The Company tests goodwill at least annually for impairment. The Company tests more frequently if indicators are present or changes in circumstances suggest that impairment may exist. These indicators include, among others, declines in sales, earnings or cash flows, or the development of a material adverse change in the business climate. The Company assesses goodwill for impairment at the reporting unit level, which is defined as an operating segment or one level below an operating segment.

In the third quarter of 2023, the Company announced the termination of the former President and Chief Executive Officer, former Chief Financial Officer, and former Chief Legal Officer, from their respective roles. Immediately following the announcement, the Company's market capitalization decreased by approximately 30%, indicating that an impairment may exist. As a result, the Company performed an interim quantitative assessment of its goodwill as of September 30, 2023.

The Company estimated the fair value of each reporting unit using a weighted average of the fair value derived from both an income approach and a market approach (all Level 3 fair value measurements). Upon performing its assessment, the Company determined its Global Spine reporting unit's fair value exceed its carrying value of net assets as of September 30, 2023.

The following table presents the net carrying value of goodwill as of September 30, 2023, and any activity recognized during the year-to-date period, including accumulated goodwill impairment losses by reportable segment:


(Unaudited, U.S. Dollars, in thousands)	Balance as of December 31, 2022			Goodwill Acquired in the Merger with SeaSpine		Impairment Recognized within Acquisition-related Amortization and Remeasurement		Balance as of September 30, 2023
Global Spine - Gross	$	71,317		$	123,450	$	—	$	194,767
Global Spine - Accumulated Impairment Loss		—			—		—	$	—
Global Spine - Net	$	71,317		$	123,450	$	—	$	194,767

Global Orthopedics - Gross	$	11,822		$	—	$	—	$	11,822
Global Orthopedics - Accumulated Impairment Loss		(11,822	)		—		—	$	(11,822	)
Global Orthopedics - Net	$	—		$	—	$	—	$	—

Goodwill, net of accumulated impairment losses	$	71,317		$	123,450	$	—	$	194,767