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Document and Entity Information - USD ($) $ in Thousands	12 Months Ended
Document and Entity Information - USD ($) $ in Thousands	Dec. 31, 2019	Mar. 02, 2020	Jun. 30, 2019
Document And Entity Information
Entity Registrant Name	Xtant Medical Holdings, Inc.
Entity Central Index Key	0001453593
Document Type	10-K
Document Period End Date	Dec. 31, 2019
Amendment Flag	false
Current Fiscal Year End Date	--12-31
Entity Well-known Seasoned Issuer	No
Entity Voluntary Filers	No
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Non-accelerated Filer
Entity Small Business Flag	true
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Public Float			$ 11,600
Entity Common Stock, Shares Outstanding		13,223,565
Document Fiscal Period Focus	FY
Document Fiscal Year Focus	2019

Consolidated Statements of Operations - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Revenue
Orthopedic product sales	$ 64,516	$ 71,814
Other revenue	166	389
Total Revenue	64,682	72,203
Cost of Sales	22,166	28,717
Gross Profit	42,516	43,486
Operating Expenses
General and administrative	17,936	14,277
Sales and marketing	25,843	31,464
Research and development	932	1,702
Amortization	58	3,437
Impairment of goodwill and intangible assets		48,146
Restructuring expenses		2,970
Separation related expenses		1,568
Total Operating Expenses	44,769	103,564
Loss from Operations	(2,253)	(60,078)
Other Income (Expense)
Interest expense	(5,772)	(10,145)
Change in warrant derivative liability	3	121
Other income (expense)	(101)	3
Total Other Expense	(5,870)	(10,021)
Net Loss from Operations Before Provision for Income Taxes	(8,123)	(70,099)
Provision for Income Taxes
Current and Deferred	(98)
Net Loss	$ (8,221)	$ (70,099)
Net loss per share:
Basic	$ (0.63)	$ (5.97)
Dilutive	$ (0.63)	$ (5.97)
Shares used in the computation:
Basic	13,163,931	11,740,550
Dilutive	13,163,931	11,740,550

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Current Assets:
Cash and cash equivalents	$ 5,237	$ 6,797
Trade accounts receivable, net of allowance for doubtful accounts of $500 and $2,140, respectively	10,124	9,990
Inventories	16,101	17,301
Prepaid and other current assets	784	589
Total current assets	32,246	34,677
Property and equipment, net	4,695	7,174
Right of use asset, net	2,100
Goodwill	3,205	3,205
Intangible assets, net	515	573
Other assets	394	793
Total Assets	43,155	46,422
Current Liabilities:
Accounts payable	2,188	6,465
Accrued liabilities	6,625	5,150
Warrant derivative liability	7	10
Current portion of lease liability	394
Current portion of finance lease obligations	176	426
Total current liabilities	9,390	12,051
Long-term Liabilities:
Lease obligation, less current portion	1,726
Finance lease obligation, less current portion		204
Long-term debt, less issuance costs	76,244	77,939
Total Liabilities	87,360	90,194
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; 75,000,000 shares authorized; 13,161,762 shares issued and outstanding as of December 31, 2019 and 50,000,000 shares authorized; 13,172,179 shares issued and outstanding as of December 31, 2018
Additional paid-in capital	179,061	171,273
Accumulated deficit	(223,266)	(215,045)
Total Stockholders' Equity (Deficit)	(44,205)	(43,772)
Total Liabilities & Stockholders' Equity (Deficit)	$ 43,155	$ 46,422

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Statement of Financial Position [Abstract]
Trade accounts receivable, allowance for doubtful accounts	$ 500	$ 2,140
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	75,000,000	50,000,000
Common stock, shares issued	13,161,762	13,172,179
Common Stock, shares outstanding	13,161,762	13,172,179

Consolidated Statements of Changes in Stockholders' Equity (Deficit) - USD ($) $ in Thousands	Common Stock [Member]	Additional Paid-In Capital [Member]	Retained Deficit [Member]	Total
Beginning Balance at Dec. 31, 2017		$ 86,247	$ (144,946)	$ (58,699)
Beginning Balance, Shares at Dec. 31, 2017	1,514,899
Stock-based compensation		814		814
Issuance of common stock		79,098		$ 79,098
Issuance of common stock, Shares	11,657,280
Issuance of warrants		5,114		$ 5,114
Net loss			(70,099)	(70,099)
Ending Balance at Dec. 31, 2018		171,273	(215,045)	(43,772)
Ending Balance, Shares at Dec. 31, 2018	13,172,179
Stock-based compensation		515		515
Issuance of warrants		9		9
Forfeiture or restricted stock
Forfeiture or restricted stock, shares	(10,417)
Debt extinguishment		7,264		7,264
Net loss			(8,221)	(8,221)
Ending Balance at Dec. 31, 2019		$ 179,061	$ (223,266)	$ (44,205)
Ending Balance, Shares at Dec. 31, 2019	13,161,762

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Operating activities:
Net loss	$ (8,221)	$ (70,099)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation and amortization	3,143	6,590
Goodwill and intangible asset impairment		48,146
Non-cash interest	5,726	9,848
Non-cash rent	20
(Gain) loss on sale of fixed assets	(61)	103
Stock-based compensation	515	694
Provision for reserve on accounts receivable	513	188
Provision for excess and obsolete inventory	509	4,932
Change in warrant derivative liability	(3)	(121)
Changes in operating assets and liabilities:
Trade accounts receivable	(647)	2,536
Inventories	692	40
Prepaid and other assets	204	1,055
Accounts payable	(4,278)	(3,011)
Accrued liabilities	1,475	311
Net cash provided by (used in) operating activities	(413)	1,212
Investing activities:
Purchases of property and equipment	(879)	(624)
Proceeds from sale of fixed assets	335	257
Net cash used in investing activities	(544)	(367)
Financing activities:
Payments on capital leases	(455)	(359)
Costs associated with Second Amended and Restated Credit Agreement	(148)
Costs associated with conversion of debt and private placement		(3,356)
Proceeds from equity private placement		6,810
Net proceeds from issuance of stock and warrants		1
Net cash provided by (used in) financing activities	(603)	3,096
Net change in cash and cash equivalents	(1,560)	3,941
Cash and cash equivalents at beginning of year	6,797	2,856
Cash and cash equivalents at end of year	$ 5,237	$ 6,797

Business Description and Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2019

Accounting Policies [Abstract]

Business Description and Summary of Significant Accounting Policies

(1) Business Description and Summary of Significant Accounting Policies

Business Description

The accompanying consolidated financial statements include the accounts of Xtant Medical Holdings, Inc., formerly known as Bacterin International Holdings, Inc., a Delaware corporation, and its wholly owned subsidiaries, Xtant Medical, Inc., a Delaware corporation, Bacterin International, Inc., (“Bacterin”) a Nevada corporation, and X-Spine Systems, Inc. (“X-spine”), an Ohio corporation (Xtant Medical Inc., Bacterin and X-spine are jointly referred to herein as “Xtant” or the “Company”). The terms “we,” “us” and “our” also refer to Xtant.

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.

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.

At December 31, 2019, the Company had cash and cash equivalents of $5.2 million, and an accumulated deficit of $223.3 million and has incurred significant losses in the current and prior periods.

Management’s evaluation of going concern was conducted as part of its discussions with the Xtant Board of Directors’ review of the 2020 Annual Operating Plan. Management believes that the Company’s cash and cash equivalents of $5.2 million as of December 31, 2019, together with the availability of $10.0 million under its Second Amended and Restated Credit Agreement, will be sufficient to meet its anticipated cash requirements and continue as a going concern through at least March 2021.

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 an amendment to the indenture governing our then outstanding 6% convertible senior unsecured notes due 2021 (the “2017 Notes”), described in the “Debt” and “Equity” sections below, on January 17, 2018, the Investors converted the 2017 Notes, plus accrued and unpaid interest, at the $9.11 per share conversion rate originally provided thereunder, into 189,645 shares of our common stock.

On February 14, 2018, after giving effect to the Reverse Stock Split (described below), $70.3 million aggregate principal amount of our then outstanding 2017 Notes 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 the 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 in gross proceeds.

Amended and Restated Certificate of Incorporation

On February 13, 2018, following a special meeting of our stockholders, we filed with the Secretary of State of the State of Delaware a Certificate of Amendment to our Certificate of Incorporation (the “Certificate Amendment”). The Certificate Amendment amended and restated our Certificate of Incorporation (the “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; and

	●	authorize the Company’s 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.

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 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 in the fiscal years 2019 or 2018. The Company provides for uncollectible amounts when specific credit issues arise. Management believes that all significant credit risks have been identified at December 31, 2019.

Use of Estimates

The preparation of the 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 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 option grants and other equity awards upon which the Company determines stock-based compensation expense. Actual results could differ from those estimates.

Cash and Cash Equivalents

The Company considers all highly liquid investments purchased with an original maturity date of three months or less to be cash equivalents. Cash equivalents are recorded at cost, which approximates market value. At times, the Company maintains deposits in financial institutions in excess of federally insured limits.

Trade Accounts Receivable

Accounts receivable represents amounts due from customers for which revenue has been recognized. Normal terms on trade accounts receivable are net 30 days, and some customers are offered discounts for early pay. The Company performs credit evaluations when considered necessary, but generally does not require collateral to extend credit.

The allowance for doubtful accounts is the Company’s best estimate of the amount of probable credit losses in the Company’s existing receivables. The Company determines the allowance based on factors such as historical collection experience, customers’ current creditworthiness, customer concentration, age of accounts receivable balance, general economic conditions that may affect a customer’s ability to pay, and management judgment. 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 doubtful accounts are charged to expense. The Company does not have any off-balance sheet credit exposure related to its customers.

Inventories

Inventories are stated at the lower of cost or net realizable value. Cost is determined using the specific identification method and includes materials, labor and overhead. The Company calculates an inventory reserve for estimated obsolescence and excess inventory based on historical usage and sales, as well as assumptions about future demand for its products. These estimates for excess and obsolete inventory are reviewed and updated on a quarterly basis. Increases in the inventory reserves result in a corresponding expense, which is recorded to cost of sales.

Property and Equipment

Property and equipment are stated at cost less accumulated depreciation. Depreciation is computed using the straight-line method over the estimated useful lives of the assets, generally three to seven years for computers and equipment and five years for surgical instruments. Leasehold improvements are depreciated over the shorter of their estimated useful life or the remaining term of the lease. Repairs and maintenance are expensed as incurred.

Intangible Assets

Intangible assets with estimable useful lives are amortized over their respective estimated useful lives to their estimated residual values and reviewed for impairment whenever events or circumstances indicate their carrying amount may not be recoverable. Intangible assets include trademarks and patents and include costs to acquire and protect Company patents. Intangible assets are carried at cost less accumulated amortization. The Company amortizes these assets on a straight-line basis over their estimated useful lives.

Other Assets

Other assets consist of the short-term and the long-term portion of prepaid expenses and security deposits.

Long-Lived Asset Impairment

Long-lived assets, including property and equipment and 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 undiscounted 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.

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. The Company conducts its impairment test on an annual basis and will review the analysis assumptions on a quarterly basis. We test goodwill for impairment at the reporting unit level, which is an operating segment or one level below an operating segment, referred to as a component. A component of an operating segment is a reporting unit if the component constitutes a business for which discrete financial information is available and segment management regularly reviews the operating results of that component.

Revenue Recognition

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 the products are shipped, and the transfer of title and risk of loss occurs. 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. 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.

Disaggregation of revenue

The Company operates in one reportable segment with its net revenue derived primarily from the sale of orthobiologics and spinal implant products across North America, Europe, Asia Pacific and Latin America. Sales are reported net of returns. No rebates, group purchasing organization fees or other customer allowances are present, and so are not relevant to net revenue determination. The following table presents revenues from these product lines for the years ended December 31, 2019 and 2018:

	Year Ended December 31, 2019		Percentage of Total Revenue			Year Ended December 31, 2018		Percentage of Total Revenue
Orthobiologics	$	46,663		72	%	$	48,984		68	%
Spinal implant		17,872		28	%		22,830		31	%
Other revenue		147		0	%		389		1	%
Total revenue	$	64,682		100	%	$	72,203		100	%

Research and Development

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

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. Diluted net loss per share was the same as basic net loss per share for the years ended December 31, 2019 and 2018, 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. Diluted net loss per share is not reported as the effects of including 4,011,754 and 2,247,567 outstanding stock options, warrants and restricted stock units for the years ended December 31, 2019 and 2018, respectively, are anti-dilutive.

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.

The Company follows a framework for measuring fair value. The framework provides a fair value 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. During the years ended December 31, 2019 and 2018, there was no reclassification 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 as of December 31, 2019 and 2018 that are measured at fair value on a recurring basis (in thousands):

Warrant derivative liability

	As of December 31, 2019		As of December 31, 2018
Level 1		—		—
Level 2		—		—
Level 3	$	7	$	10

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).

Recent Accounting Pronouncements

In June 2016, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2016-13, Financial Instruments - Credit losses: Measurement of Credit Losses on Financial Instruments, which amends certain provisions of Accounting Standards Codification (“ASC”) 326, Financial Instruments-Credit Loss. The new standard is effective for reporting periods beginning after December 15, 2019. The standard replaces the impairment methodology with a methodology that reflects expected credit losses for accounts receivables, loans and other financial instruments. The standard is not expected to have a material impact on our consolidated financial statements.

Reclassification

Certain prior year amounts have been reclassified to conform with current year presentation.

Inventories

12 Months Ended

Dec. 31, 2019

Inventory Disclosure [Abstract]

Inventories

(2) Inventories

Inventories consist of the following (in thousands):

	December 31, 2019			December 31, 2018

Raw materials	$	3,805		$	4,136
Work in process		1,603			949
Finished goods		22,135			24,618
Gross inventories		27,543			29,703
Reserve for obsolescence		(11,442	)		(12,402	)
	$	16,101		$	22,423

Property and Equipment, Net

12 Months Ended

Dec. 31, 2019

Property, Plant and Equipment [Abstract]

Property and Equipment, Net

(3) Property and Equipment, Net

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

	December 31, 2019			December 31, 2018
Equipment	$	4,250		$	4,145
Computer equipment		455			481
Computer software		570			570
Furniture and fixtures		124			164
Leasehold improvements		3,980			3,941
Vehicles		10			10
Surgical instruments		10,897			10,772
Total cost		20,286			20,083
Less: accumulated depreciation		(15,591	)		(12,909	)
	$	4,695		$	7,174

Depreciation expense related to property and equipment, including property under capital lease, for the years ended December 31, 2019 and 2018 was $3.1 million and $3.2 million, respectively. .

The Company leases certain equipment under finance leases. For financial reporting purposes, minimum lease payments relating to the assets have been capitalized. As of December 31, 2019 and 2018, the Company has recorded $1.4 million and $1.6 million, respectively, within Equipment, and $1.0 million and $0.9 million, respectively, of accumulated depreciation.

Goodwill and Intangible Assets

12 Months Ended

Dec. 31, 2019

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill and Intangible Assets

(4) Goodwill and Intangible Assets

Goodwill represents the excess of costs over fair value of assets on businesses acquired associated with the acquisition of X-spine.

During the fourth quarter of 2018, changes in our business led us to conclude that a goodwill impairment charge was appropriate. First, in connection with our annual planning process for 2019, we determined that the revenue growth rates for our fixation business likely would not be consistent with the expectations on which our initial 2018 annual plan was built. Second, in connection with our annual planning process for 2019, we curtailed a new sales channel strategy that we had implemented in 2018 to build a direct sales force since we determined that the sales channel strategy was not generating the benefits that we had originally thought it would. We also determined by the end of 2018 that our assumptions regarding the expansion of our international business likely would not prove to be true in the near future in light of our business priorities, international regulatory issues and anticipated funding requirements.

We engaged a third-party specialist to assist in performing a single-step impairment analysis which compared the carrying value of the assets, including cash, and non-interest-bearing liabilities, to the derived enterprise value of the business. As a result, we recorded a non-cash goodwill impairment charge of $38.3 million during the year ended December 31, 2018. There was no impairment of goodwill recorded in 2019.

Intangible assets consist of various patents with regards to processes for our products and intangible assets associated with the acquisition of X-spine.

In connection with the goodwill impairment analysis performed during 2018, management analyzed the Company’s finite-lived intangible assets for impairment in accordance with ASC 360, Property, Plant and Equipment. As a result of the analysis, the Company recorded an impairment charge of $9.8 million to its intangible assets during the year ended December 31, 2018. We did not have a triggering event in 2019.

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

	December 31, 2019			December 31, 2018
Patents	$	847		$	847
Accumulated amortization		(332	)		(274	)
Net carrying value	$	515		$	573

Amortization expense for the years ended December 31, 2019 and 2018 was $58 thousand and $3.4 million, respectively. The following is a summary of estimated future amortization expense for intangible assets as of December 31, 2019 (in thousands):

2020	$	56
2021		56
2022		55
2023		53
2024		52
Thereafter		243
Total	$	515

Accrued Liabilities

12 Months Ended

Dec. 31, 2019

Payables and Accruals [Abstract]

Accrued Liabilities

(5) Accrued Liabilities

Accrued liabilities consist of the following (in thousands):

	December 31, 2019		December 31, 2018
Wages/commissions payable	$	3,902	$	3,332
Other accrued liabilities		2,723		1,818
Accrued liabilities	$	6,625	$	5,150

Debt

12 Months Ended

Dec. 31, 2019

Debt Disclosure [Abstract]

Debt

(6) Debt

Second Amended and Restated Credit Agreement

On March 29, 2019, the Company and the Investors entered into a Second Amended and Restated Credit Agreement (the “Second Amended and Restated Credit Agreement”), which amended and restated the Amended and Restated Credit Agreement by and between Bacterin and ROS (collectively, the “Prior Credit Agreement” and the facility created under such agreement, the “Credit Facility”). Under the Second Amended and Restated Credit Agreement:

	●	We may continue to make requests for term loans in amounts equal to the remaining commitment for additional delayed draw loans, which was approximately $2.2 million as of the date of the Second Amended and Restated Credit Agreement, and may request additional term loans with the Investors in an aggregate amount of up to $10.0 million, with the amount of each loan draw to be subject to our production of a thirteen-week cash flow forecast that is approved by the Investors and which shows a projected cash balance for the following two-week period of less than $1.5 million, as well as the satisfaction (or waiver in writing by each Investor) of conditions precedent, including closing certificate, delivery of budget, and other satisfactory documents;

	●	no interest will accrue on the Loans under the Second Amended and Restated Credit Agreement from and after January 1, 2019 until March 31, 2020;

	●	beginning April 1, 2020 through the maturity date of the Second Amended and Restated Credit Agreement, interest payable in cash will accrue on the Loans under the Credit Agreement at a rate per annum equal to the sum of (a) 10.00% plus (b) the higher of (x) the LIBO Rate (as such term is defined in the Second Amended and Restated Credit Agreement) and (y) 2.3125%;

	●	the maturity date of the Loans is March 31, 2021;

	●	the Consolidated Senior Leverage Ratio and Consolidated EBITDA (as such terms were defined in the Prior Credit Agreement) financial covenants were deleted, and a new Revenue Base (as such term is defined in the Second Amended and Restated Credit Agreement) financial covenant was added; and

	●	the key person event default provision was revised to refer specifically to certain then recently-hired executive officers of the Company.

Long-term debt, less issuance costs consists of long-term debt due to the lenders under the Second Amended and Restated Credit Agreement as of December 31, 2019 and under the Prior Credit Agreement as of December 31, 2018. The execution of the Second Amended and Restated Credit Agreement during the first quarter of 2019 and the changes to our credit facility reflected therein, including the interest rate relief and extended maturity, along with the additional availability, were determined to be and accounted for as a debt extinguishment under U.S. generally accepted accounting principles (“GAAP”), resulting in the write-off of the original loan and associated issuance costs. The present value of the new loan was determined to be $72.7 million as of March 31, 2019 with the Company recording an increase to additional paid-in capital of $7.3 million. Because of the related party affiliation between the Company and the credit facility lenders, this debt extinguishment resulted in an increase in additional paid-in capital rather than flowing through our consolidated statements of operations as a gain on extinguishment. As of December 31, 2019, our long-term debt, less issuance costs was $76.2 million. Assuming no debt payments are made, our long-term debt, less issuance costs line item will continue to increase until the loan’s March 31, 2021 maturity date.

While our long-term debt, less issuance costs balance was $76.2 million as reported under GAAP as of December 31, 2019, the Company owes a principal balance of $55.8 million plus accrued PIK interest of $21.1 million as of December 31, 2019.

Due to the terms within the Second Amended and Restated Credit Agreement, the Company performed an assessment of the changes to the terms of the Prior Credit Agreement in accordance with ASC 470. Given there were cumulative changes to the Prior Credit Agreement within one year of March 29, 2019, the debt terms that existed as of March 29, 2018 were used in the evaluation of the present value of cash flows for the old and new debt instruments which resulted in the extinguishment of the Prior Credit Agreement and recognition of the Second Amended and Restated Credit Agreement. A new effective interest rate of 13.19% for the Second Amended and Restated Credit Agreement was calculated based on the carrying amount of the debt and the present value of the revised future cash flows. This rate is effective through the remaining life of the loan.

On April 1, 2019, the Company issued warrants to purchase an aggregate of 1.2 million shares of Company common stock to the Investors, with an exercise price of $0.01 per share and an expiration date of April 1, 2029 (collectively, the “2019 Warrants”). The issuance of the 2019 Warrants (see Note 9) occurred on April 1, 2019 and was a condition to the effectiveness of the Second Amended and Restated Credit Agreement.

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

	December 31, 2019			December 31, 2018
Amounts due under the Credit Facility	$	72,657		$	55,787
PIK interest payable related to the Credit Facility		3,280			27,178
Plus: 2% exit fee on Credit Facility		399			254
Gross long-term debt		76,336			83,219
Less: discount on Credit Facility		—			(5,114	)
Less: total debt issuance costs		(92	)		(166	)
Long-term debt, less issuance costs	$	76,244		$	77,939

All gross long-term debt will mature March 31, 2021 and become payable at that time.

Convertible Note Indenture

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.

Amendments to Prior Credit Agreement

Twenty-Second Amendment to the Prior Credit Agreement

Effective January 30, 2018, the Company and Investors entered into the Twenty-Second Amendment to the Amended and Restated Credit Agreement dated July 27, 2015, which amended the Prior Credit Agreement. This amendment further deferred the Company’s accrued interest payment date until February 28, 2018.

Twenty-Third Amendment to the Prior Credit Agreement

Effective February 14, 2018, the Company and Investors entered into the Twenty-Third Amendment to the Prior Credit Agreement, which further amended the Prior Credit Agreement and terms of the Credit Facility. As of result of this amendment, the interest payable was carried forward and as modified, the interest rate options within the Credit Facility were as follows: (a) through December 31, 2018, we would 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 would 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 would 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 in the Prior Credit Agreement, 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 Prior Credit Agreement.

Twenty-Fourth Amendment to the Prior Credit Agreement

On September 17, 2018, the Company and Investors entered into the Twenty-Fourth Amendment to the Prior Credit Agreement (the “24^thAmendment”), which further amended the Prior Credit Agreement and terms of the Credit Facility, effective as of April 1, 2018. Under the terms of the 24^th Amendment, no interest would be charged on the loans under the Credit Facility (the “Loans”) from April 1, 2018 until June 30, 2018.

Due to the interest rate relief provided by the 24^th Amendment, the Company performed an assessment of the changes to the terms of the Credit Facility in accordance ASC 470, Debt. The Credit Facility was modified based on an evaluation of the present value of cash flows for the old and new debt instruments. Given the modification, a new effective interest rate of 13.45% for the modified loan was calculated based on the carrying amount of the debt and the present value of the revised future cash flows. The modified interest rate is effective through the remaining life of the loan.

Twenty-Fifth Amendment to the Prior Credit Agreement

Also, on September 17, 2018, the Company and the Investors entered into the Twenty-Fifth Amendment to the Prior Credit Agreement (the “25^th Amendment”), which further amended the Prior Credit Agreement and terms of the Credit Facility, effective as of August 1, 2018. Under the terms of the 25^th Amendment:

	●	no interest would be charged on the Loans under the Credit Facility from July 1, 2018 until December 31, 2018;

	●	the Optional PIK Interest (as such term is defined in the Prior Credit Agreement) was decreased from 15% plus the LIBO Rate (as such term is defined in the Prior Credit Agreement) to 10% plus the LIBO Rate, with a 2.3125% floor;

	●	a LIBO Rate floor of 2.3125% was added; and

	●	the fee due upon payment, prepayment or repayment of the principal amount of the Loans under the Credit Facility, whether on the maturity date or otherwise, was increased to 2% from 1% of the aggregate principal amount of such payment, prepayment or repayment.

Equity

12 Months Ended

Dec. 31, 2019

Equity [Abstract]

Equity

(7) Equity

Charter Amendment

On October 30, 2019, the Company’s stockholders, upon recommendation of the Board, approved an amendment to the Company’s Charter to increase the number of authorized shares of common stock from 50,000,000 to 75,000,000. This Charter amendment was effective upon the filing of a Certificate of Amendment with the Office of the Secretary of State of the State of Delaware on October 30, 2019.

Convertible Note Indenture

During the first quarter of 2018, in connection with the 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 Securities and Exchange Commission (“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

12 Months Ended

Dec. 31, 2019

Share-based Payment Arrangement [Abstract]

Stock-Based Compensation

(8) Stock-Based Compensation

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 and on October 30, 2019 at our 2019 annual meeting of stockholders, our stockholders approved an amendment to increase the number of shares of common stock available thereunder by 1,500,000 shares (as amended, the “2018 Plan”). The 2018 Plan became effective immediately upon initial approval of the plan by our stockholders on August 1, 2018 and will expire on July 31, 2028, unless terminated earlier. The 2018 Plan replaced the Amended and Restated Xtant Medical Equity Incentive Plan (the “Prior Plan”) with respect to future grants of equity awards, although the Prior Plan continues to govern equity awards granted under the Prior 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 2,807,747 shares, of which 1,650,005 shares remained available for grant as of December 31, 2019. Under the 2018 Plan, shares of our common stock related to awards granted under the plan that terminate by expiration, forfeiture, cancellation, or otherwise without the issuance of the shares become available again for grant under the plan.

The Board has granted various awards under the 2018 Plan to certain directors, officers and employees. As of December 31, 2019, stock options to purchase an aggregate of 585,595 shares of our common stock, a restricted stock award for 13,021 shares of common stock, and restricted stock units covering 499,914 shares were outstanding under the 2018 Plan. During the year ended December 31, 2019, options to purchase 420,000 shares of common stock granted under the 2018 Plan were forfeited and cancelled as a result of the termination of employment of optionees. During the year ended December 31, 2019, 459,914 restricted stock units were granted, which vest over a weighted average period of 4.3 years.

Various awards also remain outstanding under the Prior Plan. As of December 31, 2019, stock options to purchase an aggregate of 17,371 shares of our common stock and restricted stock awards for 23,438 shares of our common stock were outstanding under the Prior Plan. During the year ended December 31, 2019, options to purchase 3,781 shares of our common stock granted under the Prior Plan were forfeited and cancelled as a result of the termination of employment of optionees and a restricted stock award for 10,417 shares of our common stock was forfeited and cancelled as a result of the termination of service of a director.

From time to time, we have granted options to purchase shares of our common stock outside of any stockholder-approved plan to new hires (collectively the “Non-Plan Grants”). As of December 31, 2019, no Non-Plan Grants were outstanding. During the year ended December 31, 2019, Non-Plan Grants to purchase 25,000 shares of common stock were forfeited and cancelled as a result of the termination of employment of the optionee.

Stock options granted under the 2018 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 stock options granted under the 2018 Plan must be at least equal to the fair market value of the shares of common stock on the date of the grant. The 2018 Plan is administered by the Board. Stock options granted under the 2018 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 the optionee.

Stock options to purchase an aggregate of 554,825 shares of common stock were issued during the year ended December 31, 2019; options to purchase an aggregate of 650,770 shares of common stock were issued during the same period in 2018.

Stock option activity, including options granted under the 2018 Plan, the Prior Plan, and the Non-Plan Grants, was as follows:

	2019							2018
						Weighted							Weighted
				Weighted		Average Fair					Weighted		Average Fair
				Average Exercise		Value at Grant					Average Exercise		Value at Grant
	Shares			Price		Date		Shares			Price		Date
Outstanding at January 1		496,958		$	9.90	$	6.62		67,465		$	71.03	$	36.85
Granted		554,825			2.55		2.01		650,770			4.79		4.15
Cancelled or expired		(448,817	)		5.96		4.45		(221,277	)		13.45		7.77
Outstanding at December 31		602,966		$	6.07	$	3.99		496,958		$	9.90	$	6.62
Exercisable at December 31		25,063		$	83.78	$	46.66		66,188		$	46.88	$	25.92

The estimated fair value of stock options granted is done using the Black-Scholes-Merton method applied to individual grants. Key assumptions used to estimate the fair value of stock awards are as follows:

	Year Ended
	December 31,
	2019			2018
Risk free interest rate		1.82	%		2.97	%
Dividend yield		0	%		0	%
Expected term		7.1 years			10.0 years
Expected volatility		92	%		89	%

Total stock-based compensation expense recognized for employees and directors was $0.5 million and $0.7 million for the years ended December 31, 2019 and 2018, respectively, and was recognized as general and administrative expense. The aggregate intrinsic value of options outstanding as of December 31, 2019 was $2 thousand. As of December 31, 2019, total compensation expense related to unvested employee stock options not yet recognized was $1.0 million, which is expected to be allocated to expenses over a weighted-average period of 4.3 years.

Warrants

12 Months Ended

Dec. 31, 2019

Warrants and Rights Note Disclosure [Abstract]

Warrants

(9) Warrants

2018 Warrants

The Company issued warrants to purchase an aggregate of 1.2 million shares of Company common stock to the Investors, with an exercise price of $0.01 per share and an expiration date of August 1, 2028. The issuance of the 2018 Warrants occurred on September 17, 2018 and was a condition to the effectiveness of the 25^th Amendment. The fair value of these warrants upon issue was determined to be $5.1 million (see Note 6). In accordance with ASC 815-40, the 2018 Warrants meet all requirements to be classified as equity awards. The number of shares of Company common stock issuable upon exercise of the 2018 Warrants are subject to standard and customary anti-dilution provisions for stock splits, stock dividends or similar transactions.

2019 Warrants

On April 1, 2019, the Company issued warrants to purchase an aggregate of 1.2 million shares of Company common stock to the Investors with an exercise price of $0.01 per share and an expiration date of April 1, 2029. As a result of the issuance of the warrants to purchase 1.2 million shares of common stock on April 1, 2019, the total outstanding common stock warrants as of April 1, 2019 was 2,910,609. The issuance of the 2019 Warrants was a condition to the effectiveness of the Second Amended and Restated Credit Agreement. The fair value of the 2019 Warrants upon issuance was determined to be $9 thousand. The significant decrease in value of the 2019 Warrants compared to the 2018 Warrants was attributable to the updated forecasts and assumptions used by the Company during the annual planning process for 2019 that resulted in our decision to conclude that a goodwill and intangible asset impairment charge was appropriate during the fourth quarter of 2018. The 2019 Warrants meet all the requirements to be classified as equity awards in accordance with ASC No. 815-40. The number of shares of Company common stock issuable upon exercise of the 2019 Warrants is subject to standard and customary anti-dilution provisions for stock splits, stock dividends, or similar transactions.

The following table summarizes our warrant activities for the years ended December 31, 2019 and 2018:

				Weighted
	Common			Average
	Stock			Exercise
	Warrants			Price
Outstanding as of January 1, 2018		519,917		$	25.68
Issued		1,200,000			.01
Expired		(9,308	)		88.84
Outstanding as of December 31, 2018		1,710,609		$	7.33
Issued		1,200,000			.01
Expired		(1,735	)		259.60
Outstanding at December 31, 2019		2,908,874		$	4.16

The following table summarizes our activities related to warrants accounted for as a derivative liability for the years ended December 31, 2019 and 2018:

	2019		2018
Balance at January 1		87,506		93,759
Derivative warrants expired		—		(6,250	)
Balance at December 31		87,509		87,509

We utilize a lattice model to determine the fair market value of the warrants accounted for as liabilities. The valuation model accommodates the probability of exercise price adjustment features as outlined in the warrant agreements. 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 the lattice model with the following weighted-average assumptions:

	Year Ended
	December 31,
	2019			2018
Value of underlying common stock (per share)	$	1.96		$	1.61
Risk free interest rate		1.67	%		2.48	%
Expected term		2.7 years			3.6 years
Volatility		82	%		92	%
Dividend yield		0	%		0	%

Commitments and Contingencies

12 Months Ended

Dec. 31, 2019

Commitments and Contingencies Disclosure [Abstract]

Commitments and Contingencies

(10) Commitments and Contingencies

In 2019, we adopted ASU No. 2016-02, Leases (Topic 842), which requires lessees to recognize a right-of-use (“ROU”) asset and lease liability on their balance sheet for all leases with terms beyond 12 months. The new standard also requires enhanced disclosures intended to provide more transparency and information to financial statement users about lease portfolios. The distinction between operating and finance leases will continue to exist under the new standard. Additionally, the recognition and measurement of operating and finance lease expenses and cash flows will not change significantly from current treatment. For finance leases, lessees will continue to recognize interest expense on the lease liability using the effective yield method, while the right-of-use asset will be amortized on a straight-line basis. For operating leases, expense will be recognized on a straight-line basis, consistent with the previous standard.

Operating Leases

We currently lease four office facilities. These leases are under non-cancelable operating lease agreements with expiration dates between 2023 and 2025. We have the option to extend certain leases to five or ten-year term(s) and we have the right of first refusal on any sale.

The Company records lease liabilities within current liabilities or long-term liabilities based upon the length of time associated with the lease payments. The Company records its long-term operating leases as right-of-use assets. Upon initial adoption, using the modified retrospective transition approach, no leases with terms less than 12 months have been capitalized to the consolidated balance sheet consistent with ASC 842. Instead, these leases are recognized in the consolidated statement of operations on a straight-line expense throughout the lives of the leases. No Company leases contain common area maintenance or security agreements.

We have made certain assumptions and judgments when applying ASC 842, the most significant of which is that we elected the package of practical expedients available for transition, which allow us to not reassess whether expired or existing contracts contain leases under the new definition of a lease, lease classification for expired or existing leases, and whether previously capitalized initial direct costs would qualify for capitalization under ASC 842. Additionally, we did not elect to use hindsight when considering judgments and estimates such as assessments of lessee options to extend or terminate a lease or purchase the underlying asset.

As of December 31, 2019, the weighted-average remaining lease term was 5 years. Lease expense related to operating leases was $588 thousand during the year ended December 31, 2019. The Company’s lease agreements do not provide a readily determinable implicit rate nor is it available to the Company from its lessors. Instead, as of December 31, 2019, the Company estimates the weighted-average discount rate for its operating leases to be 5.2% to present value based on the incremental borrowing rate.

Future minimum payments for the next five years and thereafter as of December 31, 2019 under these long-term operating leases are as follows (in thousands):

2020	$	501
2021		507
2022		521
2023		489
2024		224
Thereafter		180
Total future minimum lease payments		2,422
Less amount representing interest		(302	)
Present value of obligations under operating leases		2,120
Less current portion		(394	)
Long-term operating lease obligations	$	1,726

Finance Leases

During the year ended December 31, 2019, we incurred lease interest cost of $51 thousand and amortization expense of $175 thousand. Future minimum payments under finance leases are as follows as of December 31, 2019 (in thousands):

2020	$	192
Less amount representing interest		(16	)
Present value of obligations under finance leases	$	176

Litigation

On December 13, 2018, a complaint was filed by RSB Spine, LLC, against Xtant Medical Holdings, Inc., which claims that some of our products, including the Irix-A Lumbar Integrated Fusion System and the Irix-C Cervical Integrated Fusion System, infringe certain of RSB Spine’s patents. On February 28, 2020, we entered into a confidential settlement and patent license agreement with RSB Spine pursuant to which we agreed to make an undisclosed settlement payment to RSB Spine and pay royalties on future sales of the two products through the expiration of the asserted patents.

In addition, we may be subject to potential liabilities under government regulations and various claims and legal actions that are pending but we believe are immaterial at this time or may be asserted in the future 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. We intend to continue to defend the Company vigorously in such matters and when warranted, take legal action against others. Furthermore, we regularly assess contingencies to determine the degree of probability and range of possible loss for potential accrual in our financial statements. An estimated loss contingency is accrued in our financial statements if it is probable that a liability has been incurred and the amount of the loss can be reasonably estimated. Based on our assessment, we have adequately accrued an amount for contingent liabilities currently in existence. We do not accrue amounts for liabilities that we do not believe are probable or that we consider immaterial to our overall financial position. Litigation is inherently unpredictable, and unfavorable resolutions could occur. As a result, assessing contingencies is highly subjective and requires judgment about future events. The amount of ultimate loss may exceed the Company’s current accruals, and it is possible that its cash flows or results of operations could be materially affected in any particular period by the unfavorable resolution of one or more of these contingencies.

Indemnifications

Our 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 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

12 Months Ended

Dec. 31, 2019

Income Tax Disclosure [Abstract]

Income Taxes

(11) Income Taxes

The Company’s provision for income taxes differs from applying the statutory U.S. Federal income tax rate to income before taxes. The primary difference results from providing for state income taxes and from deducting certain expenses for financial statement purposes but not for federal income tax purposes.

The components of income loss before provision for income taxes consist of the following (in thousands):

	Year Ended December 31,
	2019			2018
United States	$	(8,123	)	$	(70,059	)

Total	$	(8,123	)	$	(70,059	)

The components of the income tax provision are as follows (in thousands):

	Year Ended December 31,
	2019		2018
Current:
Federal	$	—	$	—
State		98		—
Total current		98		—

Deferred:
Federal		—		—
State		—		—
Total deferred		—		—

Total Provision for Income Taxes	$	98	$	—

The reconciliation of income tax attributable to operations computed at the U.S. Federal statutory income tax rate of 21% to income tax expense is as follows (in thousands):

	Year Ended December 31,
	2019			2018
Statutory Federal tax rate	$	(1,706	)	$	(14,712	)
Valuation allowance		73			7,270
State income taxes, net of Federal benefit		34			(1,740	)
Goodwill impairment		—			8,049
Change in state income tax rate		(136	)		396
Gain on extinguishment of debt		1,534			—
Change in warrant derivative liability		—			(25	)
Stock compensation adjustment and other reconciling items		282			349
Nondeductible interest		—			247
Restructuring expenses		—			117
Nondeductible meals and entertainment expense		17			49

Total Provision for Income Taxes	$	98		$	—

Deferred tax components are as follows (in thousands):

	At December 31,
	2019			2018
Deferred tax assets:
Accrued liability for vacation	$	111		$	77
Accrued commissions and bonuses / compensation		298			332
Accrued contingencies		132			121
Amortization		36			40
Depreciation		157			—
Bad debt reserve		133			552
Charitable contributions carryforward		8			7
Lease liability		564			—
Interest expense		3,407			2,173
Inventory reserve		3,058			3,200
Net operating loss carryovers		22,009			22,996
Stock option compensation		476			475
Other		102			24
Total deferred tax assets		30,491			29,997

Deferred tax liabilities:
Right of use asset		(558	)		—
Depreciation		—			(137	)
Total deferred tax liabilities		(558	)		(137	)

Valuation allowance		(29,933	)		(29,860	)

Net deferred tax assets	$	—		$	—

The ultimate realization of deferred tax assets is dependent upon the existence, or generation, of taxable income in the periods when those temporary differences and net operating loss carryovers are deductible. Management considers the scheduled reversal of deferred tax liabilities, taxes paid in carryover years, projected future taxable income, available tax planning strategies, and other factors in making this assessment. Based on available evidence, management does not believe it is more likely than not that all of the deferred tax assets will be realized. Accordingly, the Company has established a valuation allowance equal to the net realizable deferred tax assets. The valuation allowance increased by $0.1 million in 2019 and increased by $7.3 million in 2018.

At December 31, 2018 and 2017, the Company had total domestic Federal and state net operating loss carryovers of approximately $149.8 million and $158.7 million, respectively. Federal and state net operating loss carryovers both expire at various dates between 2024 and 2038. Federal net operating losses generated after 2017 have an indefinite carryforward and are only available to offset 80% taxable income.

Under the Tax Reform Act of 1986, as amended, the amounts of and benefits from net operating loss carryovers and research and development credits may be impaired or limited in certain circumstances. Events which cause limitations in the amount of net operating losses that the Company may utilize in any one year include, but are not limited to, a cumulative ownership change of more than 50%, as defined, over a three-year period. The Company has not performed an analysis to determine if an ownership change has occurred for 2019 or 2018.

The 2016 through 2018 tax years remain open to examination by the Internal Revenue Service and various other state tax agencies. These taxing authorities have the authority to examine those tax years until the applicable statute of limitations expire.

The Company did not recognize any material interest or penalties related to income taxes for the years ended December 31, 2019 and 2018.

Employee Benefit Plans

12 Months Ended

Dec. 31, 2019

Retirement Benefits [Abstract]

Employee Benefit Plans

(12) Employee Benefit Plans

We have a 401(k) plan for our employees. The 401(k) plan is a defined contribution plan covering substantially all of our employees. Employees are eligible to participate in the plan on the first day of any month after starting employment. Employees are allowed to contribute a percentage of their wages to the 401(k) plan, subject to statutorily prescribed limits and are subject to a discretionary employer match of 100% of their wage deferrals not in excess of 4% of their wages. The Company contributed $0.2 and $0.3 million as part of the employer match program for the year ended December 31, 2019 and 2018, respectively.

Supplemental Disclosure of Cash Flow Information

12 Months Ended

Dec. 31, 2019

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):

	Year Ended
	December 31,
	2019		2018
Cash paid during the period for:
Interest	$	51	$	186
Non-cash activities:
Lease liability from right of use asset	$	2,296	$	—
Issuance of capital leases	$	—	$	84
Interest converted into common stock	$	—	$	556
Conversion of convertible debt to equity	$	—	$	71,856
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
Debt discount on long-term credit facility	$	—	$	5,114
Extinguishment of Prior Credit Agreement (including debt issuance costs)	$	79,624	$	—
Write-off of Prior Credit Agreement debt issuance costs and existing ROS fees	$	307	$	—
Recognition of Second Amended and Restated Credit Agreement	$	72,657	$	—
Recognition of 2019 Warrants	$	9		—
Net Transfer of inventory to property and equipment	$	—	$	149
Restricted stock unit vesting	$	—	$	120

Related Party Transactions

12 Months Ended

Dec. 31, 2019

Related Party Transactions

(14) Related Party Transactions

The Investors, owning approximately 70% of the Company’s outstanding common stock, are the sole holders of our outstanding long-term debt. In addition, as described in more detail under Note 1, “Business Description and Summary of Significant Accounting Policies,” we are party 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 the Second Amended and Restated Credit Agreement, the Prior Credit Agreement, the Investor Rights Agreement, and the Registration Rights Agreement, as noted above.

On April 5, 2019, the Company entered into a Sublease Agreement wherein the Company leases from Cardialen, Inc., a portion of Cardialen’s office space commencing April 2019 on a month-to-month basis until January 2024, unless terminated earlier upon notice of 60 days. The rent was $2,100 per month for the months of April through July 2019 and is currently $1,260 per month. Because Jeffrey Peters is both a member of our Board and the Chief Executive Officer, President, and a Director of Cardialen, this transaction qualifies as a related party transaction.

All related party transactions are reviewed and approved by the Audit Committee or the disinterested members of the full Board.

Segment and Geographic Information

12 Months Ended

Dec. 31, 2019

Segment Reporting [Abstract]

Segment and Geographic Information

(15) Segment and Geographic Information

The Company’s management reviews our 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 96% and 95% of revenue were in the United States for the years ended December 31, 2019 and 2018, respectively. Total revenue by major geographic area is as follows (in thousands):

	Year Ended December 31,
	2019		2018
United States	$	62,377	$	68,880
Rest of World		2,305		3,323
Total	$	64,682	$	72,203

Business Description and Summary of Significant Accounting Policies (Policies)

12 Months Ended

Dec. 31, 2019

Accounting Policies [Abstract]

Business Description

Business Description

All intercompany balances and transactions have been eliminated in consolidation.

At December 31, 2019, the Company had cash and cash equivalents of $5.2 million, and an accumulated deficit of $223.3 million and has incurred significant losses in the current and prior periods.

Corporate Restructuring

Corporate Restructuring

Restructuring Agreement

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; and

	●	authorize the Company’s 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.

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

Cash and Cash Equivalents

Cash and Cash Equivalents

Trade Accounts Receivable

Trade Accounts Receivable

Inventories

Inventories

Property and Equipment

Property and Equipment

Intangible Assets

Intangible Assets

Other Assets

Other Assets

Other assets consist of the short-term and the long-term portion of prepaid expenses and security deposits.

Long-Lived Asset Impairment

Long-Lived Asset Impairment

Goodwill

Goodwill

Revenue Recognition

Revenue Recognition

Disaggregation of revenue

	Year Ended December 31, 2019		Percentage of Total Revenue			Year Ended December 31, 2018		Percentage of Total Revenue
Orthobiologics	$	46,663		72	%	$	48,984		68	%
Spinal implant		17,872		28	%		22,830		31	%
Other revenue		147		0	%		389		1	%
Total revenue	$	64,682		100	%	$	72,203		100	%

Research and Development

Research and Development

Research and development costs, which are principally related to internal costs for the development of new products, 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 as of December 31, 2019 and 2018 that are measured at fair value on a recurring basis (in thousands):

Warrant derivative liability

	As of December 31, 2019		As of December 31, 2018
Level 1		—		—
Level 2		—		—
Level 3	$	7	$	10

Recent Accounting Pronouncements

Recent Accounting Pronouncements

Reclassification

Reclassification

Certain prior year amounts have been reclassified to conform with current year presentation.

Business Description and Summary of Significant Accounting Policies (Tables)

12 Months Ended

Dec. 31, 2019

Accounting Policies [Abstract]

Summary of Revenues from Product Lines

. The following table presents revenues from these product lines for the years ended December 31, 2019 and 2018:

	Year Ended December 31, 2019		Percentage of Total Revenue			Year Ended December 31, 2018		Percentage of Total Revenue
Orthobiologics	$	46,663		72	%	$	48,984		68	%
Spinal implant		17,872		28	%		22,830		31	%
Other revenue		147		0	%		389		1	%
Total revenue	$	64,682		100	%	$	72,203		100	%

Schedule of Assets and Liabilities Measured on Recurring Basis

The following table sets forth by level, within the fair value hierarchy, our liabilities as of December 31, 2019 and 2018 that are measured at fair value on a recurring basis (in thousands):

Warrant derivative liability

	As of December 31, 2019		As of December 31, 2018
Level 1		—		—
Level 2		—		—
Level 3	$	7	$	10

Inventories (Tables)

12 Months Ended

Dec. 31, 2019

Inventory Disclosure [Abstract]

Schedule of Inventories

Inventories consist of the following (in thousands):

	December 31, 2019			December 31, 2018

Raw materials	$	3,805		$	4,136
Work in process		1,603			949
Finished goods		22,135			24,618
Gross inventories		27,543			29,703
Reserve for obsolescence		(11,442	)		(12,402	)
	$	16,101		$	22,423

Property and Equipment, Net (Tables)

12 Months Ended

Dec. 31, 2019

Property, Plant and Equipment [Abstract]

Schedule of Property and Equipment, Net

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

	December 31, 2019			December 31, 2018
Equipment	$	4,250		$	4,145
Computer equipment		455			481
Computer software		570			570
Furniture and fixtures		124			164
Leasehold improvements		3,980			3,941
Vehicles		10			10
Surgical instruments		10,897			10,772
Total cost		20,286			20,083
Less: accumulated depreciation		(15,591	)		(12,909	)
	$	4,695		$	7,174

Goodwill and Intangible Assets (Tables)

12 Months Ended

Dec. 31, 2019

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Intangible Assets

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

	December 31, 2019			December 31, 2018
Patents	$	847		$	847
Accumulated amortization		(332	)		(274	)
Net carrying value	$	515		$	573

Schedule of Estimated Amortization Expense for Intangible Assets

2020	$	56
2021		56
2022		55
2023		53
2024		52
Thereafter		243
Total	$	515

Accrued Liabilities (Tables)

12 Months Ended

Dec. 31, 2019

Payables and Accruals [Abstract]

Schedule of Accrued Liabilities

Accrued liabilities consist of the following (in thousands):

	December 31, 2019		December 31, 2018
Wages/commissions payable	$	3,902	$	3,332
Other accrued liabilities		2,723		1,818
Accrued liabilities	$	6,625	$	5,150

Debt (Tables)

12 Months Ended

Dec. 31, 2019

Debt Disclosure [Abstract]

Schedule of Long-term Debt

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

	December 31, 2019			December 31, 2018
Amounts due under the Credit Facility	$	72,657		$	55,787
PIK interest payable related to the Credit Facility		3,280			27,178
Plus: 2% exit fee on Credit Facility		399			254
Gross long-term debt		76,336			83,219
Less: discount on Credit Facility		—			(5,114	)
Less: total debt issuance costs		(92	)		(166	)
Long-term debt, less issuance costs	$	76,244		$	77,939

Stock-Based Compensation (Tables)

12 Months Ended

Dec. 31, 2019

Share-based Payment Arrangement [Abstract]

Schedule of Share-based Compensation, Stock Options, Activity

Stock option activity, including options granted under the 2018 Plan, the Prior Plan, and the Non-Plan Grants, was as follows:

	2019							2018
						Weighted							Weighted
				Weighted		Average Fair					Weighted		Average Fair
				Average Exercise		Value at Grant					Average Exercise		Value at Grant
	Shares			Price		Date		Shares			Price		Date
Outstanding at January 1		496,958		$	9.90	$	6.62		67,465		$	71.03	$	36.85
Granted		554,825			2.55		2.01		650,770			4.79		4.15
Cancelled or expired		(448,817	)		5.96		4.45		(221,277	)		13.45		7.77
Outstanding at December 31		602,966		$	6.07	$	3.99		496,958		$	9.90	$	6.62
Exercisable at December 31		25,063		$	83.78	$	46.66		66,188		$	46.88	$	25.92

Schedule of Assumptions of Stock Option Granted

	Year Ended
	December 31,
	2019			2018
Risk free interest rate		1.82	%		2.97	%
Dividend yield		0	%		0	%
Expected term		7.1 years			10.0 years
Expected volatility		92	%		89	%

Warrants (Tables)

12 Months Ended

Dec. 31, 2019

Warrants and Rights Note Disclosure [Abstract]

Schedule of Warrant Activity

The following table summarizes our warrant activities for the years ended December 31, 2019 and 2018:

				Weighted
	Common			Average
	Stock			Exercise
	Warrants			Price
Outstanding as of January 1, 2018		519,917		$	25.68
Issued		1,200,000			.01
Expired		(9,308	)		88.84
Outstanding as of December 31, 2018		1,710,609		$	7.33
Issued		1,200,000			.01
Expired		(1,735	)		259.60
Outstanding at December 31, 2019		2,908,874		$	4.16

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 years ended December 31, 2019 and 2018:

	2019		2018
Balance at January 1		87,506		93,759
Derivative warrants expired		—		(6,250	)
Balance at December 31		87,509		87,509

Schedule of Warrant Valuation Assumptions

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

	Year Ended
	December 31,
	2019			2018
Value of underlying common stock (per share)	$	1.96		$	1.61
Risk free interest rate		1.67	%		2.48	%
Expected term		2.7 years			3.6 years
Volatility		82	%		92	%
Dividend yield		0	%		0	%

Commitments and Contingencies (Tables)

12 Months Ended

Dec. 31, 2019

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 December 31, 2019 under these long-term operating leases are as follows (in thousands):

2020	$	501
2021		507
2022		521
2023		489
2024		224
Thereafter		180
Total future minimum lease payments		2,422
Less amount representing interest		(302	)
Present value of obligations under operating leases		2,120
Less current portion		(394	)
Long-term operating lease obligations	$	1,726

Schedule of Future Minimum Lease Payments for Financing Leases

2020	$	192
Less amount representing interest		(16	)
Present value of obligations under finance leases	$	176

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2019

Income Tax Disclosure [Abstract]

Schedule of Components of Income Loss Before Provision for Income Taxes

The components of income loss before provision for income taxes consist of the following (in thousands):

	Year Ended December 31,
	2019			2018
United States	$	(8,123	)	$	(70,059	)

Total	$	(8,123	)	$	(70,059	)

Schedule of Components of Income Tax Provision

The components of the income tax provision are as follows (in thousands):

	Year Ended December 31,
	2019		2018
Current:
Federal	$	—	$	—
State		98		—
Total current		98		—

Deferred:
Federal		—		—
State		—		—
Total deferred		—		—

Total Provision for Income Taxes	$	98	$	—

Schedule of Effective Income Tax Rate Reconciliation

The reconciliation of income tax attributable to operations computed at the U.S. Federal statutory income tax rate of 21% to income tax expense is as follows (in thousands):

	Year Ended December 31,
	2019			2018
Statutory Federal tax rate	$	(1,706	)	$	(14,712	)
Valuation allowance		73			7,270
State income taxes, net of Federal benefit		34			(1,740	)
Goodwill impairment		—			8,049
Change in state income tax rate		(136	)		396
Gain on extinguishment of debt		1,534			—
Change in warrant derivative liability		—			(25	)
Stock compensation adjustment and other reconciling items		282			349
Nondeductible interest		—			247
Restructuring expenses		—			117
Nondeductible meals and entertainment expense		17			49

Total Provision for Income Taxes	$	98		$	—

Schedule of Deferred Tax Assets and Liabilities

Deferred tax components are as follows (in thousands):

	At December 31,
	2019			2018
Deferred tax assets:
Accrued liability for vacation	$	111		$	77
Accrued commissions and bonuses / compensation		298			332
Accrued contingencies		132			121
Amortization		36			40
Depreciation		157			—
Bad debt reserve		133			552
Charitable contributions carryforward		8			7
Lease liability		564			—
Interest expense		3,407			2,173
Inventory reserve		3,058			3,200
Net operating loss carryovers		22,009			22,996
Stock option compensation		476			475
Other		102			24
Total deferred tax assets		30,491			29,997

Deferred tax liabilities:
Right of use asset		(558	)		—
Depreciation		—			(137	)
Total deferred tax liabilities		(558	)		(137	)

Valuation allowance		(29,933	)		(29,860	)

Net deferred tax assets	$	—		$	—

Supplemental Disclosure of Cash Flow Information (Tables)

12 Months Ended

Dec. 31, 2019

Supplemental Cash Flow Elements [Abstract]

Schedule of Supplemental Cash Flow Information

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

	Year Ended
	December 31,
	2019		2018
Cash paid during the period for:
Interest	$	51	$	186
Non-cash activities:
Lease liability from right of use asset	$	2,296	$	—
Issuance of capital leases	$	—	$	84
Interest converted into common stock	$	—	$	556
Conversion of convertible debt to equity	$	—	$	71,856
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
Debt discount on long-term credit facility	$	—	$	5,114
Extinguishment of Prior Credit Agreement (including debt issuance costs)	$	79,624	$	—
Write-off of Prior Credit Agreement debt issuance costs and existing ROS fees	$	307	$	—
Recognition of Second Amended and Restated Credit Agreement	$	72,657	$	—
Recognition of 2019 Warrants	$	9		—
Net Transfer of inventory to property and equipment	$	—	$	149
Restricted stock unit vesting	$	—	$	120

Segment and Geographic Information (Tables)

12 Months Ended

Dec. 31, 2019

Segment Reporting [Abstract]

Schedule of Revenues by Geographic Region

	Year Ended December 31,
	2019		2018
United States	$	62,377	$	68,880
Rest of World		2,305		3,323
Total	$	64,682	$	72,203

Business Description and Summary of Significant Accounting Policies (Details Narrative)						3 Months Ended	12 Months Ended
	May 18, 2018 USD ($) $ / shares shares	Apr. 27, 2018 USD ($) $ / shares shares	Feb. 14, 2018 USD ($) $ / shares shares	Feb. 13, 2018 shares	Jan. 17, 2018 $ / shares shares	Mar. 31, 2018	Dec. 31, 2019 USD ($) Segment shares	Dec. 31, 2018 USD ($) shares	Oct. 30, 2019 shares	Mar. 29, 2019 USD ($)
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
Cash and cash equivalents \| $							$ 5,237,000	$ 6,797,000
Accumulated deficit \| $							$ (223,266,000)	$ (215,045,000)
Stock issued during period, shares, new issues	129
Shares issued, price per share \| $ / shares	$ 0.0869816
Stock issued during period, value, new issues \| $	$ 900							$ 79,098,000
Common stock, shares authorized							75,000,000	50,000,000	50,000,000
Preferred stock, shares authorized							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							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%.
Number of reportable segments \| Segment							1
Antidilutive securities excluded from computation of earnings per share, amount							4,011,754	2,247,567
Surgical Instruments [Member]
Property and equipment, estimated useful lives							5 years
Revenue [Member]
Concentration risk percentage							10.00%
Accounts Receivable [Member]
Concentration risk percentage							10.00%
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 \| $			$ 6,800,000
Before Reverse Stock Split [Member]
Common stock, shares authorized				95,000,000
Preferred stock, shares authorized				5,000,000
After Reverse Stock Split 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
Maximum [Member] \| Computers and Equipment [Member]
Property and equipment, estimated useful lives							7 years
Minimum [Member]
Outstanding common stock in percentage			40.00%
Minimum [Member] \| Computers and Equipment [Member]
Property and equipment, estimated useful lives							3 years
6% Convertible Senior Unsecured Notes [Member]
Debt instrument due date description					Convertible senior unsecured promissory notes due in 2021	All of the outstanding 6.00% convertible senior unsecured notes due 2021
Debt conversion, converted instrument, shares issued					189,645
Debt instrument principal amount \| $			$ 70,300,000
Stock issued during period, shares, new issues			10,401,309
6% Convertible Senior Unsecured Notes [Member] \| OrbiMed Royalty Opportunities II, LP [Member]
Non-controlling interest, ownership percentage by parent			70.00%
6% Convertible Senior Unsecured Notes [Member] \| 2017 Notes [Member]
Debt instrument, stated percentage					6.00%
Debt instrument due date description					Convertible senior unsecured notes due 2021
Debt instrument, conversion price per share \| $ / shares					$ 9.11
Debt conversion, converted instrument, shares issued					189,645
Debt instrument principal amount \| $			$ 70,300,000
Debt instrument, convertible, conversion ratio			138.8889
Stock issued during period, shares, new issues			10,401,309
6% Convertible Senior Unsecured Notes [Member] \| Remaining Notes [Member]
Debt instrument principal amount \| $			$ 1,000
6% Convertible Senior Unsecured Notes [Member] \| Notes Exchange [Member]
Debt instrument, conversion price per share \| $ / shares			$ 7.20
Second Amended and Restated Credit Agreement [Member]
Debt instrument principal amount \| $							$ 55,800,000			$ 2,200,000
Restructuring Agreement [Member]
Stock issued during period, shares, new issues		129
Shares issued, price per share \| $ / shares		$ 7.20
Rights offering expired		Jun. 18, 2018
Stock issued during period, value, new issues \| $		$ 900
Restructuring Agreement [Member] \| Maximum [Member]
Stock issued during period, shares, new issues		1,137,515
2020 Annual Operating Plan [Member] \| Second Amended and Restated Credit Agreement [Member]
Cash and cash equivalents \| $							5,200,000
Debt capital \| $							$ 10,000,000
Management evaluation description							Management believes that the Company's cash and cash equivalents of $5.2 million as of December 31, 2019, together with the availability of $10.0 million under its Second Amended and Restated Credit Agreement, will be sufficient to meet its anticipated cash requirements and continue as a going concern through at least March 2021.

Business Description and Summary of Significant Accounting Policies - Summary of Revenues from Product Lines (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Total revenue	$ 64,682	$ 72,203
Percentage of total revenue	100.00%	100.00%
Orthobiologics [Member]
Total revenue	$ 46,663	$ 48,984
Percentage of total revenue	72.00%	68.00%
Spinal Implant [Member]
Total revenue	$ 17,872	$ 22,830
Percentage of total revenue	28.00%	31.00%
Other Revenue [Member]
Total revenue	$ 147	$ 389
Percentage of total revenue	0.00%	1.00%

Business Description and Summary of Significant Accounting Policies - Schedule of Assets and Liabilities Measured on Recurring Basis (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Warrant derivative liability	$ 7	$ 10
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	$ 7	$ 10

Inventories - Schedule of Inventories (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Inventory Disclosure [Abstract]
Raw materials	$ 3,805	$ 4,136
Work in process	1,603	949
Finished goods	22,135	24,618
Gross inventories	27,543	29,703
Reserve for obsolescence	(11,442)	(12,402)
Total	$ 16,101	$ 17,301

Property and Equipment, Net (Details Narrative) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Property, Plant and Equipment [Abstract]
Depreciation expense	$ 3,100	$ 3,200
Finance leases assets, gross	1,400	1,600
Finance leases, lessee balance sheet, assets by major class, accumulated depreciation	$ 1,000	$ 900

Property and Equipment, Net - Schedule of Property and Equipment, Net (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Property, Plant and Equipment [Line Items]
Total cost	$ 20,286	$ 20,083
Less: accumulated depreciation	(15,591)	(12,909)
Property and equipment, net	4,695	7,174
Equipment [Member]
Property, Plant and Equipment [Line Items]
Total cost	4,250	4,145
Computer Equipment [Member]
Property, Plant and Equipment [Line Items]
Total cost	455	481
Computer Software [Member]
Property, Plant and Equipment [Line Items]
Total cost	570	570
Furniture and Fixtures [Member]
Property, Plant and Equipment [Line Items]
Total cost	124	164
Leasehold Improvements [Member]
Property, Plant and Equipment [Line Items]
Total cost	3,980	3,941
Vehicles [Member]
Property, Plant and Equipment [Line Items]
Total cost	10	10
Surgical Instruments [Member]
Property, Plant and Equipment [Line Items]
Total cost	$ 10,897	$ 10,772

Goodwill and Intangible Assets (Details Narrative) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill impairment charge		$ 38,300
Impairment of Intangible assets		9,800
Amortization expense	$ 58	$ 3,437

Goodwill and Intangible Assets - Schedule of Intangible Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Goodwill and Intangible Assets Disclosure [Abstract]
Patents	$ 847	$ 847
Accumulated amortization	(332)	(274)
Intangible assets, net	$ 515	$ 573

Goodwill and Intangible Assets - Schedule of Estimated Amortization Expense for Intangible Assets (Details) $ in Thousands	Dec. 31, 2019 USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
2020	$ 56
2021	56
2022	55
2023	53
2024	52
Thereafter	243
Total	$ 515

Accrued Liabilities - Schedule of Accrued Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Payables and Accruals [Abstract]
Wages/commissions payable	$ 3,902	$ 3,332
Other accrued liabilities	2,723	1,818
Accrued liabilities	$ 6,625	$ 5,150

Debt (Details Narrative) - USD ($)					3 Months Ended		12 Months Ended
Debt (Details Narrative) - USD ($)	Mar. 29, 2019	Sep. 17, 2018	Feb. 14, 2018	Jan. 17, 2018	Mar. 31, 2019	Mar. 31, 2018	Dec. 31, 2019	Apr. 02, 2019	Dec. 31, 2018
Debt instrument description		The Optional PIK Interest (as such term is defined in the Prior Credit Agreement) was decreased from 15% plus the LIBO Rate (as such term is defined in the Prior Credit Agreement) to 10% plus the LIBO Rate, with a 2.3125% floor; a LIBO Rate floor of 2.3125% was added
Long-term debt							$ 76,244,000		$ 77,939,000
New effective interest rate							13.45%
Issuance of warrants to purchase a common stock		1,200,000
Exercise price of warrants		$ 0.01					$ 4.16
Warrants expiration date		Aug. 01, 2028
Maximum [Member]
Credit facility percentage		2.00%
Minimum [Member]
Credit facility percentage		1.00%
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 September 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% Convertible Senior Unsecured Notes [Member]
Debt instrument face amount			$ 70,300,000
Debt instrument due date description				Convertible senior unsecured promissory notes due in 2021		All of the outstanding 6.00% convertible senior unsecured notes due 2021
2019 Warrants [Member] \| Investors [Member]
Issuance of warrants to purchase a common stock								1,200,000
Exercise price of warrants								$ 0.01
Warrants expiration date								Apr. 01, 2029
Second Amended and Restated Credit Agreement [Member]
Debt instrument face amount	$ 2,200,000						$ 55,800,000
Debt instrument maturity date	Mar. 31, 2021
Debt instrument description	No interest will accrue on the Loans under the Second Amended and Restated Credit Agreement from and after January 1, 2019 until March 31, 2020; beginning April 1, 2020 through the maturity date of the Second Amended and Restated Credit Agreement, interest payable in cash will accrue on the Loans under the Credit Agreement at a rate per annum equal to the sum of (a) 10.00% plus (b) the higher of (x) the LIBO Rate (as such term is defined in the Second Amended and Restated Credit Agreement) and (y) 2.3125%; the maturity date of the Loans is March 31, 2021;
Long-term debt					$ 72,700,000		76,200,000
Increase in additional paid-in capital					$ 7,300,000
Accrued PIK interest							$ 21,100,000
New effective interest rate	13.19%
Second Amended and Restated Credit Agreement [Member] \| Forecast [Member]
Cash balance	$ 1,500,000
Second Amended and Restated Credit Agreement [Member] \| Investors [Member]
Debt instrument face amount	$ 10,000,000

Debt - Schedule of Long-term Debt (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Debt Disclosure [Abstract]
Amounts due under the Credit Facility	$ 72,657	$ 55,787
PIK interest payable related to the Credit Facility	3,280	27,178
Plus: 2% exit fee on Credit Facility	399	254
Gross long-term debt	76,336	83,219
Less: discount on Credit Facility		(5,114)
Less: total debt issuance costs	(92)	(166)
Long-term debt, less issuance costs	$ 76,244	$ 77,939

Equity (Details Narrative) - USD ($)				3 Months Ended	12 Months Ended
Equity (Details Narrative) - USD ($)	May 18, 2018	Feb. 14, 2018	Jan. 17, 2018	Mar. 31, 2018	Dec. 31, 2019	Dec. 31, 2018	Oct. 30, 2019
Schedule of Equity Method Investments [Line Items]
Common stock, shares authorized					75,000,000	50,000,000	50,000,000
Debt conversion of convertible debt						$ 71,856,000
Stock issued during period, shares, new issues	129
Shares issued, price per share	$ 0.0869816
Stock issued during period, value, new issues	$ 900					$ 79,098,000
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 SPA [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		$ 6,800,000
6% Convertible Senior Unsecured Notes [Member]
Schedule of Equity Method Investments [Line Items]
Debt instrument due date description			Convertible senior unsecured promissory notes due in 2021	All of the outstanding 6.00% convertible senior unsecured notes due 2021
Debt conversion of convertible debt			$ 1,600,000
Debt conversion, converted instrument, shares issued			189,645
Dent instrument face amount		$ 70,300,000
Stock issued during period, shares, new issues		10,401,309

Stock-Based Compensation (Details Narrative) - USD ($) $ in Thousands		12 Months Ended
	Aug. 01, 2018	Dec. 31, 2019	Dec. 31, 2018
Options granted to purchase shares		554,825	650,770
Restricted stock granted during period, shares		459,914
Restricted stock granted vested weighted average period		4 years 3 months 19 days
Intrinsic value of options outstanding		$ 2
Unvested employee stock options not yet recognized		$ 1,000
Stock option vested weighted average period		4 years 3 months 19 days
Employees and Directors [Member]
Allocated share-based compensation expense		$ 500	$ 700
2018 Equity Incentive Plan [Member]
Number of shares available for issuance	2,807,747
Term of plan, description	The 2018 Plan became effective immediately upon initial approval of the plan by our stockholders on August 1, 2018 and will expire on July 31, 2028, unless terminated earlier.
Number of common stock shares remaining available	1,650,005
Options granted to purchase shares		585,595
Restricted stock granted during period, shares		13,021
Options to purchase shares of common stock forfeited and cancelled		420,000
2018 Equity Incentive Plan [Member] \| Restricted Stock Units (RSUs) [Member]
Options granted to purchase shares		499,914
2018 Equity Incentive Plan [Member] \| Maximum [Member]
Number of shares available for issuance	1,500,000
Xtant Medical Equity Incentive Plan [Member]
Options granted to purchase shares		17,371
Restricted stock granted during period, shares		23,438
Xtant Medical Equity Incentive Plan [Member] \| Termination of Employment of Optionees [Member]
Options to purchase shares of common stock forfeited and cancelled		3,781
Xtant Medical Equity Incentive Plan [Member] \| Termination of Service of Director [Member]
Options to purchase shares of common stock forfeited and cancelled		10,417
Non-Plan Grants [Member]
Options to purchase shares of common stock forfeited and cancelled		25,000

Stock-Based Compensation - Schedule of Share-based Compensation, Stock Options, Activity (Details) - Equity Option [Member] - $ / shares	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Shares Outstanding, Beginning Balance	496,958	67,465
Shares Granted	554,825	650,770
Shares Cancelled or Expired	(448,817)	(221,277)
Shares Outstanding, Ending Balance	602,966	496,958
Shares Exercisable, Ending Balance	25,063	66,188
Weighted Average Exercise Price, Outstanding Beginning Balance	$ 9.90	$ 71.03
Weighted Average Exercise Price, Granted	2.55	4.79
Weighted Average Exercise Price, Cancelled or Expired	5.96	13.45
Weighted Average Exercise Price, Outstanding Ending Balance	6.07	9.90
Weighted Average Exercise Price, Exercisable Ending Balance	83.78	46.88
Weighted Average Fair Value at Grant Date, Outstanding Beginning Balance	6.62	36.85
Weighted Average Fair Value at Grant Date, Granted	2.01	4.15
Weighted Average Fair Value at Grant Date, Cancelled or Expired	4.45	7.77
Weighted Average Fair Value at Grant Date, Outstanding Ending Balance	3.99	6.62
Weighted Average Fair Value at Grant Date, Exercisable, Ending Balance	$ 46.66	$ 25.92

Stock-Based Compensation - Schedule of Assumptions of Stock Option Granted (Details)	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Share-based Payment Arrangement [Abstract]
Risk free interest rate	1.82%	2.97%
Dividend yield	0.00%	0.00%
Expected term	7 years 1 month 6 days	10 years
Expected volatility	92.00%	89.00%

Warrants (Details Narrative) - USD ($) $ / shares in Units, $ in Thousands	Apr. 02, 2019	Sep. 17, 2018	Dec. 31, 2019
Class of Warrant or Right [Line Items]
Issuance of warrants to purchase a common stock		1,200,000
Exercise price of warrants		$ 0.01	$ 4.16
Warrants expiration date		Aug. 01, 2028
2018 Warrants [Member] \| Investors [Member]
Class of Warrant or Right [Line Items]
Issuance of warrants to purchase a common stock		1,200,000
Exercise price of warrants		$ 0.01
Warrants expiration date		Aug. 01, 2028
Fair value of warrants		$ 5,100
2019 Warrants [Member] \| Investors [Member]
Class of Warrant or Right [Line Items]
Issuance of warrants to purchase a common stock	1,200,000
Exercise price of warrants	$ 0.01
Warrants expiration date	Apr. 01, 2029
Fair value of warrants	$ 9
Number of outstanding common stock warrants	2,910,609

Warrants - Schedule of Warrant Activity (Details) - $ / shares	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Warrants and Rights Note Disclosure [Abstract]
Common Stock Warrants Outstanding, Beginning Balance	1,710,609	519,917
Common Stock Warrants, Issued	1,200,000	1,200,000
Common Stock Warrants, Expired	(1,735)	(9,308)
Common Stock Warrants Outstanding, Ending Balance	2,908,874	1,710,609
Weighted Average Exercise Price Outstanding Beginning Balance	$ 7.33	$ 25.68
Weighted Average Exercise Price, Issued	0.01	0.01
Weighted Average Exercise Price, Expired	259.60	88.84
Weighted Average Exercise Price Outstanding Ending Balance	$ 4.16	$ 7.33

Warrants - Schedule of Warrants Activities Used in Derivative Liability (Details) - Warrant [Member] - shares	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Class of Warrant or Right [Line Items]
Common Stock Warrants Outstanding, Beginning Balance	87,506	93,759
Derivative warrants expired		(6,250)
Common Stock Warrants Outstanding, Ending Balance	87,506	87,506

Warrants - Schedule of Warrant Valuation Assumptions (Details)	Dec. 31, 2019 $ / shares	Dec. 31, 2018 $ / shares	May 18, 2018 $ / shares
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Value of underlying common stock (per share)			$ 0.0869816
Warrant [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Value of underlying common stock (per share)	$ 1.96	$ 1.61
Warrants and rights outstanding, measurement Input, expected term (In years)	2 years 8 months 12 days	3 years 7 months 6 days
Warrant [Member] \| Risk Free Interest Rate [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Warrants and rights outstanding, measurement Input	1.67	2.48
Warrant [Member] \| Volatility [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Warrants and rights outstanding, measurement Input	82	92
Warrant [Member] \| Dividend Yield [Member]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Warrants and rights outstanding, measurement Input	0	0

Commitments and Contingencies (Details Narrative) $ in Thousands	12 Months Ended
	Dec. 31, 2019 USD ($)
Operating lease expiration description	Expiration dates between 2023 and 2025
Operating lease weighted-average remaining lease term	5 years
Lease expense related to operating leases	$ 588
Operating lease weighted-average discount rate	5.20%
Lease interest cost	$ 51
Amortization expense	$ 175
Minimum [Member]
Lessee leasing arrangements operating leases term of each option to extend	5 years
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) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Commitments and Contingencies Disclosure [Abstract]
2020	$ 501
2021	507
2022	521
2023	489
2024	224
Thereafter	180
Total future minimum lease payments	2,422
Less amount representing interest	(302)
Present value of obligations under operating leases	2,120
Less current portion	(394)
Long-term operating lease obligations	$ 1,726

Commitments and Contingencies - Schedule of Future Minimum Lease Payments for Financing Leases (Details) $ in Thousands	Dec. 31, 2019 USD ($)
Commitments and Contingencies Disclosure [Abstract]
2020	$ 192
Less amount representing interest	(16)
Present value of obligations under financing leases	$ 176

Income Taxes (Details Narrative) - USD ($) $ in Thousands	12 Months Ended
Income Taxes (Details Narrative) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Income Tax Disclosure [Abstract]
Federal statutory income tax rate	21.00%
Increase in Valuation allowance	$ 1,000	$ 7,300
Operating loss carryforwards	$ 149,800	158,700
Operating loss carryforwards expiration period	Between 2024 and 2038
Indefinite carryforward available to offset taxable income percentage	80.00%
Operating Loss Carryforwards, Limitations on Use	Events which cause limitations in the amount of net operating losses that the Company may utilize in any one year include, but are not limited to, a cumulative ownership change of more than 50%, as defined, over a three-year period.
Interest or penalties related to income taxes

Income Taxes - Schedule of Components of Income Loss Before Provision for Income Taxes (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Income (loss) before provision for income taxes	$ (8,123)	$ (70,099)
United States [Member]
Income (loss) before provision for income taxes	$ (8,123)	$ (70,059)

Income Taxes - Schedule of Components of Income Tax Provision (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Income Tax Disclosure [Abstract]
Current: Federal
Current: State	98
Total current	98
Deferred: Federal
Deferred: State
Total deferred
Total Provision for Income Taxes	$ 98

Income Taxes - Schedule of Effective Income Tax Rate Reconciliation (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Income Tax Disclosure [Abstract]
Statutory Federal tax rate	$ (1,706)	$ (14,712)
Valuation allowance	73	7,270
State income taxes, net of Federal benefit	34	(1,740)
Goodwill impairment		8,049
Change in state income tax rate	(136)	396
Gain on extinguishment of debt	1,534
Change in warrant derivative liability		(25)
Stock compensation adjustment and other reconciling items	282	349
Nondeductible interest		247
Restructuring expenses		117
Nondeductible meals and entertainment expense	17	49
Total Provision for Income Taxes	$ 98

Income Taxes - Schedule of Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2019	Dec. 31, 2018
Income Tax Disclosure [Abstract]
Accrued liability for vacation	$ 111	$ 77
Accrued commissions and bonuses / compensation	298	332
Accrued contingencies	132	121
Amortization	36	40
Depreciation	157
Bad debt reserve	133	552
Charitable contributions carryforward	8	7
Lease liability	564
Interest expense	3,407	2,173
Inventory reserve	3,058	3,200
Net operating loss carryovers	22,009	22,996
Stock option compensation	476	475
Other	102	24
Total deferred tax assets	30,491	29,997
Right of use asset	(558)
Depreciation		(137)
Total deferred tax liabilities	(558)	(137)
Valuation allowance	(29,933)	(29,860)
Net deferred tax assets

Employee Benefit Plans (Details Narrative) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Retirement Benefits [Abstract]
Discretionary Match	100.00%
Contribution Limit, description	Wage deferrals not in excess of 4% of their wages.
Employer contributed amount	$ 2,000	$ 3,000

Supplemental Disclosure of Cash Flow Information - Schedule of Supplemental Cash Flow Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Supplemental Cash Flow Elements [Abstract]
Interest	$ 51	$ 186
Lease liability from right of use asset	2,296
Issuance of capital leases		84
Interest converted into common stock		556
Conversion of convertible debt to equity		71,856
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
Debt discount on long-term credit facility		5,114
Extinguishment of Prior Credit Agreement (including debt issuance costs)	79,624
Write-off of Prior Credit Agreement debt issuance costs and existing ROS fees	307
Recognition of Second Amended and Restated Credit Agreement	72,657
Recognition of 2019 Warrants	9
Net Transfer of inventory to property and equipment		149
Restricted stock unit vesting		$ 120

Related Party Transactions (Details Narrative) - USD ($) $ in Thousands		4 Months Ended	12 Months Ended
	Apr. 05, 2019	Jul. 31, 2019	Dec. 31, 2019
Related Party Transaction [Line Items]
Operating lease description			Expiration dates between 2023 and 2025
Sublease Agreement [Member] \| Cardialen, Inc., [Member]
Related Party Transaction [Line Items]
Operating lease description	Portion of Cardialen's office space commencing April 2019, on a month-to-month basis until January 2024, unless terminated earlier upon notice of 60 days.
Sublease rent expense		$ 2,100
Monthly rental expenses			$ 1,260
Investors [Member]
Related Party Transaction [Line Items]
Ownership percentage			70.00%

Segment and Geographic Information (Details Narrative) - Revenue [Member]	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Concentration risk, percentage	10.00%
Geographic Concentration Risk [Member] \| United States [Member]
Concentration risk, percentage	96.00%	95.00%

Segment and Geographic Information - Schedule of Revenues by Geographic Region (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018
Total revenue	$ 64,682	$ 72,203
United States [Member]
Total revenue	62,377	68,880
Rest of World [Member]
Total revenue	$ 2,305	$ 3,323