Xtant Medical Announces Fourth Quarter and 2018 Financial Results BELGRADE, MT

Medical Announces Fourth Quarter and 2018 Financial Results

MT, April 1, 2019 - Xtant Medical Holdings, Inc. (NYSE American: XTNT), a global medical technology company focused on surgical

solutions for the treatment of spinal disorders, today reported financial and operating results for the fourth quarter and year

ended December 31, 2018.

Quarter 2018 Financial Highlights and Recent Announcements:

Jensen, VP, Finance and Interim CFO of Xtant Medical, said, "Our success in executing cost reductions and revitalizing our

sales channel has allowed us to make significant progress in repositioning the Company. The appointment of several proven sales

leaders to our team is expected to further advance and expand our sales capabilities and potentially support the introduction

of new products in late 2019. With OrbiMed's recent investment of $10 million in additional debt capital, we have made progress

toward strengthening our capital structure and improving our financial flexibility. We appreciate OrbiMed's continued support

and confidence in Xtant's growth potential. We believe we have a strong foundation on which to achieve the Company's

long-term objectives and remain committed to creating value for patients and shareholders."

Quarter and Full Year 2018 Financial Results

quarter 2018 revenue was $18.3 million, compared to $19.3 million for the same period in 2017. Full year 2018 revenue was $72.2

million, compared to $82.6 million for 2017. The decreases occurred primarily due to the decrease in sales in the spinal hardware

implant product line.

profit for the fourth quarter of 2018 was 39.7%, compared to 53.2% for the same period in 2017 and was 60.2% for 2018, compared

to 60.6% in 2017. In the fourth quarter of 2018 and 2017, the Company increased its inventory reserve by $4.4 million and $2.2

million, respectively, primarily due to excess inventory in the spinal implant product line. Excluding the inventory reserve adjustments

in 2018 and 2017, gross profit would have been 63.7% and 64.6% for the fourth quarter, respectively, and 66.3% and 63.3%, for

the full year, respectively.

expenses for the fourth quarter of 2018 were $62.0 million, compared to $37.4 million for the fourth quarter of 2017, and were

$103.6 million in 2018 compared to $87.9 million in 2017. In the fourth quarter of 2018 and 2017, the Company incurred non-cash

impairment charges to goodwill and intangibles attributed to the X-Spine acquisition totaling $48.1 million and $17.6 million,

respectively. Excluding the non-cash impairment charges, operating expenses were $13.8 million in the fourth quarter of 2018 compared

to $19.8 million in the fourth quarter of 2017, and $55.4 million in 2018 compared to $70.3 million in 2017. These decreases were

primarily attributable to lower commission expense as a result of lower revenue during 2018, a decrease in general and administrative

expenses, and cost reduction initiatives to consolidate facilities.

quarter 2018 net loss was $56.7 million, or $4.31 per share, compared to fourth quarter 2017 net loss of $28.4 million, or $18.77

per share. Net loss for 2018 was $70.1 million, or $5.97 per share, compared to $52.4 million, or $34.76 per share, in 2017. Excluding

the non-cash impairment charges and the inventory reserve charges, the net loss was $4.2 million, or $0.32 per share, in the fourth

quarter of 2018, compared to $8.6 million, or $5.70 per share, for the fourth quarter of 2017, and $17.6 million, or $1.50 per

share, in 2018 compared to $32.6 million, or $21.64 per share, in 2017.

Adjusted EBITDA for the fourth quarter of 2018 was $1.3 million compared to a loss of $0.9 million for the same period of 2017.

Non-GAAP Adjusted EBITDA for 2018 was $4.7 million, compared to $0.5 million for 2017. The Company defines Adjusted EBITDA as

net income/loss from operations before depreciation, amortization and interest expense, and as further adjusted to add back in

or exclude, as applicable, non-cash special charges, provision for losses on inventory, non-cash impairment charges, non-cash

compensation, change in warrant derivative liability, separation related expenses, litigation reserve, facility consolidation

costs and restructuring expenses. A calculation and reconciliation of non-GAAP Adjusted EBITDA to net loss can be found in the

attached financial tables.

to Credit Facility and Debt Capital Investment

March 29, 2019, the Company and its lenders entered into a Second Amended and Restated Credit Agreement, which, among other provisions,

increased availability by an additional $10 million via an incremental delayed draw term loan, extended the maturity date to March

31, 2021 and the period during which no interest accrues from December 31, 2018 until March 31, 2020, and replaced the Minimum

Consolidated EBITDA and Consolidated Senior Leverage Ratio Covenants with a new Minimum Revenue Covenant, to support the Company's

working capital needs. In connection with new amendment, the Company issued warrants for the purchase of 1.2 million shares of

Xtant common stock with an exercise price of $0.01 per share and an expiration date of April 1, 2029, to OrbiMed Royalty

Opportunities II, LP and ROS Acquisition Offshore LP, which collectively own approximately 70% of Xtant's outstanding

common stock and are the sole holders of the Company's outstanding long-term debt under the credit facility.

Medical will host a webcast and conference call to discuss the fourth quarter and full year 2018 financial results on Monday,

April 1, 2019 at 9:00 AM ET. To access the webcast, Click Here. To access the conference call, dial 877-407-6184 within

the U.S. or 201-389-0877 outside the U.S. A replay of the call will be available at www.xtantmedical.com, under "Investor

Xtant Medical Holdings, Inc.

Medical Holdings, Inc. (www.xtantmedical.com) is a global medical technology company focused on the design, development, and commercialization

of a comprehensive portfolio of orthobiologics and spinal implant systems to facilitate spinal fusion in complex spine, deformity

and degenerative procedures. Xtant people are dedicated and talented, operating with the highest integrity to serve our customers.

and denote trademarks and registered trademarks of Xtant Medical Holdings, Inc. or its affiliates, registered as indicated

in the United States, and in other countries. All other trademarks and trade names referred to in this release are the property

of their respective owners.

supplement the Company's consolidated financial statements prepared in accordance with U.S. generally accepted accounting

principles (GAAP), the Company uses certain non-GAAP financial measures in this release, including Adjusted EBITDA, net loss excluding

non-cash impairment charges, operating expenses excluding non-cash impairment charges and gross profit excluding inventory reserve

adjustments. Reconciliations of the non-GAAP financial measures used in this release to the most comparable GAAP measures for

the respective periods can be found in tables later in this release. The Company's management believes that the presentation

of these measures provides useful information to investors. These measures may assist investors in evaluating the Company's

operations, period over period. Management uses the non-GAAP measures in this release internally for evaluation of the performance

of the business, including the allocation of resources. Investors should consider non-GAAP financial measures only as a supplement

to, not as a substitute for or as superior to, measures of financial performance prepared in accordance with GAAP.

Cautions Regarding Forward-looking Statements

press release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995.

Forward-looking statements include statements that are predictive in nature, that depend upon or refer to future events or conditions,

or that include words such as expects,'' anticipates,'' intends,''

plans,'' believes,'' estimates,'' "continue,"

"future," will,'' "potential" similar expressions or the negative thereof, and

the use of future dates. The Company cautions that its forward-looking statements by their nature involve risks and uncertainties,

and actual results may differ materially depending on a variety of important factors, including, among others: the Company's

future operating results and financial performance; the ability to increase or maintain revenue; the ability to remain competitive;

the ability to innovate and develop new products; the effect of recent management changes and the ability to engage and retain

qualified personnel; government and third-party coverage and reimbursement for Company products; the ability to obtain and maintain

regulatory approvals and comply with government regulations; the effect of product liability claims and other litigation to which

the Company may be subject; the effect of product recalls and defects; timing and results of clinical studies; the ability to

obtain and protect Company intellectual property and proprietary rights and operate without infringing the rights of others; the

ability to service Company debt and comply with debt covenants; the ability to raise additional financing and other factors. Additional

risk factors are contained in the Company's Annual Report on Form 10-K for the year ended December 31, 2017 filed with the

Securities and Exchange Commission (SEC) on April 2, 2018 and subsequent SEC filings by the Company, including without limitation

its most recent Quarterly Report on Form 10-Q for the quarter ended September 30, 2018 filed with the SEC on November 14, 2018

and its Annual Report on Form 10-K for the year ended December 31, 2018 anticipated to be filed with the SEC. Investors are encouraged

to read the Company's filings with the SEC, available at www.sec.gov, for a discussion of these and other risks and uncertainties.

The Company undertakes no obligation to release publicly any revisions to any forward-looking statements to reflect events or

circumstances after the date hereof or to reflect the occurrence of unanticipated events, except as required by law. All forward-looking

statements attributable to the Company or persons acting on its behalf are expressly qualified in their entirety by this cautionary

MEDICAL HOLDINGS, INC.

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MEDICAL HOLDINGS, INC.

CONSOLIDATED STATEMENTS OF OPERATIONS

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