0001493152-22-006240 | 10-K | XBRL Viewer | Xtant Medical Holdings INC

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Consolidated Statements of Operations - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Revenue
Orthopedic product sales	$ 55,146	$ 53,188
Other revenue	117	149
Total Revenue	55,263	53,337
Cost of Sales	22,773	18,945
Gross Profit	32,490	34,392
Operating Expenses
General and administrative	14,449	13,503
Sales and marketing	21,025	20,983
Research and development	870	657
Total Operating Expenses	36,344	35,143
Loss from Operations	(3,854)	(751)
Other Expense
Interest expense	(995)	(5,976)
Total Other Expense	(995)	(5,976)
Net Loss from Operations Before Provision for Income Taxes	(4,849)	(6,727)
Provision for Income Taxes Current and Deferred		(296)
Net Loss	$ (4,849)	$ (7,023)
Net loss per share:
Basic	$ (0.06)	$ (0.25)
Dilutive	$ (0.06)	$ (0.25)
Shares used in the computation:
Basic	85,456,175	28,499,847
Dilutive	85,456,175	28,499,847

Consolidated Balance Sheets - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Current Assets:
Cash and cash-equivalents	$ 18,243	$ 2,341
Restricted cash	144
Trade accounts receivable, net of allowance for credit losses of $552 and $653, respectively	7,154	6,880
Inventories	17,945	21,408
Prepaid and other current assets	844	736
Total current assets	44,330	31,365
Property and equipment, net	5,212	4,347
Right of use asset, net	1,258	1,690
Other assets	287	402
Intangible assets, net	400	457
Goodwill	3,205	3,205
Total Assets	54,692	41,466
Current Liabilities:
Accounts payable	2,615	2,947
Accrued liabilities	4,349	5,462
Current portion of lease liability	462	423
Current portion of finance lease obligations	31	20
Line of credit	3,620
Current portion of long-term debt		16,797
Total current liabilities	11,077	25,649
Long-term Liabilities:
Lease liability, net	842	1,303
Financing lease obligations, net	103
Long-term debt, plus premium and less issuance costs	11,787
Total Liabilities	23,809	26,952
Commitments and Contingencies (note 11)
Stockholders’ Equity:
Preferred stock, $0.000001 par value; 10,000,000 shares authorized; no shares issued and outstanding
Common stock, $0.000001 par value; 300,000,000 shares authorized; 87,068,980 share issued and outstanding as of December 31, 2021 and 300,000,000 shares authorized; 77,573,680 shares issued and outstanding as of December 31, 2020
Additional paid-in capital	266,068	244,850
Accumulated deficit	(235,185)	(230,336)
Total Stockholders’ Equity	30,883	14,514
Total Liabilities & Stockholders’ Equity	$ 54,692	$ 41,466

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Statement of Financial Position [Abstract]
Allowance of accounts receivable, net	$ 552	$ 653
Preferred stock, par value	$ 0.000001	$ 0.000001
Preferred stock, shares authorized	10,000,000	10,000,000
Preferred stock, shares issued	0	0
Preferred stock, shares outstanding	0	0
Common stock, par value	$ 0.000001	$ 0.000001
Common stock, shares authorized	300,000,000	300,000,000
Common stock, shares issued	87,068,980	77,573,680
Common Stock, shares outstanding	87,068,980	77,573,680

Consolidated Statements of Changes in Stockholders' Equity (Deficit) - USD ($) $ in Thousands	Common Stock [Member]	Additional Paid-in Capital [Member]	Retained Earnings [Member]	Total
Beginning balance, value at Dec. 31, 2019		$ 179,061	$ (223,266)	$ (44,205)
Beginning balance, shares at Dec. 31, 2019	13,161,762
ASU 2016-13 cumulative effect adjustment			(47)	(47)
Stock-based compensation		1,084		1,084
Common stock issued on vesting of restricted stock units
Common stock issued on vesting of restricted stock units, shares	144,878
Issuance of warrant		1,862		1,862
Debt exchange, net of exchange costs of $1,058		62,175		62,175
Debt exchange, net of exchange costs of $1,058, shares	58,754,394
Issuance of common shares, net of issuance costs of $143		620		620
Issuance of common shares, net of issuance costs of $143, shares	712,646
Exercise of warrants		48		48
Exercise of warrants adjusting to additional paid in capital, shares	4,800,000
Net loss			(7,023)	(7,023)
Ending balance, value at Dec. 31, 2020		244,850	(230,336)	14,514
Ending balance, shares at Dec. 31, 2020	77,573,680
Stock-based compensation		2,209		2,209
Common stock issued on vesting of restricted stock units
Common stock issued on vesting of restricted stock units, shares	782,596
Private placement of common stock, net of issuance costs of $1,926		12,831		12,831
Private placement of common stock, net of issuance costs of $1,926, shares	8,888,890
Warrants issued in connection with the private placement		5,243		5,243
Warrants issued in connection with the private placement to placement agents		351		351
Gain on debt extinguishment		785		785
Withholding of common stock upon vesting of restricted stock units		(201)		(201)
Withholding of common stock upon vesting of restricted stock units, shares	(176,186)
Net loss			(4,849)	(4,849)
Ending balance, value at Dec. 31, 2021		$ 266,068	$ (235,185)	$ 30,883
Ending balance, shares at Dec. 31, 2021	87,068,980

Consolidated Statements of Changes in Stockholders' Equity (Deficit) (Parenthetical) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Statement of Stockholders' Equity [Abstract]
Debt, exchange costs		$ 1,058
Share issuance costs		$ 143
Payments of stock issuance costs	$ 1,926

Consolidated Statements of Cash Flow - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Operating activities:
Net loss	$ (4,849)	$ (7,023)
Adjustments to reconcile net loss to net cash provided by (used in) operating activities:
Depreciation and amortization	1,332	2,079
Non-cash interest	147	5,963
Non-cash rent	9	16
Gain on sale of fixed assets	(86)	(369)
Stock-based compensation	2,209	1,084
Provision for reserve on accounts receivable	45	307
Provision for excess and obsolete inventory	839	485
Changes in operating assets and liabilities:
Trade accounts receivable	(319)	2,890
Inventories	2,624	(5,792)
Prepaid and other assets	(67)	40
Accounts payable	(332)	101
Accrued liabilities	(1,113)	(512)
Net cash provided by (used in) operating activities	439	(731)
Investing activities:
Purchases of property and equipment	(2,115)	(1,545)
Proceeds from sale of fixed assets	225	241
Net cash used in investing activities	(1,890)	(1,304)
Financing activities:
Payment of taxes from withholding of common stock on vesting of restricted stock units	(201)
Payments on financing leases	(50)	(156)
Costs associated with refinancing	(136)	(1,058)
Payments on long-term debt	(411)	(315)
Borrowings on line of credit	36,361
Repayments on line of credit	(36,492)
Proceeds from issuance of common stock, net of issuance costs	18,426	620
Proceeds from exercise of common stock warrants		48
Net cash provided by (used in) financing activities	17,497	(861)
Net change in cash and cash equivalents and restricted cash	16,046	(2,896)
Cash and cash equivalents and restricted cash at beginning of year	2,341	5,237
Cash and cash equivalents and restricted cash at end of year	18,387	2,341
Reconciliation of cash and cash equivalents and restricted cash reported in the consolidated balance sheets
Cash and cash equivalents	18,243	2,341
Restricted cash	144
Total cash and cash equivalents and restricted cash reported in the consolidated balance sheets	$ 18,387	$ 2,341

Business Description and Summary of Significant Accounting Policies

12 Months Ended

Dec. 31, 2021

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Business Description and Summary of Significant Accounting Policies

(1) Business Description and Summary of Significant Accounting Policies

Business Description

The accompanying 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.

Since March 2020, the COVID-19 pandemic has caused business closures, severe travel restrictions and implementation of social distancing measures. At the onset of the COVID-19 pandemic, hospitals and other medical facilities cancelled or deferred elective procedures, diverted resources to patients suffering from infections and limited access for non-patients, including our direct and indirect sales representatives. Because of the COVID-19 pandemic, surgeons and their patients have been, and may continue to be, required, or are choosing, to defer procedures in which our products otherwise would be used, and many facilities that specialize in the procedures in which our products otherwise would be used have experienced temporary closures or reduced operating hours. These circumstances have negatively impacted, and may continue to negatively impact, the ability of our employees, independent sales representatives and distributors to effectively market and sell our products, which has had and will likely continue to have a material adverse effect on our revenues.

At December 31, 2021, the Company had cash and cash equivalents of $18.2 million, and an accumulated deficit of $235.2 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 2022 Annual Operating Plan. Management believes that our $18.2 million of cash and cash equivalents as of December 31, 2021, together with amounts available under our line of credit, will be sufficient to meet our anticipated cash requirements through at least March 2023.

Investor Rights Agreement

We are party to an Investor Rights Agreement with ROS Acquisition Offshore (“ROS”) and OrbiMed Royalty Opportunities II, LP (“Royalty Opportunities”), which are funds affiliated with OrbiMed Advisors LLC (“OrbiMed”). Under the Investor Rights Agreement, Royalty Opportunities and ROS are permitted to nominate a majority of the directors and designate the chairperson of our Board of Directors at subsequent annual meetings, as long as they maintain an ownership threshold in our Company of at least 40% of our then outstanding common stock (the “Ownership Threshold”). If Royalty Opportunities and ROS are unable to maintain the Ownership Threshold, the Investor Rights Agreement contemplates a reduction of nomination rights commensurate with our ownership interests. In addition, for so long as the Ownership Threshold is met, we must obtain the approval of a majority of our common stock held by Royalty Opportunities and ROS to proceed with the following actions: (i) issue new securities; (ii) incur over $250,000 of debt in a fiscal year; (iii) sell or transfer over $250,000 of our assets or businesses or our subsidiaries in a fiscal year; (iv) acquire over $250,000 of assets or properties in a fiscal year; (v) make capital expenditures over $125,000 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 our Board of Directors; 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 $250,000 in a fiscal year. As long as the Ownership Threshold is met, we may not increase the size of our Board or Directors beyond seven directors without the approval of a majority of the directors nominated by Royalty Opportunities and ROS.

The Investor Rights Agreement grants Royalty Opportunities and ROS 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 our written notice, ROS or Royalty Opportunities if the ownership percentage of our then outstanding common stock of ROS and Royalty Opportunities is less than 10%, or (c) upon written notice of ROS and Royalty Opportunities.

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 our revenue or accounts receivable in the fiscal years 2021 or 2020. Management believes that all significant credit risks have been identified at December 31, 2021.

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, Cash Equivalents, and Restricted Cash

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.

Cash and cash equivalents classified as restricted cash on our condensed consolidated balance sheets are restricted as to withdrawal or use under the terms of certain credit agreements. The December 31, 2021 balance included lockbox deposits that are temporarily restricted due to timing at the period end. The lockbox deposits are applied against our line of credit the next business day.

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.

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 to change the impairment model for most financial assets and certain other instruments. For trade and other receivables, held to maturity debt securities, loans, and other instruments, entities are required to use a new forward-looking “expected loss” model that generally will result in the earlier recognition of allowances for losses. The Company adopted the guidance on January 1, 2020 and recognized a cumulative effect adjustment of $47,000 to retained earnings and accounts receivable, net as a result of adoption. The Company has included the additional disclosures required by ASU 2016-13 in Note 2, “Receivables.”

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. In addition, we include provision for current expected credit loss based on historical collection experience adjusted for current economic conditions affecting collectability. Actual customer collections could differ from estimates. Account balances are charged to the allowance after all means of collection have been exhausted and the potential for recovery is considered remote. Provisions to the allowance for 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 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 reviews the 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, original equipment manufacturer 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. 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, 2021 and 2020 (dollars in thousands):

	Year Ended December 31, 2021		Percentage of Total Revenue			Year Ended December 31, 2020		Percentage of Total Revenue
Orthobiologics	$	42,259		77	%	$	39,308		74	%
Spinal implant		12,887		23	%		13,880		26	%
Other revenue		117		0	%		149		0	%
Total revenue	$	55,263		100	%	$	53,337		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, 2021 and 2020, as shares issuable upon the exercise of stock options and warrants and settlement of restricted stock units 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 13,282,882 and 5,115,868 outstanding stock options, warrants and restricted stock units for the years ended December 31, 2021 and 2020, 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, 2021 and 2020, there was no reclassification in financial assets or liabilities between Level 1, 2 or 3 categories.

Reclassification

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

Receivables

12 Months Ended

Dec. 31, 2021

Credit Loss [Abstract]

Receivables

(2) Receivables

Concurrent with the adoption of ASU 2016-13, the Company’s allowance for doubtful accounts was expanded to include provision for current expected credit loss (“CECL”). The Company’s provision for CECL is determined based on historical collection experience adjusted for current economic conditions affecting collectability. Actual customer collections could differ from estimates. Account balances are charged to the allowance after all means of collection have been exhausted and the potential for recovery is considered remote. Provisions to the allowance for credit losses are charged to expense. Activity within the allowance for credit losses was as follows for years ended December 31, 2021 and 2020 (in thousands):

Schedule of Allowance for Credit Losses

	December 31, 2021			December 31, 2020

Balance at January 1	$	653		$	547
Provision for current expected credit losses		45			307
Write-offs against allowance		(146	)		(201	)
	$	552		$	653

Inventories

12 Months Ended

Dec. 31, 2021

Inventory Disclosure [Abstract]

Inventories

(3) Inventories

Inventories consist of the following (in thousands):

Schedule of Inventories

	December 31, 2021		December 31, 2020
Raw materials	$	5,613	$	3,757
Work in process		571		1,733
Finished goods		11,761		15,918
Total	$	17,945	$	21,408

Property and Equipment, Net

12 Months Ended

Dec. 31, 2021

Property, Plant and Equipment [Abstract]

Property and Equipment, Net

(4) Property and Equipment, Net

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

Schedule of Property and Equipment, Net

	December 31, 2021			December 31, 2020
Equipment	$	5,541		$	4,807
Computer equipment		828			649
Computer software		490			570
Furniture and fixtures		94			133
Leasehold improvements		3,994			3,987
Other		10			10
Surgical instruments		11,424			11,291
Total cost		22,381			21,447
Less: accumulated depreciation		(17,169	)		(17,100	)
Total	$	5,212		$	4,347

Depreciation expense related to property and equipment, including property under capital lease, for the years ended December 31, 2021 and 2020 was $1.3 million and $2.0 million, respectively.

Goodwill and Intangible Assets

12 Months Ended

Dec. 31, 2021

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill and Intangible Assets

(5) Goodwill and Intangible Assets

The results of the Company’s annual goodwill impairment tests for the years ended December 31, 2021 and 2020 indicated that no goodwill impairment existed as of the test date.

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

	December 31, 2021			December 31, 2020
Patents	$	847		$	847
Accumulated amortization		(447	)		(390	)
Net carrying value	$	400		$	457

Amortization expense was $0.1 million for both of the years ended December 31, 2021 and 2020. The following is a summary of estimated future amortization expense for intangible assets as of December 31, 2021 (in thousands):


2022	$	54
2023		53
2024		52
2025		52
2026		49
Thereafter		140
Total	$	400

Accrued Liabilities

12 Months Ended

Dec. 31, 2021

Payables and Accruals [Abstract]

Accrued Liabilities

(6) Accrued Liabilities

Accrued liabilities consist of the following (in thousands):

Schedule of Accrued Liabilities

	December 31, 2021		December 31, 2020
Wages/commissions payable	$	3,184	$	4,057
Other accrued liabilities		1,165		1,405
Accrued liabilities	$	4,349	$	5,462

Debt

12 Months Ended

Dec. 31, 2021

Debt Disclosure [Abstract]

Debt

(7) Debt

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

Schedule of Long-term Debt

	December 31, 2021			December 31, 2020
Amounts due under the Term Facility	$	12,000		$	—
Accrued end-of-term payments		83			—
Amounts due under the Second A&R Credit Agreement		—			15,556
Premium related to Second Amendment		—			1,241
Less: unamortized debt issuance costs		(296	)		—
Less: current maturities		—			(16,797	)
Long-term debt, less issuance costs	$	11,787		$	—

Current Credit Facilities

On May 6, 2021 (the “Closing Date”), the Company, as guarantor, and its subsidiaries, as borrowers (collectively, the “Borrowers”), entered into a (i) Credit, Security and Guaranty Agreement (Term Loan) (the “Term Credit Agreement”) with MidCap Financial Trust, in its capacity as agent (the “Agent”), and a lender and the additional lenders from time to time party thereto and (ii) Credit, Security and Guaranty Agreement (Revolving Loan) (the “Revolving Credit Agreement,” and, together with the Term Credit Agreement, the “Credit Agreements”), with the Agent and the lenders from time to time party thereto. Contemporaneously with the execution and delivery of the Credit Agreements, that certain Second Amended and Restated Credit Agreement, dated March 29, 2019, among the Company, the Borrowers, OrbiMed Royalty Opportunities II, LP (“Royalty Opportunities”) and ROS Acquisition Offshore LP (“ROS”), as subsequently amended (the “Second A&R Credit Agreement”), which was scheduled to mature on December 31, 2021, was terminated in accordance with the terms thereof and all outstanding amounts were repaid by the Borrowers to Royalty Opportunities in its role as sole lender thereunder.

The Term Credit Agreement provides for a secured term loan facility (the “Term Facility”) in an aggregate principal amount of $12.0 million (the “Term Loan Commitment”), which was funded to the Borrowers on the Closing Date, and an additional $5.0 million tranche available solely at the discretion of the Agent and the lenders, for the purposes agreed to between the Company, the Borrowers and the lenders in advance of the making of loans under such additional tranche. The Revolving Credit Agreement provides for a secured revolving credit facility (the “Revolving Facility,” and, together with the Term Facility, the “Facilities”) under which the Borrowers may borrow up to $8,000,000 (such amount, the “Revolving Loan Commitment”) at any one time, the availability of which is determined based on a borrowing base equal to percentages of certain accounts receivable and inventory of the Borrowers in accordance with a formula set forth in the Revolving Credit Agreement. As of December 31, 2021, the Company had $3.2 million available under the Revolving Credit Agreement. All borrowings under the Revolving Facility are subject to the satisfaction of customary conditions, including the absence of default, the accuracy of representations and warranties in all material respects and the delivery of an updated borrowing base certificate.

The Facilities have a maturity date of May 1, 2026. The proceeds of the Term Facility were used to pay transaction fees in connection with the Facilities and to pay in full all outstanding indebtedness and accrued interest under the Second A&R Credit Agreement. The proceeds of the Revolving Facility were used to pay transaction fees in connection with the Facilities, to pay in full all outstanding indebtedness and accrued interest under the Second A&R Credit Agreement, and for working capital and general corporate purposes. As a result of the refinancing, we recorded a gain on extinguishment totaling $0.8 million. The gain represents the difference between the carrying value of our outstanding loans under the Second A&R Credit Agreement prior to the extinguishment and $15.6 million, the reacquisition price. Because of the related party affiliation between the Company and ROS, 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.

The loans and other obligations pursuant to the Credit Agreements bear interest at a per annum rate equal to the sum of the LIBOR rate, as such term is defined in the Credit Agreements, plus the applicable margin of 7.00% in the case of the Term Credit Agreement, and 4.50% in the case of the Revolving Credit Agreement, subject in each case to a LIBOR floor of 1.00%. The Company is also required to make a final payment in an amount equal to 3.75% of the principal amount borrowed under the Term Facility. The final payment is being accreted to interest expense over the term of the Term Facility using the effective interest method. The effective rate of the Term Facility, inclusive of amortization of debt issuance costs and accretion of the final payment, was 9.87% as of December 31, 2021. In addition to paying interest on the outstanding loans under the Facilities, the Borrowers are also required to pay an unused line fee equal to 0.50% per annum in respect of unutilized commitments under the Revolving Facility, a fee for failure to maintain a minimum balance under the Revolving Facility, a collateral management fee under the Revolving Facility equal to 0.50% of the amount outstanding under the Revolving Facility, an origination fee equal to 0.50% of the Revolving Loan Commitment and 0.50% of the Term Loan Commitment, and if activated, of any additional term loan tranche, and certain other customary fees related to the Agent’s administration of the Facilities.

The Credit Agreements contain affirmative and negative covenants customarily applicable to senior secured credit facilities, including covenants that, among other things, limit or restrict the ability of the Borrowers, subject to negotiated exceptions, to incur additional indebtedness and additional liens on their assets, engage in mergers or acquisitions or dispose of assets, pay dividends or make other distributions, voluntarily prepay other indebtedness, enter into transactions with affiliated persons, make investments, and change the nature of their businesses. In addition, the Credit Agreements require the Borrowers and the Company to maintain net product revenue at or above minimum levels and to maintain a minimum adjusted EBITDA and a minimum liquidity, in each case at levels specified in the Credit Agreements.

On March 7, 2022, the Credit Agreements were amended to, among other things, (i) provide for a waiver of compliance with respect to the Company’s minimum adjusted EBITDA requirement if and so long as the Company’s liquidity (as specifically defined in the Credit Agreements) is in excess of $14 million and there is not otherwise an event of default under the Credit Agreements, commencing with the next delivery of the compliance certificate required under the Credit Agreements, and (ii) re-set the date certain fees payable in connection with optional prepayments are determined to the date the amendment was executed and consequently extend such fees’ original expiration. In addition, the exit fees were increased by 25 basis points.

Prior Credit Facilities

Under the Second A&R Credit Agreement, we could make requests for term loans from ROS and Royalty Opportunities in their sole discretion 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 A&R Credit Agreement, and could request additional term loans with ROS and Royalty Opportunities in their sole discretion in an aggregate amount of up to $10.0 million. No interest was scheduled to accrue on the Second A&R Credit Agreement through March 31, 2020.

On May 6, 2020, we entered into a First Amendment to the Second A&R Credit Agreement (the “First Amendment”) with ROS and Royalty Opportunities which, among other things, provided that:

●

No interest would accrue on the Loans from and after March 31, 2020 until September 30, 2020;

●

Beginning October 1, 2020 through the maturity date of the Second A&R Credit Agreement, interest payable in cash would accrue on the Loans under the Second A&R Credit Agreement at a rate per annum equal to the sum of (i) 10.00% plus (ii) the higher of (x) the LIBO Rate (as such term is defined in the Second A&R Credit Agreement) and (y) 2.3125%;

●

The maturity date of the Loans was December 31, 2021.

On May 6, 2020, we issued warrants to purchase an aggregate of 2.4 million shares of our common stock to ROS and Royalty Opportunities, with an exercise price of $0.01 per share and an expiration date of May 6, 2030 (collectively, the “2020 Warrants”). The issuance of the 2020 Warrants was a condition to the effectiveness of the First Amendment. The First Amendment was accounted for as a debt modification whereby the recorded debt balance was discounted for the fair value of the 2020 Warrants issued and interest expense is accrued through the maturity date of the Loans at the post-amendment effective interest rate of 10.02%. These 2020 Warrants were exercised in full in November 2020.

On October 1, 2020, we entered into a Second Amendment to the Second A&R Credit Agreement (the “Second Amendment”) with ROS and Royalty Opportunities, which among other things, provided for:

●

Extinguishment by ROS and Royalty Opportunities of approximately $61.9 million of principal and paid-in-kind interest outstanding on the Loans in exchange for approximately 57.8 million shares of our common stock and the addition of a principal amount equal to prepayment fees associated with the Loans not paid in cash or exchanged for shares of our common stock;

●

Exchange of approximately $0.9 million of prepayment fees associated with the Loans for approximately 0.9 million shares of our common stock (the “Prepayment Fee Shares”);

●

Elimination of the availability of additional draw loan advances and reduction of available additional term loans to $5.0 million, the availability of which is in the sole and absolute discretion of the lender;

●

Accrual of interest payable in cash for the remaining term of the Second A&R Credit Agreement at a rate per annum equal to the sum of (i) 7.00% plus (ii) the higher of (x) the LIBO Rate (as such term is defined in the Second A&R Credit Agreement) and (y) 1.00%; and

●

Elimination of certain financial covenants.

As a result of the debt restructuring, as previously described, we recorded a gain on restructuring totaling $15.1 million during the year ended December 31, 2020. The gain represents the excess of the carrying value of our outstanding loans under the Second A&R Credit Agreement prior to the extinguishment of such debt in the debt restructuring transaction, $80.3 million, over the sum of the fair value of the 57.8 million shares issued therewith, $48.2 million based on the closing price of our common stock on October 1, 2020, and $17.1 million of undiscounted future cash payments associated with the Second Amendment. Because of the related party affiliation between the Company and ROS and Royalty Opportunities, 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.

The carrying value of loans outstanding under the Second A&R Credit Agreement was equal to the undiscounted future cash payments associated with the Second Amendment and principal associated with loans thereunder. Cash interest payments in connection with the Second A&R Credit Agreement reduced the carrying value of associated loans; and accordingly, no interest expense related to cash interest payments was recorded for the remaining duration of the Second A&R Credit Agreement.

- Definition

The entire disclosure for information about short-term and long-term debt arrangements, which includes amounts of borrowings under each line of credit, note payable, commercial paper issue, bonds indenture, debenture issue, own-share lending arrangements and any other contractual agreement to repay funds, and about the underlying arrangements, rationale for a classification as long-term, including repayment terms, interest rates, collateral provided, restrictions on use of assets and activities, whether or not in compliance with debt covenants, and other matters important to users of the financial statements, such as the effects of refinancing and noncompliance with debt covenants.

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+ Details

Equity

12 Months Ended

Dec. 31, 2021

Equity [Abstract]

Equity

(8) Equity

Charter Amendments

On August 7, 2020, 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 75 million to 300 million. 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 1, 2020.

Debt Restructuring

On October 1, 2020, we issued 58.7 million shares of our common stock in connection with our debt restructuring. See Note (7) Debt.

Rights Offering

On November 6, 2020, we distributed to holders of our common stock, at no charge, non-transferable subscription rights to purchase up to an aggregate of 14,018,690 shares of our common stock (the “Rights Offering”). In the Rights Offering, holders received 0.194539 subscription rights for each share of common stock held on the record date, November 5, 2020. Each whole subscription right entitled the holder to purchase one share of our common stock for $1.07 in cash. The Rights Offering was commenced on November 6, 2020 and expired on December 4, 2020, at which time the rights were no longer exercisable. We issued 712,646 shares of our common stock in the Rights Offering, resulting in $0.8 million in gross proceeds to us.

Warrant Exercises

On November 17, 2020, ROS and Royalty Opportunities exercised warrants representing an aggregate of 4.8 million shares of our common stock and in connection therewith we received aggregate proceeds of $48,000. See Note (10) Warrants.

Private Placement

On February 24, 2021, we issued in a private placement (the “Private Placement”) to a single healthcare-focused institutional accredited investor (the “Investor”) 8,888,890 shares of our common stock at a purchase price of $2.25 per share, and warrants to purchase up to 6,666,668 shares of our common stock (the “Investor Warrant”). We received net cash proceeds of approximately $18.4 million, after deducting fees and other estimated offering expenses, from the Private Placement.

The Investor Warrant, described in more detail in Note (10), Warrants, has an exercise price of $2.25 per share, subject to customary anti-dilution, but not price protection, adjustments, is immediately exercisable and expires on the five-year anniversary of the date of issuance.

In connection with the Private Placement, we entered into a placement agent agreement with a placement agent (the “Placement Agent”) pursuant to which the Placement Agent served as our exclusive placement agent in connection with the Private Placement (the “Placement Agent Agreement”). Pursuant to the Placement Agent Agreement, we agreed to pay the Placement Agent a fee equal to a certain percentage of the aggregate gross proceeds from the Private Placement. In addition to the cash fee, we agreed to issue to the Placement Agent a warrant to purchase up to 5.0% of the shares sold to the Investor in the Private Placement, or 444,444 shares of our common stock (the “Placement Agent Warrant”). The Placement Agent Warrant, described in more detail in Note 10, “Warrants”, has an exercise price of $2.8125 per share, subject to customary anti-dilution, but not price protection, adjustments, is immediately exercisable and expires on the five-year anniversary of the date of issuance.

- Definition

The entire disclosure for shareholders' equity comprised of portions attributable to the parent entity and noncontrolling interest, including other comprehensive income. Includes, but is not limited to, balances of common stock, preferred stock, additional paid-in capital, other capital and retained earnings, accumulated balance for each classification of other comprehensive income and amount of comprehensive income.

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+ Details

Stock-Based Compensation

12 Months Ended

Dec. 31, 2021

Share-based Payment Arrangement [Abstract]

Stock-Based Compensation

(9) 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. On October 27, 2020, at our 2020 annual meeting of stockholders, our stockholders approved an amendment to further increase the number of shares of our common stock available for issuance under the 2018 Plan by an additional 5,550,308 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 8,358,055 shares, of which 1,246,080 shares remained available for grant as of December 31, 2021. 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.

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

	2021							2020
						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		2,190,892		$	2.25	$	1.65		602,966		$	6.07	$	3.99
Granted		1,012,083			1.27		1.07		1,708,743			1.24		1.01
Cancelled or expired		(1,309	)		345.82		170.89		(120,817	)		6.95		4.31
Outstanding at December 31		3,201,666		$	1.80	$	1.40		2,190,892		$	2.25	$	1.65
Exercisable at December 31		649,042		$	3.36	$	2.37		122,739		$	14.74	$	8.95

The estimated fair value of stock options granted is determined 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,
	2021			2020
Risk free interest rate		0.97	%		0.54	%
Dividend yield		0	%		0	%
Expected term		6.3 years			6.3 years
Expected volatility		113	%		105	%

Restricted stock unit activity for awards granted under the 2018 Plan was as follows:

Schedule of Restricted Stock Activity

	2021					2020
	Shares			Weighted Average Fair Value at Grant Date Per Share		Shares			Weighted Average Fair Value at Grant Date Per Share
Outstanding at January 1		2,503,698		$	1.54		499,914		$	2.87
Granted		1,249,002		$	1.27		2,148,662		$	1.29
Vested		(782,596	)	$	1.72		(144,878	)	$	2.52
Outstanding at December 31		2,970,104		$	1.39		2,503,698		$	1.54

Total stock-based compensation expense recognized for employees and directors was $2.2 million and $1.1 million for the years ended December 31, 2021 and 2020, respectively, and was recognized as general and administrative expense. As of December 31, 2021, total compensation expense related to unvested employee stock options not yet recognized was $2.7 million, which is expected to be allocated to expenses over a weighted-average period of 3.1 years. Total compensation expense related to unvested restricted stock units not yet recognized was $3.4 million as of December 31, 2021, which is expected to be allocated to expenses over a weighted-average period of 2.8 years.

Warrants

12 Months Ended

Dec. 31, 2021

Warrants

Warrants

(10) Warrants

2021 Warrants

As noted in Note 8, “Equity,” on February 22, 2021, the Company issued the Investor Warrants and Placement Agent Warrants. The Investor and Placement Agent Warrants meet all the requirements to be classified as equity awards in accordance with Accounting Standards Codification (“ASC”) No. 815-40. The number of shares of Company common stock issuable upon exercise of the Investor Warrants and Placement Agent Warrants is subject to standard and customary anti-dilution provisions for stock splits, stock dividends, or similar transactions. In addition, the Investor Warrants include a buy-out right whereby the holders of such warrants may put the warrants back to the Company or its successor in the event of a purchase, tender or exchange offer accepted by 50% or more of the Company’s holders of common stock and not approved by the Company’s board of directors. The buy-out amount is equal to the Black-Scholes value of the warrants on the date the triggering transaction is consummated based on certain inputs as defined in the Investor Warrant agreement. The consideration to be paid if the buy-out provision is triggered shall be in the same type or form of consideration that is being offered and paid to the holders of Company common stock in connection with the triggering transaction.

While the Investor Warrants are classified as a component of equity, we were required to allocate the proceeds of the Private Placement between the shares of common stock and Investor Warrants issued based on their relative fair values. We utilized a lattice valuation model to determine the fair value of the Investor Warrants. The fair value of the Placement Agent Warrants issued in connection with the Private Placement was determined using a Black Scholes model. Significant assumptions in both models included contractual term (5 years) and the estimated volatility factor based on a weighted average of comparable published betas of peer companies (61%).

2020 Warrants

As noted in Note 7, “Debt,” on May 6, 2020, we issued warrants to purchase an aggregate 2.4 million shares of our common stock to ROS and Royalty Opportunities with an exercise price of $0.01 per share and an expiration date of May 6, 2030. The issuance of the 2020 Warrants was a condition to the effectiveness of the First Amendment. The fair value of the 2020 Warrants upon issuance was determined to be $1.9 million. The 2020 Warrants met all the requirements to be classified as equity awards in accordance with ASC No. 815-40. The number of shares of our common stock issuable upon exercise of the 2020 Warrants was subject to standard and customary anti-dilution provisions for stock splits, stock dividends, or similar transactions. The 2020 Warrants were exercised in full on November 17, 2020.

The following table summarizes our warrant activities for the years ended December 31, 2021 and 2020:

Schedule of Warrant Activity

				Weighted
	Common			Average
	Stock			Exercise
	Warrants			Price
Outstanding as of January 1, 2020		2,908,874		$	4.16
Issued		2,400,000			0.01
Exercised		(4,800,000	)		0.01
Expired		(87,596	)		85.92
Outstanding as of December 31, 2020		421,278		$	10.80
Issued		7,111,112			2.29
Expired		(421,278	)		10.80
Outstanding at December 31, 2021		7,111,112		$	2.29

Commitments and Contingencies

12 Months Ended

Dec. 31, 2021

Commitments and Contingencies Disclosure [Abstract]

Commitments and Contingencies

(11) Commitments and Contingencies

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, 2021, the weighted-average remaining lease term was 3 years. Lease expense related to operating leases was $0.6 million for both of the years ended December 31, 2021 and 2020. 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, 2021, 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 as of December 31, 2021 under these long-term operating leases are as follows (in thousands):


2022	$	521
2023		489
2024		224
2025		180
Total future minimum lease payments		1,414
Less amount representing interest		(110	)
Present value of obligations under operating leases		1,304
Less current portion		(462	)
Long-term operating lease obligations	$	842

Litigation

In November 2020, we received a letter from a third party’s legal counsel alleging that some of our hardware products allegedly infringe an expired patent and offering to discuss settlement terms. Without admitting any liability, in July 2021, we entered into a confidential settlement agreement and release that included, among other things, a full release of all asserted patent claims from the third party and otherwise settled the dispute in exchange for a one-time lump sum payment of $550,000, which was recorded as a special charge in general and administrative expense.

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, 2021

Income Tax Disclosure [Abstract]

Income Taxes

(12) 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,
	2021			2020
United States	$	(4,849	)	$	(6,727	)

Total	$	(4,849	)	$	(6,727	)

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


	Year Ended December 31,
	2021			2020
Current:
Federal	$	(51	)	$	51
State		51			245
Total current		—			296

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

Total provision for income taxes	$	—		$	296

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,
	2021			2020
Statutory Federal tax rate	$	(1,018	)	$	(1,413	)
Valuation allowance		315			(10,968	)
State income taxes, net of Federal benefit		(110	)		619
Attribute reduction related to Sec. 382		—			8,607
Change in state income tax rate		(33	)		(61	)
Gain on extinguishment of debt		165			3,488
Stock compensation adjustment and other reconciling items		557			14
Nondeductible executive compensation		124			—
Nondeductible meals and entertainment expense		—			10

Total provision for income taxes	$	—		$	296

Deferred tax components are as follows (in thousands):


	At December 31,
	2021			2020
Deferred tax assets:
Accrued liability for vacation	$	130		$	123
Accrued commissions and bonuses / compensation		284			565
Accrued contingencies		52			42
Amortization		27			32
Bad debt reserve		148			174
Charitable contributions carryforward		15			—
Lease liability		350			459
Interest expense		1,968			2,342
Inventory reserve		2,777			2,975
Net operating loss carryovers		13,164			12,114
Stock option compensation		783			653
Other		113			109
Total deferred tax assets		19,811			19,588

Deferred tax liabilities:
Right of use asset		(338	)		(450	)
Prepaids		(83	)		(73	)
Depreciation		(111	)		(100	)
Total deferred tax liabilities		(532	)		(623	)

Valuation allowance		(19,279	)		(18,965	)

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 deferred tax assets. The valuation allowance increased by $0.3 million in 2021 and decreased by $11.0 million in 2020.

At December 31, 2021 and 2020, the Company had total domestic Federal and state net operating loss carryovers of approximately $101.8 million and $97.0 million, respectively. Federal net operating losses generated prior to 2018 and State net operating loss carryovers expire at various dates between 2024 and 2040. Federal net operating losses generated after 2017 have an indefinite carryforward and are only available to offset 80% of taxable income beginning in 2021.

On March 27, 2020 the Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”) was signed into law. The CARES Act provided for an increased interest deduction for tax years 2019 and 2020, as well as the deferral of the employer portion of social security taxes.

The Company has completed a study to assess whether an ownership change, as defined by Section 382 of the Internal Revenue Code, had occurred from the Company’s formation through December 31, 2019. Based upon this study, the Company determined that an ownership change occurred during 2018. Accordingly, the Company reduced its deferred tax assets related to the federal net operating loss carryforwards that are anticipated to expire unused as a result of these ownership changes. These tax attributes were excluded from deferred tax assets with a corresponding reduction of the valuation allowance with no net effect on income tax expense or the effective tax rate. Future ownership changes may further limit the Company’s ability to utilize its remaining tax attributes.

The 2018 through 2020 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, 2021 and 2020.

- Definition

The entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
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-Subparagraph (SX 210.4-08(h)(2))
-URI http://asc.fasb.org/extlink&oid=120395691&loc=d3e23780-122690

+ Details

Employee Benefit Plans

12 Months Ended

Dec. 31, 2021

Retirement Benefits [Abstract]

Employee Benefit Plans

(13) 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 401(k) plan matching contributions by the Company were temporarily suspended at the onset of the COVID-19 pandemic, but future plan matching contributions were subsequently restored effective July 1, 2020. The Company contributed $0.3 million and $0.2 million as part of the employer match program for the years ended December 31, 2021 and 2020, respectively.

Supplemental Disclosure of Cash Flow Information

12 Months Ended

Dec. 31, 2021

Supplemental Cash Flow Elements [Abstract]

Supplemental Disclosure of Cash Flow Information

(14) Supplemental Disclosure of Cash Flow Information

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


	Year Ended
	December 31,
	2021		2020
Cash paid during the period for:
Interest	$	846	$	13
Non-cash activities:
Gain on extinguishment of Second A&R Credit Agreement	$	785	$	—
Extinguishment of Second A&R Credit Agreement financed by line of credit	$	3,755	$	—
Prepaid debt issuance costs	$	75	$	—
Fixed assets acquired under finance lease	$	163	$	—
Warrants issued in connection with the Private Placement to placement agents	$	351	$	—
ASU 2016-13 cumulative effect adjustment	$	—	$	47
Recognition of 2020 Warrants	$	—	$	1,862
Partial extinguishment of Second Amended and Restated Credit Agreement (including debt issuance costs)	$	—	$	63,233

Related Party Transactions

12 Months Ended

Dec. 31, 2021

Related Party Transactions

(15) Related Party Transactions

Royalty Opportunities, which owns approximately 20% of the Company’s outstanding common stock, was the sole holder of our outstanding long-term debt and a party to the Second A&R Credit Agreement, which was terminated in connection with our debt refinancing described under Note 8, “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 Royalty Opportunities and ROS. Transactions between the Company and Royalty Opportunities and ROS are conducted under the provisions of the Second A&R Credit Agreement, the Prior Credit Agreement, the Investor Rights Agreement, and the Registration Rights Agreement, as noted above.

The Company was party to a Sublease Agreement wherein the Company leased from Cardialen, Inc., a portion of Cardialen’s office space on a month-to-month. The rent was approximately $1,000 per month. The agreement was terminated effective September 30, 2021. Because Jeffrey Peters is both a member of our Board of Directors and the Chief Executive Officer, President, and a director of Cardialen, this transaction qualified 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, 2021

Segment Reporting [Abstract]

Segment and Geographic Information

(16) 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 99% and 98% of revenue was in the United States for the years ended December 31, 2021 and 2020, respectively. Total revenue by major geographic area is as follows (in thousands):

	Year Ended December 31,
	2021		2020
United States	$	54,570	$	52,147
Rest of World		693		1,190
Total	$	55,263	$	53,337

- Definition

The entire disclosure for reporting segments including data and tables. Reportable segments include those that meet any of the following quantitative thresholds a) it's reported revenue, including sales to external customers and intersegment sales or transfers is 10 percent or more of the combined revenue, internal and external, of all operating segments b) the absolute amount of its reported profit or loss is 10 percent or more of the greater, in absolute amount of 1) the combined reported profit of all operating segments that did not report a loss or 2) the combined reported loss of all operating segments that did report a loss c) its assets are 10 percent or more of the combined assets of all operating segments.

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+ Details

Business Description and Summary of Significant Accounting Policies (Policies)

12 Months Ended

Dec. 31, 2021

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Business Description

All intercompany balances and transactions have been eliminated in consolidation.

At December 31, 2021, the Company had cash and cash equivalents of $18.2 million, and an accumulated deficit of $235.2 million and has incurred significant losses in the current and prior periods.

Investor Rights Agreement

Concentrations and Credit Risk

Use of Estimates

Cash, Cash Equivalents, and Restricted Cash

Trade Accounts Receivable

Inventories

Property and Equipment

Intangible 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

Goodwill

Revenue Recognition

Disaggregation of revenue

	Year Ended December 31, 2021		Percentage of Total Revenue			Year Ended December 31, 2020		Percentage of Total Revenue
Orthobiologics	$	42,259		77	%	$	39,308		74	%
Spinal implant		12,887		23	%		13,880		26	%
Other revenue		117		0	%		149		0	%
Total revenue	$	55,263		100	%	$	53,337		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

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.

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, 2021

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Summary of Revenues from Product Lines

	Year Ended December 31, 2021		Percentage of Total Revenue			Year Ended December 31, 2020		Percentage of Total Revenue
Orthobiologics	$	42,259		77	%	$	39,308		74	%
Spinal implant		12,887		23	%		13,880		26	%
Other revenue		117		0	%		149		0	%
Total revenue	$	55,263		100	%	$	53,337		100	%

Receivables (Tables)

12 Months Ended

Dec. 31, 2021

Credit Loss [Abstract]

Schedule of Allowance for Credit Losses

	December 31, 2021			December 31, 2020

Balance at January 1	$	653		$	547
Provision for current expected credit losses		45			307
Write-offs against allowance		(146	)		(201	)
	$	552		$	653

Inventories (Tables)

12 Months Ended

Dec. 31, 2021

Inventory Disclosure [Abstract]

Schedule of Inventories

Inventories consist of the following (in thousands):

Schedule of Inventories

	December 31, 2021		December 31, 2020
Raw materials	$	5,613	$	3,757
Work in process		571		1,733
Finished goods		11,761		15,918
Total	$	17,945	$	21,408

Property and Equipment, Net (Tables)

12 Months Ended

Dec. 31, 2021

Property, Plant and Equipment [Abstract]

Schedule of Property and Equipment, Net

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

Schedule of Property and Equipment, Net

	December 31, 2021			December 31, 2020
Equipment	$	5,541		$	4,807
Computer equipment		828			649
Computer software		490			570
Furniture and fixtures		94			133
Leasehold improvements		3,994			3,987
Other		10			10
Surgical instruments		11,424			11,291
Total cost		22,381			21,447
Less: accumulated depreciation		(17,169	)		(17,100	)
Total	$	5,212		$	4,347

Goodwill and Intangible Assets (Tables)

12 Months Ended

Dec. 31, 2021

Goodwill and Intangible Assets Disclosure [Abstract]

Schedule of Goodwill and Intangible Assets

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

	December 31, 2021			December 31, 2020
Patents	$	847		$	847
Accumulated amortization		(447	)		(390	)
Net carrying value	$	400		$	457

Summary of Future Amortization Expense for Intangible Assets


2022	$	54
2023		53
2024		52
2025		52
2026		49
Thereafter		140
Total	$	400

Accrued Liabilities (Tables)

12 Months Ended

Dec. 31, 2021

Payables and Accruals [Abstract]

Schedule of Accrued Liabilities

Accrued liabilities consist of the following (in thousands):

Schedule of Accrued Liabilities

	December 31, 2021		December 31, 2020
Wages/commissions payable	$	3,184	$	4,057
Other accrued liabilities		1,165		1,405
Accrued liabilities	$	4,349	$	5,462

Debt (Tables)

12 Months Ended

Dec. 31, 2021

Debt Disclosure [Abstract]

Schedule of Long-term Debt

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

Schedule of Long-term Debt

	December 31, 2021			December 31, 2020
Amounts due under the Term Facility	$	12,000		$	—
Accrued end-of-term payments		83			—
Amounts due under the Second A&R Credit Agreement		—			15,556
Premium related to Second Amendment		—			1,241
Less: unamortized debt issuance costs		(296	)		—
Less: current maturities		—			(16,797	)
Long-term debt, less issuance costs	$	11,787		$	—

Stock-Based Compensation (Tables)

12 Months Ended

Dec. 31, 2021

Share-based Payment Arrangement [Abstract]

Schedule of Share-based Compensation, Stock Options, Activity

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

	2021							2020
						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		2,190,892		$	2.25	$	1.65		602,966		$	6.07	$	3.99
Granted		1,012,083			1.27		1.07		1,708,743			1.24		1.01
Cancelled or expired		(1,309	)		345.82		170.89		(120,817	)		6.95		4.31
Outstanding at December 31		3,201,666		$	1.80	$	1.40		2,190,892		$	2.25	$	1.65
Exercisable at December 31		649,042		$	3.36	$	2.37		122,739		$	14.74	$	8.95

Schedule of Assumptions of Stock Option Granted

	Year Ended
	December 31,
	2021			2020
Risk free interest rate		0.97	%		0.54	%
Dividend yield		0	%		0	%
Expected term		6.3 years			6.3 years
Expected volatility		113	%		105	%

Schedule of Restricted Stock Activity

Restricted stock unit activity for awards granted under the 2018 Plan was as follows:

Schedule of Restricted Stock Activity

	2021					2020
	Shares			Weighted Average Fair Value at Grant Date Per Share		Shares			Weighted Average Fair Value at Grant Date Per Share
Outstanding at January 1		2,503,698		$	1.54		499,914		$	2.87
Granted		1,249,002		$	1.27		2,148,662		$	1.29
Vested		(782,596	)	$	1.72		(144,878	)	$	2.52
Outstanding at December 31		2,970,104		$	1.39		2,503,698		$	1.54

Warrants (Tables)

12 Months Ended

Dec. 31, 2021

Warrants

Schedule of Warrant Activity

The following table summarizes our warrant activities for the years ended December 31, 2021 and 2020:

Schedule of Warrant Activity

				Weighted
	Common			Average
	Stock			Exercise
	Warrants			Price
Outstanding as of January 1, 2020		2,908,874		$	4.16
Issued		2,400,000			0.01
Exercised		(4,800,000	)		0.01
Expired		(87,596	)		85.92
Outstanding as of December 31, 2020		421,278		$	10.80
Issued		7,111,112			2.29
Expired		(421,278	)		10.80
Outstanding at December 31, 2021		7,111,112		$	2.29

Commitments and Contingencies (Tables)

12 Months Ended

Dec. 31, 2021

Commitments and Contingencies Disclosure [Abstract]

Schedule of Future Minimum Rental Payments for Operating Leases

Future minimum payments as of December 31, 2021 under these long-term operating leases are as follows (in thousands):


2022	$	521
2023		489
2024		224
2025		180
Total future minimum lease payments		1,414
Less amount representing interest		(110	)
Present value of obligations under operating leases		1,304
Less current portion		(462	)
Long-term operating lease obligations	$	842

Income Taxes (Tables)

12 Months Ended

Dec. 31, 2021

Income Tax Disclosure [Abstract]

Schedule of Components of Income Loss Before Provision for Income Tax

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


	Year Ended December 31,
	2021			2020
United States	$	(4,849	)	$	(6,727	)

Total	$	(4,849	)	$	(6,727	)

Schedule of Components of Income Tax Provision

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


	Year Ended December 31,
	2021			2020
Current:
Federal	$	(51	)	$	51
State		51			245
Total current		—			296

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

Total provision for income taxes	$	—		$	296

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,
	2021			2020
Statutory Federal tax rate	$	(1,018	)	$	(1,413	)
Valuation allowance		315			(10,968	)
State income taxes, net of Federal benefit		(110	)		619
Attribute reduction related to Sec. 382		—			8,607
Change in state income tax rate		(33	)		(61	)
Gain on extinguishment of debt		165			3,488
Stock compensation adjustment and other reconciling items		557			14
Nondeductible executive compensation		124			—
Nondeductible meals and entertainment expense		—			10

Total provision for income taxes	$	—		$	296

Schedule of Deferred Tax Assets and Liabilities

Deferred tax components are as follows (in thousands):


	At December 31,
	2021			2020
Deferred tax assets:
Accrued liability for vacation	$	130		$	123
Accrued commissions and bonuses / compensation		284			565
Accrued contingencies		52			42
Amortization		27			32
Bad debt reserve		148			174
Charitable contributions carryforward		15			—
Lease liability		350			459
Interest expense		1,968			2,342
Inventory reserve		2,777			2,975
Net operating loss carryovers		13,164			12,114
Stock option compensation		783			653
Other		113			109
Total deferred tax assets		19,811			19,588

Deferred tax liabilities:
Right of use asset		(338	)		(450	)
Prepaids		(83	)		(73	)
Depreciation		(111	)		(100	)
Total deferred tax liabilities		(532	)		(623	)

Valuation allowance		(19,279	)		(18,965	)

Net deferred tax assets	$	—		$	—

Supplemental Disclosure of Cash Flow Information (Tables)

12 Months Ended

Dec. 31, 2021

Supplemental Cash Flow Elements [Abstract]

Schedule of Supplemental Cash Flow Information

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


	Year Ended
	December 31,
	2021		2020
Cash paid during the period for:
Interest	$	846	$	13
Non-cash activities:
Gain on extinguishment of Second A&R Credit Agreement	$	785	$	—
Extinguishment of Second A&R Credit Agreement financed by line of credit	$	3,755	$	—
Prepaid debt issuance costs	$	75	$	—
Fixed assets acquired under finance lease	$	163	$	—
Warrants issued in connection with the Private Placement to placement agents	$	351	$	—
ASU 2016-13 cumulative effect adjustment	$	—	$	47
Recognition of 2020 Warrants	$	—	$	1,862
Partial extinguishment of Second Amended and Restated Credit Agreement (including debt issuance costs)	$	—	$	63,233

Segment and Geographic Information (Tables)

12 Months Ended

Dec. 31, 2021

Segment Reporting [Abstract]

Schedule of Revenues by Geographic Region

	Year Ended December 31,
	2021		2020
United States	$	54,570	$	52,147
Rest of World		693		1,190
Total	$	55,263	$	53,337

Summary of Revenues from Product Lines (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Total revenue	$ 55,263	$ 53,337
Percentage of total revenue	100.00%	100.00%
Orthobiologics [Member]
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Total revenue	$ 42,259	$ 39,308
Percentage of total revenue	77.00%	74.00%
Spinal Implant [Member]
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Total revenue	$ 12,887	$ 13,880
Percentage of total revenue	23.00%	26.00%
Other Revenue [Member]
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Total revenue	$ 117	$ 149
Percentage of total revenue	0.00%	0.00%

- Definition

Amount, excluding tax collected from customer, of revenue from satisfaction of performance obligation by transferring promised good or service to customer. Tax collected from customer is tax assessed by governmental authority that is both imposed on and concurrent with specific revenue-producing transaction, including, but not limited to, sales, use, value added and excise.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 30
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8906-108599

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 40
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e9031-108599

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 41
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e9038-108599

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8933-108599

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8933-108599

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 4
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130543-203045

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 22
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8736-108599

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 22
-Subparagraph (a)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8736-108599

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 42
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e9054-108599

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 606
-SubTopic 10
-Section 50
-Paragraph 5
-URI http://asc.fasb.org/extlink&oid=123351226&loc=SL49130545-203045

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 924
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SAB Topic 11.L)
-URI http://asc.fasb.org/extlink&oid=6472922&loc=d3e499488-122856

+ Details

Business Description and Summary of Significant Accounting Policies (Details Narrative) - USD ($) $ in Thousands		12 Months Ended
	Jan. 02, 2020	Dec. 31, 2021	Dec. 31, 2020
Product Information [Line Items]
Cash and Cash Equivalents, at Carrying Value		$ 18,243	$ 2,341
Retained Earnings (Accumulated Deficit)		235,185	$ 230,336
Cash and cash equivalents		$ 18,200
Antidilutive securities excluded from computation of earnings per share, amount		13,282,882	5,115,868
Computers and Equipment [Member]
Product Information [Line Items]
Property and equipment, estimated useful lives		three to seven years
Surgical Instruments [Member]
Product Information [Line Items]
Property and equipment, estimated useful lives		five years
Accounting Standards Update 2016-13 [Member]
Product Information [Line Items]
Cumulative effect adjustment	$ 47,000
Revenue Benchmark [Member] \| No Customer [Member] \| Concentration Credit Risk [Member]
Product Information [Line Items]
Concentration risk, percentage		10.00%	10.00%
Investor Rights Agreement [Member]
Product Information [Line Items]
Invester rights agreement, description		In addition, for so long as the Ownership Threshold is met, we must obtain the approval of a majority of our common stock held by Royalty Opportunities and ROS to proceed with the following actions: (i) issue new securities; (ii) incur over $250,000 of debt in a fiscal year; (iii) sell or transfer over $250,000 of our assets or businesses or our subsidiaries in a fiscal year; (iv) acquire over $250,000 of assets or properties in a fiscal year; (v) make capital expenditures over $125,000 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 our Board of Directors; 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 $250,000 in a fiscal year. As long as the Ownership Threshold is met, we may not increase the size of our Board or Directors beyond seven directors without the approval of a majority of the directors nominated by Royalty Opportunities and ROS.

Schedule of Allowance for Credit Losses (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Credit Loss [Abstract]
Beginning balance	$ 653	$ 547
Provision for expected credit losses	45	307
Write-offs against allowance	(146)	(201)
Ending balance	$ 552	$ 653

Schedule of Inventories (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Inventory Disclosure [Abstract]
Raw materials	$ 5,613	$ 3,757
Work in process	571	1,733
Finished goods	11,761	15,918
Total	$ 17,945	$ 21,408

Schedule of Property and Equipment, Net (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Property, Plant and Equipment [Line Items]
Total cost	$ 22,381	$ 21,447
Less: accumulated depreciation	(17,169)	(17,100)
Total	5,212	4,347
Equipment [Member]
Property, Plant and Equipment [Line Items]
Total cost	5,541	4,807
Computer Equipment [Member]
Property, Plant and Equipment [Line Items]
Total cost	828	649
Computer Softwares [Member]
Property, Plant and Equipment [Line Items]
Total cost	490	570
Furniture and Fixtures [Member]
Property, Plant and Equipment [Line Items]
Total cost	94	133
Leasehold Improvements [Member]
Property, Plant and Equipment [Line Items]
Total cost	3,994	3,987
Other Properties [Member]
Property, Plant and Equipment [Line Items]
Total cost	10	10
Surgical Instruments [Member]
Property, Plant and Equipment [Line Items]
Total cost	$ 11,424	$ 11,291

Property and Equipment, Net (Details Narrative) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Property, Plant and Equipment [Abstract]
Depreciation expenses	$ 1.3	$ 2.0

Schedule of Goodwill and Intangible Assets (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
Patents	$ 847	$ 847
Accumulated amortization	(447)	(390)
Net carrying value	$ 400	$ 457

Summary of Future Amortization Expense for Intangible Assets (Details) $ in Thousands	Dec. 31, 2021 USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
2022	$ 54
2023	53
2024	52
2025	52
2026	49
Thereafter	140
Total	$ 400

Goodwill and Intangible Assets (Details Narrative) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization of intangible assets	$ 0.1	$ 0.1

Schedule of Accrued Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Payables and Accruals [Abstract]
Wages/commissions payable	$ 3,184	$ 4,057
Other accrued liabilities	1,165	1,405
Accrued liabilities	$ 4,349	$ 5,462

Schedule of Long-term Debt (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Debt Disclosure [Abstract]
Amounts due under the Term Facility	$ 12,000
Accrued end-of-term payments	83
Amounts due under the Second A&R Credit Agreement		15,556
Premium related to Second Amendment		1,241
Less: unamortized debt issuance costs	(296)
Less: current maturities		(16,797)
Long-term debt, less issuance costs	$ 11,787

- Definition

Amount, after unamortized (discount) premium and debt issuance costs, of long-term debt. Includes, but not limited to, notes payable, bonds payable, debentures, mortgage loans and commercial paper. Excludes capital lease obligations.

+ References + Details

Debt (Details Narrative) - USD ($) $ / shares in Units, shares in Millions				12 Months Ended
	Mar. 07, 2022	May 06, 2021	Oct. 02, 2020	Dec. 31, 2021	Dec. 31, 2020	May 06, 2020
Debt Instrument [Line Items]
Line of credit facility expiration date		May 01, 2026		Dec. 31, 2021
Increase in liquidity amount	$ 14
Debt conversion converted instrument			$ 61,900,000
Debt conversion converted instrument, shares			57.8
Values issued prepayment fees			$ 900,000
Shares issued prepayment fees			0.9
Debt instrument face amount			$ 5,000.0
Line of credit facility interest rate at period			7.00%
Gain on restructuring					$ 15,100,000
Conversion of convertible securities			$ 80,300,000
Conversion of convertible securities, shares			57.8
Conversion of convertible securities, shares			$ 48,200,000
Undiscontinued future cash payments			$ 17,100,000
2020 Warrants [Member] \| ROS and Royalty Opportunities [Member]
Debt Instrument [Line Items]
New effective interest rate						10.02%
Issuance of warrants to purchase a common stock						2.4
Exercise price of warrants						$ 0.01
Warrants expiration date						May 06, 2030
Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Line of credit, interest rate		4.50%
London Interbank Offered Rate (LIBOR) [Member]
Debt Instrument [Line Items]
Debt instrument, interest rate		7.00%
Line of credit facility interest rate at period			1.00%
Term Loan Commitment [Member]
Debt Instrument [Line Items]
Line of credit facility, maximum borrowing capacity		$ 12,000,000.0
Term Loan Commitment [Member] \| Agent and Lenders [Member]
Debt Instrument [Line Items]
Line of credit facility, maximum borrowing capacity		5,000,000.0
Line of credit				$ 3,200,000
Revolving Loan Commitment [Member]
Debt Instrument [Line Items]
Line of credit facility, maximum borrowing capacity		$ 8,000,000
Revolving Loan Commitment [Member] \| London Interbank Offered Rate (LIBOR) [Member]
Debt Instrument [Line Items]
Line of credit, interest rate		1.00%
Second A&R Credit Agreement [Member]
Debt Instrument [Line Items]
Gain on extinguishment		$ 800,000
Reacquisition price		$ 15,600,000
Credit Agreements [Member]
Debt Instrument [Line Items]
Line of credit				3.75%
New effective interest rate				9.87%
Line of credit, description		In addition to paying interest on the outstanding loans under the Facilities, the Borrowers are also required to pay an unused line fee equal to 0.50% per annum in respect of unutilized commitments under the Revolving Facility, a fee for failure to maintain a minimum balance under the Revolving Facility, a collateral management fee under the Revolving Facility equal to 0.50% of the amount outstanding under the Revolving Facility, an origination fee equal to 0.50% of the Revolving Loan Commitment and 0.50% of the Term Loan Commitment, and if activated, of any additional term loan tranche, and certain other customary fees related to the Agent’s administration of the Facilities
Second A And R Credit Agreements [Member]
Debt Instrument [Line Items]
Line of credit				$ 2,200,000
Line of credit, description				Beginning October 1, 2020 through the maturity date of the Second A&R Credit Agreement, interest payable in cash would accrue on the Loans under the Second A&R Credit Agreement at a rate per annum equal to the sum of (i) 10.00% plus (ii) the higher of (x) the LIBO Rate (as such term is defined in the Second A&R Credit Agreement) and (y) 2.3125%
Line of credit facility maximum amount outstanding				$ 10,000,000.0

Equity (Details Narrative) - USD ($)					12 Months Ended
Equity (Details Narrative) - USD ($)	Feb. 24, 2021	Nov. 17, 2020	Nov. 06, 2020	Oct. 02, 2020	Dec. 31, 2021	Dec. 31, 2020	Aug. 07, 2020
Subsidiary, Sale of Stock [Line Items]
Common stock, shares authorized					300,000,000	300,000,000
Shares issued in exchange of loans outstanding				57,800,000
Stock issued during period, shares, new issues			712,646
Shares issued, price per share			$ 0.194539
Share price			$ 1.07
Right offering expired date			Nov. 06, 2020
Proceeds from common stock			$ 800,000		$ 18,426,000	$ 620,000
Investor [Member] \| Private Placement [Member]
Subsidiary, Sale of Stock [Line Items]
Stock issued during period, shares, new issues	8,888,890
Shares issued, price per share	$ 2.25
Proceeds from private placement	$ 18,400,000
Investor Warrant [Member] \| Private Placement [Member]
Subsidiary, Sale of Stock [Line Items]
Warrants to purchase common stock	6,666,668
Warrant exercise price	$ 2.25
ROS and Royalty Opportunities [Member]
Subsidiary, Sale of Stock [Line Items]
Proceeds from warrant exercise		$ 48,000
Restructuring Agreement [Member] \| Royalty Opportunities and ROS [Member]
Subsidiary, Sale of Stock [Line Items]
Shares issued in exchange of loans outstanding				58,700,000
Placement Agent Agreement [Member] \| Investor [Member] \| Private Placement [Member]
Subsidiary, Sale of Stock [Line Items]
Stock issued during period, shares, new issues	444,444
Warrants exercise price percentage	5.00%
Placement Agent Agreement [Member] \| Investor [Member] \| Private Placement Warrant [Member]
Subsidiary, Sale of Stock [Line Items]
Warrant exercise price	$ 2.8125
Warrant term description	five-year
Minimum [Member]
Subsidiary, Sale of Stock [Line Items]
Common stock, shares authorized							75,000,000
Maximum [Member]
Subsidiary, Sale of Stock [Line Items]
Common stock, shares authorized							300,000,000
Stock issued during period, shares, new issues			14,018,690

Schedule of Share-based Compensation, Stock Options, Activity (Details) - Equity Option [Member] - 2018 Equity Incentive Plan [Member] - $ / shares	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares, Outstanding, Beginning Balance	2,190,892	602,966
Weighted Average Exercise Price, Outstanding Beginning Balance	$ 2.25	$ 6.07
Weighted Average Fair Value at Grant Date, Outstanding Beginning Balance	$ 1.65	$ 3.99
Shares, Granted	1,012,083	1,708,743
Weighted Average Exercise Price, Granted	$ 1.27	$ 1.24
Weighted Average Fair Value at Grant Date, Granted	$ 1.07	$ 1.01
Shares, Cancelled or expired	(1,309)	(120,817)
Weighted Average Exercise Price, Cancelled or expired	$ 345.82	$ 6.95
Weighted Average Fair Value at Grant Date, Cancelled or expired	$ 170.89	$ 4.31
Shares, Outstanding, Ending Balance	3,201,666	2,190,892
Weighted Average Exercise Price, Outstanding Ending Balance	$ 1.80	$ 2.25
Weighted Average Fair Value at Grant Date, Outstanding Ending Balance	$ 1.40	$ 1.65
Shares, Exercisable, Ending Balance	649,042	122,739
Weighted Average Exercise Price, Exercisable Ending Balance	$ 3.36	$ 14.74
Weighted Average Fair Value at Grant Date, Exercisable, Ending Balance	$ 2.37	$ 8.95

Schedule of Assumptions of Stock Option Granted (Details)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Share-based Payment Arrangement [Abstract]
Risk free interest rate	0.97%	0.54%
Dividend yield	0.00%	0.00%
Expected term	6 years 3 months 18 days	6 years 3 months 18 days
Expected volatility	113.00%	105.00%

Schedule of Restricted Stock Activity (Details) - Restricted Stock Units (RSUs) [Member] - 2018 Equity Incentive Plan [Member] - $ / shares	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares Outstanding, Beginning Balance	2,503,698	499,914
Weighted Average Fair Value at Grant Date, Outstanding Beginning Balance	$ 1.54	$ 2.87
Shares Granted	1,249,002	2,148,662
Weighted Average Fair Value at Grant Date, Granted	$ 1.27	$ 1.29
Shares Vested	(782,596)	(144,878)
Weighted Average Fair Value at Grant Date, Vested	$ 1.72	$ 2.52
Shares Outstanding, Ending Balance	2,970,104	2,503,698
Weighted Average Fair Value at Grant Date, Outstanding Ending Balance	$ 1.39	$ 1.54

Stock-Based Compensation (Details Narrative) - USD ($) $ in Thousands		12 Months Ended
	Aug. 01, 2018	Dec. 31, 2021	Dec. 31, 2020	Oct. 27, 2018
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share based compensation		$ 2,209	$ 1,084
Share-based Payment Arrangement, Option [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unvested employee stock options not yet recognized		$ 2,700
Stock option vested weighted average period		3 years 1 month 6 days
Restricted Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unvested employee stock options not yet recognized		$ 3,400
Stock option vested weighted average period		2 years 9 months 18 days
Employees And Directors [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share based compensation		$ 2,200	$ 1,100
2018 Equity Incentive Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares available for issuance		8,358,055
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		1,246,080
2018 Equity Incentive Plan [Member] \| Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares available for issuance	1,500,000			5,550,308

Schedule of Warrant Activity (Details) - $ / shares shares in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Warrants
Common Stock Warrants Outstanding, Beginning Balance	421,278	2,908,874
Weighted Average Exercise Price Outstanding Beginning Balance	$ 10.80	$ 4.16
Common Stock Warrants, Issued	7,111,112	2,400,000
Weighted Average Exercise Price, Issued	$ 2.29	$ 0.01
Common Stock Warrants, Exercised		(4,800,000)
Weighted Average Exercise Price, Exercised		$ 0.01
Common Stock Warrants, Expired	(421,278)	(87,596)
Weighted Average Exercise Price, Expired	$ 10.80	$ 85.92
Common Stock Warrants Outstanding, Ending Balance	7,111,112	421,278
Weighted Average Exercise Price Outstanding Ending Balance	$ 2.29	$ 10.80

Warrants (Details Narrative) $ / shares in Units, shares in Millions, $ in Millions	May 06, 2020 USD ($) $ / shares shares	Dec. 31, 2021
2020 Warrant [Member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Issuance of warrants to purchase a common stock \| shares	2.4
Exercise price of warrants \| $ / shares	$ 0.01
Warrants expiration date	May 06, 2030
Fair value of warrants \| $	$ 1.9
Measurement Input, Expected Term [Member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Warrants contractual term		5 years
Measurement Input, Price Volatility [Member]
Fair Value Measurement Inputs and Valuation Techniques [Line Items]
Warrants and rights outstanding, measurement input		0.61

Schedule of Future Minimum Rental Payments for Operating Leases (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Commitments and Contingencies Disclosure [Abstract]
2022	$ 521
2023	489
2024	224
2025	180
Total future minimum lease payments	1,414
Less amount representing interest	(110)
Present value of obligations under operating leases	1,304
Less current portion	(462)	$ (423)
Long-term operating lease obligations	$ 842	$ 1,303

Commitments and Contingencies (Details Narrative) - USD ($)	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020	Jul. 02, 2021
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Operating lease expiration description	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
Operating lease weighted-average remaining lease term	3 years
Lease expense related to operating leases	$ 600,000	$ 600,000
Operating lease weighted-average discount rate	5.20%
Settlement Agreement [Member]
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Reserve for one-time lump sum amount			$ 550,000

Schedule of Components of Income Loss Before Provision for Income Tax (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Total	$ (4,849)	$ (6,727)
UNITED STATES
Total	$ (4,849)	$ (6,727)

- Definition

Amount of income (loss) from continuing operations, including income (loss) from equity method investments, before deduction of income tax expense (benefit), and income (loss) attributable to noncontrolling interest.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (c)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8933-108599

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 30
-Subparagraph (b)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8906-108599

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 32
-Subparagraph (f)
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8933-108599

Reference 4: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 940
-SubTopic 20
-Section 25
-Paragraph 1
-URI http://asc.fasb.org/extlink&oid=123384075&loc=d3e41242-110953

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 22
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8736-108599

Reference 6: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 220
-SubTopic 10
-Section S99
-Paragraph 2
-Subparagraph (SX 210.5-03(10))
-URI http://asc.fasb.org/extlink&oid=123367319&loc=SL114868664-224227

Reference 7: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 944
-SubTopic 220
-Section S99
-Paragraph 1
-Subparagraph (SX 210.7-04(8))
-URI http://asc.fasb.org/extlink&oid=120400993&loc=SL114874131-224263

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 942
-SubTopic 235
-Section S99
-Paragraph 1
-Subparagraph (SX 210.9-05(b)(2))
-URI http://asc.fasb.org/extlink&oid=120399901&loc=d3e537907-122884

Reference 9: http://www.xbrl.org/2003/role/exampleRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 280
-SubTopic 10
-Section 50
-Paragraph 31
-URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8924-108599

Reference 10: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 942
-SubTopic 220
-Section S99
-Paragraph 1
-Subparagraph (SX 210.9-04(15))
-URI http://asc.fasb.org/extlink&oid=120399700&loc=SL114874048-224260

+ Details

Schedule of Components of Income Tax Provision (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Income Tax Disclosure [Abstract]
Federal	$ (51)	$ 51
State	51	245
Total current		296
Federal
State
Total deferred
Total provision for income taxes		$ 296

- Definition

Amount of current income tax expense (benefit) and deferred income tax expense (benefit) pertaining to continuing operations.

+ References + Details

Schedule of Effective Income Tax Rate Reconciliation (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Income Tax Disclosure [Abstract]
Statutory Federal tax rate	$ (1,018)	$ (1,413)
Valuation allowance	315	(10,968)
State income taxes, net of Federal benefit	(110)	619
Attribute reduction related to Sec. 382		8,607
Change in state income tax rate	(33)	(61)
Gain on extinguishment of debt	165	3,488
Stock compensation adjustment and other reconciling items	557	14
Nondeductible executive compensation	124
Nondeductible meals and entertainment expense		10
Total provision for income taxes		$ 296

Schedule of Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands	Dec. 31, 2021	Dec. 31, 2020
Income Tax Disclosure [Abstract]
Accrued liability for vacation	$ 130	$ 123
Accrued commissions and bonuses / compensation	284	565
Accrued contingencies	52	42
Amortization	27	32
Bad debt reserve	148	174
Charitable contributions carryforward	15
Lease liability	350	459
Interest expense	1,968	2,342
Inventory reserve	2,777	2,975
Net operating loss carryovers	13,164	12,114
Stock option compensation	783	653
Other	113	109
Total deferred tax assets	19,811	19,588
Right of use asset	(338)	(450)
Prepaids	(83)	(73)
Depreciation	(111)	(100)
Total deferred tax liabilities	(532)	(623)
Valuation allowance	(19,279)	(18,965)
Net deferred tax assets

Income Taxes (Details Narrative) - USD ($) $ in Millions	12 Months Ended
Income Taxes (Details Narrative) - USD ($) $ in Millions	Dec. 31, 2021	Dec. 31, 2020
Income Tax Disclosure [Abstract]
Valuation allowance deferred tax asset change in amou	$ 0.3	$ 11.0
Operating loss carryforwards	$ 101.8	$ 97.0
Operating loss carryforwards expiration period	Federal net operating losses generated prior to 2018 and State net operating loss carryovers expire at various dates between 2024 and 2040
Indefinite carryforward available to offset taxable income percentage	80.00%

Employee Benefit Plans (Details Narrative) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Retirement Benefits [Abstract]
Discretionary match	100.00%
Contribution limit, description	wage deferrals not in excess of 4% of their wages
Employer contributed amount	$ 0.3	$ 0.2

Schedule of Supplemental Cash Flow Information (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Supplemental Cash Flow Elements [Abstract]
Interest	$ 846	$ 13
Gain on extinguishment of Second A&R Credit Agreement	785
Extinguishment of Second A&R Credit Agreement financed by line of credit	3,755
Prepaid debt issuance costs	75
Fixed assets acquired under finance lease	163
Warrants issued in connection with the Private Placement to placement agents	351
ASU 2016-13 cumulative effect adjustment		47
Recognition of 2020 Warrants		1,862
Partial extinguishment of Second Amended and Restated Credit Agreement (including debt issuance costs)		$ 63,233

Related Party Transactions (Details Narrative)	12 Months Ended
Related Party Transactions (Details Narrative)	Dec. 31, 2021 USD ($)
Sublease Agreement [Member]
Deferred Compensation Arrangement with Individual, Excluding Share-based Payments and Postretirement Benefits [Line Items]
Rent expense	$ 1,000
Soleholders [Member]
Deferred Compensation Arrangement with Individual, Excluding Share-based Payments and Postretirement Benefits [Line Items]
Equity Method Investment, Ownership Percentage	20.00%

Schedule of Revenues by Geographic Region (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
Revenues from External Customers and Long-Lived Assets [Line Items]
Total revenue	$ 55,263	$ 53,337
UNITED STATES
Revenues from External Customers and Long-Lived Assets [Line Items]
Total revenue	54,570	52,147
Rest of World [Member]
Revenues from External Customers and Long-Lived Assets [Line Items]
Total revenue	$ 693	$ 1,190

- Definition

+ References

+ Details

Segment and Geographic Information (Details Narrative) - Concentration Credit Risk [Member] - Revenue Benchmark [Member]	12 Months Ended
	Dec. 31, 2021	Dec. 31, 2020
One Customer [Member]
Revenue, Major Customer [Line Items]
Concentration risk, percentage	99.00%
Two Customer [Member]
Revenue, Major Customer [Line Items]
Concentration risk, percentage		98.00%