The Company changed its reportable business segments, beginning with the first quarter of 2019, to align with changes in how the Company manages its business, reviews operating performance and allocates resources. The Company now reports results under two reportable segments: Global Spine and Global Extremities. These reporting segments represent the operating segments for which the Chief Executive Officer, who is also Chief Operating Decision Maker (the “CODM”), reviews financial information and makes resource allocation decisions among businesses. The primary metric used by the CODM in managing the Company is earnings before interest, tax, depreciation, and amortization (“EBITDA”). The Company neither discretely allocates assets, other than goodwill, to its operating segments nor evaluates the operating segments using discrete asset information. Accordingly, the reporting segment information has been prepared based on these two reporting segments. Prior periods have been recast to present the change in reporting segements.

The Global Spine reporting segment offers three primary product categories: Bone Growth Therapies, Spinal Implants, and Biologics.

The Bone Growth Therapies product category manufactures, distributes, and provides support services of market leading bone growth stimulator devices that enhance bone fusion. These Class III medical devices are indicated as an adjunctive, noninvasive treatment to improve fusion success rates in the cervical and lumbar spine as well as a therapeutic treatment for non-spine fractures that have not healed (non-unions). This product category uses distributors and sales representatives to sell its devices to hospitals, healthcare providers, and patients, primarily in the U.S.

The Spinal Implants product category designs, develops, and markets a broad portfolio of motion preservation and fixation implant products used in surgical procedures of the spine. Spinal Implants distributes its products through a network of distributors and sales representatives to sell spine products to hospitals and healthcare providers, globally.

The Biologics product category provides a portfolio of regenerative products and tissue forms that allow physicians to successfully treat a variety of spinal and orthopedic conditions. This product category specializes in the marketing of the Company’s exclusive regeneration tissue forms and distributes its tissues to hospitals and healthcare providers, primarily in the U.S., through a network of independent distributors and sales representatives. The partnership with MTF allows the Company to exclusively market the Trinity Evolution and Trinity ELITE tissue forms for musculoskeletal defects to enhance bony fusion.

The Global Extremities reporting segment offers products and solutions that allow physicians to successfully treat a variety of orthopedic conditions unrelated to the spine. This reporting segment specializes in the design, development, and marketing of the Company’s orthopedic products used in fracture repair, deformity correction and bone reconstruction procedures. Global Extremities distributes its products through a network of distributors and sales representatives to sell orthopedic products to hospitals, and healthcare providers, globally.

Corporate activities are comprised of the operating expenses and activities of the Company not necessarily identifiable within the two reporting segments.

The table below presents net sales by major product category by reporting segment:

	Year Ended December 31,
	2019					2018					2017
(U.S. Dollars, in thousands)	Net Sales		Percent of Total Net Sales			Net Sales		Percent of Total Net Sales			Net Sales		Percent of Total Net Sales
Bone Growth Therapies	$	197,181		42.9	%	$	195,252		43.1	%	$	185,900		42.9	%
Spinal Implants		94,544		20.6	%		91,658		20.2	%		81,957		18.9	%
Biologics		65,496		14.2	%		59,684		13.2	%		62,724		14.4	%
Global Spine		357,221		77.7	%		346,594		76.5	%		330,581		76.2	%
Global Extremities		102,734		22.3	%		106,448		23.5	%		103,242		23.8	%
Net sales	$	459,955		100.0	%	$	453,042		100.0	%	$	433,823		100.0	%

The following table presents EBITDA, the primary metric used in managing the Company, by reporting segment:

	Year Ended December 31,
(U.S. Dollars, in thousands)	2019			2018			2017
Global Spine	$	39,528		$	76,545		$	84,034
Global Extremities		7,496			9,453			7,143
Corporate		(49,252	)		(43,626	)		(34,246	)
Total EBITDA		(2,228	)		42,372			56,931
Depreciation and amortization		(24,699	)		(18,659	)		(20,124	)
Interest expense, net		(122	)		(828	)		(416	)
Income (loss) before income taxes	$	(27,049	)	$	22,885		$	36,391

The following table presents depreciation and amortization by reporting segment:

	Year Ended December 31,
(U.S. Dollars, in thousands)	2019		2018		2017
Global Spine	$	14,329	$	9,512	$	9,834
Global Extremities		5,575		5,342		6,040
Corporate		4,795		3,805		4,250
Total	$	24,699	$	18,659	$	20,124

	Year Ended December 31,
(U.S. Dollars, in thousands)	2019		2018		2017
U.S.	$	361,939	$	355,353	$	345,145
Italy		19,560		19,331		17,059
Germany		12,688		11,606		7,063
United Kingdom		10,090		8,731		8,725
Brazil		7,685		7,120		10,356
Others		47,993		50,901		45,475
Net sales	$	459,955	$	453,042	$	433,823

The table below presents net sales by geographic destination for each reporting segment and for the consolidated Company:

	Year Ended December 31,
(U.S. Dollars, in thousands)	2019		2018		2017
Global Spine
U.S.	$	335,410	$	326,994	$	318,227
International		21,811		19,600		12,354
Total Global Spine		357,221		346,594		330,581

Global Extremities
U.S.		26,529		28,359		26,918
International		76,205		78,089		76,324
Total Global Extremities		102,734		106,448		103,242

Consolidated
U.S.		361,939		355,353		345,145
International		98,016		97,689		88,678
Net sales	$	459,955	$	453,042	$	433,823

(U.S. Dollars, in thousands)	2019		2018
U.S.	$	51,278	$	31,344
Italy		7,937		7,732
Germany		849		861
United Kingdom		1,082		896
Brazil		141		191
Others		1,440		1,811
Total	$	62,727	$	42,835