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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, 2020 | 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% | 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) |
Deferred Tax Liabilities, Deferred Expense | 8,600 |  |  |  |  |
Tax Cuts and Jobs Act, Transition Tax for Accumulated Foreign Earnings, Liability | $ 0 |  |  |  |  |
Cash paid related to taxes |  |  | $ 500 | $ 8,100 | 15,600 |
Federal income tax refund recieved |  |  | 3,500 |  |  |
Net increase in valuation allowance |  |  | 11,800 |  |  |
Unremitted foreign earnings |  |  | $ 53,700 | 49,200 |  |
Minimum percentage of income tax benefit |  |  | 50.00% |  |  |
Gross unrecognized tax benefit |  |  | $ 4,600 | 16,900 |  |
Net interest and penalties on unrecognized tax benefits |  |  | (5,400) | (100) | 1,400 |
Accrued interest and penalties related to unrecognized tax benefits |  |  | 1,200 | 6,600 |  |
Income taxes |  |  | (2,885) | 1,413 | $ 9,074 |
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 |  |  | 1,000 |  |  |
Maximum [Member] |  |  |  |  |  |
Components Of Income Tax Expense Benefit [Line Items] |  |  |  |  |  |
Decrease in unrecognized tax benefits, exclusive of interest and penalties |  |  | 1,500 |  |  |
State and Foreign Jurisdiction [Member] |  |  |  |  |  |
Components Of Income Tax Expense Benefit [Line Items] |  |  |  |  |  |
Cash paid related to taxes |  |  | 4,000 |  |  |
State [Member] |  |  |  |  |  |
Components Of Income Tax Expense Benefit [Line Items] |  |  |  |  |  |
Operating loss carry forwards, net of tax |  |  | $ 33,600 |  |  |
Operating loss carryforwards, expiration year |  |  | 2027 |  |  |
State [Member] | Spinal Kinetics [Member] |  |  |  |  |  |
Components Of Income Tax Expense Benefit [Line Items] |  |  |  |  |  |
Operating loss carry forwards, net of tax |  |  | $ 21,400 |  |  |
Federal [Member] |  |  |  |  |  |
Components Of Income Tax Expense Benefit [Line Items] |  |  |  |  |  |
Operating loss carry forwards, net of tax |  |  | $ 21,400 |  |  |
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 |  |  | $ 140,200 |  |  |
Operating loss carryforwards, expiration year |  |  | 2021 |  |  |

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