payment		18 months
Second payment		36 months
Bargain purchase gain			$ 0.1
Business Combination, Bargain Purchase, Gain, Statement of Income or Comprehensive Income [Extensible Enumeration]			Other Nonoperating Income (Expense)

Business Combinations and Acq_5

Business Combinations and Acquisitions - Schedule of Fair Value of Identifiable Assets Acquired and Liabilities Assumed (Details) - Prompt - Asset Purchase Agreement $ in Thousands	Apr. 30, 2021 USD ($)
Business Acquisition [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 - Addi

Stock-Based Compensation - Additional Information (Details) $ in Millions		12 Months Ended
	May 07, 2021 shares	Dec. 31, 2022 USD ($) plan shares	Dec. 31, 2021 USD ($) shares
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Number of stock based compensation plans | plan		3
ESPP | Board of Directors
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares of common stock allowed to be issued (in shares)		99,428	22,220
Employee's compensation minimum percentage	1%
Employee's compensation maximum percentage	15%
ESPP offering period	6 months
Look back period	6 months
Fair market value of common stock percentage	85%
Number of shares reserved for issuance (in shares)		166,666
Number of stock issued value, employee stock purchase plan | $		$ 0.2	$ 0.4
Number of shares issued (in shares)		45,018
Stock Option
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Exercise price percentage		100%
Total unrecognized stock-based compensation expense | $		$ 0.5
Expected weighted-average period of expense recognition		2 years 5 months 19 days
Stock Option | Minimum
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Contractual term of stock options granted		5 years
Vesting period		1 year
Stock Option | Maximum
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Contractual term of stock options granted		10 years
Vesting period		5 years
Restricted Stock Awards
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Exercise price percentage		100%
Shares granted (in shares)		0
Fair market value of restricted stock | $		$ 0.1	1.9
Total unrecognized stock-based compensation expense | $		$ 0.2
Expected weighted-average period of expense recognition		8 months 12 days
Restricted Stock Awards | Employees
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares granted (in shares)		0
Restricted Stock Awards | Non-employee directors
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares granted (in shares)		0
Restricted Stock Awards | Minimum
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Vesting period		1 year
Restricted Stock Awards | Maximum
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Vesting period		3 years
Restricted Stock Units
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Exercise price percentage		100%
Shares granted (in shares)		679,403
Fair market value of restricted stock | $		$ 0.4	$ 0
Total unrecognized stock-based compensation expense | $		$ 4.6
Expected weighted-average period of expense recognition		1 year 5 months 15 days
Restricted Stock Units | Employees
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares granted (in shares)		565,118
Restricted Stock Units | Non-employee directors
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares granted (in shares)		114,285
Restricted Stock Units | Minimum
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Vesting period		1 year
Restricted Stock Units | Maximum
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Vesting period		3 years
2021 Incentive Compensation Plan
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares of common stock allowed to be issued (in shares)	666,666
2021 Inducement Compensation Plan
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Shares of common stock allowed to be issued (in shares)	300,000

Stock-Based Compensation - Stoc

Stock-Based Compensation - Stock-Based Compensation Recognized (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation	$ 4,634	$ 5,212
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	4,289	4,839
Research and development
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation	$ 345	$ 352

Stock-Based Compensation - St_2

Stock-Based Compensation - Stock Options Outstanding, Exercisable and Available for Grant (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Number of Options
Outstanding beginning balance (in shares)	177,665
Granted (in shares)	0
Exercised (in shares)	0
Forfeited or expired (in shares)	(101,512)
Outstanding ending balance (in shares)	76,153	177,665
Vested or expected to vest (in shares)	76,153
Exercisable (in shares)	52,562
Available for grant (in shares)	288,585
Weighted Average Exercise Price
Outstanding beginning balance (in dollars per share)	$ 92.26
Granted (in dollars per share)	0
Exercised (in dollars per share)	0
Forfeited or expired (in dollars per share)	99.26
Outstanding ending balance (in dollars per share)	82.94	$ 92.26
Vested or expected to vest (in dollars per share)	82.94
Exercisable (in dollars per share)	$ 88.02
Weighted Average Remaining Contractual Life (Years)
Outstanding at December 31, 2022	6 years 9 months 7 days	3 years 11 months 15 days
Vested or expected to vest	6 years 9 months 7 days
Exercisable at December 31, 2022	6 years 3 months 25 days
Aggregate Intrinsic Value, Outstanding	$ 0	$ 0
Aggregate Intrinsic Value, Vested or expected to vest	0
Aggregate Intrinsic Value, Exercisable	$ 0

Stock-Based Compensation - Othe

Stock-Based Compensation - Other Information Concerning Stock Options (Details) - USD ($) $ / shares in Units, $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Share-Based Payment Arrangement [Abstract]
Weighted average fair value of stock options granted (in dollars per share)	$ 0	$ 0.93
Aggregate intrinsic value of stock options exercised	$ 0	$ 0

Stock-Based Compensation - Sche

Stock-Based Compensation - Schedule of Weighted-Average Assumptions Used to Determine Fair Value of Options (Details)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Employee Stock Ownership Plan (ESOP) Disclosures [Line Items]
Expected term (years)	0 years	6 years 4 months 6 days
Risk free interest rate	0%	0.72%
Volatility factor	0%	49.97%
Dividend yield	0%	0%
ESPP
Employee Stock Ownership Plan (ESOP) Disclosures [Line Items]
Expected term (years)	6 months	6 months
Risk free interest rate	1.03%	0.05%
Volatility factor	91.99%	84.32%
Dividend yield	0%	0%

Stock-Based Compensation - Unve

Stock-Based Compensation - Unvested Restricted Stock Awards (Details)	12 Months Ended
	Dec. 31, 2022 $ / shares shares
Restricted Stock Awards
Number of Shares
Beginning balance (in shares) | shares	21,788
Granted (in shares) | shares	0
Vested (in shares) | shares	(10,833)
Forfeited (in shares) | shares	(4,496)
Ending balance (in shares) | shares	6,459
Weighted Average Grant Date Fair Value
Beginning balance (in dollars per share) | $ / shares	$ 86.65
Granted (in dollars per share) | $ / shares	0
Vested (in dollars per share) | $ / shares	94.42
Forfeited (in dollars per share) | $ / shares	83.49
Ending balance (in dollars per share) | $ / shares	$ 75.81
Restricted Stock Units
Number of Shares
Beginning balance (in shares) | shares	158,972
Granted (in shares) | shares	679,403
Vested (in shares) | shares	(75,970)
Forfeited (in shares) | shares	(66,314)
Ending balance (in shares) | shares	696,091
Weighted Average Grant Date Fair Value
Beginning balance (in dollars per share) | $ / shares	$ 48.83
Granted (in dollars per share) | $ / shares	5.88
Vested (in dollars per share) | $ / shares	50.19
Forfeited (in dollars per share) | $ / shares	29.13
Ending balance (in dollars per share) | $ / shares	$ 8.64

Inventories (Details)

Inventories (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Inventory [Line Items]
Provision for inventory write-downs	$ 19,972	$ 9,096
E&O charge	3,200
Settlement received	900	3,900
Oxford Supply Agreement
Inventory [Line Items]
Prepayment write off	200	3,000
E&O
Inventory [Line Items]
Provision for inventory write-downs	20,000	$ 9,100
Product Portfolio Rationalization Initiatives
Inventory [Line Items]
Provision for inventory write-downs	$ 13,800

Prepaid and Other Current Ass_3

Prepaid and Other Current Assets - Schedule of Prepaid and Other Current Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Deferred Costs, Capitalized, Prepaid, and Other Assets Disclosure [Abstract]
Leasehold improvement reimbursement	$ 2,885	$ 0
Income tax receivable	958	4,116
OEM Safety Stock receivable	900	1,000
Prepaid expenses	941	2,553
Other receivable	965	815
Insurance recovery receivable	0	1,500
Prepaid and other current assets	$ 6,649	$ 9,984

Property and Equipment - Compon

Property and Equipment - Components of Property and Equipment (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Property, Plant and Equipment [Line Items]
Property and equipment - net	$ 2,057	$ 945
Processing equipment
Property, Plant and Equipment [Line Items]
Property and equipment - net	266	346
Surgical instruments
Property, Plant and Equipment [Line Items]
Property and equipment - net	543	489
Office equipment, furniture and fixtures
Property, Plant and Equipment [Line Items]
Property and equipment - net	1	15
Computer equipment and software
Property, Plant and Equipment [Line Items]
Property and equipment - net	40	44
Construction in process
Property, Plant and Equipment [Line Items]
Property and equipment - net	$ 1,207	$ 51

Property and Equipment - Additi

Property and Equipment - Additional Information (Details) - USD ($)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Property, Plant and Equipment [Line Items]
Depreciation expense	$ 2,000,000	$ 2,500,000
ERP implementation expense	700,000	100,000
Property and equipment
Property, Plant and Equipment [Line Items]
Asset impairment and abandonment charges	3,700,000	11,000,000
Surgical instruments
Property, Plant and Equipment [Line Items]
Capitalized internal software expense	1,200,000	0
Compensation expense	100,000	0
Capitalized computer software impairments	0	0
Software Development
Property, Plant and Equipment [Line Items]
Asset impairment and abandonment charges	0	4,400,000
Capitalized cost of ERP system	$ 0	$ 4,500,000

Property and Equipment- Constru

Property and Equipment- Construction in Progress (Details) - Construction in process - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Movement in Property, Plant and Equipment [Roll Forward]
Beginning balance as of January 1	$ 51	$ 0
Capitalized	1,207	5,015
Impairment	0	(4,964)
Assets transferred into service	(51)	0
Ending balance as of December 31	$ 1,207	$ 51

Debt - Narrative (Details)

Debt - Narrative (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 30, 2021
Debt Instrument [Line Items]
Seller Notes	$ 10,612
Seller Notes
Debt Instrument [Line Items]
Seller Notes	10,192	$ 9,982
Seller Notes | Unsecured Seller Notes
Debt Instrument [Line Items]
Debt issuance amount			$ 10,600
Seller Notes	10,200	10,000
Stated rate			6.80%
Accrued interest expense	200	0
Accredited	800	0
Interest expense	1,000	0
Long -term debt default increase rate			4%
Seller Notes | Unsecured Seller Notes | Level 2
Debt Instrument [Line Items]
Fair value	$ 10,200	$ 10,000

Debt - Schedule of Long-term De

Debt - Schedule of Long-term Debt Instruments (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Debt Instrument [Line Items]
Total Seller Notes - related party	$ 10,612
Seller Notes
Debt Instrument [Line Items]
Less: accretion of acquisition adjustment	(420)	$ (630)
Total Seller Notes - related party	10,192	9,982
Current portion of seller notes	0	0
Total long-term seller notes, excluding current portion	10,192	9,982
Seller Notes | P. Lewicki
Debt Instrument [Line Items]
Seller Notes	5,306	5,306
Seller Notes | K. Siemionow
Debt Instrument [Line Items]
Seller Notes	$ 5,306	$ 5,306

Debt - Schedule of Future Matur

Debt - Schedule of Future Maturities of Long-term Debt (Details) $ in Thousands	Dec. 31, 2022 USD ($)
Debt Disclosure [Abstract]
2023	$ 0
2024	10,612
2025	0
2026	0
2027	0
Thereafter	0
Total Seller Notes - related party	$ 10,612

Net Loss Per Common Share - Com

Net Loss Per Common Share - Common Stock Used in Calculation of Basic and Diluted Earnings Per Share (Details) - shares	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Earnings Per Share [Abstract]
Weighted average basic shares (in shares)	6,555,207	4,086,409

Net Loss Per Common Share - Sch

Net Loss Per Common Share - Schedule of Number of Potential Dilutive Shares that Excluded Due to Anti-dilutive Effect (Details) - shares	12 Months Ended
	Dec. 31, 2022	Dec. 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)	5,870,747	106,607
Stock Options
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Number of potential dilutive shares excluded due to anti-dilutive effect (in shares)	0	0
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)	268,502	106,607
Pre-funded Warrants
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Number of potential dilutive shares excluded due to anti-dilutive effect (in shares)	4,926,498	0
Warrants
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Number of potential dilutive shares excluded due to anti-dilutive effect (in shares)	675,747	0

Net Loss Per Common Share - Add

Net Loss Per Common Share - Additional Information (Details) - shares	12 Months Ended
	Dec. 31, 2022	Dec. 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)	5,870,747	106,607
Option exercise ice exceeds average market price
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Number of potential dilutive shares excluded due to anti-dilutive effect (in shares)	92,358	176,856
Out-of-the-money Warrants
Antidilutive Securities Excluded From Computation Of Earnings Per Share [Line Items]
Number of potential dilutive shares excluded due to anti-dilutive effect (in shares)	1,601,545	1,024,154

Fair Value Information - Additi

Fair Value Information - Additional Information (Details) - USD ($)					12 Months Ended
	Jan. 14, 2022	Oct. 23, 2020	Sep. 29, 2020	Mar. 08, 2019	Dec. 31, 2022	Dec. 31, 2021
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Common stock, par value (in dollars per share)					$ 0.001	$ 0.001
Property and equipment - net					$ 2,057,000	$ 945,000
Asset impairment and abandonments					5,352,000	12,195,000
Property And Equipment Written Down To Estimated Fair Value
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Property and equipment - net					6,000,000	12,000,000
Level 3
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Property and equipment - net					2,316,000	945,000
Asset impairment and abandonments					5,352,000	12,195,000
Level 3 | Property And Equipment Written Down To Estimated Fair Value
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Plant, and equipment, net fair value					2,300,000	900,000
Holo Surgical Inc. | Stock 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)		208,333
Common stock, par value (in dollars per share)			$ 0.001
Contingent consideration (up to)			$ 83,000,000
Contingent consideration payable closing milestones, term		6 years	6 years
Trading days			5 days
Number of contingent consideration shares issued (in shares)	288,333
Equity interests issued and issuable	$ 5,900,000
Contingent liability	$ 10,000,000				24,100,000	51,900,000
Holo Surgical Inc. | Stock purchase agreement | Common Stock
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Shares issuable at closing (in shares)			208,333
Maximum shares to be issued including contingent shares (in shares)			496,666
Paradigm
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items]
Cash consideration				$ 100,000,000
Shares issuable at closing (in shares)				357,653
Contingent consideration (up to)				$ 150,000,000
Trading days				5 days
Contingent liability					$ 0	$ 0
Total considerations including acquisition contingencies				$ 300,000,000
Cash to be paid at closing				150,000,000
Number of common stock to be issued at closing, value				$ 50,000,000

Fair Value Information - Schedu

Fair Value Information - Schedule of Fair Value Measurement Inputs Valuation Technique (Details) - Holo Surgical Inc. - Level 3 $ in Thousands	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)
Consideration for remaining ownership, achievement of all milestones
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Contingent liability	$ 24,061	$ 51,928	$ 56,515
Earn-Out Valuation | Consideration for remaining ownership, achievement of all milestones
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Contingent liability	$ 24,061	$ 51,928
Earn-Out Valuation | Probability of success factor | Minimum
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Unobservable Inputs	0	0
Earn-Out Valuation | Probability of success factor | Maximum
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Unobservable Inputs	0.95	0.90
Earn-Out Valuation | Discount rates | Minimum
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Unobservable Inputs	0.1309	0.0006
Earn-Out Valuation | Discount rates | Maximum
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Unobservable Inputs	0.1380	0.1160

Fair Value Information - Reconc

Fair Value Information - Reconciliation of Acquisition Contingencies (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Business Combination, Contingent Consideration, Liability [Roll Forward]
Gain on acquisition contingency	$ 17,867	$ 4,587
Holo Surgical Inc. | Consideration for remaining ownership, achievement of all milestones | Level 3
Business Combination, Contingent Consideration, Liability [Roll Forward]
Beginning balance as of January 1	51,928	56,515
Contingent consideration – Holo Milestone Payments	(10,000)	0
Gain on acquisition contingency	(17,867)	(4,587)
Ending balance as of December 31	$ 24,061	$ 51,928

Fair Value Information - Summar

Fair Value Information - Summary of Impairments of Long-Lived Assets and Related Post Impairment Fair Values (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Impairment
Asset impairment and abandonments	$ 5,352	$ 12,195
Net Book Value
Property and equipment - net	2,057	945
Total assets	70,242	123,799
Level 3
Impairment
Property and equipment - net	3,684	11,018
Definite-lived intangible assets - net	492	782
Other assets - net	1,176	395
Asset impairment and abandonments	5,352	12,195
Net Book Value
Property and equipment - net	2,316	945
Definite-lived intangible assets - net	0	0
Other assets - net	5,527	5,970
Total assets	$ 7,843	$ 6,915

Fair Value Information - Sche_2

Fair Value Information - Schedule of Liabilities Measured at Fair Value on Recurring Basis (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Level 3 | Warrant liability
Fair Value Liabilities Measured On Recurring Basis [Line Items]
Warrant liability	$ 22,982	$ 12,013

Fair Value Information - Sche_3

Fair Value Information - Schedule of Changes in Fair Value of Level 3 Valuation for the Warrant Liability (Details) - Level 3 - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
June 14, 2021 Warrants
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance as of January 1	$ 12,013	$ 0
Fair value of warrants on date of issuance	0	26,749
Change in fair value of restriked warrants	866	0
Transfer of warrants	(929)	0
Change in fair value of warrant liability	(11,937)	(14,736)
Ending balance as of December 31	13	12,013
Warrant Liability February 15 2022
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance as of January 1	0
Fair value of warrants on date of issuance	10,157
Change in fair value of restriked warrants		448
Transfer of warrants	(1,064)
Redemption of shares	(1,749)
Change in fair value of warrant liability	(7,350)
Ending balance as of December 31	442	0
Warrant Liability November 13, 2022 | Pre-funded Warrants
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance as of January 1	0
Fair value of warrants on date of issuance	12,724
Transfer of warrants	0
Redemption of shares	(487)
Change in fair value of warrant liability	(2,434)
Ending balance as of December 31	9,803	0
Warrant Liability November 13, 2022 | Series A Warrants
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance as of January 1	0
Fair value of warrants on date of issuance	10,671
Transfer of warrants	1,993
Redemption of shares	0
Change in fair value of warrant liability	(2,421)
Ending balance as of December 31	10,243	0
Warrant Liability November 13, 2022 | Series B Warrants
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance as of January 1	0
Fair value of warrants on date of issuance	2,570
Transfer of warrants	0
Redemption of shares	0
Change in fair value of warrant liability	(570)
Ending balance as of December 31	2,000	0
Warrant Liability November 13, 2022 | Placement Agent Warrants
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance as of January 1	0
Fair value of warrants on date of issuance	596
Transfer of warrants	0
Redemption of shares	0
Change in fair value of warrant liability	(115)
Ending balance as of December 31	$ 481	$ 0

Fair Value Information - Fair V

Fair Value Information - Fair Value of Warrant Liability Valuation Inputs (Details) - Black-Scholes Option Pricing Model	Dec. 31, 2022 USD ($) $ / shares	Dec. 31, 2021 USD ($)
Stock price | June 14, 2021 Warrants
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Measurement inputs | $	1.99	0.72
Stock price | Warrant Liability February 15 2022
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Measurement inputs	1.99
Stock price | Warrant Liability November 13, 2022 | Pre-funded Warrants
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Measurement inputs | $ / shares	1.99
Stock price | Warrant Liability November 13, 2022 | Series A Warrants
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Measurement inputs | $ / shares	1.99
Stock price | Warrant Liability November 13, 2022 | Series B Warrants
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Measurement inputs | $ / shares	1.99
Stock price | Warrant Liability November 13, 2022 | Placement Agent Warrants
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Measurement inputs | $ / shares	1.99
Risk-free interest rate | June 14, 2021 Warrants
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Measurement inputs | $	0.0453	0.0084
Risk-free interest rate | Warrant Liability February 15 2022
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Measurement inputs	0.0405
Risk-free interest rate | Warrant Liability November 13, 2022 | Series A Warrants
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Measurement inputs	0.0396
Risk-free interest rate | Warrant Liability November 13, 2022 | Series B Warrants
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Measurement inputs	0.0420
Risk-free interest rate | Warrant Liability November 13, 2022 | Placement Agent Warrants
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Measurement inputs	0.0397
Dividend yield | June 14, 2021 Warrants
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Measurement inputs | $	0	0
Dividend yield | Warrant Liability February 15 2022
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Measurement inputs	0
Dividend yield | Warrant Liability November 13, 2022 | Series A Warrants
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Measurement inputs	0
Dividend yield | Warrant Liability November 13, 2022 | Series B Warrants
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Measurement inputs	0
Dividend yield | Warrant Liability November 13, 2022 | Placement Agent Warrants
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Measurement inputs	0
Volatility | June 14, 2021 Warrants
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Measurement inputs | $	1.10	1.30
Volatility | Warrant Liability February 15 2022
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Measurement inputs	0.95
Volatility | Warrant Liability November 13, 2022 | Series A Warrants
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Measurement inputs	0.90
Volatility | Warrant Liability November 13, 2022 | Series B Warrants
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Measurement inputs	1.05
Volatility | Warrant Liability November 13, 2022 | Placement Agent Warrants
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Measurement inputs	0.90

Share Offering and Warrants (De

Share Offering and Warrants (Details) - USD ($) $ / shares in Units, $ in Thousands					12 Months Ended
	Nov. 13, 2022	Feb. 15, 2022	Jun. 14, 2021	Feb. 01, 2021	Dec. 31, 2022	Dec. 31, 2021
Class Of Warrant Or Right [Line Items]
Percentage of placement agent sash fee equal to gross proceeds from warrants (as a percent)		7%
Management fee equal to aggregate of gross proceeds of warrants (as a percent)		1%
Change in fair value of warrant liability					$ (24,827)	$ (14,736)
Warrant financing	$ 17,000
Pre-funded Warrants
Class Of Warrant Or Right [Line Items]
Warrants (in shares)					331,000
Warrant outstanding (in shares)					4,929,000
Existing Warrant
Class Of Warrant Or Right [Line Items]
Change in fair value of warrant liability	$ 1,300
Public Offering Warrants
Class Of Warrant Or Right [Line Items]
Warrants (in shares)		163,043
Purchase Agreement
Class Of Warrant Or Right [Line Items]
Common stock sold (in shares)	740,000	1,285,507		956,666
Warrants (in shares)	360,000
Proceeds from issuance of common stock	$ 12,000	$ 20,000
Sale of stock price (in dollars per share)	$ 2
Net proceeds from the direct offering, after deducting investor and management fees	$ 10,800
Issuance costs	$ 1,200
Percentage of placement agent sash fee equal to gross proceeds from warrants (as a percent)	7%
Management fee equal to aggregate of gross proceeds of warrants (as a percent)	1%
Common stock price per share (in dollars per share)				$ 45
Purchase Agreement | Pre-funded Warrants
Class Of Warrant Or Right [Line Items]
Warrants (in shares)	5,260,000	163,768
Sale of warrants, price per share (in dollars per share)	$ 1.9990
Purchase Agreement | Series A Warrants
Class Of Warrant Or Right [Line Items]
Warrants (in shares)	6,000,000
Purchase Agreement | Series B Warrants
Class Of Warrant Or Right [Line Items]
Warrants (in shares)	1,500,000
Purchase Agreement | November 16, 2022, Warrants
Class Of Warrant Or Right [Line Items]
Fees allocated to the warrant liabilities					$ 15,700
Purchase Agreement | June 2021 Warrants
Class Of Warrant Or Right [Line Items]
Warrants (in shares)	521,739
Purchase Agreement | February 2022 Warrants
Class Of Warrant Or Right [Line Items]
Warrants (in shares)	597,826
Strike price of warrants (in dollars per share)	$ 18
Purchase Agreement | Existing Warrant
Class Of Warrant Or Right [Line Items]
Strike price of warrants (in dollars per share)	$ 1.8150
Purchase Agreement | Placement Agent Warrants
Class Of Warrant Or Right [Line Items]
Warrants (in shares)	360,000
Strike price of warrants (in dollars per share)	$ 2.5000
At-the-Market Offering
Class Of Warrant Or Right [Line Items]
Proceeds from issuance of common stock			$ 50,000
Net proceeds from the direct offering, after deducting investor and management fees			45,800
Issuance costs			$ 4,200
Percentage of placement agent sash fee equal to gross proceeds from warrants (as a percent)			7%
Management fee equal to aggregate of gross proceeds of warrants (as a percent)			1%
Investor and other filing fees			$ 2,100
Common stock sold (in shares)			966,183
At-the-Market Offering | June 2021 Warrants
Class Of Warrant Or Right [Line Items]
Warrants (in shares)			966,183
Strike price of warrants (in dollars per share)	$ 51.7500		$ 51.7500
Fees allocated to the warrant liabilities			$ 2,100
At-the-Market Offering | Placement Agent Warrants
Class Of Warrant Or Right [Line Items]
Warrants (in shares)			57,971
Strike price of warrants (in dollars per share)			$ 64.6875
Public Offering
Class Of Warrant Or Right [Line Items]
Common stock sold (in shares)		1,285,507
Proceeds from issuance of common stock		$ 20,000
Sale of stock price (in dollars per share)		$ 13.8000
Net proceeds from the direct offering, after deducting investor and management fees		$ 17,700		$ 44,500
Issuance costs		2,300
Investor and other filing fees		$ 1,400
Common stock sold (in shares)			966,183
Public Offering | Pre-funded Warrants
Class Of Warrant Or Right [Line Items]
Warrants (in shares)		163,768
Public Offering | February 2022 Warrants
Class Of Warrant Or Right [Line Items]
Warrants (in shares)		1,086,956
Strike price of warrants (in dollars per share)		$ 18
Fees allocated to the warrant liabilities		$ 900
Public Offering | Placement Agent Warrants
Class Of Warrant Or Right [Line Items]
Warrants (in shares)		86,956	57,971
Strike price of warrants (in dollars per share)		$ 17.2500
Over-Allotment Option
Class Of Warrant Or Right [Line Items]
Common stock sold (in shares)		217,391
Over-Allotment Option | Pre-funded Warrants
Class Of Warrant Or Right [Line Items]
Sale of warrants, price per share (in dollars per share)		$ 13.7970
Over-Allotment Option | Public Offering Warrants
Class Of Warrant Or Right [Line Items]
Warrants (in shares)		163,043
Sale of warrants, price per share (in dollars per share)		$ 0.0030

Accrued Expenses - Schedule of

Accrued Expenses - Schedule of Accrued Expenses (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Payables and Accruals [Abstract]
Accrued compensation	$ 3,614	$ 5,258
Accrued distributor commissions	3,801	2,957
Accrued severance and restructuring costs	1,041	0
Accrued securities class action settlement	0	1,500
Other	4,690	8,054
Accrued expenses	$ 13,146	$ 17,769

Other Long-term liabilities - S

Other Long-term liabilities - Schedule of Other Long-term Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Other Liabilities, Noncurrent [Abstract]
Acquisition contingencies	$ 24,061	$ 26,343
Warrant liability	22,982	12,013
Lease obligations	1,142	947
Retention credit	3,222	0
Other	3,219	2,229
Total other long-term liabilities	$ 54,626	$ 41,532

Income Taxes - Schedule of Pre-

Income Taxes - Schedule of Pre-Tax Loss (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Pre-tax loss:
Domestic (U.S., state and local)	$ (42,987)	$ (114,731)
Foreign (loss) income	(12,661)	(9,061)
Loss before income tax provision	$ (55,648)	$ (123,792)

Income Taxes - Schedule of Inco

Income Taxes - Schedule of Income Tax Provision (Benefit) (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Current:
Federal	$ 151	$ 426
State	23	(1,325)
International	34	184
Total current	208	(715)
Deferred:
Federal	0	(25)
State	0	(4)
International	(1,251)	(142)
Total deferred	(1,251)	(171)
Total income tax (benefit) provision	$ (1,043)	$ (886)

Income Taxes - Schedule of Defe

Income Taxes - Schedule of Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2022	Dec. 31, 2021
Assets
Accounts receivable	$ 2,385	$ 2,376
Accrued liabilities	1,951	720
Deferred compensation	943	1,876
Fixed assets and intangibles	19,128	22,096
Inventory	11,845	7,066
Net operating losses and other carryforwards	36,382	30,187
Tax credits	1,406	265
Lease Liability	230	318
Right of Use Asset	0	0
Capitalized Research and Development	4,326	0
Other	14	408
Valuation allowance	(77,123)	(65,007)
Total	1,487	305
Liabilities
Right of Use Asset	(143)	(224)
Other	0	0
Total	$ (143)	$ (224)

Income Taxes - Additional Infor

Income Taxes - Additional Information (Details) $ in Thousands		3 Months Ended	12 Months Ended
	Dec. 30, 2021 USD ($) payment	Dec. 31, 2021 USD ($)	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)	Dec. 31, 2020 USD ($)
Income Tax [Line Items]
Asset acquisition expenses			$ 0	$ 72,087
Capitalization of R&D costs		$ 0	4,326	0
Net operating loss carryforwards		30,187	36,382	30,187
Net operating loss carryforwards, not subject to expiration			23,400
Non-U.S. net operating loss carryforwards			5,400
Research and development credit carryforwards		1,400		1,400
Disallowed U.S. interest expense net of tax			500
Income tax benefit for the release of valuation allowances			1,500
Valuation allowance		65,007	77,123	65,007
Unrecognized tax benefits		2,082	2,082	2,082	$ 2,991
Accrued interest and penalties		100	200	100
U.S. Federal
Income Tax [Line Items]
Net operating loss carryforwards			24,900
Net operating loss carryforwards, subject to expiration			1,500
U.S. State
Income Tax [Line Items]
Net operating loss carryforwards			4,600
Net operating loss carryforwards, subject to expiration			3,700
Net operating loss carryforwards, not subject to expiration			900
Non-U.S.
Income Tax [Line Items]
Net operating loss carryforwards			$ 6,600
INN Acquisition
Income Tax [Line Items]
Payments to acquire businesses	$ 19,900
Noncontrolling interest	41,700
Asset acquisition expenses	72,100			$ 72,100
INN Acquisition | Assembled Workforce
Income Tax [Line Items]
Asset acquisition expenses	$ 200	$ 200
INN Acquisition | INN Acquisition
Income Tax [Line Items]
Remaining equity interest	58%
INN Acquisition | Consideration for remaining ownership, achievement of all milestones
Income Tax [Line Items]
Payments to acquire businesses	$ 72,300
Contingent consideration (up to)	$ 10,300
Number of milestone payments | payment	3
Accrued acquisition and integration expenses	$ 400

Income Taxes - Summary of Unrec

Income Taxes - Summary of Unrecognized Tax Benefits (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns [Roll Forward]
Opening balance	$ 2,082	$ 2,991
Additions based on tax positions related to the current year	0	0
Additions for tax positions of prior years	0	542
Reductions for tax positions of prior years	0	(1,451)
Reductions for expiration of statute of limitations	0	0
Closing balance	$ 2,082	$ 2,082

Income Taxes - Schedule of Effe

Income Taxes - Schedule of Effective Tax Rate (Details)	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Income Tax Disclosure [Abstract]
Statutory federal rate	21%	21%
State income taxes—net of federal tax benefit	0.03%	0%
Foreign rate differential	6.03%	1.33%
Acquisition expenses	0%	(5.21%)
Loss on acquisition contingency	6.74%	0.78%
Change in fair value of the warrant liability	9.37%	2.50%
Non-deductible items	(11.58%)	(0.99%)
Noncontrolling interest	0%	(7.11%)
Tax attributes	1.26%	(0.22%)
Valuation allowances	(24.90%)	(12.61%)
Uncertain tax positions	(0.18%)	0.95%
Tax filings & account adjustments	(5.74%)	0.04%
Other reconciling items, net	(0.16%)	0.25%
Effective tax rate	1.87%	0.71%

Stockholders' Equity (Details)

Stockholders' Equity (Details)	12 Months Ended
	Dec. 31, 2022 vote shares	Dec. 31, 2021 shares
Equity [Abstract]
Common stock, shares authorized (in shares) | shares	300,000,000	300,000,000
Vote for each share held | vote	1

Severance and Restructuring C_3

Severance and Restructuring Costs - Additional Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Restructuring Cost and Reserve [Line Items]
Inventory write downs	$ 3,200
Severance and restructuring costs	1,148	$ 208
Employee-Related | 2022 Restructuring Plan
Restructuring Cost and Reserve [Line Items]
Severance and restructuring costs	1,200
Product Rationalization | 2022 Restructuring Plan
Restructuring Cost and Reserve [Line Items]
Inventory write downs	13,800
Product Rationalization | Domestic | 2022 Restructuring Plan
Restructuring Cost and Reserve [Line Items]
Inventory write downs	6,900
Product Rationalization | International | 2022 Restructuring Plan
Restructuring Cost and Reserve [Line Items]
Inventory write downs	6,900
Minimum | 2022 Restructuring Plan
Restructuring Cost and Reserve [Line Items]
Estimated cash savings in 2023	30,000
Minimum | Employee-Related | 2022 Restructuring Plan
Restructuring Cost and Reserve [Line Items]
Restructuring, expected cost	5,500
Minimum | Other exit and disposal costs | 2022 Restructuring Plan
Restructuring Cost and Reserve [Line Items]
Other exit and disposal costs	2,500
Maximum | 2022 Restructuring Plan
Restructuring Cost and Reserve [Line Items]
Estimated cash savings in 2023	35,000
Maximum | Employee-Related | 2022 Restructuring Plan
Restructuring Cost and Reserve [Line Items]
Restructuring, expected cost	7,500
Maximum | Other exit and disposal costs | 2022 Restructuring Plan
Restructuring Cost and Reserve [Line Items]
Other exit and disposal costs	$ 3,500

Severance and Restructuring C_4

Severance and Restructuring Costs - Restructuring Costs by Major Component Recognized (Details) - 2022 Restructuring Plan $ in Thousands	12 Months Ended
	Dec. 31, 2022 USD ($)
Restructuring Cost and Reserve [Line Items]
Restructuring costs	$ 14,970
Employee-Related
Restructuring Cost and Reserve [Line Items]
Restructuring costs	1,148
Product Rationalization
Restructuring Cost and Reserve [Line Items]
Restructuring costs	$ 13,822

Severance and Restructuring C_5

Severance and Restructuring Costs - Restructuring Activities (Details) - 2022 Restructuring Plan $ in Thousands	12 Months Ended
	Dec. 31, 2022 USD ($)
Restructuring Cost and Reserve [Line Items]
Incurred during 2022	$ 14,970
Paid during 2022	(107)
Non-cash adjustment	(13,822)
Balance as of December 31, 2022	1,041
Employee-Related
Restructuring Cost and Reserve [Line Items]
Incurred during 2022	1,148
Paid during 2022	(107)
Non-cash adjustment	0
Balance as of December 31, 2022	1,041
Product Rationalization
Restructuring Cost and Reserve [Line Items]
Incurred during 2022	13,822
Paid during 2022	0
Non-cash adjustment	(13,822)
Balance as of December 31, 2022	$ 0

Retirement Benefits (Details)

Retirement Benefits (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Retirement Benefits [Abstract]
Employer matching contribution, percent of match (up to)	6%
Amounts expensed	$ 1.3	$ 0.7

Commitment and Contingencies (D

Commitment and Contingencies (Details)							12 Months Ended
	Jan. 14, 2022 USD ($) shares	Dec. 30, 2021 USD ($) payment	Mar. 12, 2021 USD ($) ft² extension_option	Oct. 23, 2020 USD ($)	Sep. 29, 2020 USD ($)	Mar. 08, 2019 USD ($) payment	Dec. 31, 2022 USD ($)	Dec. 31, 2021 USD ($)	Aug. 05, 2022 USD ($)	Jul. 20, 2020 agreement
Commitment And Contingencies [Line Items]
Current portion of accrued acquisition contingency - Holo							$ 0	$ 25,585,000
Change in fair value							(17,867,000)	(4,587,000)
Operating lease cost							462,000	706,000
Cash paid for amounts included in the measurement of lease liabilities							$ 1,405,000	$ 1,237,000
Royalty payment term							7 years	7 years
Royalty expense							$ 1,200,000	$ 1,600,000
Actual royalty rate (as a percentage)							1.50%	1.80%
Minimum
Commitment And Contingencies [Line Items]
Agreement royalty rate							1%	1%
Maximum
Commitment And Contingencies [Line Items]
Agreement royalty rate							10%	10%
Manufacturing and Distribution Agreements with Affiliates of Montague Private Equity
Commitment And Contingencies [Line Items]
Number of manufacturing and distribution agreements | agreement										3
Obligation, to be paid, year three									$ 17,900,000
Pioneer Shortfall In Contract Year 1 and Year 2
Commitment And Contingencies [Line Items]
Short fall									$ 2,100,000
Design and Development Agreement
Commitment And Contingencies [Line Items]
Short fall							$ 0
San Diego Lease | Premises
Commitment And Contingencies [Line Items]
Operating lease term of contract			12 years
Number of lease extension options | extension_option			1
Lease extension term			7 years
Lease rentable area (square feet) | ft²			94,457
Operating lease cost			$ 64,600,000
Rent abatement term			13 months
Cash paid for amounts included in the measurement of lease liabilities			$ 2,500,000
Prepaid reimbursement			$ 2,900,000
Paradigm
Commitment And Contingencies [Line Items]
Contingent consideration (up to)						$ 150,000,000
Number of potential milestone payments | payment						3
Contingent liability							0	$ 0
Cash consideration						$ 100,000,000
Aziyo
Commitment And Contingencies [Line Items]
Remaining purchase order							16,400,000	16,400,000
INN Acquisition
Commitment And Contingencies [Line Items]
Equity interests issued and issuable		$ 19,300,000
Percentage of additional voting interests acquired (as a percent)		19.30%
Cash consideration		$ 5,000,000					0	5,000,000
INN Acquisition | INN Acquisition
Commitment And Contingencies [Line Items]
Remaining equity interest		58%
INN Acquisition | Consideration for remaining ownership, achievement of all milestones
Commitment And Contingencies [Line Items]
Contingent consideration (up to)		$ 10,300,000
Contingent liability		$ 10,600,000
Number of milestone payments | payment		3
Contingent consideration for future commitments		$ 57,900,000
Mezzanine section							10,000,000
Holo Surgical Inc. | Stock purchase agreement
Commitment And Contingencies [Line Items]
Contingent consideration (up to)					$ 83,000,000
Contingent liability	$ 10,000,000						24,100,000	51,900,000
Equity interests issued and issuable	$ 5,900,000
Number of contingent consideration shares issued (in shares) | shares	288,333
Cash consideration	$ 4,100,000			$ 30,000,000	$ 30,000,000
Current portion of accrued acquisition contingency - Holo							0	25,600,000
Noncurrent contingent consideration							24,100,000	26,300,000
Change in fair value								$ (17,900,000)
Holo Surgical Inc. | Consideration for remaining ownership, achievement of all milestones | Stock purchase agreement
Commitment And Contingencies [Line Items]
Contingent liability							$ 24,100,000

Legal Actions (Details)

Legal Actions (Details) $ in Thousands	Sep. 30, 2021 USD ($)	Jul. 27, 2021 USD ($)	Jul. 27, 2018 patent	Dec. 31, 2022 USD ($) claim	Dec. 31, 2021 USD ($)
Loss Contingencies [Line Items]
Insurance recovery receivable				$ 0	$ 1,500
Indemnified Claims
Loss Contingencies [Line Items]
Number of pending claims | claim				1,026
LifeNet Health, Inc., Patent Infringement
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
Derivative Actions
Loss Contingencies [Line Items]
Number of pending claims | claim				3
Damages sought value, liability	$ 1,500
Derivative Actions | Prepaid Expenses and Other Current Assets
Loss Contingencies [Line Items]
Insurance recovery receivable					1,500
Derivative Actions | Accrued Liabilities, Current
Loss Contingencies [Line Items]
Liability					$ 1,500

Regulatory Actions (Details)

Regulatory Actions (Details) - SEC - USD ($)	Dec. 31, 2022	Aug. 03, 2022
Public Utilities, General Disclosures [Line Items]
Payment of civil penalty		$ 2,000,000
Recouped compensation expected to receive	$ 0	$ 600,000

Related Party Transactions (Det

Related Party Transactions (Details) - USD ($) $ in Thousands					12 Months Ended
	Jan. 14, 2022	Dec. 30, 2021	Oct. 23, 2020	Sep. 29, 2020	Dec. 31, 2022	Dec. 31, 2021
Related Party Transaction [Line Items]
Percent of beneficial owner of common stock					5%
Holo Surgical Inc. | Stock purchase agreement
Related Party Transaction [Line Items]
Cash consideration	$ 4,100		$ 30,000	$ 30,000
Shares issuable at closing (in shares)			208,333
Shares issued			$ 12,300
Contingent liability	$ 10,000				$ 24,100	$ 51,900
Maximum shares to be issued (in shares)			288,333
Contingent consideration payable closing milestones, term			6 years	6 years
Holo Surgical Inc. | Stock purchase agreement | Director | Dr. Pawel Lewicki
Related Party Transaction [Line Items]
Indirect outstanding ownership percent			57.50%
Holo Surgical Inc. | Stock purchase agreement | Director | Dr. Krzysztof Siemionow
Related Party Transaction [Line Items]
Indirect outstanding ownership percent			42.50%
INN Acquisition
Related Party Transaction [Line Items]
Cash consideration		$ 5,000			$ 0	$ 5,000
Shares issuable at closing (in shares)		227,359
Shares issued		$ 4,900
INN Acquisition | INN Acquisition
Related Party Transaction [Line Items]
Remaining equity interest		58%

Subsequent Events - Additional

Subsequent Events - Additional Information (Details) - Subsequent Event - USD ($) $ in Thousands	Feb. 28, 2023	Mar. 27, 2023	Feb. 27, 2023
Subsequent Event [Line Items]
Prefunded warrants exercised (in shares)		833,000	465,000
Prefunded warrants outstanding (in shares)		3,631,000
Sold | Coflex Purchase Agreement
Subsequent Event [Line Items]
Disposal group, including discontinued operation, ownership interest disposed	100%
Total consideration	$ 17,000

Schedule II - Valuation and Q_2

Schedule II - Valuation and Qualifying Accounts (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021
Allowance for doubtful accounts
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Balance at Beginning of Period	$ 9,272	$ 8,203
Charged to Costs and Expenses	1,982	1,722
Deductions, Write-offs, or Payments	1,393	653
Balance at End of Period	9,861	9,272
Allowance for product returns
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Balance at Beginning of Period	105	105
Charged to Costs and Expenses	0	0
Deductions, Write-offs, or Payments	50	0
Balance at End of Period	55	105
Deferred tax asset valuation allowance
SEC Schedule, 12-09, Movement in Valuation Allowances and Reserves [Roll Forward]
Balance at Beginning of Period	65,007	45,126
Charged to Costs and Expenses	12,600	20,459
Deductions, Write-offs, or Payments	484	578
Balance at End of Period	$ 77,123	$ 65,007