Companion Spine LLC Completes Acquisition of the Business and Assets of Paradigm Spine GmbH, including the Coflex® and CoFix® Spine Implants and All Other Implant Systems, from Xtant™ Medical Holdings, Inc.

• Companion Spine is the first company in the world with a product portfolio solely focused on Total Disease State Solutions™ (“TDS™”) for degenerative spine diseases.

• This acquisition creates the world’s largest and most comprehensive product portfolio of minimally invasive surgical (“MIS”) Posterior Dynamic Solutions™ of spine stabilization and motion preserving implants.

• The combined company can now treat the full range of lumbar spinal stenosis (“LSS”) and degenerative disc disease (“DDD”) conditions across the spectrum of disease progression with our SMART™ (Solution Based, Minimal Access, Reliable Technologies) portfolio.

Companion Spine LLC (“Companion Spine” or “the Company”), the French-American specialist in spine implant surgery, announced today that it has completed its previously announced acquisition of the Coflex® Interlaminar Stabilization® device (“Coflex®”) and CoFix® Posterior MIS Fusion System (“CoFix®”) implants, Paradigm Spine GmbH, its subsidiaries and all Paradigm Spine-related business activity globally (“Paradigm Spine”) from Xtant™ Medical Holdings, Inc. (NYSE:XTNT) (“Xtant Medical”).

Paradigm Spine will retain its name and branding and will maintain its office in Wurmlingen, Germany. Anthony G. Viscogliosi will lead the combined company as Executive Chairman and Chief Executive Officer and Enrico Sangiorgio will be Executive Vice President International of Paradigm Spine and General Manager of Companion Spine Outside the U.S. (“OUS”). William Pfost will continue in his role as Chief Sales Officer of Companion Spine, focused on the U.S. markets.

“The acquisition of Paradigm Spine was a clear opportunity to expand Companion Spine’s mission to safely and effectively treat spine pain through treating lumbar and cervical degenerative spine diseases,” said Anthony G. Viscogliosi, Executive Chairman and Chief Executive Officer of Companion Spine. “As a combined company, we have the largest footprint of Posterior Dynamic Solutions™ for spine stabilization in degenerative spine diseases, and are well positioned to meet demand both in the U.S. and in high-growth international markets. Together, we will continue to dedicate our work to restoring form, function, motion, balance, stabilization and alignment while reducing or eliminating pain. I’m excited to bring together these talented teams and innovative products to continue to achieve excellence in spine care.”

“I can surely speak on behalf of the entire Paradigm Spine team when I say that we are thrilled for this opportunity to combine our product portfolio with Companion Spine’s to best support patients and physicians across the globe, and also to expand our relationships with our valued partners and distributors,” said Enrico Sangiorgio, Executive Vice President International of Paradigm Spine and General Manager of Companion Spine OUS. “With our combined product portfolio—treating the full range of LSS and DDD conditions across the spectrum of disease progression—we are also providing enhancements for our distributors as we substantially expand our growth on a global scale. We would not be able to get our technologies to patients without these valued partners, and we look forward to the work we’ll continue to do together.”

The combined company’s portfolio of products and uses include: Coflex® when a decompression is required for LSS or CoFix® when a larger decompression is needed and there exists more instability for LSS, LISA™ Lumbar Implant for Stiffness Augmentation for when there is a decompression with significant instability requiring greater stabilization, or the HPS™ 2.0 Hybrid Performance System when there is significant instability but a desire to preserve adjacent segments. In the cervical anatomy, the DCI™ Dynamic Cervical Implant is designed as a Coflex® concept applied in an anterior interbody fashion for maintenance of motion. Lastly, Companion Spine’s DIAM™ Spinal Stabilization System product is designed for use in DDD patients.

“We are pleased to intensify our efforts in the U.S. markets, now bringing the full power of our combined portfolio of U.S. FDA Premarket Approval (“PMA”) products to patients across the full range of LSS and DDD conditions,” said William Pfost, Chief Sales Officer of Companion Spine. “With the realignment of key technologies that treat patients and the origin of their back pain, our focus in the U.S. is on educating physicians on the utilization of our SMART™ technologies portfolio so they can best select the right amount of stabilization—neither under nor over stabilization—for their patients. With this strategy, we are confident that we will continue to be the Companion to our physicians, and their patients.”

Said Anthony G. Viscogliosi in his role as Principal of Viscogliosi Brothers, LLC: “The Viscogliosi Brothers family of companies is delighted for the prodigal son—Paradigm Spine—to return to the portfolio through this acquisition by Companion Spine. Now, as a more globally-powerful organization, the combined company will grow further with Paradigm Spine’s twenty-year legacy of U.S. FDA PMA approval products and strong clinical safety performance in the treatment of degenerative spine diseases. With the transformation in the U.S. private payer reimbursement market, we are well positioned to continue to support physicians, patients and payers alike through the deployment of the right tools, at the right time and for the right patient.”

As Sean Browne, Chief Executive Officer of Xtant Medical, said of the transaction: “This is a terrific transaction for both organizations. For Xtant, the sale of these business units allows us to strategically focus on our core business, while meaningfully reducing our debt and improving our balance sheet. Moreover, these fantastic motion preservation technologies such as Coflex®, HPS™ 2.0 and DCI™ will get the kind of focus only the Viscogliosi Brothers and Companion Spine can provide to optimize their commercial development. This type of development is in the DNA of the Viscogliosi Brothers, while it is far afield of Xtant Medical’s core competencies; so we expect big things for Companion Spine in the years ahead.”

Innovatus Capital Partners is the current senior lender to Companion Spine. Companion Spine is advised in this acquisition by Dorsey & Whitney, LLP as lead legal counsel, McDermott Will & Schulte as tax and German legal counsel, Gide Loyrette Nouel as French legal counsel, Farber LLC as intellectual property legal counsel, Natixis Partners as capital access financial advisor, FTI Consulting as strategic communications advisor, Deloitte Finance as financial due diligence advisor, MCRA as regulatory, clinical and reimbursement advisor, and UHY LLP as U.S. auditor. Xtant Medical is advised by Fox Rothschild LLP as legal counsel and LifeSci Partners as investor relations advisor.

About Companion Spine

Founded in 2020 in New York, United States, and Bordeaux, France, Companion Spine is a global company specialized in the treatment of spine degenerative conditions using Posterior Dynamic Solutions™ and motion preserving technology while dynamically stabilizing the spine, preserving motion and reducing or eliminating spine pain. Companion Spine's comprehensive system of SMART™ (Solution Based, Minimal Access, Reliable Technologies) solutions target lumbar spinal stenosis and degenerative disc disease, two of the most common indications for back and leg pain worldwide. With the widest and deepest product portfolio of implant systems and solutions for the patient for posterior dynamic spine stabilization and motion preservation, Companion Spine provides spine specialists and their patients earlier, safe, effective, reversible and minimally invasive alternatives to more invasive implant procedures.

For more information, please visit: www.companion-spine.com

About Paradigm Spine

Paradigm Spine is a provider of non-fusion and fusion spinal implant solutions that serve to address the unmet clinical needs of spine surgeons and their patients. Starting with the Coflex® Interlaminar Stabilization® device, Paradigm Spine develops a full non-fusion product portfolio of motion preserving, tissue sparing technologies, as well as fusion products. Their commitment is to lead the positioning of non-fusion technologies to the forefront of improving the quality of life in patients with spinal diseases through being surgeon centric, indication specific and data driven.

About Xtant Medical Holdings, Inc.

Xtant Medical's mission of honoring the gift of donation so that our patients can live as full and complete a life as possible, is the driving force behind our company. Xtant 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 serving the chronic and surgical wound care and sports medicine markets, as well as spinal implant systems. Xtant people are dedicated and talented, operating with the highest integrity to serve our customers.

The symbols ™ 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.

About Viscogliosi Brothers, LLC

Viscogliosi Brothers is a family-owned New York City-based single family office dedicated to driving growth and innovation in the neuro-musculoskeletal industry. Established in 1999, the firm focuses on identifying and building groundbreaking innovations in healthcare, aiming to address unmet clinical needs, enhance patient outcomes, and drive cost efficiency in the healthcare system. Since its inception 26 years ago, Viscogliosi Brothers has founded, financed, operated and grown 43 businesses with operations and distribution across more than 80 countries. These businesses have positively impacted millions of patients with cutting-edge innovations in healthcare. The firm has led the transformation of multiple businesses in the spine industry specifically including: Spine Solutions, Spine Next, Paradigm Spine, Simplify Medical, Centinel Spine, Companion Spine, Spine BioPharma, Woven Orthopedics Technologies and VB Spine, among others. For more information, please visit: www.vbllc.com

Viscogliosi Brothers, LLC is the largest shareholder of Companion Spine.

About Viscogliosi Brothers Watermark LLC (“VBW”)

Viscogliosi Brothers Watermark LLC is a New York City-based holding company specializing in investing in innovation within the MedTech sector. Founded in 2022, VBW is committed to creating wealth for its shareholders while enhancing humanity's well-being. With a portfolio-driven investment mandate and strategic expertise, VBW supports its invested entities through financing and manufacturing support capabilities. For more information, visit www.vbwholdings.com.

VBW is a key shareholder of Companion Spine.

Cautionary Statement Regarding Forward-Looking Statements

This 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 “intends,” ‘‘expects,’’ ‘‘anticipates,’’ ‘‘plans,’’ ‘‘believes,’’ ‘‘estimates,’’ “continue,” “future,” ‘‘will,’’ “potential,” “going forward,” “guidance,” 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; its ability to increase or maintain revenue; the Company’s ability to become operationally self-sustaining and less reliant on third-party manufacturers and suppliers; risks associated with its acquisitions and the integration of those businesses; the ability to implement successfully its future growth initiatives and risks associated therewith; possible future impairment charges to long-lived assets and goodwill and write-downs of excess inventory; the ability to remain competitive; the ability to innovate, develop and introduce new products and the success of those products; the ability to engage and retain new and existing independent distributors and agents and qualified personnel and the Company’s dependence on key independent agents for a significant portion of its revenue; the effect of labor and hospital staffing shortages on the Company’s business, operating results and financial condition, especially when they affect key markets; the effect of inflation, increased interest rates and other recessionary factors and supply chain disruptions; the effect of product sales mix changes on the Company’s financial results; 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; the ability to license certain of the Company’s intellectual property on commercially reasonable terms and to maintain any such licenses; the ability to obtain and protect Company intellectual property and proprietary rights and operate without infringing the rights of others; risks associated with the Company’s clinical trials; international risks; the ability to service Company debt, comply with its debt covenants and access additional indebtedness; the ability to maintain sufficient liquidity to fund its operations and obtain financing on favorable terms or at all; and other factors. 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 statement.

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