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Summary of Significant Accounting Policies - Narrative (Details) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2024 USD ($) activity $ / shares	Mar. 31, 2023 USD ($) $ / shares	Jan. 01, 2024	Dec. 31, 2023
Property, Plant and Equipment [Line Items]
Depreciation expense, decrease \| $	$ (1,100)	$ (1,100)
Decrease in net loss \| $	$ (10,904)	$ (11,125)
Net loss per share, basic (in usd per share) \| $ / shares	$ (0.27)	$ (0.32)
Net loss per share, diluted (in usd per share) \| $ / shares	$ (0.27)	$ (0.32)
Number of business activities \| activity	1
Service life
Property, Plant and Equipment [Line Items]
Depreciation expense, decrease \| $	$ 500
Decrease in net loss \| $	$ 500
Net loss per share, basic (in usd per share) \| $ / shares	$ 0.01
Net loss per share, diluted (in usd per share) \| $ / shares	$ 0.01
Instrument trays
Property, Plant and Equipment [Line Items]
Estimated useful life			5 years	3 years

- Definition

The amount of net income (loss) for the period per each share of common stock or unit outstanding during the reporting period.

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- Definition

The amount of net income (loss) for the period available to each share of common stock or common unit outstanding during the reporting period and to each share or unit that would have been outstanding assuming the issuance of common shares or units for all dilutive potential common shares or units outstanding during the reporting period.

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- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

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+ Details

Stock-Based Incentive Compensation Plans

3 Months Ended

Mar. 31, 2024

Share-Based Payment Arrangement [Abstract]

Stock-Based Incentive Compensation Plans

Stock Options

The table below summarizes the stock option activity for the three months ended March 31, 2024:


	Number of Shares	Weighted- Average Exercise Price		Weighted-Average Contractual Remaining Life (Years)	Aggregate Intrinsic Value (in thousands)
Outstanding as of December 31, 2023	1,188,708	$	10.14	3.51	$	13,197

Exercised	(29,892)	$	3.49
Canceled and forfeited	—	—
Outstanding as of March 31, 2024	1,158,816	$	10.31	3.34	$	8,839
Options vested and exercisable, March 31, 2024	1,158,816	$	10.31	3.34	$	8,839
Options vested and expected to vest, March 31, 2024	1,158,816	$	10.31	3.34	$	8,839

As of March 31, 2024, there is no unrecognized compensation cost related to stock options.

There were no stock options granted during the three months ended March 31, 2024 and 2023.

Restricted Stock Units (“RSUs”)

RSUs are share awards that entitle the holder to receive freely tradable shares of the Company’s common stock upon vesting. RSUs generally vest over two to four years based upon continued services and are settled at vesting in shares of the Company's common stock. Certain RSUs vest based upon continued services and the achievement of financial milestones. The grant date fair value of the RSUs is equal to the closing price of the Company’s common stock on the grant date. As of March 31, 2024, the unrecognized compensation cost related to the RSUs was $36.5 million, which is expected to be recognized over a period of approximately 2.6 years.

The Company granted performance-based restricted stock unit awards subject to market and service vesting conditions to certain executive officers under SI-BONE's 2018 Equity Incentive Plan (“PSUs”). The shares subject to PSUs vest over a three-year performance period. The actual number of PSUs that will vest in each measurement period will be determined by the Compensation Committee based on the Company’s total shareholder return (“TSR”) relative to the TSR of the Median Peer Companies (as defined in the award agreement). The grant date fair value of each stock award with a market condition was determined using the Monte Carlo valuation model. The table below summarizes the assumptions used to estimate the grant date fair value of the PSUs granted:


	Three Months Ended March 31,
						2024				2023
Expected volatility of common stock				47.0%	to	59.0%		58.0%	to	73.0%
Expected volatility of peer companies						29.0%	to	97.0%		33.0%	to	141.0%
Correlation coefficient of peer companies				(0.01)	to	1.00		(0.15)	to	1.00
Risk-free interest rate						4.1%	to	4.7%		3.9%	to	5.0%
Dividend yield	0.6%	to	4.7%	—%	to	1.3%

As of March 31, 2024, the unrecognized compensation cost related to the PSUs was $7.0 million, which is expected to be recognized over a period of approximately 2.4 years.

The table below summarizes RSU and PSU activity for the three months ended March 31, 2024:


	RSUs		PSUs
	Number of Shares	Weighted Average Grant Date Fair Value	Number of Shares	Weighted Average Grant Date Fair Value
Outstanding as of December 31, 2023	1,899,790	$19.93	385,122	$14.74
Granted	615,056	20.48	319,858	18.48
Vested	(261,132)	20.52	(94,439)	16.27
Canceled and forfeited	(17,234)	20.95	—	—
Outstanding as of March 31, 2024	2,236,480	20.01	610,541	16.47

Employee Stock Purchase Plan

The Company’s 2018 Employee Stock Purchase Plan (the “ESPP”) allows eligible employees to purchase shares of the Company's common stock through payroll deductions at the price equal to 85% of the lesser of the fair market value of the stock as of the first date or the ending date of each six month offering period. The offering period generally commences in May and November. On March 26, 2020, the Company's Compensation Committee approved the amendment of the terms of future offerings under the ESPP which, among other things, increased the maximum number of shares that may be purchased on any single purchase date, provided for automatic enrollment in a new offering.

The fair value of the ESPP shares is estimated using the Black-Scholes option pricing model, which is being amortized over the requisite service period. The Company did not issue any shares under ESPP for the three months ended March 31, 2024 and 2023. As of March 31, 2024 and December 31, 2023, total accumulated ESPP related employee payroll deductions amounted to $1.4 million and $0.4 million, respectively, which were included within accrued compensation and related expenses in the condensed consolidated balance sheets.

Stock-Based Compensation

The table below presents the detail of stock-based compensation expense amounts included in the condensed consolidated statements of operations:


	Three Months Ended March 31,
	2024		2023
	(in thousands)
Cost of goods sold	$	235	$	137
Sales and marketing	3,221		2,910
Research and development	820		752
General and administrative	2,754		2,395
	$	7,030	$	6,194

Warrants

The table below summarizes common stock warrants activity for the three months ended March 31, 2024:


Date		Outstanding Balance at December 31, 2023	Price per Share		Warrants Issued	Warrant Exercised	Warrant Expired	Outstanding Balance at March 31, 2024
Issuance	Expiration
3/1/2017	3/1/2027	1,388	$	5.94	—	—	—	1,388
11/26/2014	11/26/2024	6,680	$	16.47	—	—	—	6,680
10/20/2015	10/20/2025	41,650	$	16.47	—	—	—	41,650
11/9/2015	11/9/2025	25,709	$	16.47	—		—	25,709
12/22/2016	12/22/2026	9,712	$	10.03	—	—	—	9,712
		85,139			—	—	—	85,139

Balance Sheet Components - Accrued Liabilities and Other (Details) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Accrued Liabilities and Other
Accrued compensation and related expenses	$ 8,034	$ 13,464
Accrued royalty	1,447	1,360
Accrued professional services	666	929
Others	1,620	1,699
Accrued liabilities and other	$ 11,767	$ 17,452

Summary of Significant Accounting Policies (Policies)	3 Months Ended
Summary of Significant Accounting Policies (Policies)	Mar. 31, 2024
Accounting Policies [Abstract]
Basis of Presentation	The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with generally accepted accounting principles in the United States of America (“U.S. GAAP”) and applicable rules and regulations of the Securities and Exchange Commission (“SEC”) regarding interim financial reporting. As permitted under those rules, certain footnotes or other financial information that are normally required by U.S. GAAP have been condensed or omitted, and accordingly the balance sheet as of December 31, 2023 has been derived from the audited consolidated financial statements at that date but does not include all of the information required by GAAP for complete financial statements.
Principles of Consolidation	These unaudited interim condensed consolidated financial statements have been prepared on the same basis as the Company’s annual financial statements and, in the opinion of management, reflect all adjustments that are necessary for a fair statement of the Company’s consolidated financial information. The results of operations for the three months ended March 31, 2024 are not necessarily indicative of the results to be expected for the year ending December 31, 2024 or for any other interim period or for any other future year.
Use of Estimates and Change in accounting estimate	Use of Estimates The preparation of financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities as of the date of the financial statements and the reported amounts of revenue and expenses during the reporting period. Significant accounting estimates and management judgments reflected in the condensed consolidated financial statements primarily includes the fair value of performance-based restricted stock unit awards. Estimates are based on historical experience, where applicable and other assumptions believed to be reasonable by the management. Actual results could differ from those estimates. Change in accounting estimate During the current quarter, the Company reassessed the useful life of its instrument trays based on a comprehensive evaluation of usage trends and its estimate on the average life of instruments before loss or damage that requires disposal. As a result of this review, the Company determined that extending the useful life of its instrument trays would more accurately reflect its anticipated future economic benefits. Effective January 1, 2024, the Company changed its estimates of the useful lives of instrument trays from three to five years. The effect of this change in estimate reduced depreciation expense by $0.5 million, resulting in a decrease in net loss of $0.5 million and basic and diluted earnings per share by $0.01 for the three months ended March 31, 2024.
Segments	Segments The Company's chief operating decision makers are the Chief Executive Officer (“CEO”) and Chief Financial Officer (“CFO”). The CEO and the CFO review financial information presented on a consolidated basis, accompanied by information about revenue by geographic region, for purposes of evaluating financial performance. The Company has one business activity and there are no segment managers who are held accountable for operations, operating results or plans for levels or components below the consolidated unit level. Accordingly, the Company has determined that it has a single reportable and operating segment structure. The Company derives substantially all of its revenue from sales to customers in the U.S. Revenue by geography is based on billing address of the customer. International revenue accounted for less than 10% of the total revenue during the periods presented. Long-lived assets held outside the U.S. are immaterial.
Recent Accounting Pronouncements	Recent Accounting Pronouncements In October 2023, the Financial Accounting Standards Board ("FASB") issued ASU 2023-06, Disclosure Agreements - Codification Amendments in Response to the SEC’s Disclosure Update and Simplification Initiative ("ASU 2023-06"). This amendment will impact various disclosure areas, including the statement of cash flows, accounting changes and error corrections, earnings per share, debt, equity, derivatives, and transfers of financial assets. The amendments in this ASU 2023-06 will be effective on the date the related disclosures are removed from Regulation S-X or Regulation S-K by the SEC, and will no longer be effective if the SEC has not removed the applicable disclosure requirement by June 30, 2027. Early adoption is prohibited. The Company is currently evaluating the impacts of the amendment on its disclosures. In November 2023, the FASB issued ASU 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures. ASU 2023-07 requires companies with a single reportable segment to provide all existing segment disclosures, as well as requires incremental segment information to be disclosed. The guidance is effective for fiscal years beginning after December 15, 2023 on a retrospective basis, and interim periods within fiscal years beginning after December 15, 2024. Early adoption is permitted. The Company is currently evaluating the guidance to determine the impact on its disclosures. In December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures ("ASU 2023-09"). ASU 2023-09 requires public business entities to disclose additional information in specified categories with respect to the reconciliation of the effective tax rate to the statutory rate (the rate reconciliation) for federal, state, and foreign income taxes. It also requires greater detail about individual reconciling items in the rate reconciliation to the extent the impact of those items exceeds a specified threshold. ASU 2023-09 is effective for fiscal years beginning after December 15, 2024, and for interim periods for fiscal years beginning after December 15, 2025. The Company is currently evaluating the impacts of ASU 2023-09 on its disclosures. In March 2024, the FASB issued ASU 2024-02 Codification Improvements. ASU 2024-02 amends the Codification to remove references to various concepts statements and impacts a variety of topics in the codification. The amendments apply to all reporting entities within the scope of the affected accounting guidance, but in most instances the references removed are extraneous and not required to understand or apply the guidance. Generally, the amendments in ASU 2024-02 are not intended to result in significant accounting changes for most entities. ASU 2024-02 is effective January 1, 2025, and the Company is currently evaluating the impacts of the amendment on its disclosures.

- Definition

Disclosure of accounting policy for segment reporting.

+ References + Details

The Company and Nature of Business (Details) - USD ($) $ / shares in Units, $ in Millions	1 Months Ended	3 Months Ended
	May 31, 2023	Mar. 31, 2024	Mar. 31, 2023
Subsidiary, Sale of Stock [Line Items]
Additional shares purchased after exercise of option (in shares)		29,892
Common Stock
Subsidiary, Sale of Stock [Line Items]
Proceeds from public offering, net of discounts, commissions and offering costs	$ 83.7
Issuance of common stock from public offerings, net of underwriting discounts, commissions and offering costs (in shares)	3,775,000
Additional shares purchased after exercise of option (in shares)	566,250	29,892	120,266,000
Public offering price (in dollars per share)	$ 22.00
Number of shares offered by a selling stockholder (in shares)	272,753

Commitments and Contingencies - Narrative (Details) - USD ($)	3 Months Ended
	Mar. 31, 2024	Dec. 31, 2023
Other Commitments [Line Items]
Operating lease liabilities that had not commenced.	$ 0
Purchase commitments related to inventory management and training materials	200,000	$ 400,000
Indemnification Agreement
Other Commitments [Line Items]
Costs to defend lawsuits or settle claims	0
Liability associated with indemnifications	$ 0

CONDENSED CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Statement of Financial Position [Abstract]
Allowance for doubtful accounts	$ 1,189	$ 1,118
Preferred stock, par value (in dollars per share)	$ 0.0001	$ 0.0001
Preferred stock authorized (in shares)	5,000,000	5,000,000
Preferred stock issued (in shares)	0	0
Preferred stock outstanding (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.0001	$ 0.0001
Common stock authorized (in shares)	100,000,000	100,000,000
Common stock issued (in shares)	41,078,762	40,693,299
Common stock outstanding (in shares)	41,078,762	40,693,299

Commitments and Contingencies (Tables)

3 Months Ended

Mar. 31, 2024

Commitments and Contingencies Disclosure [Abstract]

Summary of Information Related to Lease Expense and Valuation of Lease Assets and Lease Liabilities

Supplemental information related to lease expense and valuation of the lease assets and lease liabilities are as follows:


	Three Months Ended March 31,
	2024		2023
Operating lease expense	$	383	$	394
Variable lease expense	135		76
Total lease expense	$	518	$	470

Cash paid for amounts included in the measurement of operating lease liabilities	$	397	$	398
Leased assets obtained in exchange for new operating lease liabilities	$	—	$	21

	March 31, 2024		December 31, 2023
Weighted average remaining lease term (in years)	2.02		2.20
Weighted average discount rate	5.91%		5.87%

Schedule of Future Minimum Lease Payments Under Non-Cancelable Operating Leases

Future minimum lease payments under non-cancelable operating leases as of March 31, 2024 was as follows:


Year Ending December 31,	(in thousands)
Remainder of 2024	$	1,160
2025	1,053
2026	563
2027	7
2028	—
Thereafter	—
Total operating lease payments	2,783
Less: imputed interest	(158)
Total operating lease liabilities	$	2,625

Commitments and Contingencies

3 Months Ended

Mar. 31, 2024

Commitments and Contingencies Disclosure [Abstract]

Commitments and Contingencies

Operating Leases

The Company has a non-cancelable operating lease for an office building space, located in Santa Clara, California which expires in May 2025 and a building used for research and development and warehouse space in Santa Clara, California which expires in October 2026. The Company also has a non-cancelable operating lease for its office building spaces in Gallarate, Italy which expires in August 2027.

The Company also leases vehicles under operating lease arrangements for certain of its personnel in Europe which expire at various times throughout 2024 to 2026.

Supplemental information related to lease expense and valuation of the lease assets and lease liabilities are as follows:


	Three Months Ended March 31,
	2024		2023
Operating lease expense	$	383	$	394
Variable lease expense	135		76
Total lease expense	$	518	$	470

Cash paid for amounts included in the measurement of operating lease liabilities	$	397	$	398
Leased assets obtained in exchange for new operating lease liabilities	$	—	$	21

	March 31, 2024		December 31, 2023
Weighted average remaining lease term (in years)	2.02		2.20
Weighted average discount rate	5.91%		5.87%

Future minimum lease payments under non-cancelable operating leases as of March 31, 2024 was as follows:


Year Ending December 31,	(in thousands)
Remainder of 2024	$	1,160
2025	1,053
2026	563
2027	7
2028	—
Thereafter	—
Total operating lease payments	2,783
Less: imputed interest	(158)
Total operating lease liabilities	$	2,625

As of March 31, 2024, the Company had no operating lease liabilities that had not commenced.

Purchase Commitments and Obligations

The Company has certain purchase commitments related to its inventory management with certain manufacturing suppliers wherein the Company is required to purchase the amounts forecasted in a blanket purchase order. The contractual obligations

represent future cash commitments and liabilities under agreements with third parties and exclude orders for goods and services entered into in the normal course of business that are not enforceable or legally binding. These outstanding commitments amounted to $0.2 million and $0.4 million as of March 31, 2024 and December 31, 2023, respectively.

Indemnification

The Company enters into standard indemnification arrangements in the ordinary course of business. Pursuant to these arrangements, the Company indemnifies, holds harmless, and agrees to reimburse the indemnified parties for losses suffered or incurred by the indemnified party, in connection with any trade secret, copyright, patent or other intellectual property infringement claim by any third-party with respect to the Company’s technology. The term of these indemnification agreements is generally perpetual. The maximum potential amount of future payments the Company could be required to make under these agreements is not determinable because it involves claims that may be made against the Company in the future, but have not yet been made.

The Company has entered into indemnification agreements with its directors and officers that may require the Company to indemnify its directors and officers against liabilities that may arise by reason of their status or service as directors or officers, other than liabilities arising from willful misconduct of the individual.

The Company has not incurred costs to defend lawsuits or settle claims related to these indemnification agreements. No liability associated with such indemnifications has been recorded to date.

Legal Contingencies

From time to time, the Company may become involved in legal proceedings arising in the ordinary course of its business. The Company is not presently a party to any material legal proceedings that, if determined adversely to the Company, would have a material adverse effect on the Company.

Marketable Securities (Tables)

3 Months Ended

Mar. 31, 2024

Investments, Debt and Equity Securities [Abstract]

Schedule of Marketable Securities

The table below summarizes the marketable securities:


	March 31, 2024
	Amortized Cost		Unrealized Gains		Unrealized Losses		Aggregate Fair Value
	(in thousands)
Money market funds	$	22,953	$	—	$	—	$	22,953


Cash equivalents	22,953		—		—		22,953

U.S. treasury securities	125,814		2		(34)		125,782



Short-term investments	125,814		2		(34)		125,782



Total marketable securities	$	148,767	$	2	$	(34)	$	148,735


	December 31, 2023
	Amortized Cost		Unrealized Gains		Unrealized Losses		Aggregate Fair Value
	(in thousands)
Money market funds	$	23,331	$	—	$	—	$	23,331

Cash equivalents	23,331		—		—		23,331

U.S. treasury securities	129,695		67		—		129,762
U.S. agency bonds	2,988		—		(2)		2,986


Short-term investments	132,683		67		(2)		132,748



Total marketable securities	$	156,014	$	67	$	(2)	$	156,079

Summary of Significant Accounting Policies - Revenue by Geography (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Disaggregation of Revenue [Line Items]
Revenue	$ 37,867	$ 32,708
United States
Disaggregation of Revenue [Line Items]
Revenue	35,425	30,450
International
Disaggregation of Revenue [Line Items]
Revenue	$ 2,442	$ 2,258

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References + Details

- 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
-Topic 924
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SAB Topic 11.L)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479941/924-10-S99-1

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 5
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-5

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 30
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-30

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 42
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-42

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 22
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-22

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-32

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 40
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-40

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 22
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-22

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-32

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 41
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482810/280-10-50-41

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 4
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479806/606-10-50-4

+ Details

Fair Value Measurement

3 Months Ended

Mar. 31, 2024

Fair Value Disclosures [Abstract]

Fair Value Measurement

Carrying amounts of certain of the Company’s financial instruments, including cash equivalents, accounts receivable, accounts payable and accrued liabilities, approximate fair value due to their relatively short maturities and market interest rates, if applicable. The carrying value of the Company’s long-term debt also approximates fair value based on management’s estimation that a current interest rate would not differ materially from the stated rate. There were no other financial assets and liabilities that require fair value hierarchy measurements and disclosures for the periods presented.

The table below summarizes the fair value of the Company’s marketable securities measured at fair value on a recurring basis based on the three-tier fair value hierarchy:


	March 31, 2024
	Level 1		Level 2		Level 3		Total
	(in thousands)
Marketable securities
Money market funds	$	22,953	$	—	$	—	$	22,953
U.S. treasury securities	125,782		—		—		125,782



Total marketable securities	$	148,735	$	—	$	—	$	148,735

	December 31, 2023
	Level 1		Level 2		Level 3		Total
	(in thousands)
Marketable securities
Money market funds	$	23,331	$	—	$	—	$	23,331
U.S. treasury securities	129,762		—		—		129,762
U.S. agency bonds	—		2,986		—		2,986


Total marketable securities	$	153,093	$	2,986	$	—	$	156,079

- Definition

The entire disclosure for the fair value of financial instruments (as defined), including financial assets and financial liabilities (collectively, as defined), and the measurements of those instruments as well as disclosures related to the fair value of non-financial assets and liabilities. Such disclosures about the financial instruments, assets, and liabilities would include: (1) the fair value of the required items together with their carrying amounts (as appropriate); (2) for items for which it is not practicable to estimate fair value, disclosure would include: (a) information pertinent to estimating fair value (including, carrying amount, effective interest rate, and maturity, and (b) the reasons why it is not practicable to estimate fair value; (3) significant concentrations of credit risk including: (a) information about the activity, region, or economic characteristics identifying a concentration, (b) the maximum amount of loss the entity is exposed to based on the gross fair value of the related item, (c) policy for requiring collateral or other security and information as to accessing such collateral or security, and (d) the nature and brief description of such collateral or security; (4) quantitative information about market risks and how such risks are managed; (5) for items measured on both a recurring and nonrecurring basis information regarding the inputs used to develop the fair value measurement; and (6) for items presented in the financial statement for which fair value measurement is elected: (a) information necessary to understand the reasons for the election, (b) discussion of the effect of fair value changes on earnings, (c) a description of [similar groups] items for which the election is made and the relation thereof to the balance sheet, the aggregate carrying value of items included in the balance sheet that are not eligible for the election; (7) all other required (as defined) and desired information.

+ References + Details

The Company and Nature of Business	3 Months Ended
The Company and Nature of Business	Mar. 31, 2024
Organization, Consolidation and Presentation of Financial Statements [Abstract]
The Company and Nature of Business	The Company and Nature of Business SI-BONE, Inc. (the “Company”) was incorporated in the state of Delaware on March 18, 2008 and is headquartered in Santa Clara, California. The Company is a medical device company that has pioneered a family of proprietary minimally invasive surgical implants to fuse the sacroiliac joint for treatment of musculoskeletal disorders of the sacropelvic anatomy. The Company introduced its first generation iFuse implant in 2009 in the U.S., in 2010 in certain countries in the European Union, and in 2015 in certain countries in the rest of the world. The second generation iFuse implant, iFuse-3D, was introduced in 2017 followed by iFuse-TORQ in 2021, iFuse Bedrock Granite in 2022 and iFuse INTRA in January 2024. In May 2023, the Company received a total of $83.7 million of net proceeds after deducting the underwriting discounts and commissions from the offering of 3,775,000 shares of the Company’s common stock and the exercise of underwriter's option to purchase from the Company an additional 566,250 shares of the Company's common stock, at a public offering price of $22.00 per share. Of these shares, 272,753 shares were offered by a selling stockholder and did not result in any proceeds to the Company

Marketable Securities - Narrative (Details) - USD ($)	3 Months Ended	12 Months Ended
Marketable Securities - Narrative (Details) - USD ($)	Mar. 31, 2024	Dec. 31, 2023
Investments, Debt and Equity Securities [Abstract]
Credit losses on investments	$ 0	$ 0
Accrued interest receivable	$ 200,000
Debt Securities, Available-for-Sale, Accrued Interest, after Allowance for Credit Loss, Statement of Financial Position [Extensible Enumeration]	Prepaid expenses and other current assets
Accrued interest writeoff	$ 0	$ 0

CONDENSED CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Current assets:
Cash and cash equivalents	$ 32,040	$ 33,271
Short-term investments	125,782	132,748
Accounts receivable, net of allowance for credit losses of $1,189 and $1,118, respectively	22,109	21,953
Inventory	21,049	20,249
Prepaid expenses and other current assets	2,647	3,173
Total current assets	203,627	211,394
Property and equipment, net	17,348	16,000
Operating lease right-of-use assets	2,415	2,706
Other non-current assets	323	325
TOTAL ASSETS	223,713	230,425
Current liabilities:
Accounts payable	7,661	4,588
Accrued liabilities and other	11,767	17,452
Operating lease liabilities, current portion	1,433	1,416
Total current liabilities	20,861	23,456
Long-term borrowings	36,107	36,065
Operating lease liabilities, net of current portion	1,192	1,511
Other long-term liabilities	16	18
TOTAL LIABILITIES	58,176	61,050
Commitments and contingencies (Note 6)
STOCKHOLDERS’ EQUITY
Preferred stock, $0.0001 par value; 5,000,000 shares authorized; no shares issued and outstanding	0	0
Common stock, $0.0001 par value; 100,000,000 shares authorized; 41,078,762 and 40,693,299 shares issued and outstanding, respectively	4	4
Additional paid-in capital	576,612	569,477
Accumulated other comprehensive income	266	335
Accumulated deficit	(411,345)	(400,441)
TOTAL STOCKHOLDERS’ EQUITY	165,537	169,375
TOTAL LIABILITIES AND STOCKHOLDERS’ EQUITY	$ 223,713	$ 230,425

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE LOSS - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Income Statement [Abstract]
Revenue	$ 37,867	$ 32,708
Cost of goods sold	8,002	5,924
Gross profit	29,865	26,784
Operating expenses:
Sales and marketing	29,387	27,313
Research and development	4,345	3,291
General and administrative	8,176	7,473
Total operating expenses	41,908	38,077
Loss from operations	(12,043)	(11,293)
Interest and other income (expense), net:
Interest income	2,113	932
Interest expense	(881)	(838)
Other income (expense)	(93)	74
Net loss	(10,904)	(11,125)
Other comprehensive income (loss):
Changes in foreign currency translation	29	(22)
Unrealized gain (loss) on marketable securities	(98)	90
Comprehensive loss	$ (10,973)	$ (11,057)
Net loss per share, basic (in usd per share)	$ (0.27)	$ (0.32)
Net loss per share, diluted (in usd per share)	$ (0.27)	$ (0.32)
Weighted-average number of common shares used to compute basic net loss per share (in shares)	40,934,392	34,916,106
Weighted-average number of common shares used to compute diluted net loss per share (in shares)	40,934,392	34,916,106

Net Loss Per Share of Common Stock - Antidilutive Common Stock Equivalents Excluded from Computation of Earnings Per Share (Details) - shares	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Common stock equivalents excluded from computation of diluted net loss per share (in shares)	4,193,148	4,930,038
Stock options
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Common stock equivalents excluded from computation of diluted net loss per share (in shares)	1,158,816	1,767,791
Restricted stock units
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Common stock equivalents excluded from computation of diluted net loss per share (in shares)	2,847,021	2,909,899
ESPP purchase rights
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Common stock equivalents excluded from computation of diluted net loss per share (in shares)	102,172	134,226
Common stock warrants
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Common stock equivalents excluded from computation of diluted net loss per share (in shares)	85,139	118,122

Insider Trading Arrangements	3 Months Ended
Insider Trading Arrangements	Mar. 31, 2024
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false

Related Party Transactions (Details) - USD ($)	3 Months Ended
Related Party Transactions (Details) - USD ($)	Mar. 31, 2024	Mar. 31, 2023
Related Party Transaction [Line Items]
Research and development	$ 4,345,000	$ 3,291,000
Related party
Related Party Transaction [Line Items]
Research and development	$ 0	0
Term of agreement	10 years
Royalties	$ 0	$ 60,000.00

Marketable Securities

3 Months Ended

Mar. 31, 2024

Investments, Debt and Equity Securities [Abstract]

Marketable Securities

All of the Company's marketable securities were available-for-sale and were classified based on their maturities. Marketable securities with remaining maturities at the date of purchase of three months or less are classified as cash equivalents. Short-term investments are securities that original maturity or remaining maturity is greater than three months and not more than twelve months. Long-term investments are securities for which the original maturity or remaining maturity is greater than twelve months.

The table below summarizes the marketable securities:


	March 31, 2024
	Amortized Cost		Unrealized Gains		Unrealized Losses		Aggregate Fair Value
	(in thousands)
Money market funds	$	22,953	$	—	$	—	$	22,953


Cash equivalents	22,953		—		—		22,953

U.S. treasury securities	125,814		2		(34)		125,782



Short-term investments	125,814		2		(34)		125,782



Total marketable securities	$	148,767	$	2	$	(34)	$	148,735


	December 31, 2023
	Amortized Cost		Unrealized Gains		Unrealized Losses		Aggregate Fair Value
	(in thousands)
Money market funds	$	23,331	$	—	$	—	$	23,331

Cash equivalents	23,331		—		—		23,331

U.S. treasury securities	129,695		67		—		129,762
U.S. agency bonds	2,988		—		(2)		2,986


Short-term investments	132,683		67		(2)		132,748



Total marketable securities	$	156,014	$	67	$	(2)	$	156,079

The amortized cost of the Company's available-for-sale securities approximates their fair value. Unrealized losses are generally due to interest rate fluctuations, as opposed to credit quality. However, the Company reviews individual securities that are in an unrealized loss position in order to evaluate whether or not they have experienced or are expected to experience credit losses. During the three months ended March 31, 2024 and 2023, unrealized gains and losses from the investments were not material and were not the result of a decline in credit quality. As a result, the Company did not recognize any credit losses related to its investments and that all unrealized gains and losses on available-for-sale securities are recorded in accumulated other comprehensive income (loss) on the condensed consolidated balance sheets as of March 31, 2024 and December 31, 2023.

The Company elected to present accrued interest receivable separately from short-term and long-term investments on its condensed consolidated balance sheets. Accrued interest receivable was $0.2 million as of March 31, 2024, and was recorded in prepaid expenses and other current assets. The Company also elected to exclude accrued interest receivable from the estimation of expected credit losses on its marketable securities and reverse accrued interest receivable through interest income (expense) when amounts are determined to be uncollectible. The Company did not write off any accrued interest receivable as of March 31, 2024 or December 31, 2023.

Net Loss Per Share of Common Stock (Tables)

3 Months Ended

Mar. 31, 2024

Earnings Per Share [Abstract]

Schedule of Computation of Basic and Diluted Net Loss per Share

The table below summarizes the computation of basic and diluted net loss per share:


	Three Months Ended March 31,
	2024		2023
	(in thousands, except share and per share data)
Net loss	$	(10,904)	$	(11,125)

Weighted-average shares used to compute basic and diluted net loss per share	40,934,392		34,916,106

Net loss per share, basic and diluted	$	(0.27)	$	(0.32)

Schedule of Anti-dilutive Common Stock Equivalents Excluded from Computation of Diluted Net Loss per Share

The following anti-dilutive common stock equivalents were excluded from the computation of diluted net loss per share for the periods presented:


	Three Months Ended March 31,
	2024	2023
Stock options	1,158,816	1,767,791
Restricted stock units	2,847,021	2,909,899

ESPP purchase rights	102,172	134,226
Common stock warrants	85,139	118,122
	4,193,148	4,930,038

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended
Pay vs Performance Disclosure - USD ($) $ in Thousands	Mar. 31, 2024	Mar. 31, 2023
Pay vs Performance Disclosure
Net loss	$ (10,904)	$ (11,125)

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

+ References

+ Details

Balance Sheet Components - Accounts Receivable and Allowance for Credit Losses (Details) - USD ($) $ in Thousands	3 Months Ended		12 Months Ended
	Mar. 31, 2024	Mar. 31, 2023	Dec. 31, 2023
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Balance at beginning of period	$ 1,118	$ 400	$ 400
Provision	82	$ 50	761
Write-offs	(11)		(43)
Balance at end of period	$ 1,189		$ 1,118

Stock-Based Incentive Compensation Plans - Restricted Stock Units Activity and Performance-Based Restricted Stock Unit Activity (Details)	3 Months Ended
	Mar. 31, 2024 $ / shares shares
Restricted Stock Units
Number of Shares
Outstanding, beginning of period (in shares) \| shares	1,899,790
Granted (in shares) \| shares	615,056
Vested (in shares) \| shares	(261,132)
Canceled and forfeited (in shares) \| shares	(17,234)
Outstanding, end of period (in shares) \| shares	2,236,480
Weighted Average Grant Date Fair Value
Outstanding, beginning of period (in dollars per share) \| $ / shares	$ 19.93
Granted (in dollars per share) \| $ / shares	20.48
Vested (in dollars per share) \| $ / shares	20.52
Canceled and forfeited (in dollars per share) \| $ / shares	20.95
Outstanding, end of period (in dollars per share) \| $ / shares	$ 20.01
Performance Shares
Number of Shares
Outstanding, beginning of period (in shares) \| shares	385,122
Granted (in shares) \| shares	319,858
Vested (in shares) \| shares	(94,439)
Canceled and forfeited (in shares) \| shares	0
Outstanding, end of period (in shares) \| shares	610,541
Weighted Average Grant Date Fair Value
Outstanding, beginning of period (in dollars per share) \| $ / shares	$ 14.74
Granted (in dollars per share) \| $ / shares	18.48
Vested (in dollars per share) \| $ / shares	16.27
Canceled and forfeited (in dollars per share) \| $ / shares	0
Outstanding, end of period (in dollars per share) \| $ / shares	$ 16.47

Commitment and Contingencies - Supplemental Information Related to Lease Expense (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023	Dec. 31, 2023
Commitments and Contingencies Disclosure [Abstract]
Operating lease expense	$ 383	$ 394
Variable lease expense	135	76
Total lease expense	518	470
Cash paid for amounts included in the measurement of operating lease liabilities	397	398
Leased assets obtained in exchange for new operating lease liabilities	$ 0	$ 21
Weighted average remaining lease term (in years)	2 years 7 days		2 years 2 months 12 days
Weighted average discount rate	5.91%		5.87%

Marketable Securities - Schedule of Marketable Securities (Details) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Cash equivalents
Carrying value	$ 22,953	$ 23,331
Short-term investments
Amortized Cost	125,814	132,683
Unrealized Gains	2	67
Unrealized Losses	(34)	(2)
Aggregate Fair Value	125,782	132,748
Total marketable securities, Amortized Cost	148,767	156,014
Total marketable securities, Aggregate Fair Value	148,735	156,079
Money market funds
Cash equivalents
Carrying value	22,953	23,331
U.S. treasury securities
Short-term investments
Amortized Cost	125,814	129,695
Unrealized Gains	2	67
Unrealized Losses	(34)	0
Aggregate Fair Value	$ 125,782	129,762
U.S. agency bonds
Short-term investments
Amortized Cost		2,988
Unrealized Gains		0
Unrealized Losses		(2)
Aggregate Fair Value		$ 2,986

Borrowings (Tables)

3 Months Ended

Mar. 31, 2024

Debt Disclosure [Abstract]

Schedule of Outstanding Borrowings

The following table summarizes the outstanding borrowings from the term loan as of periods presented:


	March 31, 2024		December 31, 2023
	(in thousands)
Principal outstanding and final fee	$	36,720	$	36,720
Less: Unamortized debt issuance costs	(75)		(81)
Unaccreted value of final fee	(538)		(574)
Outstanding debt, net of debt issuance costs and unaccreted value of final fee	$	36,107	$	36,065
Classified as:

Long-term borrowings	$	36,107	$	36,065

Schedule of Future Principal and Final Fee Payments

The table below summarizes the future principal and final fee payments under the Fist-Citizens Term Loan as of March 31, 2024:


Year ending December 31,	(in thousands)
Remainder of 2024	$	—
2025	8,400
2026	14,400
2027	13,920
2028	—

Total principal and final fee payments	$	36,720

- Definition

Tabular disclosure of long-debt instruments or arrangements, including identification, terms, features, collateral requirements and other information necessary to a fair presentation. These are debt arrangements that originally required repayment more than twelve months after issuance or greater than the normal operating cycle of the entity, if longer.

+ References

Reference 1: http://www.xbrl.org/2003/role/exampleRef
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Reference 3: http://www.xbrl.org/2009/role/commonPracticeRef
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+ Details

Stock-Based Incentive Compensation Plans - Valuation Assumptions for Stock Options (Details) - Performance Shares	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Black-Scholes option-pricing model assumptions
Expected volatility of common stock, minimum (percent)	47.00%	58.00%
Expected volatility of common stock, maximum (percent)	59.00%	73.00%
Expected volatility of peer companies, minimum (percent)	29.00%	33.00%
Expected volatility of peer companies, maximum (percent)	97.00%	141.00%
Correlation coefficient of peer companies, minimum	(1.00%)	(15.00%)
Correlation coefficient of peer companies, maximum	100.00%	100.00%
Risk-free interest rate, minimum (percent)	4.10%	3.90%
Risk-free interest rate, maximum (percent)	4.70%	5.00%
Minimum
Black-Scholes option-pricing model assumptions
Dividend yield (percent)	0.60%	0.00%
Maximum
Black-Scholes option-pricing model assumptions
Dividend yield (percent)	4.70%	1.30%

Commitments and Contingencies - Aggregate Future Minimum Lease Payments (Details) $ in Thousands	Mar. 31, 2024 USD ($)
Aggregate Future Minimum Lease Payments
Remainder of 2024	$ 1,160
2025	1,053
2026	563
2027	7
2028	0
Thereafter	0
Total operating lease payments	2,783
Less: imputed interest	(158)
Total operating lease liabilities	$ 2,625

Net Loss Per Share of Common Stock

3 Months Ended

Mar. 31, 2024

Earnings Per Share [Abstract]

Net Loss Per Share of Common Stock

The table below summarizes the computation of basic and diluted net loss per share:


	Three Months Ended March 31,
	2024		2023
	(in thousands, except share and per share data)
Net loss	$	(10,904)	$	(11,125)

Weighted-average shares used to compute basic and diluted net loss per share	40,934,392		34,916,106

Net loss per share, basic and diluted	$	(0.27)	$	(0.32)

Because the Company has reported a net loss in all periods presented, outstanding stock options, restricted stock units, ESPP purchase rights and common stock warrants are anti-dilutive and therefore diluted net loss per common share is the same as basic net loss per common share for the periods presented. The following anti-dilutive common stock equivalents were excluded from the computation of diluted net loss per share for the periods presented:


	Three Months Ended March 31,
	2024	2023
Stock options	1,158,816	1,767,791
Restricted stock units	2,847,021	2,909,899

ESPP purchase rights	102,172	134,226
Common stock warrants	85,139	118,122
	4,193,148	4,930,038

Balance Sheet Components - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023	Dec. 31, 2023
Property, Plant and Equipment [Line Items]
Inventory, finished goods, gross	$ 19,400		$ 18,800
Inventory, work in process, gross	1,600		1,400
Property and equipment, gross	33,657		31,246
Depreciation expense	1,100	$ 1,100
Construction in progress, surgical placement instrument set
Property, Plant and Equipment [Line Items]
Property and equipment, gross	4,800		3,500
Construction in progress, software costs
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 300		$ 400

Fair Value Measurement (Tables)

3 Months Ended

Mar. 31, 2024

Fair Value Disclosures [Abstract]

Schedule of Marketable Securities Measured at Fair Value on Recurring Basis

The table below summarizes the fair value of the Company’s marketable securities measured at fair value on a recurring basis based on the three-tier fair value hierarchy:


	March 31, 2024
	Level 1		Level 2		Level 3		Total
	(in thousands)
Marketable securities
Money market funds	$	22,953	$	—	$	—	$	22,953
U.S. treasury securities	125,782		—		—		125,782



Total marketable securities	$	148,735	$	—	$	—	$	148,735

	December 31, 2023
	Level 1		Level 2		Level 3		Total
	(in thousands)
Marketable securities
Money market funds	$	23,331	$	—	$	—	$	23,331
U.S. treasury securities	129,762		—		—		129,762
U.S. agency bonds	—		2,986		—		2,986


Total marketable securities	$	153,093	$	2,986	$	—	$	156,079

Borrowings - Summary of Borrowings (Details) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Debt Disclosure [Abstract]
Principal outstanding and final fee	$ 36,720	$ 36,720
Less: Unamortized debt issuance costs	(75)	(81)
Unaccreted value of final fee	(538)	(574)
Outstanding debt, net of debt issuance costs and unaccreted value of final fee	36,107	36,065
Long-term borrowings	$ 36,107	$ 36,065

- Definition

Amount, after deduction of unamortized premium (discount) and debt issuance cost, of long-term debt. Excludes lease obligation.

+ References + Details

Balance Sheet Components - Property and Equipment, Net (Details) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Property and Equipment, Net
Property and equipment, gross	$ 33,657	$ 31,246
Less: Accumulated depreciation and amortization	(16,309)	(15,246)
Property and equipment, net	17,348	16,000
Instrument trays
Property and Equipment, Net
Property and equipment, gross	18,800	18,205
Machinery and equipment
Property and Equipment, Net
Property and equipment, gross	3,173	3,067
Construction in progress
Property and Equipment, Net
Property and equipment, gross	5,111	3,856
Computer and office equipment
Property and Equipment, Net
Property and equipment, gross	2,312	1,856
Leasehold improvements
Property and Equipment, Net
Property and equipment, gross	3,873	3,873
Furniture and fixtures
Property and Equipment, Net
Property and equipment, gross	$ 388	$ 389

Summary of Significant Accounting Policies

3 Months Ended

Mar. 31, 2024

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

Basis of Presentation and Principles of Consolidation

The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with generally accepted accounting principles in the United States of America (“U.S. GAAP”) and applicable rules and regulations of the Securities and Exchange Commission (“SEC”) regarding interim financial reporting. As permitted under those rules, certain footnotes or other financial information that are normally required by U.S. GAAP have been condensed or omitted, and accordingly the balance sheet as of December 31, 2023 has been derived from the audited consolidated financial statements at that date but does not include all of the information required by GAAP for complete financial statements. These unaudited interim condensed consolidated financial statements have been prepared on the same basis as the Company’s annual financial statements and, in the opinion of management, reflect all adjustments that are necessary for a fair statement of the Company’s consolidated financial information. The results of operations for the three months ended March 31, 2024 are not necessarily indicative of the results to be expected for the year ending December 31, 2024 or for any other interim period or for any other future year.

The accompanying condensed consolidated financial statements should be read in conjunction with the audited financial statements and related notes thereto for the year ended December 31, 2023 contained in the 2023 Annual Report.

Use of Estimates

The preparation of financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities as of the date of the financial statements and the reported amounts of revenue and expenses during the reporting period. Significant accounting estimates and management judgments reflected in the condensed consolidated financial statements primarily includes the fair value of performance-based restricted stock unit awards. Estimates are based on historical experience, where applicable and other assumptions believed to be reasonable by the management. Actual results could differ from those estimates.

Change in accounting estimate

During the current quarter, the Company reassessed the useful life of its instrument trays based on a comprehensive evaluation of usage trends and its estimate on the average life of instruments before loss or damage that requires disposal. As a result of this review, the Company determined that extending the useful life of its instrument trays would more accurately reflect its anticipated future economic benefits. Effective January 1, 2024, the Company changed its estimates of the useful lives of instrument trays from three to five years. The effect of this change in estimate reduced depreciation expense by $0.5 million, resulting in a decrease in net loss of $0.5 million and basic and diluted earnings per share by $0.01 for the three months ended March 31, 2024.

Significant Accounting Policies

The Company’s significant accounting policies are disclosed in the 2023 Annual Report. There have been no material changes to these accounting policies.

Segments

The Company's chief operating decision makers are the Chief Executive Officer (“CEO”) and Chief Financial Officer (“CFO”). The CEO and the CFO review financial information presented on a consolidated basis, accompanied by information about revenue by geographic region, for purposes of evaluating financial performance. The Company has one business activity and there are no segment

managers who are held accountable for operations, operating results or plans for levels or components below the consolidated unit level. Accordingly, the Company has determined that it has a single reportable and operating segment structure.

The Company derives substantially all of its revenue from sales to customers in the U.S. Revenue by geography is based on billing address of the customer. International revenue accounted for less than 10% of the total revenue during the periods presented. Long-lived assets held outside the U.S. are immaterial. Following table summarizes the Company's revenue by geography:


	Three Months Ended March 31,
	2024		2023
	(in thousands)
United States	$	35,425	$	30,450
International	2,442		2,258
	$	37,867	$	32,708

Recent Accounting Pronouncements

In October 2023, the Financial Accounting Standards Board ("FASB") issued ASU 2023-06, Disclosure Agreements - Codification Amendments in Response to the SEC’s Disclosure Update and Simplification Initiative ("ASU 2023-06"). This amendment will impact various disclosure areas, including the statement of cash flows, accounting changes and error corrections, earnings per share, debt, equity, derivatives, and transfers of financial assets. The amendments in this ASU 2023-06 will be effective on the date the related disclosures are removed from Regulation S-X or Regulation S-K by the SEC, and will no longer be effective if the SEC has not removed the applicable disclosure requirement by June 30, 2027. Early adoption is prohibited. The Company is currently evaluating the impacts of the amendment on its disclosures.

In November 2023, the FASB issued ASU 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures. ASU 2023-07 requires companies with a single reportable segment to provide all existing segment disclosures, as well as requires incremental segment information to be disclosed. The guidance is effective for fiscal years beginning after December 15, 2023 on a retrospective basis, and interim periods within fiscal years beginning after December 15, 2024. Early adoption is permitted. The Company is currently evaluating the guidance to determine the impact on its disclosures.

In December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures ("ASU 2023-09"). ASU 2023-09 requires public business entities to disclose additional information in specified categories with respect to the reconciliation of the effective tax rate to the statutory rate (the rate reconciliation) for federal, state, and foreign income taxes. It also requires greater detail about individual reconciling items in the rate reconciliation to the extent the impact of those items exceeds a specified threshold. ASU 2023-09 is effective for fiscal years beginning after December 15, 2024, and for interim periods for fiscal years beginning after December 15, 2025. The Company is currently evaluating the impacts of ASU 2023-09 on its disclosures.

In March 2024, the FASB issued ASU 2024-02 Codification Improvements. ASU 2024-02 amends the Codification to remove references to various concepts statements and impacts a variety of topics in the codification. The amendments apply to all reporting entities within the scope of the affected accounting guidance, but in most instances the references removed are extraneous and not required to understand or apply the guidance. Generally, the amendments in ASU 2024-02 are not intended to result in significant accounting changes for most entities. ASU 2024-02 is effective January 1, 2025, and the Company is currently evaluating the impacts of the amendment on its disclosures.

Stock-Based Incentive Compensation Plans - Common Stock Warrants Activity (Details) - $ / shares	3 Months Ended
	Mar. 31, 2024	Dec. 31, 2023
Share-Based Compensation Arrangement by Share-Based Payment Award, Non-Option Equity Instruments, Outstanding [Roll Forward]
Warrants outstanding, beginning balance (in shares)	85,139	85,139
Warrants Issued (in shares)	0
Warrants Exercised (in shares)	0
Warrants Expired (in shares)	0
Warrants outstanding, ending balance (in shares)	85,139
Warrants Issued 3/1/2017
Class of Warrant or Right [Line Items]
Price per Share (in dollars per share)		$ 5.94
Share-Based Compensation Arrangement by Share-Based Payment Award, Non-Option Equity Instruments, Outstanding [Roll Forward]
Warrants outstanding, beginning balance (in shares)	1,388	1,388
Warrants Issued (in shares)	0
Warrants Exercised (in shares)	0
Warrants Expired (in shares)	0
Warrants outstanding, ending balance (in shares)	1,388
Warrants Issued 11/26/2014
Class of Warrant or Right [Line Items]
Price per Share (in dollars per share)		$ 16.47
Share-Based Compensation Arrangement by Share-Based Payment Award, Non-Option Equity Instruments, Outstanding [Roll Forward]
Warrants outstanding, beginning balance (in shares)	6,680	6,680
Warrants Issued (in shares)	0
Warrants Exercised (in shares)	0
Warrants Expired (in shares)	0
Warrants outstanding, ending balance (in shares)	6,680
Warrants Issued 10/20/2015
Class of Warrant or Right [Line Items]
Price per Share (in dollars per share)		$ 16.47
Share-Based Compensation Arrangement by Share-Based Payment Award, Non-Option Equity Instruments, Outstanding [Roll Forward]
Warrants outstanding, beginning balance (in shares)	41,650	41,650
Warrants Issued (in shares)	0
Warrants Exercised (in shares)	0
Warrants Expired (in shares)	0
Warrants outstanding, ending balance (in shares)	41,650
Warrants Issued 11/9/2015
Class of Warrant or Right [Line Items]
Price per Share (in dollars per share)		$ 16.47
Share-Based Compensation Arrangement by Share-Based Payment Award, Non-Option Equity Instruments, Outstanding [Roll Forward]
Warrants outstanding, beginning balance (in shares)	25,709	25,709
Warrants Issued (in shares)	0
Warrants Exercised (in shares)
Warrants Expired (in shares)	0
Warrants outstanding, ending balance (in shares)	25,709
Warrants Issued 12/22/2016
Class of Warrant or Right [Line Items]
Price per Share (in dollars per share)		$ 10.03
Share-Based Compensation Arrangement by Share-Based Payment Award, Non-Option Equity Instruments, Outstanding [Roll Forward]
Warrants outstanding, beginning balance (in shares)	9,712	9,712
Warrants Issued (in shares)	0
Warrants Exercised (in shares)	0
Warrants Expired (in shares)	0
Warrants outstanding, ending balance (in shares)	9,712

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	3 Months Ended		12 Months Ended
	Mar. 31, 2024	Mar. 31, 2023	Dec. 31, 2023
Cash flows from operating activities
Net loss	$ (10,904)	$ (11,125)
Adjustments to reconcile net loss to net cash used in operating activities:
Stock-based compensation	7,030	6,194
Depreciation and amortization	1,089	1,086
Accounts receivable credit losses	82	50	$ 761
Amortization of discount and premium on marketable securities	(1,561)	(615)
Amortization of debt issuance costs	42	81
Loss on disposal of property and equipment	388	190
Changes in operating assets and liabilities:
Accounts receivable	(196)	(2,019)
Inventory	(772)	(536)
Prepaid expenses and other assets	524	311
Accounts payable	2,371	(745)
Accrued liabilities and other	(5,664)	(3,625)
Net cash used in operating activities	(7,571)	(10,753)
Cash flows from investing activities
Maturities of marketable securities	67,000	30,000
Purchases of marketable securities	(58,571)	(15,718)
Purchases of property and equipment	(2,082)	(2,579)
Net cash provided by investing activities	6,347	11,703
Cash flows from financing activities
Proceeds from debt financing	0	36,000
Repayments of debt financing	0	(35,275)
Payments of debt issuance costs	0	(40)
Proceeds from the exercise of stock options	105	520
Net cash provided by financing activities	105	1,205
Effect of exchange rate changes on cash and cash equivalents	(112)	97
Net increase (decrease) in cash and cash equivalents	(1,231)	2,252
Cash and cash equivalents at
Beginning of period	33,271	20,717	20,717
End of period	32,040	22,969	$ 33,271
Supplemental disclosure of non-cash information
Unpaid purchases of property and equipment	$ 1,228	$ 887

Stock-Based Incentive Compensation Plans - Stock-Based Compensation Expense (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation expense	$ 7,030	$ 6,194
Cost of goods sold
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation expense	235	137
Sales and marketing
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation expense	3,221	2,910
Research and development
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation expense	820	752
General and administrative
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation expense	$ 2,754	$ 2,395

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 35
-Paragraph 1D
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480483/718-10-35-1D

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 35
-Paragraph 3
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480483/718-10-35-3

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
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-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
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-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (a)(2)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (a)(3)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(1)(i)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(1)(ii)
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-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(1)(iii)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(1)(iv)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(1)(iv)(01)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(1)(iv)(02)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(1)(iv)(03)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(1)(iv)(04)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(2)(i)
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-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 15: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(2)(ii)
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-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 16: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
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-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(2)(iii)
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-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 17: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(2)(iii)(01)
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-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 18: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
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-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(2)(iii)(02)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 19: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
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-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)(2)(iii)(03)
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-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 20: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
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-Section 50
-Paragraph 2
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Reference 21: http://www.xbrl.org/2003/role/disclosureRef
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Reference 22: http://www.xbrl.org/2003/role/disclosureRef
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Reference 23: http://www.xbrl.org/2003/role/disclosureRef
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Reference 24: http://www.xbrl.org/2003/role/disclosureRef
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Reference 25: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
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-Section 50
-Paragraph 2
-Subparagraph (f)(2)(ii)
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-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 26: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (f)(2)(iii)
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Reference 27: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
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-Section 50
-Paragraph 2
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-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

Reference 28: http://www.xbrl.org/2003/role/disclosureRef
-Topic 718
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (f)(2)(v)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480429/718-10-50-2

+ Details

Balance Sheet Components (Tables)

3 Months Ended

Mar. 31, 2024

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Schedule of Property and Equipment, Net

Property and Equipment, net:


	March 31, 2024		December 31, 2023
	(in thousands)
Instrument trays	$	18,800	$	18,205
Machinery and equipment	3,173		3,067
Construction in progress	5,111		3,856
Computer and office equipment	2,312		1,856
Leasehold improvements	3,873		3,873
Furniture and fixtures	388		389
	33,657		31,246
Less: Accumulated depreciation and amortization	(16,309)		(15,246)
	$	17,348	$	16,000

Schedule of Accrued Liabilities and Other

Accrued Liabilities and Other:


	March 31, 2024		December 31, 2023
	(in thousands)
Accrued compensation and related expenses	$	8,034	$	13,464

Accrued royalty	1,447		1,360
Accrued professional services	666		929

Others	1,620		1,699
	$	11,767	$	17,452

Schedule of Accounts Receivable and Allowance for Credit Losses

The movement in the allowance for credit losses was as follows:


	March 31, 2024		December 31, 2023
	(in thousands)
Balance at beginning of period	$	1,118	$	400
Provision	82		761
Write-offs	(11)		(43)
Balance at end of period	$	1,189	$	1,118

CONDENSED CONSOLIDATED STATEMENTS OF CHANGES IN STOCKHOLDERS' EQUITY - USD ($) $ in Thousands	Total	Common Stock	Additional Paid-in Capital	Accumulated Other Comprehensive Income	Accumulated Deficit
Stockholders' equity, beginning of period (in shares) at Dec. 31, 2022		34,731,577,000
Stockholders' equity, beginning of period at Dec. 31, 2022	$ 98,302	$ 3	$ 455,172	$ 232	$ (357,105)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock upon exercise of stock options, net of shares withheld (in shares)		120,266,000
Issuance of common stock upon exercise of stock options, net of shares withheld	520		520
Issuance of common stock upon vesting of restricted stock units (in shares)		254,320,000
Stock-based compensation	6,194		6,194
Foreign currency translation	(22)			(22)
Net unrealized gain (loss) on marketable securities	90			90
Net loss	(11,125)				(11,125)
Stockholders' equity, end of period (in shares) at Mar. 31, 2023		35,106,163,000
Stockholders' equity, end of period at Mar. 31, 2023	$ 93,959	$ 3	461,886	300	(368,230)
Stockholders' equity, beginning of period (in shares) at Dec. 31, 2023	40,693,299	40,693,299
Stockholders' equity, beginning of period at Dec. 31, 2023	$ 169,375	$ 4	569,477	335	(400,441)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock upon exercise of stock options, net of shares withheld (in shares)	29,892	29,892
Issuance of common stock upon exercise of stock options, net of shares withheld	$ 105		105
Issuance of common stock upon vesting of restricted stock units (in shares)		355,571
Stock-based compensation	7,030		7,030
Foreign currency translation	29			29
Net unrealized gain (loss) on marketable securities	(98)			(98)
Net loss	$ (10,904)				(10,904)
Stockholders' equity, end of period (in shares) at Mar. 31, 2024	41,078,762	41,078,762
Stockholders' equity, end of period at Mar. 31, 2024	$ 165,537	$ 4	$ 576,612	$ 266	$ (411,345)

Borrowings - Narrative (Details)		3 Months Ended
Borrowings - Narrative (Details)	Jan. 06, 2023 USD ($) quick_ratio	Mar. 31, 2024 USD ($)	Mar. 31, 2023	Aug. 12, 2021 USD ($)
SVB Term Loan \| Term loan
Debt Instrument [Line Items]
Aggregate principal amount				$ 35,000,000
Proceeds from (repayments of) term loan	$ (35,000,000)
First-Citizens Amended Term Loan \| Term loan
Debt Instrument [Line Items]
Proceeds from (repayments of) term loan	$ 36,000,000
Final fee as percentage of aggregate principal amount	2.00%
First-Citizens Amended Term Loan \| Term loan \| Minimum
Debt Instrument [Line Items]
Basis spread on variable rate	0.50%
First-Citizens Amended Term Loan \| Term loan \| Maximum
Debt Instrument [Line Items]
Basis spread on variable rate	6.75%
First-Citizens Amended Term Loan \| Term loan \| Revolving credit facility
Debt Instrument [Line Items]
Accordion feature, increase limit	$ 15,000,000
Accounts receivable borrowing base (percent)	80.00%
Fixed interest rate	6.25%
Adjusted quick ratio threshold \| quick_ratio	1.5
First-Citizens Amended Term Loan \| Line of credit \| Revolving credit facility
Debt Instrument [Line Items]
Revolving credit facility, aggregate principal amount	$ 15,000,000
Total commitment fee, amount	187,500
Contingent fee, amount	$ 150,000
Line of credit outstanding		$ 0
First-Citizens Term Loan \| Term loan
Debt Instrument [Line Items]
Effective interest rate during the period		9.30%	8.60%

Balance Sheet Components

3 Months Ended

Mar. 31, 2024

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Balance Sheet Components

Inventory

As of March 31, 2024, inventory consisted of finished goods of $19.4 million and work-in-progress and components of $1.6 million. As of December 31, 2023, inventory consisted of finished goods of $18.8 million and work-in-progress and components of $1.4 million.

Property and Equipment, net:


	March 31, 2024		December 31, 2023
	(in thousands)
Instrument trays	$	18,800	$	18,205
Machinery and equipment	3,173		3,067
Construction in progress	5,111		3,856
Computer and office equipment	2,312		1,856
Leasehold improvements	3,873		3,873
Furniture and fixtures	388		389
	33,657		31,246
Less: Accumulated depreciation and amortization	(16,309)		(15,246)
	$	17,348	$	16,000

As of March 31, 2024, construction in progress pertains to the cost of individual components of an instrument tray used for surgical placement of the Company's products that have not yet been placed into service of $4.8 million and software costs of $0.3 million. As of December 31, 2023, construction in progress pertains to cost of individual components of a custom instrument set used for surgical placement of the Company's products that have not yet been placed into service of $3.5 million and software costs of $0.4 million. Depreciation expense was $1.1 million for each of the three months ended March 31, 2024 and 2023.

Accrued Liabilities and Other:


	March 31, 2024		December 31, 2023
	(in thousands)
Accrued compensation and related expenses	$	8,034	$	13,464

Accrued royalty	1,447		1,360
Accrued professional services	666		929

Others	1,620		1,699
	$	11,767	$	17,452

Accounts Receivable and Allowance for Credit Losses:

The movement in the allowance for credit losses was as follows:


	March 31, 2024		December 31, 2023
	(in thousands)
Balance at beginning of period	$	1,118	$	400
Provision	82		761
Write-offs	(11)		(43)
Balance at end of period	$	1,189	$	1,118

Related Party Transactions	3 Months Ended
Related Party Transactions	Mar. 31, 2024
Related Party Transactions [Abstract]
Related Party Transactions	Related Party Transactions On February 24, 2020, the Company entered into a joint development agreement (the “Development Agreement”) with SeaSpine Orthopedics Corporation (“SeaSpine”), which recently merged with Orthofix Medical, Inc. ("Orthofix"), to develop a next generation device for sacropelvic fixation. Mr. Keith Valentine, who serves as the President, Chief Executive Officer and a member of the board of directors of SeaSpine, also serves as a member of the Company's Board of Directors since August 2015. On April 27, 2021, Addendum No.1 to the Development Agreement was entered into by and between the Company and SeaSpine to extend certain obligations as described under the Development Agreement to a consultant of the Company. On October 4, 2023, Keith C. Valentine resigned as a member of the Board of Directors of Orthofix. As such, subsequent to October 4, 2023, SeaSpine is no longer a related party of the Company. Pursuant to the development plan, SeaSpine shall use reasonable efforts to assist in the development of the potential product offering, including licensing certain existing intellectual property to be incorporated into such product. Under the terms of the Development Agreement, the Company agreed to make monthly payments to SeaSpine to reimburse for full time resources employed by SeaSpine responsible to conduct the development activities. For the three months ended March 31, 2024 and March 31, 2023, the Company did not incur any reimbursement charges from Seaspine. Certain intellectual property developed pursuant to the project plan will be owned by the Company, certain intellectual property developed pursuant to the project plan will be owned by SeaSpine, and other intellectual property developed pursuant to the project plan will be jointly owned by SeaSpine and the Company. The Company also agreed to provide SeaSpine a royalty-free, worldwide, perpetual, non-exclusive license of certain of the Company's intellectual property incorporated into the product to be developed. The Company also agreed to pay SeaSpine a product royalty, in an amount specified in the Development Agreement, for each resulting product sold for a period of 10 years beginning on the initial market launch. The term of the Development Agreement shall continue until the expiration of all royalty terms, unless earlier terminated by either party, as provided for by the Development Agreement. The Company recorded zero and $0.06 million of royalty for the three months ended March 31, 2024 and March 31, 2023, respectively.

- Definition

The entire disclosure for related party transactions. Examples of related party transactions include transactions between (a) a parent company and its subsidiary; (b) subsidiaries of a common parent; (c) and entity and its principal owners; and (d) affiliates.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480990/946-20-50-2

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 5
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480990/946-20-50-5

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 6
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480990/946-20-50-6

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 235
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481062/946-235-50-2

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 235
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (e)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481062/946-235-50-2

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 850
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483326/850-10-50-1

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 220
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.6-07(2)(g)(3))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483575/946-220-S99-1

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 220
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.6-07(2)(c))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483575/946-220-S99-1

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 946
-SubTopic 220
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.6-07(2)(e))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483575/946-220-S99-1

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 850
-Name Accounting Standards Codification
-Publisher FASB
-URI https://asc.fasb.org//850/tableOfContent

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 850
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 6
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483326/850-10-50-6

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 850
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483326/850-10-50-1

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 850
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483326/850-10-50-1

+ Details

Stock-Based Incentive Compensation Plans - Stock Option Activity (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended	12 Months Ended
	Mar. 31, 2024	Dec. 31, 2023
Number of Shares
Outstanding, beginning of period (in shares)	1,188,708
Exercised (in shares)	(29,892)
Canceled and forfeited (in shares)	0
Outstanding, end of period (in shares)	1,158,816	1,188,708
Options vested and exercisable (in shares)	1,158,816
Options vested and expected to vest (in shares)	1,158,816
Weighted- Average Exercise Price
Outstanding, beginning of period (in dollars per share)	$ 10.14
Exercised (in dollars per share)	3.49
Canceled and forfeited (in dollars per share)	0
Outstanding, end of period (in dollars per share)	10.31	$ 10.14
Options vested and exercisable (in dollars per share)	10.31
Options vested and expected to vest (in dollars per share)	$ 10.31
Weighted-Average Remaining Contractual Life and Aggregate Intrinsic Value
Weighted-average remaining contractual life, options outstanding	3 years 4 months 2 days	3 years 6 months 3 days
Weighted-average remaining contractual life, options vested and exercisable	3 years 4 months 2 days
Weighted-average remaining contractual life, options vested and expected to vest	3 years 4 months 2 days
Aggregate intrinsic value, options outstanding	$ 8,839	$ 13,197
Aggregate intrinsic value, options vested and exercisable	8,839
Aggregate intrinsic value, options vested and expected to vest	$ 8,839

Stock-Based Incentive Compensation Plans - Narrative (Details) - USD ($)	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023	Dec. 31, 2023
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation cost, stock options	$ 0
Stock options granted (in shares)	0	0
2018 ESPP
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Purchase price of common stock as a percent of fair market value (percent)	85.00%
Employee stock purchase program offering period interval (in months)	6 months
Accrued compensation and related expenses for employee payroll deductions	$ 1,400,000		$ 400,000
Restricted Stock Units
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation cost	$ 36,500,000
Unrecognized compensation cost, expected period for recognition (in years)	2 years 7 months 6 days
Restricted Stock Units \| Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Performance period	2 years
Restricted Stock Units \| Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Performance period	4 years
Performance Shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation cost	$ 7,000,000
Unrecognized compensation cost, expected period for recognition (in years)	2 years 4 months 24 days
Performance Shares \| 2018 ESPP
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Performance period	3 years

Stock-Based Incentive Compensation Plans (Tables)

3 Months Ended

Mar. 31, 2024

Share-Based Payment Arrangement [Abstract]

Schedule of Stock Option Activity

The table below summarizes the stock option activity for the three months ended March 31, 2024:


	Number of Shares	Weighted- Average Exercise Price		Weighted-Average Contractual Remaining Life (Years)	Aggregate Intrinsic Value (in thousands)
Outstanding as of December 31, 2023	1,188,708	$	10.14	3.51	$	13,197

Exercised	(29,892)	$	3.49
Canceled and forfeited	—	—
Outstanding as of March 31, 2024	1,158,816	$	10.31	3.34	$	8,839
Options vested and exercisable, March 31, 2024	1,158,816	$	10.31	3.34	$	8,839
Options vested and expected to vest, March 31, 2024	1,158,816	$	10.31	3.34	$	8,839

Schedule of Share-based Payment Award, Equity Instruments Other Than Options, Valuation Assumptions

The table below summarizes the assumptions used to estimate the grant date fair value of the PSUs granted:


	Three Months Ended March 31,
						2024				2023
Expected volatility of common stock				47.0%	to	59.0%		58.0%	to	73.0%
Expected volatility of peer companies						29.0%	to	97.0%		33.0%	to	141.0%
Correlation coefficient of peer companies				(0.01)	to	1.00		(0.15)	to	1.00
Risk-free interest rate						4.1%	to	4.7%		3.9%	to	5.0%
Dividend yield	0.6%	to	4.7%	—%	to	1.3%

Schedule of Restricted Stock Unit Activity

The table below summarizes RSU and PSU activity for the three months ended March 31, 2024:


	RSUs		PSUs
	Number of Shares	Weighted Average Grant Date Fair Value	Number of Shares	Weighted Average Grant Date Fair Value
Outstanding as of December 31, 2023	1,899,790	$19.93	385,122	$14.74
Granted	615,056	20.48	319,858	18.48
Vested	(261,132)	20.52	(94,439)	16.27
Canceled and forfeited	(17,234)	20.95	—	—
Outstanding as of March 31, 2024	2,236,480	20.01	610,541	16.47

Schedule of Performance-based Restricted Stock Unit Activity Arrangement

The table below summarizes RSU and PSU activity for the three months ended March 31, 2024:


	RSUs		PSUs
	Number of Shares	Weighted Average Grant Date Fair Value	Number of Shares	Weighted Average Grant Date Fair Value
Outstanding as of December 31, 2023	1,899,790	$19.93	385,122	$14.74
Granted	615,056	20.48	319,858	18.48
Vested	(261,132)	20.52	(94,439)	16.27
Canceled and forfeited	(17,234)	20.95	—	—
Outstanding as of March 31, 2024	2,236,480	20.01	610,541	16.47

Schedule of Stock-Based Compensation

The table below presents the detail of stock-based compensation expense amounts included in the condensed consolidated statements of operations:


	Three Months Ended March 31,
	2024		2023
	(in thousands)
Cost of goods sold	$	235	$	137
Sales and marketing	3,221		2,910
Research and development	820		752
General and administrative	2,754		2,395
	$	7,030	$	6,194

Schedule of Warrants Issued and Outstanding

The table below summarizes common stock warrants activity for the three months ended March 31, 2024:


Date		Outstanding Balance at December 31, 2023	Price per Share		Warrants Issued	Warrant Exercised	Warrant Expired	Outstanding Balance at March 31, 2024
Issuance	Expiration
3/1/2017	3/1/2027	1,388	$	5.94	—	—	—	1,388
11/26/2014	11/26/2024	6,680	$	16.47	—	—	—	6,680
10/20/2015	10/20/2025	41,650	$	16.47	—	—	—	41,650
11/9/2015	11/9/2025	25,709	$	16.47	—		—	25,709
12/22/2016	12/22/2026	9,712	$	10.03	—	—	—	9,712
		85,139			—	—	—	85,139

Net Loss Per Share of Common Stock - Computation of Earnings Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Earnings Per Share [Abstract]
Net loss	$ (10,904)	$ (11,125)
Weighted-average number of common shares used to compute basic net loss per share (in shares)	40,934,392	34,916,106
Weighted-average number of common shares used to compute diluted net loss per share (in shares)	40,934,392	34,916,106
Net loss per share, basic (in usd per share)	$ (0.27)	$ (0.32)
Net loss per share, diluted (in usd per share)	$ (0.27)	$ (0.32)

- Definition

The amount of net income (loss) for the period per each share of common stock or unit outstanding during the reporting period.

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483443/250-10-50-3

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 260
-SubTopic 10
-Name Accounting Standards Codification
-Section 55
-Paragraph 15
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482635/260-10-55-15

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 815
-SubTopic 40
-Name Accounting Standards Codification
-Section 65
-Paragraph 1
-Subparagraph (e)(4)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480175/815-40-65-1

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 815
-SubTopic 40
-Name Accounting Standards Codification
-Section 65
-Paragraph 1
-Subparagraph (f)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480175/815-40-65-1

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 11
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483443/250-10-50-11

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 11
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483443/250-10-50-11

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 7
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483443/250-10-50-7

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 260
-SubTopic 10
-Name Accounting Standards Codification
-Section 45
-Paragraph 2
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482689/260-10-45-2

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 260
-SubTopic 10
-Name Accounting Standards Codification
-Section 45
-Paragraph 60B
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482689/260-10-45-60B

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 4
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483443/250-10-50-4

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 260
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482662/260-10-50-1

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 220
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 2
-Subparagraph (SX 210.5-03(25))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483621/220-10-S99-2

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 942
-SubTopic 220
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.9-04(27))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483589/942-220-S99-1

Reference 14: http://www.xbrl.org/2003/role/disclosureRef
-Topic 944
-SubTopic 220
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.7-04(23))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147483586/944-220-S99-1

Reference 15: http://www.xbrl.org/2003/role/exampleRef
-Topic 260
-SubTopic 10
-Name Accounting Standards Codification
-Section 55
-Paragraph 52
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482635/260-10-55-52

Reference 16: http://www.xbrl.org/2003/role/disclosureRef
-Topic 260
-SubTopic 10
-Name Accounting Standards Codification
-Section 45
-Paragraph 7
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482689/260-10-45-7

+ Details

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

+ References

+ Details

Summary of Significant Accounting Policies (Tables)

3 Months Ended

Mar. 31, 2024

Accounting Policies [Abstract]

Schedule of Revenue by Geography

Following table summarizes the Company's revenue by geography:


	Three Months Ended March 31,
	2024		2023
	(in thousands)
United States	$	35,425	$	30,450
International	2,442		2,258
	$	37,867	$	32,708

Borrowings - Debt Maturity (Details) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Future principal and final fee payments
Remainder of 2024	$ 0
2025	8,400
2026	14,400
2027	13,920
2028	0
Total principal and final fee payments	$ 36,720	$ 36,720

Income Taxes	3 Months Ended
Income Taxes	Mar. 31, 2024
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes In determining quarterly provisions for income taxes, the Company uses the annual estimated effective tax rate applied to the actual year-to-date profit or loss, adjusted for discrete items arising in that quarter. The Company updates its estimate of its annual effective tax rate at the end of each quarterly period. The estimate takes into account annual forecasted income (loss) before income taxes, the geographic mix of income (loss) before income taxes and any significant permanent tax items. The Company did not have provision for income taxes for the three months ended March 31, 2024 and 2023. The Company continues to maintain a full valuation allowance against its net deferred tax assets due to the uncertainty surrounding realization of such assets. The Company accounts for the uncertainty in income taxes by utilizing a comprehensive model for the recognition, measurement, presentation and disclosure in financial statements of any uncertain tax positions that have been taken or are expected to be taken on an income tax return. There had been no changes in the estimated uncertain tax benefits recorded as of March 31, 2024 compared to December 31, 2023.

- 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
-Topic 946
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480990/946-20-50-13

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 235
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08(h)(2))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480678/235-10-S99-1

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-Name Accounting Standards Codification
-Publisher FASB
-URI https://asc.fasb.org//740/tableOfContent

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 14
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482685/740-10-50-14

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 21
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482685/740-10-50-21

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 270
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482526/740-270-50-1

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 17
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482685/740-10-50-17

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SAB TOPIC 6.I.5.Q1)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479360/740-10-S99-1

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 2
-Subparagraph (SAB Topic 11.C)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147479360/740-10-S99-2

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 30
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147482603/740-30-50-2

+ Details

Fair Value Measurement (Details) - Recurring - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Marketable securities
Marketable securities	$ 148,735	$ 156,079
Money market funds
Marketable securities
Marketable securities	22,953	23,331
U.S. treasury securities
Marketable securities
Marketable securities	125,782	129,762
U.S. agency bonds
Marketable securities
Marketable securities		2,986
Level 1
Marketable securities
Marketable securities	148,735	153,093
Level 1 \| Money market funds
Marketable securities
Marketable securities	22,953	23,331
Level 1 \| U.S. treasury securities
Marketable securities
Marketable securities	125,782	129,762
Level 1 \| U.S. agency bonds
Marketable securities
Marketable securities		0
Level 2
Marketable securities
Marketable securities	0	2,986
Level 2 \| Money market funds
Marketable securities
Marketable securities	0	0
Level 2 \| U.S. treasury securities
Marketable securities
Marketable securities	0	0
Level 2 \| U.S. agency bonds
Marketable securities
Marketable securities		2,986
Level 3
Marketable securities
Marketable securities	0	0
Level 3 \| Money market funds
Marketable securities
Marketable securities	0	0
Level 3 \| U.S. treasury securities
Marketable securities
Marketable securities	$ 0	0
Level 3 \| U.S. agency bonds
Marketable securities
Marketable securities		$ 0

Borrowings

3 Months Ended

Mar. 31, 2024

Debt Disclosure [Abstract]

Borrowings

Term Loan

The following table summarizes the outstanding borrowings from the term loan as of periods presented:


	March 31, 2024		December 31, 2023
	(in thousands)
Principal outstanding and final fee	$	36,720	$	36,720
Less: Unamortized debt issuance costs	(75)		(81)
Unaccreted value of final fee	(538)		(574)
Outstanding debt, net of debt issuance costs and unaccreted value of final fee	$	36,107	$	36,065
Classified as:

Long-term borrowings	$	36,107	$	36,065

The outstanding debt is related to a term loan pursuant to the Loan and Security Agreement dated August 12, 2021 entered into by the Company with Silicon Valley Bank (“SVB” or the “Lender”) (the “Original Loan Agreement”). Pursuant to the Original Loan Agreement, SVB provided a term loan in an aggregate principal amount of $35.0 million to the Company (the “Original Term Loan”).

On January 6, 2023, the Company entered into a First Amendment to Loan and Security Agreement (the “First Amendment”) with SVB, which amended the Company's Original Term Loan pursuant to which the Company received a new term loan facility in an aggregate principal amount of $36.0 million (the “Original Loan Agreement” with the Amendment, collectively the “Amended Loan Agreement”). Upon entry into the Amended Loan Agreement, the Company borrowed $36.0 million pursuant to a term loan (the "Term Loan"), which was substantially used to repay in full the $35.0 million term loan outstanding under the Original Loan Agreement and secured a revolving credit facility in an aggregate principal amount of up to $15.0 million (the “Revolving Line”). The Amended Loan Agreement also includes an uncommitted accordion term loan in an aggregate principal amount of up to $15.0 million, which accordion may be approved by the Lender solely in its discretion, upon the Company’s request. The Term Loan matures on December 1, 2027 (the “Term Loan Maturity Date”). Interest on the Term Loan will be payable monthly at a floating annual rate set at the greater of (i) the prime rate as published in the Wall Street Journal plus 0.5% or (ii) 6.75%. Commencing on July 1, 2025, the Company will be required to make monthly principal Term Loan amortization payments. A final fee payment of 2% of the original principal amount of the Term Loan is due upon the earlier of the Term Loan Maturity Date, termination of the Amended Loan

Agreement, acceleration by the Lender following an event of default, or prepayment of the Term Loan. The Company may elect to prepay the Term Loan in whole prior to the Term Loan Maturity Date subject to a prepayment fee equal to 2% of the principal amount of the Term Loan prepaid at such time. No prepayment fee would be due if the Term Loan is refinanced by the Lender. Pursuant to the terms of the Amended Loan Agreement, revolving loans may be borrowed, repaid and reborrowed until the maturity date, which will be July 6, 2025 (the “Revolving Line Maturity Date”). Borrowings under the Revolving Line are based on 80% of eligible domestic accounts receivable borrowing base. Interest on the outstanding balance of the Revolving Line will be payable monthly at a floating annual rate set at the greater of the prime rate as published in the Wall Street Journal or 6.25%. Interest on borrowings is due monthly and any principal balance is due on the Revolving Line Maturity Date, provided that when Revolving Line Advances are outstanding, in the event the Company does not maintain an adjusted quick ratio of at least 1.5 to 1.0, then falling below such threshold will allow the Lender to apply accounts receivable collections to outstanding Revolving Line borrowings. The Company will pay a total commitment fee of $187,500 on account of the Revolving Line payable in installments, but fully earned at close. The Company will also be required to pay a fee of $150,000 if it terminates the Amended Loan Agreement or Revolving Line prior to Revolving Line Maturity Date, or if the Lender terminates the Loan Agreement or the Revolving Line following an event of default. No termination fee would be due if the Revolving Line is replaced with a new facility with the Lender.

On March 14, 2023 all of SVB’s assets and liabilities, including all of SVB’s rights as the lender pursuant to the Amended Loan Agreement, were assigned to Silicon Valley Bridge Bank. On March 27, 2023, all of Silicon Valley Bridge Bank’s assets and liabilities were assigned and assumed by First-Citizens Bank & Trust Company (“First-Citizens”). On January 25, 2024, the Company entered into a Second Amendment to Loan and Security Agreement with SVB which amends the Company's Amended Loan Agreement (the “Second Amendment” and together with the Amended Loan Agreement, the “Second Amended Loan Agreement”). The Second Amendment revised certain provisions related to financial covenants and the periods in which the covenants apply. No amounts were outstanding under the Revolver as of March 31, 2024.

The Company accounted for the Amended Loan Agreement as a debt modification. Accordingly, the remaining unamortized debt issuance costs related to the Original Loan Agreement together with any lender fees incurred in connection with the entry of the Amended Loan Agreement are amortized to interest expense using the straight-line method over the new term of the loan through December 2027.

The effective interest rate related to the First-Citizens Term Loan for the three months ended March 31, 2024 and March 31, 2023 was 9.3% and 8.6%, respectively.

The table below summarizes the future principal and final fee payments under the Fist-Citizens Term Loan as of March 31, 2024:


Year ending December 31,	(in thousands)
Remainder of 2024	$	—
2025	8,400
2026	14,400
2027	13,920
2028	—

Total principal and final fee payments	$	36,720

The Second Amended Loan Agreement includes affirmative and negative covenants applicable to the Company and certain of its foreign subsidiaries. The affirmative covenants include, among others, covenants requiring the Company to maintain its legal existence and governmental compliance, deliver certain financial reports, and maintain insurance coverage. The negative covenants include, among others, restrictions regarding transferring collateral, pledging the Company's intellectual property to other parties, engaging in mergers or acquisitions, paying dividends or making other distributions, incurring indebtedness, transacting with affiliates, and entering into certain investments, in each case subject to certain exceptions. As of March 31, 2024, the Company was in compliance with all debt covenants.

- 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.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1B
-Subparagraph (h)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1B

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 235
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-Section S99
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-Subparagraph (SX 210.4-08(c))
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147480678/235-10-S99-1

Reference 3: http://fasb.org/us-gaap/role/ref/legacyRef
-Topic 470
-Name Accounting Standards Codification
-Publisher FASB
-URI https://asc.fasb.org//470/tableOfContent

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
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-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1B

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
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-Paragraph 1B
-Subparagraph (g)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1B

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
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-Paragraph 1B
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-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1B

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1C
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-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1C

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
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-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1C

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
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-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1E

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
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-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1I

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
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-Section 50
-Paragraph 1I
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-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1I

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1I
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org//1943274/2147481139/470-20-50-1I

+ Details

Cover Page - shares	3 Months Ended
Cover Page - shares	Mar. 31, 2024	May 01, 2024
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Mar. 31, 2024
Document Transition Report	false
Entity File Number	001-38701
Entity Registrant Name	SI-BONE, INC.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	26-2216351
Entity Address, Address Line One	471 El Camino Real
Entity Address, Address Line Two	Suite 101
Entity Address, City or Town	Santa Clara
Entity Address, State or Province	CA
Entity Address, Postal Zip Code	95050
City Area Code	408
Local Phone Number	207-0700
Title of 12(b) Security	Common Stock, par value $0.0001 per share
Trading Symbol	SIBN
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Filer Category	Large Accelerated Filer
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		41,204,796
Entity Central Index Key	0001459839
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2024
Document Fiscal Period Focus	Q1
Amendment Flag	false

Income Taxes (Details) - USD ($)	3 Months Ended
Income Taxes (Details) - USD ($)	Mar. 31, 2024	Mar. 31, 2023
Income Tax Disclosure [Abstract]
Income tax provision	$ 0	$ 0

- Definition

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

+ References + Details