Document and Entity Information - shares	6 Months Ended
Document and Entity Information - shares	Jun. 30, 2018	Aug. 08, 2018
Document And Entity Information
Entity Registrant Name	Xtant Medical Holdings, Inc.
Entity Central Index Key	0001453593
Document Type	10-Q
Document Period End Date	Jun. 30, 2018
Amendment Flag	false
Current Fiscal Year End Date	--12-31
Entity Filer Category	Smaller Reporting Company
Entity Common Stock, Shares Outstanding		13,145,305
Trading symbol	XTNT
Document Fiscal Period Focus	Q2
Document Fiscal Year Focus	2018

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Jun. 30, 2018	Dec. 31, 2017
Current Assets:
Cash and cash equivalents	$ 6,049	$ 2,856
Trade accounts receivable, net of allowance for doubtful accounts of $2,118 and $1,923, respectively	10,404	12,714
Current inventories, net	22,446	22,229
Prepaid and other current assets	801	1,706
Total current assets	39,700	39,505
Non-current inventories, net		194
Property and equipment, net	8,928	9,913
Goodwill	41,535	41,535
Intangible assets, net	12,106	13,826
Other assets	516	732
Total Assets	102,785	105,705
Current Liabilities:
Accounts payable	7,526	9,316
Accounts payable - related party (note 13)		160
Accrued liabilities	4,310	15,845
Warrant derivative liability	90	131
Current portion of capital lease obligations	469	366
Total current liabilities	12,395	25,818
Long-term Liabilities:
Capital lease obligation, less current portion	353	624
Long-term convertible debt, less issuance costs		70,853
Long-term debt, less issuance costs	79,429	67,109
Total Liabilities	92,177	164,404
Commitments and Contingencies (note 10)
Stockholders' Equity (Deficit):
Preferred stock, $0.000001 par value; 10,000,000 shares authorized; no shares issued and outstanding
Common stock, $0.000001 par value; 50,000,000 shares authorized; 13,145,305 shares issued and outstanding as of June 30, 2018 and 1,514,899 shares issued and outstanding as of December 31, 2017
Additional paid-in capital	165,809	86,247
Accumulated deficit	(155,521)	(144,946)
Total Stockholders' Equity (Deficit)	10,608	(58,699)
Total Liabilities & Stockholders' Equity (Deficit)	$ 102,785	$ 105,705

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Jun. 30, 2018	Dec. 31, 2017
Statement of Financial Position [Abstract]
Trade accounts receivable, allowance for doubtful accounts (in dollars)	$ 2,118	$ 1,923
Preferred stock, par value	$ 0.000001	$ 0.000001
Preferred stock, shares authorized	10,000,000	10,000,000
Preferred stock, shares issued
Preferred stock, shares outstanding
Common stock, par value	$ 0.000001	$ 0.000001
Common stock, shares authorized	50,000,000	50,000,000
Common stock, shares issued	13,145,305	1,514,899
Common Stock, shares outstanding	13,145,305	1,514,899

Condensed Consolidated Statements of Operations (Unaudited) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2018	Jun. 30, 2017	Jun. 30, 2018	Jun. 30, 2017
Revenue
Orthopedic product sales	$ 18,653	$ 21,371	$ 36,483	$ 43,367
Other revenue	88	37	191	124
Total Revenue	18,741	21,408	36,674	43,491
Cost of sales	6,266	7,880	11,968	15,056
Gross Profit	12,475	13,528	24,706	28,435
Operating Expenses
General and administrative	3,402	4,527	6,425	8,655
Sales and marketing	8,545	11,137	16,894	22,134
Research and development	418	640	832	1,339
Depreciation and amortization	1,041	1,470	2,045	2,751
Restructuring expenses	1,234	1,632	1,968	1,632
Separation related expenses	55	381	55	605
Non-cash compensation expense	41	92	405	237
Total Operating Expenses	14,736	19,879	28,624	37,353
Loss from Operations	(2,261)	(6,351)	(3,918)	(8,918)
Other (Expense) Income
Interest expense	(2,820)	(3,328)	(6,366)	(6,729)
Change in warrant derivative liability	79	(14)	41	156
Other (expense) income			(12)	11
Total Other (Expense) Income	(2,741)	(3,342)	(6,337)	(6,562)
Net Loss from Operations	$ (5,002)	$ (9,693)	$ (10,255)	$ (15,480)
Net loss per share:
Basic	$ (0.38)	$ (6.43)	$ (1.00)	$ (10.31)
Dilutive	$ (0.38)	$ (6.43)	$ (1.00)	$ (10.31)
Shares used in the computation:
Basic	13,085,668	1,507,716	10,299,090	1,501,079
Dilutive	13,085,668	1,507,716	10,299,090	1,501,079

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2018	Jun. 30, 2017
Operating activities:
Net loss	$ (10,255)	$ (15,480)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation and amortization	3,227	4,171
Non-cash interest	6,205	6,211
Loss on disposal of fixed assets	205	1,586
Non-cash compensation expense/stock option expense	405	397
Provision for losses on accounts receivable and inventory	83	1,063
Change in derivative warrant liability	(41)	(156)
Changes in operating assets and liabilities:
Accounts receivable	2,152	2,544
Inventories	(388)	1,202
Prepaid and other assets	1,120	12
Accounts payable	(1,948)	(2,372)
Accrued liabilities	(421)	63
Net cash provided by (used in) operating activities	344	(756)
Investing activities:
Purchases of property and equipment and intangible assets	(288)	(1,068)
Net cash used in investing activities	(288)	(1,068)
Financing activities:
Proceeds from long-term debt		11,387
Payments on capital leases	(167)	(28)
Payments on revolving line credit		(10,448)
Expenses associated with private placement and convertible debt conversion	(3,507)
Proceeds from equity private placement	6,810
Proceeds from issuance of stock	1
Net cash provided by financing activities	3,137	911
Net change in cash and cash equivalents	3,193	(914)
Cash and cash equivalents at beginning of period	2,856	2,578
Cash and cash equivalents at end of period	$ 6,049	$ 1,665

Business Description and Summary of Significant Accounting Policies

6 Months Ended

Jun. 30, 2018

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Business Description and Summary of Significant Accounting Policies

(1) Business Description and Summary of Significant Accounting Policies

Business Description

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 products serve the combined specialized needs of orthopedic and neurological surgeons, including orthobiologics for the promotion of bone healing, implants and instrumentation for the treatment of spinal disease, tissue grafts for the treatment of orthopedic disorders to promote healing following spine, cranial and foot surgeries and the development, manufacturing and sale of medical devices for use in orthopedic spinal surgeries.

The markets in which the Company competes are highly competitive and rapidly changing. Significant technological advances, changes in customer requirements, or the emergence of competitive products with new capabilities or technologies could adversely affect the Company’s operating results. The Company’s business could be harmed by a decline in demand for, or in the prices of, its products or as a result of, among other factors, any change in pricing or distribution methods, increased price competition, changes in government regulations or a failure by the Company to keep up with technological change. Further, a decline in available donors could have an adverse impact on our business.

The accompanying interim condensed consolidated financial statements of Xtant for the three and six months ended June 30, 2018 and 2017 are unaudited and are 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 which may be achieved in the future for the full year ending December 31, 2018.

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, 2017. 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.

As described in more detail below, effective as of February 13, 2018, the Company effected a 1-for-12 reverse split of its common stock (the “Reverse Stock Split”). The Reverse Stock Split is reflected in the share amounts in all periods presented in this report.

Corporate Restructuring

Restructuring Agreement

On January 11, 2018, we entered into a Restructuring and Exchange Agreement (the “Restructuring Agreement”) with ROS Acquisition Offshore LP, OrbiMed Royalty Opportunities II, LP (collectively referred to herein as the “Investors”), Bruce Fund, Inc., Park West Partners International, Limited (“PWPI”), Park West Investors Master Fund, Limited (“PWIMF”), and Telemetry Securities, L.L.C., and with the Investors, are collectively referred to herein as the “Holders”.

Pursuant to the Restructuring Agreement, and following the execution of the Sixth Amendment to the 2017 Notes, described in the “Debt” and “Equity” sections below, on January 17, 2018, the Investors converted the 6.00% convertible senior unsecured notes due 2021, plus accrued and unpaid interest, at the $9.11 per share conversion rate originally provided thereunder (the “2017 Notes”), into 189,645 shares of our common stock.

In connection with the Restructuring Agreement, we held a special meeting of stockholders on February 13, 2018 (“Special Meeting”), where our stockholders approved the following actions:

● Approval of the issuance of shares of common stock for purposes of Sections 713(a) and 713(b) of the NYSE American Company Guide.

● Approval of an amendment to our certificate of incorporation (“Charter”) to change the number of authorized shares of common stock and preferred stock available for issuance and to make such other changes as are described below.

● Approval of six new directors to constitute a new board of directors, to serve until the 2018 Annual Meeting of Stockholders and until they or respective successors have been duly elected and qualified.

After giving effect to the Reverse Stock Split (described below), $70.3 million aggregate principal amount of our then outstanding 6.00% convertible senior unsecured notes due 2021 held by the Holders (the “Remaining Notes”), plus accrued and unpaid interest, were exchanged for newly-issued shares of our common stock at an exchange rate of 138.8889 shares per $1,000 principal amount of the Remaining Notes, for an exchange price of $7.20 per share (the “Notes Exchange”). This resulted in the issuance of 10,401,309 shares of our common stock to the Holders and the Investors acquiring an approximately 70% controlling interest in our outstanding shares of common stock. Upon the completion of the Notes Exchange, all outstanding obligations under our convertible senior secured notes were satisfied in full and the Indentures governing such notes were discharged.

Pursuant to the terms of the Restructuring Agreement, we commenced a rights offering to allow our stockholders as of April 27, 2018 record date to purchase up to an aggregate of 1,137,515 shares of our common stock at a subscription price of $7.20 per share. The rights offering expired on June 18, 2018. We issued 129 shares of common stock in the rights offering and received $0.9 thousand gross proceeds.

Amended and Restated Certificate of Incorporation

On February 13, 2018, following the Special Meeting, we filed with the Secretary of State of the State of Delaware a Certificate of Amendment to our Charter (the “Certificate Amendment”) The Certificate Amendment amended and restated our Charter, to, among other things:

	●	effect the Reverse Stock Split;

	●	after giving effect to the Reverse Stock Split, decrease the number of authorized shares of common stock available for issuance from 95,000,000 to 50,000,000 and increase the number of authorized shares of preferred stock available for issuance from 5,000,000 to 10,000,000;

	●	authorize the Board of Directors (“Board”) to increase or decrease the number of shares of any series of our capital stock, provided that such increase or decrease does not exceed the number of authorized shares or be less than the number of shares then outstanding;

	●	authorize the Board to issue new series of preferred stock without approval of the holders of common stock or other series of preferred stock, with such powers, preferences and rights as may be determined by the Board;

	●	authorize a majority of the Board to fix the number of our directors;

	●	indemnify the members of the Board to the fullest extent permitted by law;

	●	remove the classification of the Board to require all directors to be elected annually;

	●	provide that special meetings of our stockholders may only be called by the Board, the chairman of the Board or our chief executive officer;

	●	provide that no stockholder will be permitted cumulative voting at any election of directors;

	●	elect not to be governed by Section 203 of the Delaware General Corporation Law (the “DGCL”);

	●	elect the Court of Chancery of the State of Delaware to be the exclusive forum for any derivative action or proceeding brought on our behalf, any action asserting a breach of a fiduciary duty owed by any of our directors, officers or other employees, any action under the DGCL, our Charter or bylaws or any actions governed by the internal affairs doctrine; and

	●	require the vote of at least two-thirds of the voting power of the then outstanding shares of our capital stock to amend or repeal certain provisions of our Charter.

The Reverse Stock Split became effective as of 5:00 p.m. Eastern Time on February 13, 2018, and our common stock began trading on a split-adjusted basis when the market opened on February 14, 2018. Upon the effectiveness of the Reverse Stock Split, every 12 shares of our issued and outstanding common stock automatically converted into one share of common stock, without any change in the par value per share. In addition, a proportionate adjustment was made to the per share exercise or conversion price and the number of shares issuable upon the exercise of all of our outstanding stock options and convertible securities to purchase shares of common stock and the number of shares underlying restricted stock awards and reserved for issuance pursuant to our equity incentive compensation plan. Any fraction of a share of common stock that would otherwise have resulted from the Reverse Stock Split was rounded down to the nearest whole share. All share and per share amounts have been retroactively restated to reflect the Reverse Stock Split.

Private Placement SPA

On February 14, 2018, we entered into a Securities Purchase Agreement (the “Private Placement SPA”) with the Investors pursuant to which the Investors purchased from us an aggregate of 945,819 shares of our common stock, at a price of $7.20 per share, for aggregate proceeds of $6.8 million.

Investor Rights Agreement

Effective February 14, 2018, we entered into an Investor Rights Agreement (the “Investor Rights Agreement”) with the Holders. Under the Investor Rights Agreement, the Investors are permitted to nominate a majority of our directors and designate the chairperson of the Board at subsequent annual meetings, as long as the Investors maintain an ownership threshold in the Company of at least 40% of our then outstanding common stock (the “Ownership Threshold”). If the Investors are unable to maintain the Ownership Threshold, the Investor Rights Agreement contemplates a reduction of nomination rights commensurate with their ownership interests.

For so long as the Ownership Threshold is met, we must obtain the approval of the Investors to proceed with the following actions: (i) issue new securities; (ii) incur over $0.25 million of debt in a fiscal year; (iii) sell or transfer over $0.25 million of our assets or businesses or our subsidiaries in a fiscal year; (iv) acquire over $0.25 million of assets or properties in a fiscal year; (v) make capital expenditures over $0.125 million individually, or $1.5 million in the aggregate during a fiscal year; (vi) approve our annual budget; (vii) hire or terminate our chief executive officer; (viii) appoint or remove the chairperson of the Board; and (ix) make, loans to, investments in, or purchase, or permit any subsidiary to purchase, any stock or other securities in another entity in excess of $0.25 million in a fiscal year. As long as the Ownership Threshold is met, we may not increase the size of the Board beyond seven directors without the approval of a majority of the directors nominated by the Investors.

The Investor Rights Agreement grants the Holders the right to purchase from us a pro rata amount of any new securities that we may propose to issue and sell. The Investor Rights Agreement may be terminated (a) upon the mutual written agreement of all the parties, (b) upon written notice of the Company or an Investor, if such Investor’s ownership percentage of our then outstanding common stock is less than 10%, or (c) upon written notice by the Investors. PWPI and PWIMF’s right to purchase from us a pro rata amount of any new securities will also terminate at such time as their aggregate ownership percentage of our then outstanding common stock is less than 8.5%.

Registration Rights Agreement

Effective February 14, 2018, we entered into a Registration Rights Agreement (the “Registration Rights Agreement”) with the Holders. The Registration Rights Agreement requires us to, among other things, file with the U. S. Securities and Exchange Commission (“SEC”) a shelf registration statement within 90 days of the date of the Registration Rights Agreement covering the resale, from time to time, of our common stock issued. This registration statement became effective on June 4, 2018.

Second Amended and Restated Bylaws

On February 14, 2018, we amended and restated our current bylaws by adopting the Second Amended and Restated Bylaws of the Company (the “Amended Bylaws”). The Amended Bylaws amended our existing bylaws to, among other things:

	●	provide for annual and special meetings of stockholders to be held through remote communications;

	●	provide for the election of any directors not elected at an annual meeting of stockholders to be elected at a special meeting of stockholders;

	●	declassify the Board into one group of directors that will hold office until the subsequent annual meeting of stockholders and until the election and qualification of such directors’ respective successors;

	●	provide for the filling of a new directorship or director vacancy by the affirmative vote of the holders of a majority of the voting power of our shares of stock;

	●	allow for a majority of the Board present to adjourn a Board meeting if a quorum is not met;

	●	unless otherwise restricted in the Amended Bylaws or our Charter, provide the Board with the authority to fix the compensation of directors, including without limitation, compensation for services as members of Board committees;

	●	allow us to enter into an agreement with a stockholder to restrict the transfer of shares held by such stockholder in any manner not prohibited by the DGCL; and

	●	allow the Board to declare dividends on our capital stock, subject to any provisions of our Charter and applicable law.

Concentrations and Credit Risk

The Company’s accounts receivables are due from a variety of health care organizations and distributors throughout the world. No single customer accounted for more than 10% of revenue or accounts receivable for the comparable periods. The Company provides for uncollectible amounts when specific credit issues arise. Management’s estimates for uncollectible amounts have been adequate during prior periods, and management believes that all significant credit risks have been identified at June 30, 2018.

Use of Estimates

The preparation of the 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 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; valuation of the warrant derivative liability, inventory, and estimates for the fair value of stock options grants and other equity awards upon which the Company determines stock-based compensation expense. Actual results could differ from those estimates.

Long-Lived Assets

Long-lived assets, including intangible assets, are reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Recoverability of assets to be held and used is measured by a comparison of the carrying amount of an asset to future net cash flows expected to be generated by the asset. If such assets are considered to be impaired, the impairment to be recognized is measured by the amount by which the carrying amount of the assets exceeds the estimated fair value of the assets. Management reviewed assumptions and tested intangible assets as of June 30, 2018 and determined that no impairment of the carrying value of the long-lived assets existed during the second quarter of 2018.

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. In its evaluation of goodwill, the Company performs an assessment of qualitative factors to determine if it is more-likely-than-not that goodwill might be impaired. The results from the assessment and a step 1 analysis allowed the Company to conclude that goodwill was not impaired as of December 31, 2017. The Company conducts its impairment test on an annual basis.

Revenue Recognition

The Company adopted the provisions of Accounting Standards Update (“ASU”) No. 2014-09, Topic 606, Revenue from Contracts with Customers, effective January 1, 2018. Given that our revenue recognition has remained generally the same as in prior years, the Company has elected the modified retrospective method of adoption. As of December 31, 2017, we finalized our assessment of the impact of the standard on the consolidated financial statements and determined adoption of Topic 606 was immaterial to our consolidated financial statements and no adjustment was necessary.

The Company’s contracts with its customers are generally reviewed and revised on an annual basis. The Company does not incur upfront costs or exclusivity fees in conjunction with entering into a customer contract. The Company’s customer contracts do not provide for percentage of completion performance measures or contingent consideration. The Company does not have deferred or unearned revenue arrangements with its customers that would give rise to contract liabilities. No contract assets or contract liabilities are recorded in our consolidated balance sheets as of June 30, 2018 or December 31, 2017.

The Company ships to certain customers under consignment arrangements whereby the Company’s product is stored by the customer. The customer is required to report usage of the product to the Company and, upon such notice, the Company invoices the customer and revenue is recognized.

In the normal course of business, the Company accepts returns of product that have not been implanted. Product returns are not material to the Company’s consolidated statements of operations. The Company accounts for shipping and handling activities as a fulfillment cost rather than a separate performance obligation. The Company’s policy is to record revenue net of any applicable sales, use, or excise taxes. Payment terms are generally net 30 days from invoice date and some customers are offered discounts for early pay.

Research and Development

Research and development costs, which are principally related to internal costs for the development of new devices and biologics are expensed as incurred.

Net Loss Per Share

Basic net income (loss) per share is computed by dividing net income (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 income (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. Diluted net loss per share was the same as basic net loss per share for the three and six months ended June 30, 2018 and 2017, as shares issuable upon the exercise of stock options and warrants were anti-dilutive as a result of the net losses incurred for those periods. Dilutive earnings per share are not reported as their effects of including 558,161 and 623,159 outstanding stock options and warrants for the three and six months ended June 30, 2018 and 2017, respectively, are anti-dilutive.

Fair Value of Financial Instruments

The carrying values of financial instruments, including trade accounts receivable, accounts payable, other accrued expenses and long-term debt, approximate their fair values based on terms and related interest rates.

The Company follows a framework for measuring fair value. The framework provides a hierarchy that prioritizes the inputs to valuation techniques used to measure fair value. The hierarchy gives the highest priority to unadjusted quoted prices in active markets for identical assets or liabilities (Level 1) and the lowest priority to unobservable inputs (Level 3). The three levels of the fair value hierarchy are described below:

Level 1: Inputs to the valuation methodology are unadjusted quoted prices for identical assets or liabilities in active markets.

Level 2: Inputs to the valuation methodology include quoted prices for similar assets and liabilities in active markets, and inputs that are observable for the asset or liability, either directly or indirectly, for substantially the full term of the financial instrument.

Level 3: Inputs to the valuation methodology are unobservable and significant to the fair value measurement.

A financial instrument’s level within the fair value hierarchy is based on the lowest level of any input that is significant to the fair value measurement. As of June 30, 2018, and December 31, 2017, there were no reclassifications in financial assets or liabilities between Level 1, 2 or 3 categories.

The following table sets forth by level, within the fair value hierarchy, our liabilities that are measured at fair value on a recurring basis:

Warrant derivative liability (in thousands):

	As of June 30, 2018		As of December 31, 2017
Level 1		-		-
Level 2		-		-
Level 3	$	90	$	131

The valuation technique used to measure fair value of the warrant liability is based on a lattice valuation model and significant assumptions and inputs determined by us (See Note 9, “Warrants” below).

Level 3 Changes

The following is a reconciliation of the beginning and ending balances for liabilities measured at fair value on a recurring basis using significant unobservable inputs (Level 3) during the six months ended June 30, 2018:

Warrant derivative liability

Balance at January 1, 2017	$	334
Gain recognized in earnings		(203	)
Balance at January 1, 2018	$	131
Gain recognized in earnings		(41	)
Balance at June 30, 2018	$	90

During the six months ended June 30, 2018, the Company did not change any of the valuation techniques used to measure its liabilities at fair value.

Recent Accounting Pronouncements

In February 2016, the FASB issued ASU No. 2016-02, Leases (Topic 842). The new standard establishes a right-of-use (“ROU”) model that requires a lessee to record a ROU asset and a lease liability on the balance sheet for all leases with terms longer than 12 months. Leases will be classified as either finance or operating, with classification affecting the pattern of expense recognition in the income statement. The new standard is effective for fiscal years beginning after December 15, 2018, including interim periods within those fiscal years. A modified retrospective transition approach is required for lessees for capital and operating leases existing at, or entered into after, the beginning of the earliest comparative period presented in the consolidated financial statements, with certain practical expedients available. While we are still evaluating the impact of our pending adoption of the new standard on our consolidated financial statements, we expect that upon adoption we will recognize ROU assets and lease liabilities and that the amounts could be material to our consolidated financial statements.

In June 2016, the FASB issued ASU No. 2016-13 Financial Instruments - Credit losses: Measurement of Credit Losses on Financial Instruments, which amends certain provisions of ASC 326, Financial Instruments-Credit Loss. The ASU changes the impairment model for most financial assets and certain other instruments. For trade and other receivables, held to maturity debt securities, loans and other instruments, entities will be required to use a new forward-looking “expected loss” model that generally will result in the earlier recognition of allowances for losses. The ASU is effective for annual reporting periods beginning after December 15, 2019, including interim periods within those annual periods, and will be applied as a cumulative effect adjustment to retained earnings as of the beginning of the first reporting period for which the guidance is effective. We currently do not expect that the adoption of these provisions will have a material effect on our consolidated financial statements.

In June 2018, the FASB issued ASU No. 2018-07, Stock Compensation (Topic 718) which amends the current standard. Specifically, the new standard expands the scope of Topic 718 to include share-based payment awards to non-employees. Additionally, the ASU expands and amends the current standard to include and realign consistent with the changes to revenue standard Topic 606. Management expects that the adoption of this new standard will qualitatively impact the Company’s financial reporting. See further information in the Stock-Based Compensation of the management disclosure section below.

Inventories, Net

6 Months Ended

Jun. 30, 2018

Inventory Disclosure [Abstract]

Inventories, Net

(2) Inventories, Net

Inventories consist of the following (in thousands):

	June 30, 2018			December 31, 2017
Current inventories:
Raw materials	$	4,040		$	4,277
Work in process		1,292			1,515
Finished goods		24,014			23,270
Gross current inventories		29,346			29,062
Reserve for obsolescence		(6,900	)		(6,833	)
Current inventories, net		22,446			22,229
Non-current inventories:
Finished goods		608			1,072
Reserve for obsolescence		(608	)		(878	)
Non-current inventories, net		-			194
Total inventories, net	$	22,446		$	22,423

The Company provides implants and biologic inventory on consignment through its various sales channels to logistically place the inventory near the anticipated surgical location. Consigned inventory was approximately $9.8 million and $12.0 million at June 30, 2018 and December 31, 2017, respectively.

Property and Equipment, Net

6 Months Ended

Jun. 30, 2018

Property, Plant and Equipment [Abstract]

Property and Equipment, Net

(3) Property and Equipment, Net

Property and equipment, net are as follows (in thousands):

	June 30, 2018			December 31, 2017
Equipment	$	4,465		$	4,471
Computer equipment		484			489
Computer software		499			524
Furniture and fixtures		215			215
Leasehold improvements		4,022			4,030
Vehicles		10			10
Surgical instruments		11,622			11,462
Total cost		21,317			21,201
Less: accumulated depreciation		(12,389	)		(11,288	)
Property and equipment, net	$	8,928		$	9,913

The Company deploys certain surgical instruments through its various sales channels for use with implant and biologic inventory to be utilized during surgical procedures. The instruments are classified as non-current assets within property and equipment and depreciated using the straight-line method over a five-year useful life.

The net book value of these surgical instruments was approximately $6.5 million and $4.6 million at June 30, 2018 and December 31, 2017, respectively. Instruments are recorded at cost and are carried at net book value (cost less accumulated depreciation).

Depreciation expense related to property and equipment, including property under capital lease, for the first six months of 2018 and 2017 was $1.6 million and $1.9 million respectively.

The Company leases certain equipment under capital leases. For financial reporting purposes, minimum lease payments relating to the assets have been capitalized. As of June 30, 2018, the Company has recorded $1.7 million gross assets in Equipment and $0.7 million of accumulated depreciation relating to assets under capital leases.

Intangible Assets

6 Months Ended

Jun. 30, 2018

Goodwill and Intangible Assets Disclosure [Abstract]

Intangible Assets

(4) Intangible Assets

The following table sets forth information regarding intangible assets (in thousands):

	June 30, 2018			December 31, 2017
Patents	$	847		$	847
Acquisition related intangibles:
Technology		13,789			13,789
Customer relationships		9,911			9,911
Tradename		1,867			1,867
Non-compete		41			41
Accumulated amortization		(14,349	)		(12,629	)
Intangible assets, net	$	12,106		$	13,826

Aggregate amortization expense:	$	1,720		$	4,629

The following is a summary of estimated future amortization expense for intangible assets as of June 30, 2018 (in thousands):

Remainder of 2018	$	1,718
2019		3,252
2020		2,170
2021		1,409
2022		1,052
Thereafter		2,505
Total	$	12,106

Accrued Liabilities

6 Months Ended

Jun. 30, 2018

Payables and Accruals [Abstract]

Accrued Liabilities

(5) Accrued Liabilities

Accrued liabilities consist of the following (in thousands):

	June 30, 2018		December 31, 2017
Accrued stock compensation	$	61	$	120
Wages/commissions payable		2,215		2,831
Accrued interest payable		-		10,835
Other accrued expenses		2,034		2,059
Accrued liabilities	$	4,310	$	15,845

Debt

6 Months Ended

Jun. 30, 2018

Debt Disclosure [Abstract]

Debt

(6) Debt

Convertible Notes

During the first quarter of 2018 in connection with our Restructuring, all of the outstanding 6.00% convertible senior unsecured notes due 2021 were converted into shares of our common stock and the Indenture governing such notes was discharged.

Twenty-Second Amendment to the Amended and Restated Credit Agreement

Effective January 30, 2018, the Company and Investors entered into the Twenty-Second Amendment to the Amended and Restated Credit Agreement, which amended the Amended and Restated Credit Agreement dated July 27, 2015 by and between Bacterin and ROS Acquisition Offshore LP (collectively, the “Amended and Restated Credit Agreement” and the facility created under such agreement, the “Credit Facility”). This amendment further deferred the Company’s accrued interest payment date for the fiscal quarters ended on December 31, 2016, March 31, 2017, June 30, 2017, September 30, 2017 and December 31, 2017 until February 28, 2018.

Twenty-Third Amendment to the Amended and Restated Credit Agreement

Effective February 14, 2018, the Company and Investors entered into the Twenty-Third Amendment to the Amended and Restated Credit Agreement, which further amended the Amended and Restated Credit Agreement and terms of the Credit Facility. As of this amendment, the interest payable has been carried forward and as modified, the interest rate options within the Credit Facility are as follows: (a) through December 31, 2018, we will have the option at our sole discretion (i) to pay PIK Interest at LIBOR (as defined in the Credit Facility) plus 12% or (ii) pay cash interest at LIBOR plus 10%; (b) beginning January 1, 2019 through June 30, 2019, we will have the option at our sole discretion to either (i) pay PIK Interest at LIBOR plus 15% or (ii) pay cash interest at LIBOR plus 10%; and (c) beginning July 1, 2019 through the maturity date of the Credit Facility, we will pay cash interest at LIBOR plus 10%. The amendment also reduced the prepayment or repayment fee under the Credit Facility to 1%.

This amendment also modified the financial covenants of the Credit Facility, including removing the minimum revenue covenant, providing a minimum liquidity covenant, a consolidated leverage ratio covenant, and a minimum consolidated EBITDA covenant, all as defined in the Amended and Restated Credit Agreement. As of June 30, 2018, we were in compliance with all applicable covenants.

Long-term debt consists of the following (in thousands):

	June 30, 2018			December 31, 2017
Amounts due under the Credit Facility	$	55,787		$	55,787
PIK interest payable related to the Credit Facility		23,850			11,582
6% convertible senior unsecured notes due 2021		-			71,865
Gross long-term debt		79,637			139,234
Less: total debt issuance costs		(208	)		(1,272	)
Long-term debt, less issuance costs	$	79,429		$	137,962

All gross long-term debt will mature July 31, 2020 and become payable at that time.

Equity

6 Months Ended

Jun. 30, 2018

Equity [Abstract]

Equity

(7) Equity

Convertible Note Indenture

During the first quarter of 2018, in connection with our Restructuring (defined above), all of the outstanding 6.00% convertible senior unsecured notes due 2021 were converted or exchanged into shares of our common stock and the Indenture governing such notes was discharged. On January 17, 2018, the Investors converted $1.6 million aggregate principal amount of 6.00% convertible senior unsecured promissory notes due in 2021, which were issued effective January 17, 2017, plus accrued and unpaid interest, into 189,645 shares of our common stock. On February 14, 2018, an additional $70.3 million aggregate principal amount of notes, plus accrued and unpaid interest, were exchanged for 10,401,309 newly-issued shares of our common stock.

Private Placement SPA

On February 14, 2018, we sold to the Investors pursuant to the Private Placement SPA 945,819 shares of our common stock, at a price of $7.20 per share, for aggregate proceeds of $6.8 million.

Registration Rights Agreement

On May 15, 2018, we filed a shelf resale registration statement with the SEC pursuant to our obligations under the Registration Rights Agreement. This registration statement was declared effective by the SEC on June 4, 2018.

Rights Offering

On May 18, 2018, we distributed to holders of our common stock, at no charge, non-transferable subscription rights to purchase up to an aggregate of 1,137,515 shares of our common stock (the “Rights Offering”). In the Rights Offering, holders received 0.0869816 subscription rights for each share of common stock held on the record date, April 27, 2018. The units were priced at $7.20 per unit. The Rights Offering expired on June 18, 2018, at which time the rights were no longer exercisable. We issued 129 shares of our common stock in the Rights Offering, resulting in $0.9 thousand in gross proceeds to us.

Stock-Based Compensation

6 Months Ended

Jun. 30, 2018

Disclosure of Compensation Related Costs, Share-based Payments [Abstract]

Stock-Based Compensation

(8) Stock-Based Compensation

The Amended and Restated Xtant Medical Equity Incentive Plan (the “Plan”) provides for stock awards, including options and performance stock awards, to be granted to employees, consultants, independent contractors, officers and directors. The purpose of the Plan is to enable us to attract, retain and motivate key employees, directors and, on occasion, independent consultants, by providing them with stock options and restricted stock grants. Stock options granted under the Plan may be either incentive stock options to employees, as defined in Section 422A of the Internal Revenue Code of 1986, or non-qualified stock options. The exercise price of all incentive stock options granted under the Plan must be at least equal to the fair market value of the shares of common stock on the date of the grant. The Plan is administered by the Board. Stock options granted under the Plan are generally not transferable, vest in installments over the requisite service period and are exercisable during the stated contractual term of the option only by such optionee. As of June 30, 2018, 153,333 shares were currently authorized under the Plan and approximately 15,000 shares remained available for issuance. Shares of common stock issued under the Plan may be newly issued shares or reacquired shares. From time to time, we have granted options to purchase common stock outside of the Plan to new hires (collectively the “Non-Plan Grants”).

Stock compensation expense recognized in the condensed consolidated statements of operations for the six months ended June 30, 2018 and 2017 is based on awards expected to vest and reflects an estimate of awards that will be forfeited. ASC 718 requires forfeitures to be estimated at the time of grant and revised, if necessary, in subsequent periods if actual forfeitures differ from those estimates. No stock options were issued in the first six months of 2018 or 2017.

Stock option activity, including options granted under the Plan and the Non-Plan Grants, was as follows (in thousands, except number of shares and per share amounts):

	2018							2017
				Weighted		Weighted Average					Weighted		Weighted Average
				Average Exercise		Fair Value at					Average Exercise		Fair Value at
	Shares			Price Per Share		Grant Date Per Share		Shares			Price Per Share		Grant Date Per Share
Outstanding at January 1		67,465		$	71.03	$	36.85		100,492		$	62.52	$	33.84
Cancelled or expired		(22,971	)		96.44		46.94		(1,611	)		137.04		94.92
Outstanding at June 30		44,494		$	53.14	$	27.36		98,881		$	61.32	$	33.60
Exercisable at June 30		44,494		$	53.14	$	27.36		32,335		$	137.04	$	68.04

The aggregate intrinsic value of options outstanding as of June 30, 2018 was zero because the closing price of the stock at June 30, 2018 was less than the strike price of all options outstanding. As of February 13, 2018, all options were fully vested and $0.2 million was expensed in the first quarter of 2018 due to the change of control as a result of the Corporate Restructuring, noted above.

Total stock-based compensation recognized for employees and directors was $0.4 million for each the six months ended June 30, 2018 and 2017, respectively and was recognized as Non-cash compensation expense as discussed below.

During the six months ended June 30, 2018, we granted an aggregate of 67,708 shares of restricted stock to our non-employee directors of the Company. These awards will vest and become non-forfeitable with respect to one-half of the underlying shares on February 14, 2019 and the remaining half on February 14, 2020. The total expense of these restricted stock awards, which amounts to $0.3 million in the aggregate or $4.80 per share, is being recognized ratably over the vesting period as Non-cash compensation expense. During the six months ended June 30, 2018, $0.1 million was expensed.

On July 25, 2017, we granted 25,974 shares of restricted stock to certain former non-employee directors of the Company. These awards became fully vested and non-forfeitable on February 13, 2018 as a result of the Restructuring, which constituted a change of control under the Plan. The total expense of these restricted stock awards, which amounted to $0.2 million in the aggregate or $9.24 per share, was being recognized over the vesting period as Non-cash compensation expense. During the three months ended March 31, 2018, the remaining $0.1 million of expense was recognized.

Effective October 6, 2016, the Board granted our Chief Executive Officer, Carl O’Connell, an option to purchase 25,000 shares of common stock at an exercise price of $13.32 per share. This option was granted outside the Plan as an inducement option. As a result of the Restructuring, which constituted a change of control under the option agreement, this option became fully vested on February 13, 2018 and was fully expensed during the quarter ended March 31, 2018.

On June 13, 2018, the Board approved, subject to stockholder approval, the Xtant Medical Holdings, Inc. 2018 Equity Incentive Plan, which is intended to replace the Plan with respect to future equity awards. On August 1, 2018, our stockholders approved the 2018 Plan. See Note 15, “Subsequent Events.”

Warrants

6 Months Ended

Jun. 30, 2018

Warrants and Rights Note Disclosure [Abstract]

Warrants

(9) Warrants

The following table summarizes our warrant activities for the six months ended June 30, 2018:

				Weighted
	Common			Average
	Stock			Exercise
	Warrants			Price
Outstanding as of January 1, 2017		524,277		$	26.76
Expired		(4,360	)		135.36
Outstanding at January 1, 2018		519,917		$	25.68
Expired		(6,250	)		5.70
Outstanding at June 30, 2018		513,667		$	25.92

We utilize a lattice valuation model to determine the fair market value of the warrants accounted for as liabilities. The lattice valuation model accommodates the probability of exercise price adjustment features as outlined in the warrant agreements. We recorded an unrealized gain of $41 thousand resulting from the change in the fair value of the warrant derivative liability for the first six months of 2018. Under the terms of some of our warrant agreements, at any time while the warrant is outstanding, the exercise price per share can be reduced to the price per share of future subsequent equity sales of our common stock or a common stock equivalent that is lower than the exercise price per share as stated in the warrant agreement.

The estimated fair value was derived using a valuation model with the following weighted-average assumptions:

	Six Months Ended
	June 30,
	2018			2017
Value of underlying common stock (per share)	$	5.55		$	7.92
Risk-free interest rate		2.62	%		1.85	%
Expected term in years		4.1			5.1
Volatility		62	%		96	%
Dividend yield		0	%		0	%

The following table summarizes our activities related to warrants accounted for as a derivative liability for the six months ended June 30, 2018 and 2017:

	2018			2017
Balance at January 1, 2018		93,759			93,759
Derivative warrants issued, exercised and expired		(6,250	)		-
Balance at June 30, 2018		87,509			93,759

Commitments and Contingencies

6 Months Ended

Jun. 30, 2018

Commitments and Contingencies Disclosure [Abstract]

Commitments and Contingencies

(10) Commitments and Contingencies

Operating Leases

We lease five office facilities under non-cancelable operating lease agreements with expiration dates between 2019 and 2025. We have the option to extend the five leases for up to another ten-year term and for one facility, we have the right of first refusal on any sale.

Future minimum payments for the next five years and thereafter as of June 30, 2018, under these leases, are as follows (in thousands):

Remainder of 2018	$	404
2019		669
2020		396
2021		375
2022		354
Thereafter		887
Total	$	3,085

Rent expense was $0.6 million and $0.4 million for the six months ended June 30, 2018 and 2017, respectively. Rent expense is determined using the straight-line method of the minimum expected rent paid over the term of the agreement. We have no contingent rent agreements.

Capital Leases

Future minimum payments for the next five years and thereafter as of June 30, 2018, under capital leases for equipment, are as follows (in thousands):

Remainder of 2018	$	267
2019		502
2020		218
2021		-
2022		-
Thereafter		-
Total minimum lease payments		987
Less amount representing interest		(165	)
Present value of obligations under capital leases		822
Less current portion		(469	)
Long-term capital lease obligations	$	353

Litigation

On August 10, 2017, a civil suit complaint was filed against Xtant in the United States District Court, District of Nevada by Axis Spine NV, LLC (“Axis”), Case No. 2:17-CV-02147-APG-VCF. The complaint alleges breach of contract, breach of the implied covenant of good faith and fair dealing, and tortious interference with prospective economic advantage with respect to an alleged medical device distribution relationship between the parties. Axis seeks relief in the form of damages in an amount in excess of $1.0 million. The Court is considering Xtant’s motions to dismiss and for summary judgment.

In addition, we are engaged in ordinary routine litigation incidental to our business from time to time, including product liability disputes.

Indemnification Arrangements

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

6 Months Ended

Jun. 30, 2018

Income Tax Disclosure [Abstract]

Income Taxes

(11) 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 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 six months ended June 30, 2018 and 2017.

On December 22, 2017, the Tax Cuts and Jobs Act (the “Act”) was signed into legislation. At December 31, 2017, the Company made a reasonable estimate of the effects on the existing deferred tax balances and recorded a provisional amount in the 2017 financial statements.

On December 22, 2017, Staff Accounting Bulletin No. 118 (“SAB 118”) was issued to address the application of U.S. GAAP in situations when a registrant does not have the necessary information available, prepared, or analyzed (including computations) in reasonable detail to complete the accounting for certain income tax effects of the Act. In accordance with SAB 118, the Company has provisionally determined that there is no tax deferred tax benefit or expense with respect to the remeasurement of certain deferred tax assets and liabilities due to the full valuation allowance against net deferred tax assets. The Company is still analyzing certain aspects of the Act and refining its calculations, which could potentially affect the measurement of these balances or potentially give rise to new deferred tax amounts. There has been no change to the provisional adjustment recorded in 2017 nor during the first six months of 2018. Additional analysis of the law and the impact to the Company will be performed and any impact will be recorded in the respective period in 2018.

Supplemental Disclosure of Cash Flow Information

6 Months Ended

Jun. 30, 2018

Supplemental Cash Flow Elements [Abstract]

Supplemental Disclosure of Cash Flow Information

(12) Supplemental Disclosure of Cash Flow Information

Supplemental cash flow information is as follows (in thousands):

	Six Months Ended
	June 30,
	2018		2017
Supplemental disclosure of cash flow information
Cash paid during the period for:
Interest	$	170	$	386
Non-cash activity:
Issuance of capital leases	$	84	$	967
Interest converted into common stock	$	556	$	480
Conversion of convertible debt to equity	$	71,865	$	-
Convertible PIK interest	$	4,764	$	-
Conversion of interest related to the Credit Facility to long-term debt	$	7,977	$	-
Write-off of convertible debt issuance cost	$	1,012	$	-
Transfer of inventory to property and equipment	$	439	$	-

Related Party Transactions

6 Months Ended

Jun. 30, 2018

Related Party Transactions

(13) Related Party Transactions

The Investors, which collectively own approximately 70% of our outstanding common stock, are the sole holders of our outstanding long-term debt. In addition, as described in more detail under Note (1), we are parties to an Investor Rights Agreement and Registration Rights Agreement with the Investors. Transactions between the Company and the Investors are conducted under the provisions of Amended and Restated Credit Agreement, the Investor Rights Agreement and the Registration Rights Agreement, as noted above.

Segment and Geographic Information

6 Months Ended

Jun. 30, 2018

Segment Reporting [Abstract]

Segment and Geographic Information

(14) 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.

The Company attributes revenues to geographic areas based on the location of the customer. Approximately 95% and 98% of sales were in the United States, respectively, for the six months ended June 30, 2018 and 2017. Total revenue by major geographic area is as follows (in thousands):

	Six Months Ended June 30,
	2018		2017
United States	$	34,792	$	42,410
Rest of world		1,882		1,081
Total revenue	$	36,674	$	43,491

Subsequent Events

6 Months Ended

Jun. 30, 2018

Subsequent Events [Abstract]

Subsequent Events

(15) Subsequent Events

Xtant Medical Holdings, Inc. 2018 Equity Incentive Plan

On August 1, 2018, our stockholders approved the Xtant Medical Holdings, Inc. 2018 Equity Incentive Plan at the 2018 annual meeting of stockholders of Xtant. The Board previously approved the 2018 Plan, subject to approval by our stockholders, on June 13, 2018. The 2018 Plan became effective immediately upon approval by our stockholders and will expire on July 31, 2028, unless terminated earlier. The 2018 Plan replaced the Amended and Restated Xtant Medical Equity Incentive Plan. The 2018 Plan permits the Board, or a committee thereof, to grant to eligible employees, non-employee directors and consultants of the Company non-statutory and incentive stock options, stock appreciation rights, restricted stock awards, restricted stock units, deferred stock units, performance awards, non-employee director awards, and other stock-based awards. The Board may select 2018 Plan participants and determine the nature and amount of awards to be granted. Subject to adjustment as provided in the 2018 Plan, the number of shares of our common stock available for issuance under the 2018 Plan is 1,307,747 shares.

After the approval and effectiveness of the 2018 Plan, the Board approved various awards thereunder to certain officers and employees, consisting of stock option grants to purchase an aggregate of 410,770 shares of our common stock and 40,000 shares of restricted stock units. In addition, a restricted stock award for 26,042 shares was approved for one of our non-employee directors. All of these awards will become effective during the third quarter ended September 30, 2018.

Business Description and Summary of Significant Accounting Policies (Policies)

6 Months Ended

Jun. 30, 2018

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Business Description

Business Description

Corporate Restructuring

Corporate Restructuring

Restructuring Agreement

In connection with the Restructuring Agreement, we held a special meeting of stockholders on February 13, 2018 (“Special Meeting”), where our stockholders approved the following actions:

● Approval of the issuance of shares of common stock for purposes of Sections 713(a) and 713(b) of the NYSE American Company Guide.

Amended and Restated Certificate of Incorporation

	●	effect the Reverse Stock Split;

	●	after giving effect to the Reverse Stock Split, decrease the number of authorized shares of common stock available for issuance from 95,000,000 to 50,000,000 and increase the number of authorized shares of preferred stock available for issuance from 5,000,000 to 10,000,000;

	●	authorize the Board of Directors (“Board”) to increase or decrease the number of shares of any series of our capital stock, provided that such increase or decrease does not exceed the number of authorized shares or be less than the number of shares then outstanding;

	●	authorize the Board to issue new series of preferred stock without approval of the holders of common stock or other series of preferred stock, with such powers, preferences and rights as may be determined by the Board;

	●	authorize a majority of the Board to fix the number of our directors;

	●	indemnify the members of the Board to the fullest extent permitted by law;

	●	remove the classification of the Board to require all directors to be elected annually;

	●	provide that special meetings of our stockholders may only be called by the Board, the chairman of the Board or our chief executive officer;

	●	provide that no stockholder will be permitted cumulative voting at any election of directors;

	●	elect not to be governed by Section 203 of the Delaware General Corporation Law (the “DGCL”);

	●	elect the Court of Chancery of the State of Delaware to be the exclusive forum for any derivative action or proceeding brought on our behalf, any action asserting a breach of a fiduciary duty owed by any of our directors, officers or other employees, any action under the DGCL, our Charter or bylaws or any actions governed by the internal affairs doctrine; and

	●	require the vote of at least two-thirds of the voting power of the then outstanding shares of our capital stock to amend or repeal certain provisions of our Charter.

Private Placement SPA

Investor Rights Agreement

Registration Rights Agreement

Second Amended and Restated Bylaws

	●	provide for annual and special meetings of stockholders to be held through remote communications;

	●	provide for the election of any directors not elected at an annual meeting of stockholders to be elected at a special meeting of stockholders;

	●	declassify the Board into one group of directors that will hold office until the subsequent annual meeting of stockholders and until the election and qualification of such directors’ respective successors;

	●	provide for the filling of a new directorship or director vacancy by the affirmative vote of the holders of a majority of the voting power of our shares of stock;

	●	allow for a majority of the Board present to adjourn a Board meeting if a quorum is not met;

	●	unless otherwise restricted in the Amended Bylaws or our Charter, provide the Board with the authority to fix the compensation of directors, including without limitation, compensation for services as members of Board committees;

	●	allow us to enter into an agreement with a stockholder to restrict the transfer of shares held by such stockholder in any manner not prohibited by the DGCL; and

	●	allow the Board to declare dividends on our capital stock, subject to any provisions of our Charter and applicable law.

Concentrations and Credit Risk

Concentrations and Credit Risk

Use of Estimates

Use of Estimates

Long-Lived Assets

Long-Lived Assets

Goodwill

Goodwill

Revenue Recognition

Revenue Recognition

Research and Development

Research and Development

Research and development costs, which are principally related to internal costs for the development of new devices and biologics are expensed as incurred.

Net Loss Per Share

Net Loss Per Share

Fair Value of Financial Instruments

Fair Value of Financial Instruments

Level 1: Inputs to the valuation methodology are unadjusted quoted prices for identical assets or liabilities in active markets.

Level 3: Inputs to the valuation methodology are unobservable and significant to the fair value measurement.

The following table sets forth by level, within the fair value hierarchy, our liabilities that are measured at fair value on a recurring basis:

Warrant derivative liability (in thousands):

	As of June 30, 2018		As of December 31, 2017
Level 1		-		-
Level 2		-		-
Level 3	$	90	$	131

Level 3 Changes

Warrant derivative liability

Balance at January 1, 2017	$	334
Gain recognized in earnings		(203	)
Balance at January 1, 2018	$	131
Gain recognized in earnings		(41	)
Balance at June 30, 2018	$	90

During the six months ended June 30, 2018, the Company did not change any of the valuation techniques used to measure its liabilities at fair value.

Recent Accounting Pronouncements

Recent Accounting Pronouncements

Business Description and Summary of Significant Accounting Policies (Tables)

6 Months Ended

Jun. 30, 2018

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Schedule of Assets and Liabilities Measured on Recurring Basis

Warrant derivative liability (in thousands):

	As of June 30, 2018		As of December 31, 2017
Level 1		-		-
Level 2		-		-
Level 3	$	90	$	131

Schedule of Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation

Warrant derivative liability

Balance at January 1, 2017	$	334
Gain recognized in earnings		(203	)
Balance at January 1, 2018	$	131
Gain recognized in earnings		(41	)
Balance at June 30, 2018	$	90

Inventories, Net (Tables)

6 Months Ended

Jun. 30, 2018

Inventory Disclosure [Abstract]

Schedule of Inventories

Inventories consist of the following (in thousands):

	June 30, 2018			December 31, 2017
Current inventories:
Raw materials	$	4,040		$	4,277
Work in process		1,292			1,515
Finished goods		24,014			23,270
Gross current inventories		29,346			29,062
Reserve for obsolescence		(6,900	)		(6,833	)
Current inventories, net		22,446			22,229
Non-current inventories:
Finished goods		608			1,072
Reserve for obsolescence		(608	)		(878	)
Non-current inventories, net		-			194
Total inventories, net	$	22,446		$	22,423

Property and Equipment, Net (Tables)

6 Months Ended

Jun. 30, 2018

Property, Plant and Equipment [Abstract]

Schedule of Property and Equipment, Net

Property and equipment, net are as follows (in thousands):

	June 30, 2018			December 31, 2017
Equipment	$	4,465		$	4,471
Computer equipment		484			489
Computer software		499			524
Furniture and fixtures		215			215
Leasehold improvements		4,022			4,030
Vehicles		10			10
Surgical instruments		11,622			11,462
Total cost		21,317			21,201
Less: accumulated depreciation		(12,389	)		(11,288	)
Property and equipment, net	$	8,928		$	9,913

Intangible Assets (Tables)

6 Months Ended

Jun. 30, 2018

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Intangible Assets

The following table sets forth information regarding intangible assets (in thousands):

	June 30, 2018			December 31, 2017
Patents	$	847		$	847
Acquisition related intangibles:
Technology		13,789			13,789
Customer relationships		9,911			9,911
Tradename		1,867			1,867
Non-compete		41			41
Accumulated amortization		(14,349	)		(12,629	)
Intangible assets, net	$	12,106		$	13,826

Aggregate amortization expense:	$	1,720		$	4,629

Schedule of Estimated Amortization Expense for Intangible Assets

The following is a summary of estimated future amortization expense for intangible assets as of June 30, 2018 (in thousands):

Remainder of 2018	$	1,718
2019		3,252
2020		2,170
2021		1,409
2022		1,052
Thereafter		2,505
Total	$	12,106

Debt (Tables)

6 Months Ended

Jun. 30, 2018

Debt Disclosure [Abstract]

Schedule of Long-term Debt

Long-term debt consists of the following (in thousands):

	June 30, 2018			December 31, 2017
Amounts due under the Credit Facility	$	55,787		$	55,787
PIK interest payable related to the Credit Facility		23,850			11,582
6% convertible senior unsecured notes due 2021		-			71,865
Gross long-term debt		79,637			139,234
Less: total debt issuance costs		(208	)		(1,272	)
Long-term debt, less issuance costs	$	79,429		$	137,962

Stock-Based Compensation (Tables)

6 Months Ended

Jun. 30, 2018

Disclosure of Compensation Related Costs, Share-based Payments [Abstract]

Schedule of Share-based Compensation, Stock Options, Activity

Stock option activity, including options granted under the Plan and the Non-Plan Grants, was as follows (in thousands, except number of shares and per share amounts):

	2018							2017
				Weighted		Weighted Average					Weighted		Weighted Average
				Average Exercise		Fair Value at					Average Exercise		Fair Value at
	Shares			Price Per Share		Grant Date Per Share		Shares			Price Per Share		Grant Date Per Share
Outstanding at January 1		67,465		$	71.03	$	36.85		100,492		$	62.52	$	33.84
Cancelled or expired		(22,971	)		96.44		46.94		(1,611	)		137.04		94.92
Outstanding at June 30		44,494		$	53.14	$	27.36		98,881		$	61.32	$	33.60
Exercisable at June 30		44,494		$	53.14	$	27.36		32,335		$	137.04	$	68.04

Warrants (Tables)

6 Months Ended

Jun. 30, 2018

Warrants and Rights Note Disclosure [Abstract]

Schedule of Warrant Activity

The following table summarizes our warrant activities for the six months ended June 30, 2018:

				Weighted
	Common			Average
	Stock			Exercise
	Warrants			Price
Outstanding as of January 1, 2017		524,277		$	26.76
Expired		(4,360	)		135.36
Outstanding at January 1, 2018		519,917		$	25.68
Expired		(6,250	)		5.70
Outstanding at June 30, 2018		513,667		$	25.92

Schedule of Warrant Valuation Assumptions

The estimated fair value was derived using a valuation model with the following weighted-average assumptions:

	Six Months Ended
	June 30,
	2018			2017
Value of underlying common stock (per share)	$	5.55		$	7.92
Risk-free interest rate		2.62	%		1.85	%
Expected term in years		4.1			5.1
Volatility		62	%		96	%
Dividend yield		0	%		0	%

Schedule of Warrants Activities Used in Derivative Liability

The following table summarizes our activities related to warrants accounted for as a derivative liability for the six months ended June 30, 2018 and 2017:

	2018			2017
Balance at January 1, 2018		93,759			93,759
Derivative warrants issued, exercised and expired		(6,250	)		-
Balance at June 30, 2018		87,509			93,759

Commitments and Contingencies (Tables)

6 Months Ended

Jun. 30, 2018

Commitments and Contingencies Disclosure [Abstract]

Schedule of Future Minimum Rental Payments for Operating Leases

Future minimum payments for the next five years and thereafter as of June 30, 2018, under these leases, are as follows (in thousands):

Remainder of 2018	$	404
2019		669
2020		396
2021		375
2022		354
Thereafter		887
Total	$	3,085

Schedule of Future Minimum Lease Payments for Capital Leases

Future minimum payments for the next five years and thereafter as of June 30, 2018, under capital leases for equipment, are as follows (in thousands):

Remainder of 2018	$	267
2019		502
2020		218
2021		-
2022		-
Thereafter		-
Total minimum lease payments		987
Less amount representing interest		(165	)
Present value of obligations under capital leases		822
Less current portion		(469	)
Long-term capital lease obligations	$	353

Supplemental Disclosure of Cash Flow Information (Tables)

6 Months Ended

Jun. 30, 2018

Supplemental Cash Flow Elements [Abstract]

Schedule of Supplemental Cash Flow Information

Supplemental cash flow information is as follows (in thousands):

	Six Months Ended
	June 30,
	2018		2017
Supplemental disclosure of cash flow information
Cash paid during the period for:
Interest	$	170	$	386
Non-cash activity:
Issuance of capital leases	$	84	$	967
Interest converted into common stock	$	556	$	480
Conversion of convertible debt to equity	$	71,865	$	-
Convertible PIK interest	$	4,764	$	-
Conversion of interest related to the Credit Facility to long-term debt	$	7,977	$	-
Write-off of convertible debt issuance cost	$	1,012	$	-
Transfer of inventory to property and equipment	$	439	$	-

Segment and Geographic Information (Tables)

6 Months Ended

Jun. 30, 2018

Segment Reporting [Abstract]

Schedule of Revenues by Geographic Region

. Total revenue by major geographic area is as follows (in thousands):

	Six Months Ended June 30,
	2018		2017
United States	$	34,792	$	42,410
Rest of world		1,882		1,081
Total revenue	$	36,674	$	43,491

Business Description and Summary of Significant Accounting Policies (Details Narrative) $ / shares in Units, $ in Thousands						3 Months Ended			6 Months Ended
	May 18, 2018 USD ($) $ / shares shares	Apr. 27, 2018 $ / shares shares	Feb. 14, 2018 USD ($) $ / shares shares	Feb. 13, 2018 shares	Jan. 17, 2018 USD ($) $ / shares shares	Jun. 30, 2018 USD ($) $ / shares shares	Mar. 31, 2018	Jun. 30, 2017 shares	Jun. 30, 2018 USD ($) $ / shares shares	Jun. 30, 2017 USD ($) shares	Dec. 31, 2017 shares
Reverse stock split, description			Upon the effectiveness of the Reverse Stock Split, every 12 shares of our issued and outstanding common stock automatically converted into one share of common stock, without any change in the par value per share.	1-for-12 reverse split
Debt conversion, converted instrument, amount \| $									$ 71,865
Stock issued during period, shares, new issues	129								129
Shares issued, price per share \| $ / shares	$ 0.0869816
Stock issued during period, value, new issues \| $	$ 900								$ 900
Common stock, shares authorized						50,000,000			50,000,000		50,000,000
Preferred stock, shares authorized						10,000,000			10,000,000		10,000,000
Description of royalty opportunities			(i) issue new securities; (ii) incur over $0.25 million of debt in a fiscal year; (iii) sell or transfer over $0.25 million of our assets or businesses or our subsidiaries in a fiscal year; (iv)acquire over $0.25 million of assets or properties in a fiscal year; (v)make capital expenditures over $0.125 million individually, or $1.5 million in the aggregate during a fiscal year; (vi) approve our annual budget; (vii) hire or terminate our chief executive officer; (viii)appoint or remove the chairperson of the Board; and (ix) make, loans to, investments in, or purchase, or permit any subsidiary to purchase, any stock or other securities in another entity in excess of $0.25 million in a fiscal year.
Ownership interest percentage description									(a) upon the mutual written agreement of all the parties, (b) upon written notice of the Company or an Investor, if such Investor’s ownership percentage of our then outstanding common stock is less than 10%, or (c) upon written notice by the Investors. PWPI and PWIMF’s right to purchase from us a pro rata amount of any new securities will also terminate at such time as their aggregate ownership percentage of our then outstanding common stock is less than 8.5%.
Impairment of longlived assets \| $
Antidilutive securities excluded from computation of earnings per share, amount						558,161		558,161	623,159	623,159
Securities Purchase Agreement [Member]
Stock issued during period, shares, new issues			945,819
Shares issued, price per share \| $ / shares			$ 7.20
Stock issued during period, value, new issues \| $			$ 6,800
Reverse Stock Split Before [Member]
Common stock, shares authorized				95,000,000
Preferred stock, shares authorized				50,000,000
Reverse Stock Split After [Member]
Common stock, shares authorized				50,000,000
Preferred stock, shares authorized				10,000,000
Maximum [Member]
Stock issued during period, shares, new issues	1,137,515
Minimum [Member]
Outstanding common stock in percentage			40.00%
Restructuring Agreement [Member]
Shares issued, price per share \| $ / shares		$ 7.20
Rights offering expired		Jun. 18, 2018
Restructuring Agreement [Member] \| Maximum [Member]
Stock issued during period, shares, new issues		1,137,515
2017 Notes [Member]
Debt conversion, converted instrument, shares issued					189,645
6.00% Convertible Senior Unsecured Notes [Member]
Debt instrument due date description					Convertible senior unsecured notes due 2021		Convertible senior unsecured notes due 2021		Convertible senior unsecured notes due 2021
Debt instrument, conversion price per share \| $ / shares						$ 7.20			$ 7.20
Debt conversion, converted instrument, shares issued			10,401,309		189,645				10,401,309
Debt conversion, converted instrument, amount \| $					$ 1,600				$ 70,300
Debt instrument, convertible, conversion ratio									138.8889
Debt instrument, face amount \| $						$ 1,000			$ 1,000
Noncontrolling interest, ownership percentage by parent						70.00%			70.00%
6.00% Convertible Senior Unsecured Notes [Member]
Debt instrument, face amount \| $			$ 70,300
6.00% Convertible Senior Unsecured Notes [Member] \| 2017 Notes [Member]
Debt instrument due date description					Convertible senior unsecured notes due 2021
2017 Notes [Member] \| 6.00% Convertible Senior Unsecured Notes [Member]
Debt instrument, conversion price per share \| $ / shares					$ 9.11

Business Description and Summary of Significant Accounting Policies - Schedule of Assets and Liabilities Measured on Recurring Basis (Details) - USD ($) $ in Thousands	Jun. 30, 2018	Dec. 31, 2017
Warrant derivative liability	$ 90	$ 131
Fair Value, Inputs, Level 1 [Member] \| Fair Value, Measurements, Recurring [Member]
Warrant derivative liability
Fair Value, Inputs, Level 2 [Member] \| Fair Value, Measurements, Recurring [Member]
Warrant derivative liability
Fair Value, Inputs, Level 3 [Member] \| Fair Value, Measurements, Recurring [Member]
Warrant derivative liability	$ 90	$ 131

Business Description and Summary of Significant Accounting Policies - Schedule of Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation (Details) - USD ($) $ in Thousands	6 Months Ended	12 Months Ended
	Jun. 30, 2018	Dec. 31, 2017
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Balance	$ 131	$ 334
Gain recognized in earnings	(41)	(203)
Balance	$ 90	$ 131

Inventories, Net - Schedule of Inventories (Details) - USD ($) $ in Thousands	Jun. 30, 2018	Dec. 31, 2017
Inventory Disclosure [Abstract]
Raw materials	$ 4,040	$ 4,277
Work in process	1,292	1,515
Finished goods	24,014	23,270
Gross current inventories	29,346	29,062
Reserve for obsolescence	(6,900)	(6,833)
Current inventories, net	22,446	22,229
Finished goods	608	1,072
Reserve for obsolescence	(608)	(878)
Non-current inventories, net		194
Total inventories, net	$ 22,446	$ 22,423

Property and Equipment, Net (Details Narrative) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2018	Jun. 30, 2017	Dec. 31, 2017
Property, Plant and Equipment [Line Items]
Estimated useful lives of assets	P5Y
Property, plant and equipment, net	$ 8,928		$ 9,913
Depreciation expense	1,600	$ 1,900
Capital leased assets, gross	1,700
Capital leases, lessee balance sheet, assets by major class, accumulated depreciation	700
Surgical Instruments Property Equipments [Member]
Property, Plant and Equipment [Line Items]
Property, plant and equipment, net	$ 6,500		$ 4,600

Property and Equipment, Net - Schedule of Property and Equipment, Net (Details) - USD ($) $ in Thousands	Jun. 30, 2018	Dec. 31, 2017
Property, Plant and Equipment [Line Items]
Total cost	$ 21,317	$ 21,201
Less: accumulated depreciation	(12,389)	(11,288)
Property and equipment, net	8,928	9,913
Equipment [Member]
Property, Plant and Equipment [Line Items]
Total cost	4,465	4,471
Computer Equipment [Member]
Property, Plant and Equipment [Line Items]
Total cost	484	489
Computer Software [Member]
Property, Plant and Equipment [Line Items]
Total cost	499	524
Furniture and Fixtures [Member]
Property, Plant and Equipment [Line Items]
Total cost	215	215
Leasehold Improvements [Member]
Property, Plant and Equipment [Line Items]
Total cost	4,022	4,030
Vehicles [Member]
Property, Plant and Equipment [Line Items]
Total cost	10	10
Surgical Instruments [Member]
Property, Plant and Equipment [Line Items]
Total cost	$ 11,622	$ 11,462

Intangible Assets - Schedule of Intangible Assets (Details) - USD ($) $ in Thousands	6 Months Ended	12 Months Ended
	Jun. 30, 2018	Dec. 31, 2017
Accumulated amortization	$ (14,349)	$ (12,629)
Intangible assets, net	12,106	13,826
Aggregate amortization expense:	1,720	4,629
Patents [Member]
Gross carrying value	847	847
Technology [Member]
Gross carrying value	13,789	13,789
Customer Relationships [Member]
Gross carrying value	9,911	9,911
Trade Name [Member]
Gross carrying value	1,867	1,867
Non-Compete [Member]
Gross carrying value	$ 41	$ 41

Intangible Assets - Schedule of Estimated Amortization Expense for Intangible Assets (Details) $ in Thousands	Jun. 30, 2018 USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
Remainder of 2018	$ 1,718
2019	3,252
2020	2,170
2021	1,409
2022	1,052
Thereafter	2,505
Total	$ 12,106

Accrued Liabilities - Schedule of Accrued Liabilities (Details) - USD ($) $ in Thousands	Jun. 30, 2018	Dec. 31, 2017
Payables and Accruals [Abstract]
Accrued stock compensation	$ 61	$ 120
Wages/commissions payable	2,215	2,831
Accrued interest payable		10,835
Other accrued expenses	2,034	2,059
Accrued Liabilities	$ 4,310	$ 15,845

Debt (Details Narrative)			3 Months Ended	6 Months Ended
Debt (Details Narrative)	Feb. 14, 2018	Jan. 17, 2018	Mar. 31, 2018	Jun. 30, 2018
Debt instrument maturity date				Jul. 31, 2020
Twenty-Third Amendment to Amended and Restated Credit Agreement [Member] \| Through December 31, 2018 [Member]
Debt instrument, basis spread on variable rate	12.00%
Debt instrument interest rate portion payable in cash	10.00%
Twenty-Third Amendment to Amended and Restated Credit Agreement [Member] \| January 1, 2019 through June 30, 2019 [Member]
Debt instrument, basis spread on variable rate	15.00%
Debt instrument interest rate portion payable in cash	10.00%
Twenty-Third Amendment to Amended and Restated Credit Agreement [Member] \| July 1, 2019 through the maturity date [Member]
Debt instrument, basis spread on variable rate	10.00%
Debt instrument, fee percentage	1.00%
6.00% Convertible Senior Unsecured Notes [Member]
Debt instrument due date description		Convertible senior unsecured notes due 2021	Convertible senior unsecured notes due 2021	Convertible senior unsecured notes due 2021

Debt - Schedule of Long-term Debt (Details) - USD ($) $ in Thousands	Jun. 30, 2018	Dec. 31, 2017
Debt Disclosure [Abstract]
Amounts due under the Credit Facility	$ 55,787	$ 55,787
PIK interest payable related to the Credit Facility	23,850	11,582
6% convertible senior unsecured notes due 2021		71,865
Gross long-term debt	79,637	139,234
Less: total debt issuance costs	(208)	(1,272)
Long-term debt, less issuance costs	$ 79,429	$ 137,962

Equity (Details Narrative) - USD ($) $ / shares in Units, $ in Thousands				3 Months Ended	6 Months Ended
	May 18, 2018	Feb. 14, 2018	Jan. 17, 2018	Mar. 31, 2018	Jun. 30, 2018	Jun. 30, 2017
Schedule of Equity Method Investments [Line Items]
Debt conversion of convertible debt					$ 71,865
Stock issued during period, shares, new issues	129				129
Shares issued, price per share	$ 0.0869816
Stock issued during period, value, new issues	$ 900				$ 900
Share price	$ 7.20
Right offering expired date	Jun. 18, 2018
Maximum [Member]
Schedule of Equity Method Investments [Line Items]
Stock issued during period, shares, new issues	1,137,515
Private Placement [Member]
Schedule of Equity Method Investments [Line Items]
Stock issued during period, shares, new issues		945,819
Shares issued, price per share		$ 7.20
Stock issued during period, value, new issues		$ 6,800
6.00% Convertible Senior Unsecured Notes [Member]
Schedule of Equity Method Investments [Line Items]
Debt principal amount		$ 70,300
6.00% Convertible Senior Unsecured Notes [Member]
Schedule of Equity Method Investments [Line Items]
Debt instrument due date description			Convertible senior unsecured notes due 2021	Convertible senior unsecured notes due 2021	Convertible senior unsecured notes due 2021
Debt conversion of convertible debt			$ 1,600		$ 70,300
Debt conversion, converted instrument, shares issued		10,401,309	189,645		10,401,309
Debt principal amount					$ 1,000

Stock - Based Compensation (Details Narrative) - USD ($) $ / shares in Units, $ in Thousands				3 Months Ended			6 Months Ended
	Feb. 13, 2018	Jul. 25, 2017	Oct. 06, 2016	Jun. 30, 2018	Mar. 31, 2018	Jun. 30, 2017	Jun. 30, 2018	Jun. 30, 2017	May 18, 2018
Shares authorized under the plan				153,333			153,333
Number of shares available for issuance				15,000			15,000
Restructuring costs	$ 200
Shares issued, price per share									$ 0.0869816
Other noncash expense				$ 41		$ 92	$ 405	$ 237
Employees and Directors [Member]
Allocated share-based compensation expense							$ 400	$ 400
Non-Employee Directors [Member]
Restricted stock granted during period, shares							67,708
Number of restricted shares awards				$ 300			$ 300
Shares issued, price per share				$ 4.80			$ 4.80
Other noncash expense							$ 100
Former Non-Employee Directors [Member]
Restricted stock granted during period, shares		25,974
Number of restricted shares awards		$ 200
Shares issued, price per share		$ 9.24
Other noncash expense					$ 100
Chief Executive Officer [Member]
Options granted to purchase shares			25,000
Exercise price share price			$ 13.32

Stock-Based Compensation - Schedule of Share-based Compensation, Stock Options, Activity (Details) - Equity Option [Member] - $ / shares	6 Months Ended
	Jun. 30, 2018	Jun. 30, 2017
Shares Outstanding, Beginning Balance	67,465	100,492
Shares Cancelled or Expired	(22,971)	(1,611)
Shares Outstanding, Ending Balance	44,494	98,881
Shares Exercisable, Ending Balance	44,494	32,335
Weighted Average Exercise Price Per Share, Outstanding Beginning Balance	$ 71.03	$ 62.52
Weighted Average Exercise Price Per Share, Cancelled or Expired	96.44	137.04
Weighted Average Exercise Price Per Share, Outstanding Ending Balance	53.14	61.32
Weighted Average Exercise Price Per Share, Exercisable Ending Balance	53.14	137.04
Weighted Average Fair Value at Grant Date, Outstanding Beginning Balance	36.85	33.84
Weighted Average Fair Value at Grant Date, Cancelled or Expired	46.94	94.92
Weighted Average Fair Value at Grant Date, Outstanding Ending Balance	27.36	33.60
Weighted Average Fair Value at Grant Date, Exercisable, Ending Balance	$ 27.36	$ 68.04

Warrants - Schedule of Warrant Activity (Details) - $ / shares	6 Months Ended	12 Months Ended
	Jun. 30, 2018	Dec. 31, 2017
Warrants and Rights Note Disclosure [Abstract]
Outstanding, Beginning Balance	519,917	524,277
Common Stock Warrants, Expired	(6,250)	(4,360)
Outstanding, Ending Balance	513,667	519,917
Weighted Average Exercise Price Outstanding Beginning Balance	$ 25.68	$ 26.76
Weighted Average Exercise Price, Expired	5.70	135.36
Weighted Average Exercise Price Outstanding Ending Balance	$ 25.92	$ 25.68

Warrants - Schedule of Warrant Valuation Assumptions (Details) - $ / shares	6 Months Ended
	Jun. 30, 2018	Jun. 30, 2017
Warrants and Rights Note Disclosure [Abstract]
Value of underlying common stock (per share)	$ 5.55	$ 7.92
Risk free interest rate	2.62%	1.85%
Expected term in years	4 years 1 month 6 days	5 years 1 month 6 days
Volatility	62.00%	96.00%
Dividend yield	0.00%	0.00%

Warrants - Schedule of Warrants Activities Used in Derivative Liability (Details) - shares	6 Months Ended
	Jun. 30, 2018	Jun. 30, 2017
Class of Warrant or Right [Line Items]
Outstanding, Beginning Balance	519,917	524,277
Outstanding, Ending Balance	513,667
Warrant [Member]
Class of Warrant or Right [Line Items]
Outstanding, Beginning Balance	93,759	93,759
Derivative warrants issued, exercised and expired	(6,250)
Outstanding, Ending Balance	87,509	93,759

Commitments and Contingencies (Details Narrative) - USD ($) $ in Thousands		6 Months Ended
	Aug. 10, 2017	Jun. 30, 2018	Jun. 30, 2017
Operating lease expiration description		Expiration dates between 2019 and 2025
Rent expense		$ 600	$ 400
Loss contingency, damages sought, value	$ 1,000
Maximum [Member]
Lessee leasing arrangements operating leases term of each option to extend		10 years

Commitments and Contingencies - Schedule of Future Minimum Rental Payments for Operating Leases (Details) $ in Thousands	Jun. 30, 2018 USD ($)
Commitments and Contingencies Disclosure [Abstract]
Remainder of 2018	$ 404
2019	669
2020	396
2021	375
2022	354
Thereafter	887
Total	$ 3,085

Commitments and Contingencies - Schedule of Future Minimum Lease Payments for Capital Leases (Details) - USD ($) $ in Thousands	Jun. 30, 2018	Dec. 31, 2017
Commitments and Contingencies Disclosure [Abstract]
Remainder of 2018	$ 267
2019	502
2020	218
2021
2022
Thereafter
Total minimum lease payments	987
Less amount representing interest	(165)
Present value of obligations under capital leases	822
Less current portion	(469)	$ (366)
Long-term capital lease obligations	$ 353	$ 624

Supplemental Disclosure of Cash Flow Information - Schedule of Supplemental Cash Flow Information (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2018	Jun. 30, 2017
Supplemental Cash Flow Elements [Abstract]
Interest	$ 170	$ 386
Issuance of capital leases	84	967
Interest converted into common stock	556	480
Conversion of convertible debt to equity	71,865
Convertible PIK interest	4,764
Conversion of interest related to the credit facility to long-term debt	7,977
Write-off of convertible debt issuance cost	1,012
Transfer of inventory to property and equipment	$ 439

Segment and Geographic Information (Details Narrative)	6 Months Ended
Segment and Geographic Information (Details Narrative)	Jun. 30, 2018	Jun. 30, 2017
Geographic Concentration Risk [Member] \| United States [Member] \| Sales Revenue, Net [Member]
Concentration risk, percentage	95.00%	98.00%

Segment and Geographic Information - Schedule of Revenues by Geographic Region (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2018	Jun. 30, 2017	Jun. 30, 2018	Jun. 30, 2017
Revenue, net, total	$ 18,741	$ 21,408	$ 36,674	$ 43,491
United States [Member]
Revenue, net, total			34,792	42,410
Rest of World [Member]
Revenue, net, total			$ 1,882	$ 1,081

Subsequent Events (Details Narrative) - Subsequent Event [Member] - 2018 Equity Incentive Plan [Member]	Aug. 01, 2018 shares
Term of plan, description	The 2018 Plan became effective immediately upon approval by our stockholders and will expire on July 31, 2028, unless terminated earlier.
Number of common stock available for issuance	1,307,747
One Non-Employee Director [Member]
Options granted	26,042
Restricted Stock Units (RSUs) [Member]
Options granted	40,000
Common Stock [Member]
Options granted	410,770

Inventories, Net (Details Narrative) - USD ($) $ in Thousands	Jun. 30, 2018	Dec. 31, 2017
Inventory Disclosure [Abstract]
Implants and biological inventory	$ 9,800	$ 12,000

Warrants (Details Narrative) $ in Thousands	6 Months Ended
Warrants (Details Narrative) $ in Thousands	Jun. 30, 2018 USD ($)
Warrants and Rights Note Disclosure [Abstract]
Unrealized gain on warranty derivative liability	$ 41

Related Party Transactions (Details Narrative)	Jun. 30, 2018
Investors [Member]
Related Party Transaction [Line Items]
Noncontrolling interest, ownership percentage by parent	70.00%