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Income Taxes - Additional Information (Detail) - USD ($) $ in Thousands | 3 Months Ended | 12 Months Ended
--- | --- | ---
Mar. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2019 | Dec. 31, 2018 | Dec. 31, 2017
Components Of Income Tax Expense Benefit [Line Items] |  |  |  |  |
Corporate income tax rate |  |  | 21.00% | 21.00% | 35.00%
Additional income tax expense benefit |  | $ 8,300 |  |  |
Tax cuts and jobs act of 2017 change in tax rate deferred tax assets and liability expected to reserve in future |  |  |  |  | $ 8,600
Change of intention for foreign earnings |  |  |  |  | 0
Tax cuts and jobs act of 2017 change in provisional income tax benefit |  |  |  |  | 300
Impact of the Tax Act | $ (600) |  |  | $ (560) | 8,347
Cash paid related to taxes |  |  | $ 8,100 | 15,600 | 3,300
Net decrease in valuation allowance |  |  | 10,300 |  |
Unremitted foreign earnings |  |  | $ 49,200 | 50,400 |
Minimum percentage of income tax benefit |  |  | 50.00% |  |
Gross unrecognized tax benefit |  |  | $ 16,900 | 21,400 |
Net interest and penalties on unrecognized tax benefits |  |  | (100) | 1,400 | 2,300
Accrued interest and penalties related to unrecognized tax benefits |  |  | 6,600 | 6,700 |
Income taxes |  |  | 1,413 | $ 9,074 | $ 29,100
Internal Revenue Service [Member] |  |  |  |  |
Components Of Income Tax Expense Benefit [Line Items] |  |  |  |  |
Income taxes |  |  | (1,800) |  |
Minimum [Member] |  |  |  |  |
Components Of Income Tax Expense Benefit [Line Items] |  |  |  |  |
Decrease in unrecognized tax benefits, exclusive of interest and penalties |  |  | 13,000 |  |
Maximum [Member] |  |  |  |  |
Components Of Income Tax Expense Benefit [Line Items] |  |  |  |  |
Decrease in unrecognized tax benefits, exclusive of interest and penalties |  |  | 13,500 |  |
State [Member] |  |  |  |  |
Components Of Income Tax Expense Benefit [Line Items] |  |  |  |  |
Operating loss carry forwards, net of tax |  |  | $ 35,500 |  |
Operating loss carryforwards, expiration year |  |  | 2020 |  |
State [Member] | Spinal Kinetics [Member] |  |  |  |  |
Components Of Income Tax Expense Benefit [Line Items] |  |  |  |  |
Operating loss carry forwards, net of tax |  |  | $ 22,000 |  |
Federal [Member] |  |  |  |  |
Components Of Income Tax Expense Benefit [Line Items] |  |  |  |  |
Operating loss carry forwards, net of tax |  |  | $ 25,500 |  |
Operating loss carryforwards, expiration year |  |  | 2026 |  |
Research and development credits |  |  | $ 1,600 |  |
Foreign Tax Authority |  |  |  |  |
Components Of Income Tax Expense Benefit [Line Items] |  |  |  |  |
Operating loss carry forwards, net of tax |  |  | $ 145,300 |  |
Operating loss carryforwards, expiration year |  |  | 2020 |  |

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