Cover
Cover - shares | 9 Months Ended | |
Sep. 30, 2022 | Nov. 01, 2022 | |
Cover [Abstract] | ||
Document Type | 10-Q | |
Amendment Flag | false | |
Document Quarterly Report | true | |
Document Transition Report | false | |
Document Period End Date | Sep. 30, 2022 | |
Document Fiscal Period Focus | Q3 | |
Document Fiscal Year Focus | 2022 | |
Current Fiscal Year End Date | --12-31 | |
Entity File Number | 001-34951 | |
Entity Registrant Name | XTANT MEDICAL HOLDINGS, INC. | |
Entity Central Index Key | 0001453593 | |
Entity Tax Identification Number | 20-5313323 | |
Entity Incorporation, State or Country Code | DE | |
Entity Address, Address Line One | 664 Cruiser Lane | |
Entity Address, City or Town | Belgrade | |
Entity Address, State or Province | MT | |
Entity Address, Postal Zip Code | 59714 | |
City Area Code | (406) | |
Local Phone Number | 388-0480 | |
Title of 12(b) Security | Common stock, par value $0.000001 per share | |
Trading Symbol | XTNT | |
Security Exchange Name | NYSE | |
Entity Current Reporting Status | Yes | |
Entity Interactive Data Current | Yes | |
Entity Filer Category | Non-accelerated Filer | |
Entity Small Business | true | |
Entity Emerging Growth Company | false | |
Entity Shell Company | false | |
Entity Common Stock, Shares Outstanding | 108,659,388 |
Condensed Consolidated Balance
Condensed Consolidated Balance Sheets - USD ($) $ in Thousands | Sep. 30, 2022 | Dec. 31, 2021 |
Current Assets: | ||
Cash and cash equivalents | $ 17,363 | $ 18,243 |
Restricted cash | 240 | 144 |
Trade accounts receivable, net of allowance for credit losses and doubtful accounts of $549 and $552, respectively | 9,839 | 7,154 |
Inventories | 16,993 | 17,945 |
Prepaid and other current assets | 673 | 844 |
Total current assets | 45,108 | 44,330 |
Property and equipment, net | 5,669 | 5,212 |
Right-of-use asset, net | 1,490 | 1,258 |
Goodwill | 3,205 | 3,205 |
Intangible assets, net | 358 | 400 |
Other assets | 219 | 287 |
Total Assets | 56,049 | 54,692 |
Current Liabilities: | ||
Accounts payable | 3,779 | 2,615 |
Accrued liabilities | 5,021 | 4,349 |
Current portion of lease liability | 443 | 462 |
Current portion of finance lease obligations | 61 | 31 |
Line of credit | 720 | 3,620 |
Current portion of long-term debt | 1,335 | |
Total current liabilities | 11,359 | 11,077 |
Long-term Liabilities: | ||
Lease liability, less current portion | 1,094 | 842 |
Finance lease obligation, less current portion | 197 | 103 |
Long-term debt, plus premium and less issuance costs | 10,626 | 11,787 |
Total Liabilities | 23,276 | 23,809 |
Commitments and Contingencies (Note 11) | ||
Stockholders’ Equity: | ||
Preferred stock, $0.000001 par value; 10,000,000 shares authorized; no shares issued and outstanding | ||
Common stock, $0.000001 par value; 300,000,000 shares authorized; 101,981,250 shares issued and outstanding as of September 30, 2022 and 87,068,980 shares issued and outstanding as of December 31, 2021 | ||
Additional paid-in capital | 274,234 | 266,068 |
Accumulated deficit | (241,461) | (235,185) |
Total Stockholders’ Equity | 32,773 | 30,883 |
Total Liabilities & Stockholders’ Equity | $ 56,049 | $ 54,692 |
Condensed Consolidated Balanc_2
Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands | Sep. 30, 2022 | Dec. 31, 2021 |
Statement of Financial Position [Abstract] | ||
Allowance of accounts receivable, net | $ 549 | $ 552 |
Preferred stock, par value | $ 0.000001 | $ 0.000001 |
Preferred stock, shares authorized | 10,000,000 | 10,000,000 |
Preferred stock, shares issued | 0 | 0 |
Preferred stock, shares outstanding | 0 | 0 |
Common stock, par value | $ 0.000001 | $ 0.000001 |
Common stock, shares authorized | 300,000,000 | 300,000,000 |
Common stock, shares issued | 101,981,250 | 87,068,980 |
Common stock, shares outstanding | 101,981,250 | 87,068,980 |
Condensed Consolidated Statemen
Condensed Consolidated Statements of Operations (Unaudited) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2022 | Sep. 30, 2021 | Sep. 30, 2022 | Sep. 30, 2021 | |
Revenue | ||||
Orthopedic product sales | $ 14,462 | $ 13,743 | $ 42,689 | $ 41,193 |
Other revenue | 34 | 10 | 100 | |
Total Revenue | 14,462 | 13,777 | 42,699 | 41,293 |
Cost of sales | 6,566 | 6,586 | 18,868 | 16,498 |
Gross Profit | 7,896 | 7,191 | 23,831 | 24,795 |
Operating Expenses | ||||
General and administrative | 3,729 | 3,107 | 11,496 | 10,307 |
Sales and marketing | 5,838 | 5,267 | 16,683 | 15,712 |
Research and development | 229 | 262 | 683 | 719 |
Total Operating Expenses | 9,796 | 8,636 | 28,862 | 26,738 |
Loss from Operations | (1,900) | (1,445) | (5,031) | (1,943) |
Other Expense | ||||
Interest expense | (440) | (329) | (1,197) | (529) |
Total Other Expense | (440) | (329) | (1,197) | (529) |
Net Loss Before Provision for Income Taxes | (2,340) | (1,774) | (6,228) | (2,472) |
Provision for Income Taxes Current and Deferred | (13) | (30) | (48) | (94) |
Net Loss | $ (2,353) | $ (1,804) | $ (6,276) | $ (2,566) |
Net loss per share: | ||||
Basic | $ (0.03) | $ (0.02) | $ (0.07) | $ (0.03) |
Dilutive | $ (0.03) | $ (0.02) | $ (0.07) | $ (0.03) |
Shares used in the computation: | ||||
Basic | 93,278,610 | 86,763,210 | 89,236,832 | 84,926,656 |
Dilutive | 93,278,610 | 86,763,210 | 89,236,832 | 84,926,656 |
Condensed Consolidated Statem_2
Condensed Consolidated Statements of Equity (Unaudited) - USD ($) $ in Thousands | Total | Common Stock [Member] | Additional Paid-in Capital [Member] | Retained Earnings [Member] |
Beginning balance at Dec. 31, 2020 | $ 14,514 | $ 244,850 | $ (230,336) | |
Beginning balance, shares at Dec. 31, 2020 | 77,573,680 | |||
Warrants issued in connection with the private placement to placement agents | 351 | 351 | ||
Common stock issued on vesting of restricted stock units | ||||
Common stock issued on vesting of restricted stock units, shares | 244,716 | |||
Stock-based compensation | 456 | 456 | ||
Net loss | (29) | (29) | ||
Private placement of common stock, net of issuance costs of $1,926 | 12,831 | 12,831 | ||
Private placement of common stock, net of issuance costs of $1,926, shares | 8,888,890 | |||
Warrants issued in connection with the private placement | 5,243 | 5,243 | ||
Ending balance at Mar. 31, 2021 | 33,366 | 263,731 | (230,365) | |
Ending balance, shares at Mar. 31, 2021 | 86,707,286 | |||
Beginning balance at Dec. 31, 2020 | 14,514 | 244,850 | (230,336) | |
Beginning balance, shares at Dec. 31, 2020 | 77,573,680 | |||
Net loss | (2,566) | |||
Ending balance at Sep. 30, 2021 | 32,637 | 265,539 | (232,902) | |
Ending balance, shares at Sep. 30, 2021 | 86,796,175 | |||
Beginning balance at Mar. 31, 2021 | 33,366 | 263,731 | (230,365) | |
Beginning balance, shares at Mar. 31, 2021 | 86,707,286 | |||
Gain on debt extinguishment | 786 | 786 | ||
Stock-based compensation | 465 | 465 | ||
Net loss | (733) | (733) | ||
Ending balance at Jun. 30, 2021 | 33,884 | 264,982 | (231,098) | |
Ending balance, shares at Jun. 30, 2021 | 86,707,286 | |||
Common stock issued on vesting of restricted stock units | ||||
Common stock issued on vesting of restricted stock units, shares | 104,856 | |||
Withholding of common stock upon vesting of restricted stock units | (23) | (23) | ||
Withholding of common stock upon vesting of restricted stock units, shares | (15,967) | |||
Stock-based compensation | 580 | 580 | ||
Net loss | (1,804) | (1,804) | ||
Ending balance at Sep. 30, 2021 | 32,637 | 265,539 | (232,902) | |
Ending balance, shares at Sep. 30, 2021 | 86,796,175 | |||
Beginning balance at Dec. 31, 2021 | 30,883 | 266,068 | (235,185) | |
Beginning balance, shares at Dec. 31, 2021 | 87,068,980 | |||
Common stock issued on vesting of restricted stock units | ||||
Common stock issued on vesting of restricted stock units, shares | 244,721 | |||
Stock-based compensation | 613 | 613 | ||
Net loss | (2,213) | (2,213) | ||
Ending balance at Mar. 31, 2022 | 29,283 | 266,681 | (237,398) | |
Ending balance, shares at Mar. 31, 2022 | 87,313,701 | |||
Beginning balance at Dec. 31, 2021 | 30,883 | 266,068 | (235,185) | |
Beginning balance, shares at Dec. 31, 2021 | 87,068,980 | |||
Net loss | (6,276) | |||
Ending balance at Sep. 30, 2022 | 32,773 | 274,234 | (241,461) | |
Ending balance, shares at Sep. 30, 2022 | 101,981,250 | |||
Beginning balance at Mar. 31, 2022 | 29,283 | 266,681 | (237,398) | |
Beginning balance, shares at Mar. 31, 2022 | 87,313,701 | |||
Stock-based compensation | 571 | 571 | ||
Net loss | (1,710) | (1,710) | ||
Ending balance at Jun. 30, 2022 | 28,144 | 267,252 | (239,108) | |
Ending balance, shares at Jun. 30, 2022 | 87,313,701 | |||
Common stock issued on vesting of restricted stock units | ||||
Common stock issued on vesting of restricted stock units, shares | 607,234 | |||
Stock-based compensation | 641 | 641 | ||
Net loss | (2,353) | (2,353) | ||
Private placement of common stock, net of issuance costs of $1,926 | 5,225 | 5,225 | ||
Private placement of common stock, net of issuance costs of $1,926, shares | 14,060,315 | |||
Warrants issued in connection with the private placement | 1,116 | 1,116 | ||
Ending balance at Sep. 30, 2022 | $ 32,773 | $ 274,234 | $ (241,461) | |
Ending balance, shares at Sep. 30, 2022 | 101,981,250 |
Condensed Consolidated Statem_3
Condensed Consolidated Statements of Equity (Unaudited) (Parenthetical) - USD ($) $ in Thousands | 3 Months Ended | |
Sep. 30, 2022 | Mar. 31, 2021 | |
Statement of Cash Flows [Abstract] | ||
Payments of stock issuance costs | $ 409 | $ 1,926 |
Condensed Consolidated Statem_4
Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands | 9 Months Ended | |
Sep. 30, 2022 | Sep. 30, 2021 | |
Operating activities: | ||
Net loss | $ (6,276) | $ (2,566) |
Adjustments to reconcile net loss to net cash (used in) provided by operating activities: | ||
Depreciation and amortization | 971 | 1,041 |
Gain on disposal of fixed assets | (91) | (164) |
Non-cash interest | 175 | 38 |
Non-cash rent | 2 | 8 |
Stock-based compensation | 1,825 | 1,501 |
Provision for reserve (recovery) on accounts receivable | 277 | (25) |
Provision for excess and obsolete inventory | 1,568 | 572 |
Changes in operating assets and liabilities: | ||
Accounts receivable | (2,962) | 584 |
Inventories | (616) | 1,128 |
Prepaid and other assets | 239 | (126) |
Accounts payable | 1,164 | (592) |
Accrued liabilities | 671 | (1,383) |
Net cash (used in) provided by operating activities | (3,053) | 16 |
Investing activities: | ||
Purchases of property and equipment and intangible assets | (1,321) | (1,489) |
Proceeds from sale of fixed assets | 184 | 194 |
Net cash used in investing activities | (1,137) | (1,295) |
Financing activities: | ||
Payment of taxes from withholding of common stock on vesting of restricted stock units | (23) | |
Payments on financing leases | (35) | (42) |
Costs associated with refinancing | (136) | |
Payments on long-term debt | (411) | |
Borrowings on line of credit | 36,680 | 22,767 |
Repayments of line of credit | (39,580) | (23,029) |
Proceeds from private placement, net of cash issuance costs | 6,341 | 18,426 |
Net cash provided by financing activities | 3,406 | 17,552 |
Net change in cash and cash equivalents and restricted cash | (784) | 16,273 |
Cash and cash equivalents and restricted cash at beginning of period | 18,387 | 2,341 |
Cash and cash equivalents and restricted cash at end of period | 17,603 | 18,614 |
Reconciliation of cash and restricted cash reported in the condensed consolidated balance sheets | ||
Cash and cash equivalents | 17,363 | 18,175 |
Restricted cash | 240 | 439 |
Total cash and restricted cash reported in the condensed consolidated balance sheets | $ 17,603 | $ 18,614 |
Business Description, Basis of
Business Description, Basis of Presentation and Summary of Significant Accounting Policies | 9 Months Ended |
Sep. 30, 2022 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Business Description, Basis of Presentation and Summary of Significant Accounting Policies | (1) Business Description, Basis of Presentation and Summary of Significant Accounting Policies Business Description and Basis of Presentation The accompanying condensed consolidated financial statements include the accounts of Xtant Medical Holdings, Inc. (“Xtant”), a Delaware corporation, and its wholly owned subsidiaries, Xtant Medical, Inc. (“Xtant Medical”), a Delaware corporation, Bacterin International, Inc. (“Bacterin”), a Nevada corporation, and X-spine Systems, Inc. (“X-spine”), an Ohio corporation (Xtant, Xtant Medical, Bacterin, and X-spine are jointly referred to herein as the “Company” or sometimes “we,” “our,” or “us”). All intercompany balances and transactions have been eliminated in consolidation. Xtant is a global medical technology company focused on the design, development, and commercialization of a comprehensive portfolio of orthobiologics and spinal implant systems to facilitate spinal fusion in complex spine, deformity, and degenerative procedures. At the onset of, and at various times during, the COVID-19 pandemic, hospitals and other medical facilities cancelled or deferred elective procedures, diverted resources to patients suffering from infections and limited access for non-patients, including our direct and indirect sales representatives. Especially during waves of increased cases and hospitalizations, surgeons and their patients have been required or chosen to defer procedures in which our products otherwise would be used, and many facilities that specialize in the procedures in which our products otherwise would be used have experienced temporary closures or reduced operating hours. These circumstances have negatively impacted, and may continue to negatively impact, the ability of our employees, independent sales representatives and distributors to effectively market and sell our products, which has had and may continue to have a material adverse effect on our revenues. The accompanying condensed consolidated balance sheet as of December 31, 2021, which has been derived from audited financial statements, and the unaudited interim condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America. They do not include all disclosures required by generally accepted accounting principles for annual consolidated financial statements, but in the opinion of management include all adjustments, consisting only of normal recurring items, necessary for a fair presentation. Interim results are not necessarily indicative of results that may be achieved in the future for the full year ending December 31, 2022. These condensed consolidated financial statements should be read in conjunction with the consolidated financial statements and notes thereto, which are included in Xtant’s Annual Report on Form 10-K for the year ended December 31, 2021. The accounting policies set forth in those annual consolidated financial statements are the same as the accounting policies utilized in the preparation of these condensed consolidated financial statements, except as modified for appropriate interim consolidated financial statement presentation. Private Placement On August 25, 2022, the Company closed the first tranche of a private placement (the “First Closing”) with several accredited investors (the “Private Placement”). At the First Closing, the Company sold approximately 14.1 3.5 6.75 We received net cash proceeds of approximately $ 6.3 The closing of the second tranche of the Private Placement (the “Second Closing”) occurred on October 7, 2022. At the Second Closing, the Company sold an additional approximately 6.2 1.6 3.0 The Warrants, described in more detail in Note 10, “Warrants”, 0.48 Use of Estimates The preparation of the condensed consolidated financial statements requires management of the Company to make a number of estimates and assumptions relating to the reported amount of assets and liabilities and the disclosure of contingent assets and liabilities at the date of the condensed consolidated financial statements and the reported amounts of revenue and expenses during the period. Significant estimates include the carrying amount of property and equipment, goodwill and intangible assets and liabilities, valuation allowances for trade receivables, inventory and deferred income tax assets and liabilities, current and long-term lease obligations and corresponding right-of-use asset and estimates for the fair value of long-term debt, stock options and other equity awards upon which the Company determines stock-based compensation expense. Actual results could differ from those estimates. Restricted Cash Cash and cash equivalents classified as restricted cash on our condensed consolidated balance sheets are restricted as to withdrawal or use under the terms of certain credit agreements. The September 30, 2022 balance included lockbox deposits that are temporarily restricted due to timing at the period end. The lockbox deposits are applied against our line of credit the next business day. Long-Lived Assets The Company reviews its long-lived assets for impairment whenever events or changes in circumstances indicate that the carrying amount of the asset may not be recovered. No impairments of long-lived assets were recorded for the three and nine months ended September 30, 2022 and 2021. Goodwill Goodwill represents the excess of costs over fair value of assets of businesses acquired. Goodwill and intangible assets acquired in a purchase business combination and determined to have indefinite useful lives are not amortized. Instead, they are tested for impairment at least annually, and whenever events or circumstances indicate, the carrying amount of the asset may not be recoverable. No impairments of goodwill were recorded for the three and nine months ended September 30, 2022 and 2021. Net Loss Per Share Basic net loss per share is computed by dividing net loss by the weighted average number of shares of common stock outstanding. Shares issued during the period and shares reacquired during the period are weighted for the portion of the period that they were outstanding. Diluted net loss per share is computed in a manner consistent with that of basic earnings per share while giving effect to all potentially dilutive shares of common stock outstanding during the period, which include the assumed exercise of stock options and warrants using the treasury stock method. Our diluted earnings per share is the same as basic earnings per share, as the effects of including 17,192,048 14,138,224 Fair Value of Financial Instruments The carrying values of financial instruments, including trade accounts receivable, accounts payable, accrued liabilities, and long-term debt, approximate their fair values based on terms and related interest rates as of September 30, 2022 and December 31, 2021. |
Revenue
Revenue | 9 Months Ended |
Sep. 30, 2022 | |
Revenue from Contract with Customer [Abstract] | |
Revenue | (2) Revenue In the United States, we generate most of our revenue from independent commissioned sales agents. We consign our orthobiologics products to hospitals and consign or loan our spinal implant sets to the independent sales agents. The spinal implant sets typically contain the instruments, disposables, and spinal implants required to complete a surgery. Consigned sets are managed by the sales agent to service hospitals that are high volume users for multiple procedures. We ship replacement inventory to independent sales agents to replace the consigned inventory used in surgeries. Loaned sets are returned to the Company’s distribution center, replenished, and made available to sales agents for the next surgical procedure. For each surgical procedure, the sales agent reports use of the product by the hospital and, as soon as practicable thereafter, ensures that the hospital provides a purchase order to the Company. Upon receipt of the hospital purchase order, the Company invoices the hospital, and revenue is recognized in the proper period. Additionally, the Company sells product directly to domestic and international stocking resellers and private label resellers. Upon receipt and acceptance of a purchase order from a stocking reseller, the Company ships product and invoices the reseller. The Company recognizes revenue when control of the promised goods is transferred to the customer, in an amount that reflects the consideration the Company expects to collect in exchange for those goods or services. There is generally no customer acceptance or other condition that prevents the Company from recognizing revenue in accordance with the delivery terms for these sales transactions. The Company operates in one reportable segment with its net revenue derived primarily from the sale of orthopaedic medical products and devices across North America, Europe, Asia Pacific, and Latin America. Sales are reported net of returns. The following table presents revenues from these product lines for the three and nine months ended September 30, 2022 and 2021 (in thousands): Summary of Revenues from Product Lines Three Months Ended September Percentage of Total Revenue Three Months Ended September 30, 2021 Percentage of Total Revenue Orthobiologics $ 12,046 83 % $ 10,795 78 % Spinal implant 2,416 17 % 2,948 22 % Other revenue — 0 % 34 0 % Total revenue $ 14,462 100 % $ 13,777 100 % Nine Months Ended 30, 2022 Percentage Revenue Nine Months Ended 30, 2021 Percentage Revenue Orthobiologics $ 34,614 81 % $ 31,264 76 % Spinal implant 8,075 19 % 9,929 24 % Other revenue 10 0 % 100 0 % Total revenue $ 42,699 100 % $ 41,293 100 % |
Receivables
Receivables | 9 Months Ended |
Sep. 30, 2022 | |
Credit Loss [Abstract] | |
Receivables | (3) Receivables The Company’s provision for current expected credit loss is determined based on historical collection experience adjusted for current economic conditions affecting collectability. Actual customer collections could differ from estimates. Account balances are charged to the allowance after all means of collection have been exhausted and the potential for recovery is considered remote. Provisions to the allowance for credit losses are charged to expense. Activity within the allowance for credit losses was as follows for the three and nine months ended September 30, 2022 and 2021 (in thousands): Schedule of Allowance for Credit Losses September 30, September 30, Balance at January 1 $ 552 $ 653 Provision for current expected credit losses 191 (63 ) Write-offs charged against allowance (173 ) (36 ) Balance at March 31 570 554 Provision for current expected credit losses (49 ) (81 ) Write-offs charged against allowance (11 ) (3 ) Balance at June 30 510 470 Provision for current expected credit losses 54 118 Write-offs charged against allowance (15 ) (12 ) Balance at September 30 $ 549 $ 576 |
Inventories
Inventories | 9 Months Ended |
Sep. 30, 2022 | |
Inventory Disclosure [Abstract] | |
Inventories | (4) Inventories Inventories consist of the following (in thousands): Schedule of Inventories September 30, December 31, Raw materials $ 5,121 $ 5,613 Work in process 957 571 Finished goods 10,915 11,761 Total $ 16,993 $ 17,945 |
Property and Equipment, Net
Property and Equipment, Net | 9 Months Ended |
Sep. 30, 2022 | |
Property, Plant and Equipment [Abstract] | |
Property and Equipment, Net | (5) Property and Equipment, Net Property and equipment, net are as follows (in thousands): Schedule of Property and Equipment, Net September 30, December 31, Equipment $ 6,302 $ 5,541 Computer equipment 1,090 828 Computer software 490 490 Furniture and fixtures 104 94 Leasehold improvements 4,333 3,994 Other 10 10 Surgical instruments 11,307 11,424 Total cost 23,636 22,381 Less: accumulated depreciation (17,967 ) (17,169 ) Property and equipment, net $ 5,669 $ 5,212 Depreciation expense related to property and equipment, including property under finance leases, for the three months ended September 30, 2022 and 2021 was $ 0.4 0.3 1 |
Intangible Assets
Intangible Assets | 9 Months Ended |
Sep. 30, 2022 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Intangible Assets | (6) Intangible Assets The following table sets forth information regarding intangible assets (in thousands): Schedule of Intangible Assets September 30, December 31, Patents $ 807 $ 847 Accumulated amortization (449 ) (447 ) Intangible assets, net $ 358 $ 400 |
Accrued Liabilities
Accrued Liabilities | 9 Months Ended |
Sep. 30, 2022 | |
Payables and Accruals [Abstract] | |
Accrued Liabilities | (7) Accrued Liabilities Accrued liabilities consist of the following (in thousands): Schedule of Accrued Liabilities September 30, December 31, Cash compensation/commissions payable $ 3,844 $ 3,184 Other accrued liabilities 1,177 1,165 Accrued liabilities $ 5,021 $ 4,349 |
Debt
Debt | 9 Months Ended |
Sep. 30, 2022 | |
Debt Disclosure [Abstract] | |
Debt | (8) Debt Long-term debt consists of the following (in thousands): Schedule of Long-term Debt September 30, 2022 December 31, 2021 Amounts due under the Term Facility $ 12,000 $ 12,000 Accrued end-of-term payments 182 83 Less: unamortized debt issuance costs (221 ) (296 ) Less: current maturities (1,335 ) — Long-term debt $ 10,626 $ 11,787 On March 7, 2022, the Company’s term loan agreement and revolving credit agreement were amended to, among other things, (i) provide for a waiver of compliance with respect to the Company’s minimum adjusted EBITDA requirement if and so long as the Company’s liquidity (as specifically defined in the term loan agreement and revolving credit agreement) is in excess of $ 14 The effective rate of the term loan, inclusive of amortization of debt issuance costs and accretion of the final payment, was 11.53 7.07 7.3 On October 27, 2022, the Company’s term loan and revolving credit agreements were amended to transition the reference rate from LIBOR to term SOFR. The term SOFR reference rate will apply to amounts outstanding and draws that place on or after November 1, 2022. |
Stock-Based Compensation
Stock-Based Compensation | 9 Months Ended |
Sep. 30, 2022 | |
Share-Based Payment Arrangement [Abstract] | |
Stock-Based Compensation | (9) Stock-Based Compensation Stock option activity, including options granted under the Xtant Medical Holdings, Inc. 2018 Equity Incentive Plan, as amended (the “2018 Plan”), and the Amended and Restated Xtant Medical Equity Incentive Plan and options granted to new hires to purchase shares of our common stock outside of any stockholder-approved plan, was as follows for the nine months ended September 30, 2022 and 2021: Schedule of Share-based Compensation, Stock Options, Activity 2022 2021 Shares Weighted Weighted Shares Weighted Weighted Average Remaining Contract Term (years) Outstanding at January 1 3,201,666 $ 1.80 2,190,892 $ 2.25 Granted 109,164 $ 0.65 1,012,083 $ 1.27 Cancelled or expired (443,125 ) $ 2.39 (269 ) $ 314.19 Outstanding at September 30 2,867,705 $ 1.66 8.1 3,202,706 $ 1.92 9.1 Exercisable at September 30 828,978 $ 2.37 7.8 210,028 $ 9.02 7.4 Restricted stock unit activity for awards granted under the 2018 Plan was as follows for the nine months ended September 30, 2022 and 2021: Schedule of Restricted Stock Activity 2022 2021 Shares Weighted Average Value at Date Per Share Shares Weighted Average Value at Date Per Outstanding at January 1 2,970,104 $ 1.39 2,503,698 $ 1.54 Granted 1,898,808 $ 0.53 1,249,002 $ 1.27 Vested (851,955 ) $ 1.33 (349,572 ) $ 1.92 Cancelled (318,805 ) $ 1.38 — $ — Outstanding at September 30 3,698,152 $ 0.96 3,403,128 $ 1.40 At the 2022 annual meeting of stockholders held on October 26, 2022, our shareholders approved an amendment to the 2018 Plan to increase the number of shares of common stock available thereunder by 8,500,000 |
Warrants
Warrants | 9 Months Ended |
Sep. 30, 2022 | |
Warrants | |
Warrants | (10) Warrants As noted in Note 1, “ Business Description, Basis of Presentation and Summary of Significant Accounting Policies While the Warrants are classified as a component of equity, we were required to allocate the proceeds of the Private Placement between the shares of common stock and the Warrants issued based on their relative fair values. The fair value of the Warrants, $ 0.40 5 107 Our warrant activity during the nine months ended September 30, 2022 was as follows: Schedule of Warrant Activity Common Stock Weighted Average Outstanding at January 1, 2022 7,111,112 $ 2.29 Issued 3,515,079 0.48 Outstanding at September 30, 2022 10,626,191 $ 1.69 |
Commitments and Contingencies
Commitments and Contingencies | 9 Months Ended |
Sep. 30, 2022 | |
Commitments and Contingencies Disclosure [Abstract] | |
Commitments and Contingencies | (11) Commitments and Contingencies Operating Leases We lease three office facilities as of September 30, 2022 in Belgrade, Montana under non-cancelable operating lease agreements. On July 14, 2022, the Company’s lease agreement for facilities at 600 Cruiser Lane in Belgrade, Montana was amended to, among other things, extend the lease term through October 2025 to align the lease term with the Company’s lease agreement for facilities at 664 Cruisier Lane in Belgrade, Montana. In addition, the Company’s lease agreement for facilities at 732 Cruiser Lane in Belgrade, Montana was amended on July 29, 2022 to extend the lease term through October 2025. 3.1 Present Value of Long-term Leases Schedule of Lease Liability (in thousands): September 30, Right-of-use assets, net $ 1,490 Current portion of lease liability $ 443 Lease liability, less current portion 1,094 Total lease liability $ 1,537 Future minimum payments for the next five years and thereafter as of September 30, 2022 under these long-term operating leases are as follows (in thousands): Schedule of Future Minimum Rental Payments for Operating Leases Remainder of 2022 131 2023 534 2024 559 2025 470 Total future minimum lease payments 1,694 Less amount representing interest (157 ) Present value of obligations under operating leases 1,537 Less current portion (443 ) Long-term operating lease obligations $ 1,094 Rent expense was $ 0.1 0.4 Litigation We are subject to potential liabilities under government regulations and various claims and legal actions that are pending or may be asserted from time to time. These matters arise in the ordinary course and conduct of our business and may include, for example, commercial, product liability, intellectual property, and employment matters. When we believe that a loss is probable and reasonably estimable, we record a charge on our condensed consolidated statements of operations for our estimated loss. We do not believe that the ultimate resolution of any such potential liabilities, claims or legal actions will have a material adverse effect upon our consolidated financial position, results of operations, or cash flows. Indemnifications Our indemnification arrangements generally include limited warranties and certain provisions for indemnifying customers against liabilities if our products or services infringe a third-party’s intellectual property rights. To date, we have not incurred any material costs as a result of such warranties or indemnification provisions and have not accrued any liabilities related to such obligations in the accompanying condensed consolidated financial statements. We have also agreed to indemnify our directors and executive officers for costs associated with any fees, expenses, judgments, fines, and settlement amounts incurred by any of these persons in any action or proceeding to which any of those persons is, or is threatened to be, made a party by reason of the person’s service as a director or officer, including any action by us, arising out of that person’s services as our director or officer or that person’s services provided to any other company or enterprise at our request. |
Income Taxes
Income Taxes | 9 Months Ended |
Sep. 30, 2022 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | (12) Income Taxes In evaluating the realizability of the net deferred tax assets, we take into account a number of factors, primarily relating to the ability to generate taxable income. Where it is determined that it is likely that we will be unable to realize deferred tax assets, a valuation allowance is established against the applicable portion of the deferred tax asset. Because it cannot be accurately determined when or if we will become profitable, a valuation allowance was provided against the entire deferred income tax asset balance. The Company did not recognize any interest or penalties related to income taxes for the three and nine months ended September 30, 2022 and 2021. |
Supplemental Disclosure of Cash
Supplemental Disclosure of Cash Flow Information | 9 Months Ended |
Sep. 30, 2022 | |
Supplemental Cash Flow Elements [Abstract] | |
Supplemental Disclosure of Cash Flow Information | (13) Supplemental Disclosure of Cash Flow Information Supplemental cash flow information is as follows (in thousands): Schedule of Supplemental Cash Flow Information 2022 2021 Nine Months Ended September 30, 2022 2021 Supplemental disclosure of cash flow information Cash paid during the period for: Interest $ 1,022 $ 485 Non-cash activities: Fixed assets acquired under finance lease $ 159 $ 163 Revaluation of lease liability and right of use asset $ 234 $ — Gain on extinguishment of Second A&R Credit Agreement $ — $ 786 Extinguishment of Second A&R Credit Agreement financed by line of credit $ — $ 3,755 Prepaid debt issuance costs $ — $ 75 Warrants issued in connection with the Private Placement to placement agents $ — $ 351 |
Related Party Transactions
Related Party Transactions | 9 Months Ended |
Sep. 30, 2022 | |
Related Party Transactions [Abstract] | |
Related Party Transactions | (14) Related Party Transactions As described in more detail under Note 1, “ Business Description and Summary of Significant Accounting Policies 72% All related party transactions are reviewed and approved by the Audit Committee or the disinterested members of the full Board of Directors. |
Segment and Geographic Informat
Segment and Geographic Information | 9 Months Ended |
Sep. 30, 2022 | |
Segment Reporting [Abstract] | |
Segment and Geographic Information | (15) Segment and Geographic Information The Company’s management reviews financial results and manages the business on an aggregate basis. Therefore, financial results are reported in a single operating segment: the development, manufacture, and marketing of orthopedic medical products and devices. The Company attributes revenues to geographic areas based on the location of the customer. Approximately 99% 99% Schedule of Revenues by Geographic Region Three Months Ended 2022 2021 United States $ 14,370 $ 13,629 Rest of world 92 148 Total revenue $ 14,462 $ 13,777 Nine Months Ended 2022 2021 United States $ 42,089 $ 40,813 Rest of world 610 480 Total revenue $ 42,699 $ 41,293 |
Business Description, Basis o_2
Business Description, Basis of Presentation and Summary of Significant Accounting Policies (Policies) | 9 Months Ended |
Sep. 30, 2022 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Business Description and Basis of Presentation | Business Description and Basis of Presentation The accompanying condensed consolidated financial statements include the accounts of Xtant Medical Holdings, Inc. (“Xtant”), a Delaware corporation, and its wholly owned subsidiaries, Xtant Medical, Inc. (“Xtant Medical”), a Delaware corporation, Bacterin International, Inc. (“Bacterin”), a Nevada corporation, and X-spine Systems, Inc. (“X-spine”), an Ohio corporation (Xtant, Xtant Medical, Bacterin, and X-spine are jointly referred to herein as the “Company” or sometimes “we,” “our,” or “us”). All intercompany balances and transactions have been eliminated in consolidation. Xtant is a global medical technology company focused on the design, development, and commercialization of a comprehensive portfolio of orthobiologics and spinal implant systems to facilitate spinal fusion in complex spine, deformity, and degenerative procedures. At the onset of, and at various times during, the COVID-19 pandemic, hospitals and other medical facilities cancelled or deferred elective procedures, diverted resources to patients suffering from infections and limited access for non-patients, including our direct and indirect sales representatives. Especially during waves of increased cases and hospitalizations, surgeons and their patients have been required or chosen to defer procedures in which our products otherwise would be used, and many facilities that specialize in the procedures in which our products otherwise would be used have experienced temporary closures or reduced operating hours. These circumstances have negatively impacted, and may continue to negatively impact, the ability of our employees, independent sales representatives and distributors to effectively market and sell our products, which has had and may continue to have a material adverse effect on our revenues. The accompanying condensed consolidated balance sheet as of December 31, 2021, which has been derived from audited financial statements, and the unaudited interim condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America. They do not include all disclosures required by generally accepted accounting principles for annual consolidated financial statements, but in the opinion of management include all adjustments, consisting only of normal recurring items, necessary for a fair presentation. Interim results are not necessarily indicative of results that may be achieved in the future for the full year ending December 31, 2022. These condensed consolidated financial statements should be read in conjunction with the consolidated financial statements and notes thereto, which are included in Xtant’s Annual Report on Form 10-K for the year ended December 31, 2021. The accounting policies set forth in those annual consolidated financial statements are the same as the accounting policies utilized in the preparation of these condensed consolidated financial statements, except as modified for appropriate interim consolidated financial statement presentation. |
Private Placement | Private Placement On August 25, 2022, the Company closed the first tranche of a private placement (the “First Closing”) with several accredited investors (the “Private Placement”). At the First Closing, the Company sold approximately 14.1 3.5 6.75 We received net cash proceeds of approximately $ 6.3 The closing of the second tranche of the Private Placement (the “Second Closing”) occurred on October 7, 2022. At the Second Closing, the Company sold an additional approximately 6.2 1.6 3.0 The Warrants, described in more detail in Note 10, “Warrants”, 0.48 |
Use of Estimates | Use of Estimates The preparation of the condensed consolidated financial statements requires management of the Company to make a number of estimates and assumptions relating to the reported amount of assets and liabilities and the disclosure of contingent assets and liabilities at the date of the condensed consolidated financial statements and the reported amounts of revenue and expenses during the period. Significant estimates include the carrying amount of property and equipment, goodwill and intangible assets and liabilities, valuation allowances for trade receivables, inventory and deferred income tax assets and liabilities, current and long-term lease obligations and corresponding right-of-use asset and estimates for the fair value of long-term debt, stock options and other equity awards upon which the Company determines stock-based compensation expense. Actual results could differ from those estimates. |
Restricted Cash | Restricted Cash Cash and cash equivalents classified as restricted cash on our condensed consolidated balance sheets are restricted as to withdrawal or use under the terms of certain credit agreements. The September 30, 2022 balance included lockbox deposits that are temporarily restricted due to timing at the period end. The lockbox deposits are applied against our line of credit the next business day. |
Long-Lived Assets | Long-Lived Assets The Company reviews its long-lived assets for impairment whenever events or changes in circumstances indicate that the carrying amount of the asset may not be recovered. No impairments of long-lived assets were recorded for the three and nine months ended September 30, 2022 and 2021. |
Goodwill | Goodwill Goodwill represents the excess of costs over fair value of assets of businesses acquired. Goodwill and intangible assets acquired in a purchase business combination and determined to have indefinite useful lives are not amortized. Instead, they are tested for impairment at least annually, and whenever events or circumstances indicate, the carrying amount of the asset may not be recoverable. No impairments of goodwill were recorded for the three and nine months ended September 30, 2022 and 2021. |
Net Loss Per Share | Net Loss Per Share Basic net loss per share is computed by dividing net loss by the weighted average number of shares of common stock outstanding. Shares issued during the period and shares reacquired during the period are weighted for the portion of the period that they were outstanding. Diluted net loss per share is computed in a manner consistent with that of basic earnings per share while giving effect to all potentially dilutive shares of common stock outstanding during the period, which include the assumed exercise of stock options and warrants using the treasury stock method. Our diluted earnings per share is the same as basic earnings per share, as the effects of including 17,192,048 14,138,224 |
Fair Value of Financial Instruments | Fair Value of Financial Instruments The carrying values of financial instruments, including trade accounts receivable, accounts payable, accrued liabilities, and long-term debt, approximate their fair values based on terms and related interest rates as of September 30, 2022 and December 31, 2021. |
Revenue (Tables)
Revenue (Tables) | 9 Months Ended |
Sep. 30, 2022 | |
Revenue from Contract with Customer [Abstract] | |
Summary of Revenues from Product Lines | Summary of Revenues from Product Lines Three Months Ended September Percentage of Total Revenue Three Months Ended September 30, 2021 Percentage of Total Revenue Orthobiologics $ 12,046 83 % $ 10,795 78 % Spinal implant 2,416 17 % 2,948 22 % Other revenue — 0 % 34 0 % Total revenue $ 14,462 100 % $ 13,777 100 % Nine Months Ended 30, 2022 Percentage Revenue Nine Months Ended 30, 2021 Percentage Revenue Orthobiologics $ 34,614 81 % $ 31,264 76 % Spinal implant 8,075 19 % 9,929 24 % Other revenue 10 0 % 100 0 % Total revenue $ 42,699 100 % $ 41,293 100 % |
Receivables (Tables)
Receivables (Tables) | 9 Months Ended |
Sep. 30, 2022 | |
Credit Loss [Abstract] | |
Schedule of Allowance for Credit Losses | Schedule of Allowance for Credit Losses September 30, September 30, Balance at January 1 $ 552 $ 653 Provision for current expected credit losses 191 (63 ) Write-offs charged against allowance (173 ) (36 ) Balance at March 31 570 554 Provision for current expected credit losses (49 ) (81 ) Write-offs charged against allowance (11 ) (3 ) Balance at June 30 510 470 Provision for current expected credit losses 54 118 Write-offs charged against allowance (15 ) (12 ) Balance at September 30 $ 549 $ 576 |
Inventories (Tables)
Inventories (Tables) | 9 Months Ended |
Sep. 30, 2022 | |
Inventory Disclosure [Abstract] | |
Schedule of Inventories | Inventories consist of the following (in thousands): Schedule of Inventories September 30, December 31, Raw materials $ 5,121 $ 5,613 Work in process 957 571 Finished goods 10,915 11,761 Total $ 16,993 $ 17,945 |
Property and Equipment, Net (Ta
Property and Equipment, Net (Tables) | 9 Months Ended |
Sep. 30, 2022 | |
Property, Plant and Equipment [Abstract] | |
Schedule of Property and Equipment, Net | Property and equipment, net are as follows (in thousands): Schedule of Property and Equipment, Net September 30, December 31, Equipment $ 6,302 $ 5,541 Computer equipment 1,090 828 Computer software 490 490 Furniture and fixtures 104 94 Leasehold improvements 4,333 3,994 Other 10 10 Surgical instruments 11,307 11,424 Total cost 23,636 22,381 Less: accumulated depreciation (17,967 ) (17,169 ) Property and equipment, net $ 5,669 $ 5,212 |
Intangible Assets (Tables)
Intangible Assets (Tables) | 9 Months Ended |
Sep. 30, 2022 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Schedule of Intangible Assets | The following table sets forth information regarding intangible assets (in thousands): Schedule of Intangible Assets September 30, December 31, Patents $ 807 $ 847 Accumulated amortization (449 ) (447 ) Intangible assets, net $ 358 $ 400 |
Accrued Liabilities (Tables)
Accrued Liabilities (Tables) | 9 Months Ended |
Sep. 30, 2022 | |
Payables and Accruals [Abstract] | |
Schedule of Accrued Liabilities | Accrued liabilities consist of the following (in thousands): Schedule of Accrued Liabilities September 30, December 31, Cash compensation/commissions payable $ 3,844 $ 3,184 Other accrued liabilities 1,177 1,165 Accrued liabilities $ 5,021 $ 4,349 |
Debt (Tables)
Debt (Tables) | 9 Months Ended |
Sep. 30, 2022 | |
Debt Disclosure [Abstract] | |
Schedule of Long-term Debt | Long-term debt consists of the following (in thousands): Schedule of Long-term Debt September 30, 2022 December 31, 2021 Amounts due under the Term Facility $ 12,000 $ 12,000 Accrued end-of-term payments 182 83 Less: unamortized debt issuance costs (221 ) (296 ) Less: current maturities (1,335 ) — Long-term debt $ 10,626 $ 11,787 |
Stock-Based Compensation (Table
Stock-Based Compensation (Tables) | 9 Months Ended |
Sep. 30, 2022 | |
Share-Based Payment Arrangement [Abstract] | |
Schedule of Share-based Compensation, Stock Options, Activity | Schedule of Share-based Compensation, Stock Options, Activity 2022 2021 Shares Weighted Weighted Shares Weighted Weighted Average Remaining Contract Term (years) Outstanding at January 1 3,201,666 $ 1.80 2,190,892 $ 2.25 Granted 109,164 $ 0.65 1,012,083 $ 1.27 Cancelled or expired (443,125 ) $ 2.39 (269 ) $ 314.19 Outstanding at September 30 2,867,705 $ 1.66 8.1 3,202,706 $ 1.92 9.1 Exercisable at September 30 828,978 $ 2.37 7.8 210,028 $ 9.02 7.4 |
Schedule of Restricted Stock Activity | Restricted stock unit activity for awards granted under the 2018 Plan was as follows for the nine months ended September 30, 2022 and 2021: Schedule of Restricted Stock Activity 2022 2021 Shares Weighted Average Value at Date Per Share Shares Weighted Average Value at Date Per Outstanding at January 1 2,970,104 $ 1.39 2,503,698 $ 1.54 Granted 1,898,808 $ 0.53 1,249,002 $ 1.27 Vested (851,955 ) $ 1.33 (349,572 ) $ 1.92 Cancelled (318,805 ) $ 1.38 — $ — Outstanding at September 30 3,698,152 $ 0.96 3,403,128 $ 1.40 |
Warrants (Tables)
Warrants (Tables) | 9 Months Ended |
Sep. 30, 2022 | |
Warrants | |
Schedule of Warrant Activity | Our warrant activity during the nine months ended September 30, 2022 was as follows: Schedule of Warrant Activity Common Stock Weighted Average Outstanding at January 1, 2022 7,111,112 $ 2.29 Issued 3,515,079 0.48 Outstanding at September 30, 2022 10,626,191 $ 1.69 |
Commitments and Contingencies (
Commitments and Contingencies (Tables) | 9 Months Ended |
Sep. 30, 2022 | |
Commitments and Contingencies Disclosure [Abstract] | |
Schedule of Lease Liability | Present Value of Long-term Leases Schedule of Lease Liability (in thousands): September 30, Right-of-use assets, net $ 1,490 Current portion of lease liability $ 443 Lease liability, less current portion 1,094 Total lease liability $ 1,537 |
Schedule of Future Minimum Rental Payments for Operating Leases | Future minimum payments for the next five years and thereafter as of September 30, 2022 under these long-term operating leases are as follows (in thousands): Schedule of Future Minimum Rental Payments for Operating Leases Remainder of 2022 131 2023 534 2024 559 2025 470 Total future minimum lease payments 1,694 Less amount representing interest (157 ) Present value of obligations under operating leases 1,537 Less current portion (443 ) Long-term operating lease obligations $ 1,094 |
Supplemental Disclosure of Ca_2
Supplemental Disclosure of Cash Flow Information (Tables) | 9 Months Ended |
Sep. 30, 2022 | |
Supplemental Cash Flow Elements [Abstract] | |
Schedule of Supplemental Cash Flow Information | Supplemental cash flow information is as follows (in thousands): Schedule of Supplemental Cash Flow Information 2022 2021 Nine Months Ended September 30, 2022 2021 Supplemental disclosure of cash flow information Cash paid during the period for: Interest $ 1,022 $ 485 Non-cash activities: Fixed assets acquired under finance lease $ 159 $ 163 Revaluation of lease liability and right of use asset $ 234 $ — Gain on extinguishment of Second A&R Credit Agreement $ — $ 786 Extinguishment of Second A&R Credit Agreement financed by line of credit $ — $ 3,755 Prepaid debt issuance costs $ — $ 75 Warrants issued in connection with the Private Placement to placement agents $ — $ 351 |
Segment and Geographic Inform_2
Segment and Geographic Information (Tables) | 9 Months Ended |
Sep. 30, 2022 | |
Segment Reporting [Abstract] | |
Schedule of Revenues by Geographic Region | Schedule of Revenues by Geographic Region Three Months Ended 2022 2021 United States $ 14,370 $ 13,629 Rest of world 92 148 Total revenue $ 14,462 $ 13,777 Nine Months Ended 2022 2021 United States $ 42,089 $ 40,813 Rest of world 610 480 Total revenue $ 42,699 $ 41,293 |
Business Description, Basis o_3
Business Description, Basis of Presentation and Summary of Significant Accounting Policies (Details Narrative) - USD ($) $ / shares in Units, $ in Thousands | 3 Months Ended | 9 Months Ended | ||||
Oct. 07, 2022 | Aug. 25, 2022 | Sep. 30, 2022 | Sep. 30, 2021 | Sep. 30, 2022 | Sep. 30, 2021 | |
Subsidiary, Sale of Stock [Line Items] | ||||||
Warrant exercise price | $ 0.40 | $ 0.40 | ||||
Antidilutive securities excluded from computation of earnings per share, amount | 17,192,048 | 14,138,224 | 17,192,048 | 14,138,224 | ||
Private Placement [Member] | Share-Based Payment Arrangement, Tranche One [Member] | ||||||
Subsidiary, Sale of Stock [Line Items] | ||||||
Number of stock sold | 14,100,000 | |||||
Warrants to purchase common stock | 3,500,000 | |||||
Proceeds from private placement | $ 6,750 | |||||
Cash proceeds | $ 6,300 | |||||
Warrant exercise price | $ 0.48 | |||||
Private Placement [Member] | Share-Based Payment Arrangement, Tranche Two [Member] | Subsequent Event [Member] | ||||||
Subsidiary, Sale of Stock [Line Items] | ||||||
Number of stock sold | 6,200,000 | |||||
Warrants to purchase common stock | 1,600,000 | |||||
Proceeds from private placement | $ 3,000 |
Summary of Revenues from Produc
Summary of Revenues from Product Lines (Details) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2022 | Sep. 30, 2021 | Sep. 30, 2022 | Sep. 30, 2021 | |
Disaggregation of Revenue [Line Items] | ||||
Total revenue | $ 14,462 | $ 13,777 | $ 42,699 | $ 41,293 |
Percentage of total revenue | 100% | 100% | 100% | 100% |
Orthobiologics [Member] | ||||
Disaggregation of Revenue [Line Items] | ||||
Total revenue | $ 12,046 | $ 10,795 | $ 34,614 | $ 31,264 |
Percentage of total revenue | 83% | 78% | 81% | 76% |
Spinal Implant [Member] | ||||
Disaggregation of Revenue [Line Items] | ||||
Total revenue | $ 2,416 | $ 2,948 | $ 8,075 | $ 9,929 |
Percentage of total revenue | 17% | 22% | 19% | 24% |
Other Revenue [Member] | ||||
Disaggregation of Revenue [Line Items] | ||||
Total revenue | $ 34 | $ 10 | $ 100 | |
Percentage of total revenue | 0% | 0% | 0% | 0% |
Schedule of Allowance for Credi
Schedule of Allowance for Credit Losses (Details) - USD ($) $ in Thousands | 3 Months Ended | |||||
Sep. 30, 2022 | Jun. 30, 2022 | Mar. 31, 2022 | Sep. 30, 2021 | Jun. 30, 2021 | Mar. 31, 2021 | |
Credit Loss [Abstract] | ||||||
Beginning balance | $ 510 | $ 570 | $ 552 | $ 470 | $ 554 | $ 653 |
Provision for expected credit losses | 54 | 49 | 191 | 118 | 81 | 63 |
Provision for expected credit losses | (54) | (49) | (191) | (118) | (81) | (63) |
Write-offs against allowance | (15) | (11) | (173) | (12) | (3) | (36) |
Ending balance | $ 549 | $ 510 | $ 570 | $ 576 | $ 470 | $ 554 |
Schedule of Inventories (Detail
Schedule of Inventories (Details) - USD ($) $ in Thousands | Sep. 30, 2022 | Dec. 31, 2021 |
Inventory Disclosure [Abstract] | ||
Raw materials | $ 5,121 | $ 5,613 |
Work in process | 957 | 571 |
Finished goods | 10,915 | 11,761 |
Total | $ 16,993 | $ 17,945 |
Schedule of Property and Equipm
Schedule of Property and Equipment, Net (Details) - USD ($) $ in Thousands | Sep. 30, 2022 | Dec. 31, 2021 |
Property, Plant and Equipment [Line Items] | ||
Total cost | $ 23,636 | $ 22,381 |
Less: accumulated depreciation | (17,967) | (17,169) |
Property and equipment, net | 5,669 | 5,212 |
Equipment [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Total cost | 6,302 | 5,541 |
Computer Equipment [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Total cost | 1,090 | 828 |
Computer Softwares [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Total cost | 490 | 490 |
Furniture and Fixtures [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Total cost | 104 | 94 |
Leasehold Improvements [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Total cost | 4,333 | 3,994 |
Other Properties [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Total cost | 10 | 10 |
Surgical Instruments [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Total cost | $ 11,307 | $ 11,424 |
Property and Equipment, Net (De
Property and Equipment, Net (Details Narrative) - USD ($) $ in Millions | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2022 | Sep. 30, 2021 | Sep. 30, 2022 | Sep. 30, 2021 | |
Property, Plant and Equipment [Abstract] | ||||
Depreciation expenses | $ 0.4 | $ 0.3 | $ 1 | $ 1 |
Schedule of Intangible Assets (
Schedule of Intangible Assets (Details) - USD ($) $ in Thousands | Sep. 30, 2022 | Dec. 31, 2021 |
Goodwill and Intangible Assets Disclosure [Abstract] | ||
Patents | $ 807 | $ 847 |
Accumulated amortization | (449) | (447) |
Intangible assets, net | $ 358 | $ 400 |
Schedule of Accrued Liabilities
Schedule of Accrued Liabilities (Details) - USD ($) $ in Thousands | Sep. 30, 2022 | Dec. 31, 2021 |
Payables and Accruals [Abstract] | ||
Cash compensation/commissions payable | $ 3,844 | $ 3,184 |
Other accrued liabilities | 1,177 | 1,165 |
Accrued liabilities | $ 5,021 | $ 4,349 |
Schedule of Long-term Debt (Det
Schedule of Long-term Debt (Details) - USD ($) $ in Thousands | Sep. 30, 2022 | Dec. 31, 2021 |
Debt Disclosure [Abstract] | ||
Amounts due under the Term Facility | $ 12,000 | $ 12,000 |
Accrued end-of-term payments | 182 | 83 |
Less: unamortized debt issuance costs | (221) | (296) |
Less: current maturities | (1,335) | |
Long-term debt | $ 10,626 | $ 11,787 |
Debt (Details Narrative)
Debt (Details Narrative) - USD ($) $ in Millions | Mar. 07, 2022 | Sep. 30, 2022 |
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items] | ||
Debt instrument interest rate | 11.53% | |
Credit Agreement [Member] | ||
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items] | ||
Increase in liquidity amount | $ 14 | |
Debt instrument interest rate | 7.07% | |
Line of credit | $ 7.3 |
Schedule of Share-based Compens
Schedule of Share-based Compensation, Stock Options, Activity (Details) - Equity Option [Member] - 2018 Equity Incentive Plan [Member] - $ / shares | 9 Months Ended | |
Sep. 30, 2022 | Sep. 30, 2021 | |
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items] | ||
Shares, Outstanding, Beginning Balance | 3,201,666 | 2,190,892 |
Weighted Average Exercise Price, Outstanding Beginning Balance | $ 1.80 | $ 2.25 |
Shares, Granted | 109,164 | 1,012,083 |
Weighted Average Exercise Price, Cancelled or expired | $ 0.65 | $ 1.27 |
Shares, Cancelled or expired | (443,125) | (269) |
Weighted Average Exercise Price, Cancelled or expired | $ 2.39 | $ 314.19 |
Shares, Outstanding, Ending Balance | 2,867,705 | 3,202,706 |
Weighted Average Exercise Price, Outstanding Ending Balance | $ 1.66 | $ 1.92 |
Weighted Average Remaining Contractual Term (Years) Outstanding | 8 years 1 month 6 days | 9 years 1 month 6 days |
Shares, Exercisable, Ending Balance | 828,978 | 210,028 |
Weighted Average Exercise Price, Exercisable Ending Balance | $ 2.37 | $ 9.02 |
Weighted Average Remaining Contractual Term (Years) Exercisable | 7 years 9 months 18 days | 7 years 4 months 24 days |
Schedule of Restricted Stock Ac
Schedule of Restricted Stock Activity (Details) - Restricted Stock Units (RSUs) [Member] - 2018 Equity Incentive Plan [Member] - $ / shares | 9 Months Ended | |
Sep. 30, 2022 | Sep. 30, 2021 | |
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items] | ||
Shares Outstanding, Beginning Balance | 2,970,104 | 2,503,698 |
Weighted Average Fair Value at Grant Date, Outstanding Beginning Balance | $ 1.39 | $ 1.54 |
Shares Granted | 1,898,808 | 1,249,002 |
Weighted Average Fair Value at Grant Date, Granted | $ 0.53 | $ 1.27 |
Shares Vested | (851,955) | (349,572) |
Weighted Average Fair Value at Grant Date, Vested | $ 1.33 | $ 1.92 |
Shares Cancelled | (318,805) | |
Weighted Average Fair Value at Grant Date, Cancelled | $ 1.38 | |
Shares Outstanding, Ending Balance | 3,698,152 | 3,403,128 |
Weighted Average Fair Value at Grant Date, Outstanding Ending Balance | $ 0.96 | $ 1.40 |
Stock-Based Compensation (Detai
Stock-Based Compensation (Details Narrative) | Sep. 30, 2022 shares |
2018 Equity Incentive Plan [Member] | |
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items] | |
Number of shares available for issuance | 8,500,000 |
Schedule of Warrant Activity (D
Schedule of Warrant Activity (Details) | 9 Months Ended |
Sep. 30, 2022 $ / shares shares | |
Warrants | |
Common Stock Warrants Outstanding, Beginning Balance | shares | 7,111,112 |
Weighted Average Exercise Price Outstanding Beginning Balance | $ / shares | $ 2.29 |
Common Stock Warrants, Issued | shares | 3,515,079 |
Weighted Average Exercise Price, Issued | $ / shares | $ 0.48 |
Common Stock Warrants Outstanding, Ending Balance | shares | 10,626,191 |
Weighted Average Exercise Price Outstanding Ending Balance | $ / shares | $ 1.69 |
Warrants (Details Narrative)
Warrants (Details Narrative) | Sep. 30, 2022 $ / shares |
Fair Value Measurement Inputs and Valuation Techniques [Line Items] | |
Class of warrant or right, exercise price of warrants or rights | $ 0.40 |
Measurement Input, Expected Term [Member] | |
Fair Value Measurement Inputs and Valuation Techniques [Line Items] | |
Warrants contractual term | 5 years |
Measurement Input, Price Volatility [Member] | |
Fair Value Measurement Inputs and Valuation Techniques [Line Items] | |
Warrants and rights outstanding, measurement input | 107 |
Schedule of Lease Liability (De
Schedule of Lease Liability (Details) - USD ($) $ in Thousands | Sep. 30, 2022 | Dec. 31, 2021 |
Commitments and Contingencies Disclosure [Abstract] | ||
Right-of-use assets, net | $ 1,490 | $ 1,258 |
Current portion of lease liability | 443 | 462 |
Lease liability, less current portion | 1,094 | $ 842 |
Total lease liability | $ 1,537 |
Schedule of Future Minimum Rent
Schedule of Future Minimum Rental Payments for Operating Leases (Details) - USD ($) $ in Thousands | Sep. 30, 2022 | Dec. 31, 2021 |
Commitments and Contingencies Disclosure [Abstract] | ||
Remainder of 2022 | $ 131 | |
2023 | 534 | |
2024 | 559 | |
2025 | 470 | |
Total future minimum lease payments | 1,694 | |
Less amount representing interest | (157) | |
Present value of obligations under operating leases | 1,537 | |
Less current portion | (443) | $ (462) |
Long-term operating lease obligations | $ 1,094 | $ 842 |
Commitments and Contingencies_2
Commitments and Contingencies (Details Narrative) - USD ($) $ in Millions | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2022 | Sep. 30, 2021 | Sep. 30, 2022 | Sep. 30, 2021 | |
Commitments and Contingencies Disclosure [Abstract] | ||||
Operating lease weighted-average remaining lease term | 3 years 1 month 6 days | 3 years 1 month 6 days | ||
Rent expense | $ 0.1 | $ 0.1 | $ 0.4 | $ 0.4 |
Schedule of Supplemental Cash F
Schedule of Supplemental Cash Flow Information (Details) - USD ($) $ in Thousands | 9 Months Ended | |
Sep. 30, 2022 | Sep. 30, 2021 | |
Supplemental Cash Flow Elements [Abstract] | ||
Interest | $ 1,022 | $ 485 |
Fixed assets acquired under finance lease | 159 | 163 |
Revaluation of lease liability and right of use asset | 234 | |
Gain on extinguishment of Second A&R Credit Agreement | 786 | |
Extinguishment of Second A&R Credit Agreement financed by line of credit | 3,755 | |
Prepaid debt issuance costs | 75 | |
Warrants issued in connection with the Private Placement to placement agents | $ 351 |
Related Party Transactions (Det
Related Party Transactions (Details Narrative) | Sep. 30, 2022 |
OrbiMed Advisors LLC [Member] | |
Equity method investment, ownership percentage | 72% |
Schedule of Revenues by Geograp
Schedule of Revenues by Geographic Region (Details) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2022 | Sep. 30, 2021 | Sep. 30, 2022 | Sep. 30, 2021 | |
Revenues from External Customers and Long-Lived Assets [Line Items] | ||||
Total revenue | $ 14,462 | $ 13,777 | $ 42,699 | $ 41,293 |
UNITED STATES | ||||
Revenues from External Customers and Long-Lived Assets [Line Items] | ||||
Total revenue | 14,370 | 13,629 | 42,089 | 40,813 |
Rest of World [Member] | ||||
Revenues from External Customers and Long-Lived Assets [Line Items] | ||||
Total revenue | $ 92 | $ 148 | $ 610 | $ 480 |
Segment and Geographic Inform_3
Segment and Geographic Information (Details Narrative) | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2022 | Sep. 30, 2021 | Sep. 30, 2022 | Sep. 30, 2021 | |
Revenue from Contract with Customer Benchmark [Member] | Geographic Concentration Risk [Member] | UNITED STATES | ||||
Revenue, Major Customer [Line Items] | ||||
Concentration risk, percentage | 99% | 99% | 99% | 99% |