Property, Plant and Equipment, Type [Axis]
Surgical Instruments Property Equipments [Member]
Computer Equipment [Member]
Surgical Instruments [Member]
Vehicles [Member]
Leasehold Improvements [Member]
Furniture and Fixtures [Member]
Computer Software [Member]
Equipment [Member]
Credit Facility [Axis]
Twenty-Third Amendment to Amended and Restated Credit Agreement [Member]
Award Type [Axis]
January 1, 2019 through June 30, 2019 [Member]
July 1, 2019 through the maturity date [Member]
Through December 31, 2018 [Member]
Debt Instrument [Axis]
6.00% Convertible Senior Unsecured Notes [Member]
Subsidiary, Sale of Stock [Axis]
Private Placement SPA [Member]
Securities Purchase Agreement [Member]
2017 Notes [Member]
Antidilutive Securities [Axis]
Reverse Stock Split Before [Member]
Reverse Stock Split After [Member]
Range [Axis]
Minimum [Member]
Fair Value Hierarchy and NAV [Axis]
Fair Value, Inputs, Level 1 [Member]
Measurement Frequency [Axis]
Fair Value, Measurements, Recurring [Member]
Fair Value, Inputs, Level 2 [Member]
Fair Value, Inputs, Level 3 [Member]
Title of Individual [Axis]
Employees and Directors [Member]
Class of Stock [Axis]
Equity Option [Member]
Long-term Debt, Type [Axis]
Type of Arrangement and Non-arrangement Transactions [Axis]
Restructuring Agreement [Member]
Maximum [Member]
Plan Name [Axis]
2018 Equity Incentive Plan [Member]
Derivative Instrument [Axis]
Warrant [Member]
Restricted Stock Units (RSUs) [Member]
Equity Components [Axis]
Common Stock [Member]
Additional Paid-In Capital [Member]
Retained Deficit [Member]
Ownership [Axis]
OrbiMed Royalty Opportunities II, LP [Member]
Second Amended and Restated Credit Agreement [Member]
Investors [Member]
Scenario [Axis]
Forecast [Member]
Finite-Lived Intangible Assets by Major Class [Axis]
Tradenames, Technology and Customer Relationships [Member]
2018 Warrants [Member]
Related Party [Axis]
2019 Warrants [Member]
Award Date [Axis]
April 1, 2019 [Member]
April 5, 2019 [Member]
Sublease Agreement [Member]
Legal Entity [Axis]
Cardialen, Inc., [Member]
Concentration Risk Type [Axis]
Geographic Concentration Risk [Member]
Concentration Risk Benchmark [Axis]
Sales Revenue, Net [Member]
Geographical [Axis]
United States [Member]
Rest of World [Member]
Subsequent Event Type [Axis]
Subsequent Event [Member]
NYSE American LLC [Member]
Non-Plan Grants [Member]
Schedule Of Warrants Activities Used In Derivative Liability [Table Text Block]
Entity Registrant Name
Entity Central Index Key
Document Type
Document Period End Date
Amendment Flag
Current Fiscal Year End Date
Entity Filer Category
Entity Small Business Flag
Entity Emerging Growth Company
Entity Ex Transition Period
Entity Common Stock, Shares Outstanding
Trading symbol
Document Fiscal Period Focus
Document Fiscal Year Focus
Statement of Financial Position [Abstract]
ASSETS
Current Assets:
Cash and cash equivalents
Trade accounts receivable, net of allowance for doubtful accounts of $2,161 and $2,140, respectively
Inventories, net
Prepaid and other current assets
Total current assets
Property and equipment, net
Right-of-use asset, net
Goodwill
Intangible assets, net
Other assets
Total Assets
LIABILITIES & STOCKHOLDERS' EQUITY (DEFICIT)
Current Liabilities:
Accounts payable
Accrued liabilities
Warrant derivative liability
Current portion of lease liability
Current portion of financing lease obligations
Total current liabilities
Long-term Liabilities:
Lease liability, less current portion
Financing lease obligation, less current portion
Long-term debt, less issuance costs
Total Liabilities
Commitments and Contingencies (note 10)
Stockholders' Equity (Deficit):
Preferred stock, $0.000001 par value; 10,000,000 shares authorized; no shares issued and outstanding
Common stock, $0.000001 par value; 50,000,000 shares authorized; 13,161,762 shares issued and outstanding as of March 31, 2019 and 13,172,179 shares issued and outstanding as of December 31, 2018
Additional paid-in capital
Accumulated deficit
Total Stockholders' Equity (Deficit)
Total Liabilities & Stockholders' Equity (Deficit)
Trade accounts receivable, allowance for doubtful accounts
Preferred stock, par value
Preferred stock, shares authorized
Preferred stock, shares issued
Preferred stock, shares outstanding
Common stock, par value
Common stock, shares authorized
Common stock, shares issued
Common Stock, shares outstanding
Income Statement [Abstract]
Revenue
Orthopedic product sales
Other revenue
Total Revenue
Cost of sales
Gross Profit
Operating Expenses
General and administrative
Sales and marketing
Research and development
Depreciation and amortization
Restructuring expenses
Non-cash compensation expense
Total Operating Expenses
Loss from Operations
Other (Expense) Income
Interest expense
Change in warrant derivative liability
Other (expense) income
Total Other (Expense)
Net Loss Before Provision for Income Taxes
Provision for Income Taxes
Net Loss
Net loss per share:
Basic
Dilutive
Shares used in the computation:
Basic
Dilutive
Statement [Table]
Statement [Line Items]
Beginning Balance
Beginning Balance, Shares
Stock-based compensation
Issuance of common stock
Issuance of common stock, Shares
Forfeiture of restricted stock
Forfeiture of restricted stock, shares
Debt extinguishment
Issuance of warrant
Net loss
Ending Balance
Ending Balance, Shares
Statement of Cash Flows [Abstract]
Operating activities:
Adjustments to reconcile net loss to net cash provided by operating activities:
Depreciation and amortization
Loss/(gain) on disposal of fixed assets
Non-cash interest
Non-cash consulting expense/stock option expense
Provision for losses on accounts receivable and inventory
Change in derivative warrant liability
Changes in operating assets and liabilities:
Accounts receivable
Inventories
Prepaid and other assets
Accounts payable
Accrued liabilities
Net cash provided by operating activities
Investing activities:
Purchases of property and equipment and intangible assets
Proceeds from sale of fixed assets
Net cash used in investing activities
Financing activities:
Payments on financing leases
Expense associated with private placement and convertible debt conversion/exchange
Proceeds from issuance of stock
Net cash (used in) provided by financing activities
Net change in cash and cash equivalents
Cash and cash equivalents at beginning of period
Cash and cash equivalents at end of period
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Business Description and Summary of Significant Accounting Policies
Inventory Disclosure [Abstract]
Inventories, Net
Property, Plant and Equipment [Abstract]
Property and Equipment, Net
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill and Intangible Assets
Payables and Accruals [Abstract]
Accrued Liabilities
Debt Disclosure [Abstract]
Debt
Equity [Abstract]
Equity
Share-based Payment Arrangement [Abstract]
Stock-Based Compensation
Warrants and Rights Note Disclosure [Abstract]
Warrants
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies
Income Tax Disclosure [Abstract]
Income Taxes
Supplemental Cash Flow Elements [Abstract]
Supplemental Disclosure of Cash Flow Information
Related Party Transactions [Abstract]
Related Party Transactions
Segment Reporting [Abstract]
Segment and Geographic Information
Subsequent Events [Abstract]
Subsequent Events
Business Description
Corporate Restructuring
Concentrations and Credit Risk
Use of Estimates
Long-Lived Assets
Goodwill
Revenue Recognition
Research and Development
Net Loss Per Share
Fair Value of Financial Instruments
Recent Accounting Pronouncements
Schedule of Assets and Liabilities Measured on Recurring Basis
Schedule of Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation
Schedule of Inventories
Schedule of Property and Equipment, Net
Schedule of Intangible Assets
Schedule of Estimated Amortization Expense for Intangible Assets
Schedule of Accrued Liabilities
Schedule of Long-term Debt
Schedule of Maturities Due on Debt
Schedule of Share-based Compensation, Stock Options, Activity
Schedule of Assumptions of Stock Option Granted
Schedule of Warrant Activity
Schedule of Warrant Valuation Assumptions
Schedule of Warrants Activities Used in Derivative Liability
Schedule of Right-of-use Assets and Lease Liability
Schedule of Future Minimum Rental Payments for Operating Leases
Schedule of Future Minimum Lease Payments for Financing Leases
Schedule of Supplemental Cash Flow Information
Schedule of Revenues by Geographic Region
Collaborative Arrangement and Arrangement Other than Collaborative [Axis]
Statistical Measurement [Axis]
Sale of Stock [Axis]
Reverse stock split, description
Debt instrument due date description
Debt instrument, conversion price per share
Debt conversion, converted instrument, shares issued
Debt conversion, converted instrument, amount
Debt instrument, convertible, conversion ratio
Debt instrument, face amount
Non-controlling interest, ownership percentage by parent
Stock issued during period, shares, new issues
Shares issued, price per share
Rights offering expired
Stock issued during period, value, new issues
Outstanding common stock in percentage
Description of royalty opportunities
Ownership interest percentage description
Concentration risk percentage
Impairment of long-lived assets
Antidilutive securities excluded from computation of earnings per share, amount
Balance
Loss recognized in earnings
Balance
Implants and biological inventory
Raw materials
Work in process
Finished goods
Gross inventories
Reserve for obsolescence
Total inventories, net
Property, Plant and Equipment [Table]
Property, Plant and Equipment [Line Items]
Estimated useful lives of assets
Property, plant and equipment, net
Depreciation expense
Capital leased assets, gross
Capital leases, lessee balance sheet, assets by major class, accumulated depreciation
Total cost
Less: accumulated depreciation
Property and equipment, net
Goodwill impairment charge
Assets impairment charges
Patents
Accumulated amortization
Remainder of 2019
2020
2021
2022
2023
Thereafter
Total
Wages/commissions payable
Other accrued liabilities
Accrued Liabilities
Schedule of Long-term Debt Instruments [Table]
Debt instrument, basis spread on variable rate
Debt instrument interest rate portion payable in cash
Debt instrument, fee percentage
Debt instrument description
Credit facility percentage
Issuance of warrants to purchase a common stock
Exercise price of warrants
Warrants expiration date
Debt instrument face amount
Cash balance
Debt instrument maturity date
Long-term debt
Increase in additional paid-in capital
Accrued PIK interest
New effective interest rate
Amounts due under Second Amended and Restated Credit Agreement
Amounts due under Prior Credit Agreement
PIK interest payable related to Credit Agreements
Plus: 2% exit fee on Prior Credit Agreement
Gross long-term debt
Less: discount on Credit Agreements
Less: total debt issuance costs on Credit Agreements
Long-term debt, less issuance costs
Remainder of 2019
2020
2021
2022
2023
Thereafter
Total
Schedule of Equity Method Investments [Table]
Schedule of Equity Method Investments [Line Items]
Debt conversion of convertible debt
Additional debt principal amount
Share price
Right offering expired date
Term of plan, description
Number of common stock available for issuance
Options granted to purchase shares
Restricted stock granted during period, shares
Options to purchase shares of common stock forfeited and cancelled
Number of shares available for issuance
Intrinsic value of options outstanding
Stock options closing price per share
Exercise price share price
Allocated share-based compensation expense
Shares Outstanding, Beginning Balance
Shares Granted
Shares Cancelled or Expired
Shares Outstanding, Ending Balance
Shares Exercisable, Ending Balance
Weighted Average Exercise Price, Outstanding Beginning Balance
Weighted Average Exercise Price, Granted
Weighted Average Exercise Price, Cancelled or Expired
Weighted Average Exercise Price, Outstanding Ending Balance
Weighted Average Exercise Price, Exercisable Ending Balance
Weighted Average Fair Value at Grant Date, Outstanding Beginning Balance
Weighted Average Fair Value at Grant Date, Granted
Weighted Average Fair Value at Grant Date, Cancelled or Expired
Weighted Average Fair Value at Grant Date, Outstanding Ending Balance
Weighted Average Fair Value at Grant Date, Exercisable, Ending Balance
Stock-based Compensation - Schedule Of Assumptions Of Stock Option Granted
Risk free interest rate
Dividend yield
Expected term
Expected volatility
Expected forfeiture rate
Class of Warrant or Right [Table]
Class of Warrant or Right [Line Items]
Fair value of warrants
Number of outstanding common stock warrants
Unrealized loss on warranty derivative liability
Common Stock Warrants Outstanding, Beginning Balance
Common Stock Warrants, Issued
Common Stock Warrants, Expired
Common Stock Warrants Outstanding, Ending Balance
Weighted Average Exercise Price Outstanding Beginning Balance
Weighted Average Exercise Price, Issued
Weighted Average Exercise Price, Expired
Weighted Average Exercise Price Outstanding Ending Balance
Fair Value, by Balance Sheet Grouping [Table]
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Value of underlying common stock (per share)
Expected term in years
Volatility
Derivative warrants issued
Derivative warrants exercised
Derivative warrants expired
Operating lease expiration description
Lessee leasing arrangements operating leases term of each option to extend
Security deposits
Operating lease weighted-average remaining lease term
Operating lease weighted-average discount rate
Rent expense
Loss contingency, damages sought, value
Commitments And Contingencies - Schedule Of Right-of-use Assets And Lease Liability
Right-of-use assets, net
Total lease liability
Remainder of 2019
2020
2021
2022
2023
Thereafter
Total future minimum lease payments
Less amount representing interest
Present value of obligations under operating leases
Less current portion
Long-term operating lease obligations
Remainder of 2019
2020
2021
2022
2023
Thereafter
Total minimum lease payments
Less amount representing interest
Present value of obligations under capital leases
Less current portion
Long-term capital lease obligations
Interest or penalties related to income taxes
Interest
Issuance of capital leases
Lease liability from right-of-use assets
Interest converted into common stock
Conversion of convertible debt to equity
Convertible PIK interest
Conversion of interest related to the Credit Facility to long-term debt
Write-off of convertible debt issuance cost
Extinguishment of Prior Credit Agreement (including debt issuance costs)
Write-off of Prior Credit Agreement debt issuance costs and existing ROS fees
Recognition of Second Amended and Restated Credit Agreement
Recognition of 2019 Warrants
Schedule of Related Party Transactions, by Related Party [Table]
Related Party Transaction [Line Items]
Ownership percentage
Operating lease description
Monthly rental fee
Concentration risk, percentage
Total revenue
Variable Rate [Axis]
Receipt of noncompliance notification description
Accrued Liabilities.
Amended and Restated Credit Agreement [Member]
April 1, 2019 [Member]
Bacterin Employee [Member]
Disclosure of accounting policy for the business description .Business description describes the nature and type of organization including but not limited to organizational structure as may be applicable to holding companies, parent and subsidiary relationships, business divisions, business units, business segments, affiliates and information about significant ownership of the reporting entity.
Amount of debt issuance costs (for example, but not limited to, legal, accounting, broker, and regulatory fees).
Computer Software [Member]
Credit facility percentage.
Represents the percentage of fee payable on a debt.
Interest rate payable in cash related to the debt instrument.
The description of royalty opportunities.
Direct Sales [Member]
Discount on credit facility.
Employee [Member]
Employees and Directors [Member]
Exit fee on prior credit agreement.
Forecast [Member]
Former Non-Employee Directors [Member]
Independent Agents [Member]
Investors [Member]
January 1, 2019 through June 30, 2019 [Member]
July 1, 2019 through the maturity date [Member]
Non-Employee Directors [Member]
The value represent non cash interest expense during the period.
One Non-Employee Director [Member]
Orbi Med [Member]
OrbiMed Royalty Opportunities II, LP [Member]
Orthobiologics [Member]
Disclosure of other equity transactions like warrants issued and its activities.
The percentage representing outstanding common stock.
Ownership interest percentage description.
Phoenix Surgical, Inc [Member]
Prior Plan [Member]
Amount of the current period expense charged against provision for losses on accounts receivable and inventory.
Rest of World [Member]
Restructuring Agreement [Member]
Reverse Stock Split After [Member]
Reverse Stock Split Before [Member]
Rights offering expired.
Schedule Of Accured Liabilities [Table Text Block]
Tabular disclosure of the carrying amount as of the balance sheet date of current and noncurrent inventory consisting of merchandise, goods, commodities, or supplies held for future sale or to be used in manufacturing, servicing or production process.
Tabular disclosure of the changes in outstanding warrants.
Tabular disclosure of warrants activities used in derivative liability.
Second Amended and Restated Credit Agreement [Member]
Securities Purchase Agreement [Member]
during the reporting period as calculated by applying the disclosed option pricing methodology.
The weighted average grant-date fair value of options exercisable during the reporting period as calculated by applying the disclosed option pricing methodology.
The weighted average grant-date fair value of options outstanding during the reporting period as calculated by applying the disclosed option pricing methodology.
Six Percentage Convertible Senior Unsecured Notes [Member]
Spinal Implant [Member]
Surgical Instruments [Member]
Surgical Instruments Property Equipments [Member]
Term of plan, description.
Through December 31, 2018 [Member]
Tradenames, Technology and Customer Relationships [Member]
Twenty-Third Amendment to Amended and Restated Credit Agreement [Member]
2018 Equity Incentive Plan [Member]
2018 Warrants [Member]
2018 Warrants [Member]
2019 Warrants [Member]
2017 Notes [Member]
X-Spine Employee [Member]
Other Revenue [Member]
Schedule Of Warrant Activity [Table Text Block]
Warrant Activity.
Number of shares called by warrants issued.
Represents the number of warrants expired
Average exercise price of warrant issued.
Number of warrants expired during the period.
Value of underlying common stock (per share)
Derivative warrants issued.
Derivative warrants exercised.
Derivative warrants expired.
Represents the period of time by which the operating lease term is extended under each option to extend.
Schedule Of Supplement Cash Flow Element Table
Schedule Of Supplement Cash Flow Element Line Items
Lease liability from right-of-use assets.
The amount of convertible kind interest related to non-cash activity.
The amount of conversion of interest related to the Credit Facility to long-term debt related to non-cash activity.
The amount of write-off of convertible debt issuance cost related to non-cash activity.
Extinguishment of Prior Credit Agreement (including debt issuance costs).
Write-off of Prior Credit Agreement debt issuance costs and existing ROS fees.
Recognition of Second Amended and Restated Credit Agreement.
Recognition of 2019 Warrants.
April 5, 2019 [Member]
Sublease Agreement [Member]
Cardialen, Inc., [Member]
NYSE American LLC [Member]
Debt instrument additional face amount.
Right offering expired date.
Including the current and noncurrent portions, aggregate carrying value as of the balance sheet date of loans payable (with maturities initially due after one year or beyond the operating cycle if longer).
Private Placement SPA [Member]
Non-Plan Grants [Member]
Stock options closing price per share.
Schedule of Right-of-use Assets and Lease Liability [Table Text Block]
Increase in additional paid-in capital.
Share based compensation arrangement by share based payment award fair value assumptions expected forfeiture rate.
Operating lease imputed interest.
Assets, Current
Assets
Liabilities, Current
Liabilities
Stockholders' Equity Attributable to Parent
Liabilities and Equity
Gross Profit
Operating Expenses [Default Label]
Operating Income (Loss)
Interest Expense
Nonoperating Income (Expense)
Weighted Average Number of Shares Outstanding, Basic
Weighted Average Number of Shares Outstanding, Diluted
Shares, Outstanding
Depreciation, Depletion and Amortization
Gain (Loss) on Disposition of Property Plant Equipment
Increase (Decrease) in Accounts Receivable
Increase (Decrease) in Inventories
Increase (Decrease) in Prepaid Expense and Other Assets
Increase (Decrease) in Accounts Payable
Increase (Decrease) in Accrued Liabilities
Net Cash Provided by (Used in) Operating Activities
Payments to Acquire Productive Assets
Net Cash Provided by (Used in) Investing Activities
Repayments of Long-term Capital Lease Obligations
Payment of Financing and Stock Issuance Costs
Net Cash Provided by (Used in) Financing Activities
Cash and Cash Equivalents, Period Increase (Decrease)
Goodwill and Intangible Assets, Goodwill, Policy [Policy Text Block]
Fair Value, Measurement with Unobservable Inputs Reconciliation, Recurring Basis, Liability Value
Inventory, Gross
Inventory Adjustments
Accumulated Depreciation, Depletion and Amortization, Property, Plant, and Equipment
Finite-Lived Intangible Assets, Accumulated Amortization
Finite-Lived Intangible Assets, Net
Long-term Debt, Gross
Capitalized Debt Issuance Costs
Long-term Debt, Maturities, Repayments of Principal, Remainder of Fiscal Year
Long-term Debt, Maturities, Repayments of Principal in Year Two
Long-term Debt, Maturities, Repayments of Principal in Year Three
Long-term Debt, Maturities, Repayments of Principal in Year Four
Long-term Debt, Maturities, Repayments of Principal in Year Five
Long-term Debt, Maturities, Repayments of Principal after Year Five
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding, Number
Share-based Compensation Arrangement by Share-based Payment Award, Options, Exercisable, Number
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding, Weighted Average Exercise Price
Share-based Compensation Arrangement by Share-based Payment Award, Options, Exercisable, Weighted Average Exercise Price
Share Based Compensation Arrangement By Share Based Payment Award Options Outstanding Weighted Average Grant Date Fair Value
Share Based Compensation Arrangement By Share Based Payment Award Options Exercisable Weighted Average Grant Date Fair Value
Warrant Outstanding Shares Expired
Operating Leases, Future Minimum Payments, Remainder of Fiscal Year
Operating Leases, Future Minimum Payments, Due in Two Years
Operating Leases, Future Minimum Payments, Due in Three Years
Operating Leases, Future Minimum Payments, Due in Four Years
Operating Leases, Future Minimum Payments, Due in Five Years
Operating Leases, Future Minimum Payments, Due Thereafter
Operating Leases, Future Minimum Payments Due
Capital Leases, Future Minimum Payments, Remainder of Fiscal Year
Capital Leases, Future Minimum Payments Due in Two Years
Capital Leases, Future Minimum Payments Due in Three Years
Capital Leases, Future Minimum Payments Due in Four Years
Capital Leases, Future Minimum Payments Due in Five Years
Capital Leases, Future Minimum Payments Due Thereafter
Capital Leases, Future Minimum Payments Due
Capital Leases, Future Minimum Payments, Interest Included in Payments