Document:

EX-10.41

 Exhibit 10.41 

EXECUTION VERSION 

CONSENT TO, REAFFIRMATION OF AND THIRD AMENDMENT TO 

INTERCREDITOR AGREEMENT 

THIS CONSENT TO, REAFFIRMATION OF AND THIRD AMENDMENT TO INTERCREDITOR AGREEMENT (this “Agreement”) is entered into as of
June 20, 2019 by and among Cortland Capital Market Services LLC, in its capacity as agent for the Second Lien Creditors under the Second Lien Loan Documents, including its successors and assigns in such capacity from time to time (“Second
Lien Agent”), and Antares Capital LP, in its capacity as agent for the First Lien Creditors under the First Lien Documents, including its successors and assigns in such capacity from time to time (“First Lien Agent”), as
acknowledged and agreed by the Borrower and the other Obligors acknowledging this Agreement. 
 RECITALS 

WHEREAS, Amendia, Inc., a Georgia corporation (the “Borrower”), the other Obligors from time to time party thereto, the First
Lien Lenders and First Lien Agent are parties to that certain Amended and Restated Credit Agreement dated as of April 13, 2017 (as amended by that certain Forbearance Agreement and First Amendment to Amended and Restated Credit Agreement dated
as of July 12, 2018, that certain Second Amendment to Amended and Restated Credit Agreement dated as of May 3, 2019, that certain Third Amendment to Amended and Restated Credit Agreement dated as of June 7, 2019, that certain Fourth Amendment to
Amended and Restated Credit Agreement dated as of June 13, 2019, and as further amended, restated, supplemented or otherwise modified from time to time in accordance with the terms of the Intercreditor Agreement (as defined below) prior to the date
hereof, the “Existing Credit Agreement”), pursuant to which the First Lien Lenders have made and will from time to time make loans and provide other financial accommodations to the Borrower; 

WHEREAS, the Borrower, the other Obligors from time to time party thereto, the Second Lien Creditors and Second Lien Agent are parties to that
certain Second Lien Note Purchase Agreement dated as of April 29, 2016 (as amended by that certain Amendment No. 1 to the Second Lien Note Purchase Agreement dated as of April 13, 2017, that certain Amendment No. 2 to the Second Lien Note
Purchase Agreement dated as of July 12, 2018, that certain Amendment No. 3 to the Second Lien Note Purchase Agreement dated as of May 3, 2019, that certain Amendment No. 4 to the Second Lien Note Purchase Agreement dated as of June 7,
2019, that certain Amendment No. 5 to the Second Lien Note Purchase Agreement dated as of June 13, 2019, and as further amended, restated, supplemented or otherwise modified from time to time in accordance with the terms of the Intercreditor
Agreement prior to the date hereof, the “Existing Second Lien Loan Agreement”), pursuant to which the Second Lien Creditors have extended, and may from time to time extend, credit to the Borrower; 

WHEREAS, First Lien Agent, on behalf of the First Lien Creditors, and Second Lien Agent, on behalf of the Second Lien Creditors, are parties
to, and the Obligors have acknowledged, that certain Intercreditor Agreement dated as of April 29, 2016 (as amended, restated, supplemented or otherwise modified from time to time, including pursuant to this

 
Agreement, the “Intercreditor Agreement”), pursuant to which Second Lien Agent, on behalf of the Second Lien Creditors, agreed, among other things, that the obligations of the
Obligors under the First Lien Documents are to be secured on a first priority basis and the obligations under the Second Lien Documents are to be secured on a second priority basis, in each case, upon the terms and subject to the conditions set
forth therein; 
 WHEREAS, on the date hereof, First Lien Agent, the First Lien Lenders signatory thereto, Borrower and the other Obligors
are to enter into that certain Fifth Amendment to Amended and Restated Credit Agreement (the “First Lien Amendment”; the Existing Credit Agreement, as amended, modified and supplemented by the First Lien Amendment, and as further
amended, restated, supplemented or otherwise modified from time to time in accordance with the terms of the Intercreditor Agreement, the “Credit Agreement”), pursuant to which, among other things, the Existing Credit Agreement shall
be amended, without constituting a novation, and the First Lien Lenders will extend certain financial accommodations to the Borrower; 

WHEREAS, on the date hereof, Second Lien Agent, the Second Lien Creditors and the Obligors are to enter into that certain Amendment No. 6
to the Second Lien Note Purchase Agreement (the “Second Lien Amendment”; the Existing Second Lien Loan Agreement, as amended, modified and supplemented by the Second Lien Amendment, and as further amended, restated, supplemented or
otherwise modified from time to time in accordance with the terms of the Intercreditor Agreement, the “Second Lien Loan Agreement”), pursuant to which, among other things, the Existing Second Lien Loan Agreement shall be amended,
without constituting a novation, and the Second Lien Lenders will extend certain financial accommodations to the Borrower; 
 WHEREAS, as a
condition precedent to the effectiveness of the First Lien Amendment, First Lien Agent and the First Lien Creditors have required the execution, delivery and performance of this Agreement by the parties hereto; and 

WHEREAS, as a condition precedent to the effectiveness of the Second Lien Amendment, Second Lien Agent and the Second Lien Creditors have
required the execution, delivery and performance of this Agreement by the parties hereto. 
 NOW, THEREFORE, (i) in order to induce
First Lien Agent and the First Lien Lenders to enter into and deliver the First Lien Amendment, (ii) in order to induce Second Lien Agent and the Second Lien Creditors to enter into and deliver the Second Lien Amendment, and (iii) for
other good and valuable consideration, the receipt and sufficiency of which hereby are acknowledged, the parties hereto agree as follows: 

NOW, THEREFORE, for good and valuable consideration, receipt of which is hereby acknowledged, the parties agree as follows: 

1.    Definitions. All capitalized terms used but not elsewhere defined herein shall have the respective
meanings ascribed to such terms in the Intercreditor Agreement. 

  
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 2.    Amendments to Intercreditor Agreement. 

(a)    The definition of “Maximum First Lien Principal Amount” set forth in Section 1.1 of the Intercreditor
Agreement is hereby amended and restated in its entirety to read as follows: 
 “Maximum First Lien Principal
Amount”: the sum of (a) the excess of (x) $124,080,000.00 plus an amount equal to 110% of the principal amount of all Incremental Revolving Loan Commitments (as defined in the First Lien Loan Agreement on the date hereof)
established on or after June 20, 2019 (the “First Lien Amendment Effective Date”) and 110% of the principal amount of all Incremental Term Loans (as defined in the First Lien Loan Agreement on the date hereof) made on or
after the First Lien Amendment Effective Date, in each case under the First Lien Loan Agreement as in effect on the date hereof over (y) the sum of (1) principal payments applied to term loans under the First Lien Loan Agreement that are
First Lien Obligations, (2) permanent reductions of commitments under the revolving credit facility provided for in the First Lien Loan Agreement (excluding any permanent reductions in such commitments resulting from the commencement of any
Insolvency Proceeding or resulting from the exercise by any or all of the First Lien Creditors of their right to reduce or terminate such commitments following the occurrence and during the continuance of any First Lien Default) (for the avoidance
of doubt, excluding the Term Loan Conversion), so long as the principal amount of any revolving credit loans in excess of the revolving credit commitments as so reduced, and accrued, unpaid interest thereon, have been paid in full, excluding, in the
case of (1) and (2) above, reductions resulting from a Refinancing or a “roll-up” of such Obligations in connection with a DIP Financing that is otherwise permitted in accordance with the terms
of this Agreement, plus (b) amounts in respect of interest, fees, costs and premium (if any), in each case above accruing in respect of or attributable to, but only accruing in respect of or attributable to, the aggregate principal amount of
the First Lien Obligations (including the undrawn amount of all Letters of Credit constituting First Lien Obligations and the aggregate original principal amount of any term loan that is a First Lien Obligation) at any one time not to exceed the
amount referred to in clause (a) above, in each case that have been paid in-kind or capitalized plus (c) Obligations owing by Obligors to the First Lien Creditors under Cash Management Agreements
(provided that the amount of such Obligations under such Cash Management Agreements at no time exceeds $500,000) or Secured Hedge Agreements. 

3.    Consent and Reaffirmation of Second Lien Agent. Second Lien Agent, on behalf of the Second Lien
Creditors, acknowledges and agrees that (a) it has received a copy of the First Lien Amendment, (b) notwithstanding the provisions of Section 4.1 of the Intercreditor Agreement or any other limitation on modifications to the First
Lien Loan Agreement or any other First Lien Document set forth therein, Second Lien Agent, on behalf of the Second Lien 

  
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Creditors, hereby consents to the execution, delivery and performance of the terms of the First Lien Amendment and the other First Lien Documents executed in connection therewith, (c) all
references to the “First Lien Loan Agreement” contained in the Intercreditor Agreement are deemed to refer to the Credit Agreement, and (d) all references to the “Second Lien Loan Agreement” contained in the Intercreditor
Agreement are deemed to refer to the Second Lien Loan Agreement. Second Lien Agent, on behalf of the Second Lien Creditors, hereby (x) ratifies and reaffirms the continued lien subordination in accordance with the terms of, and its agreements
under, the Intercreditor Agreement, (y) acknowledges that First Lien Agent does not waive, diminish or limit any term or condition contained in the Intercreditor Agreement, and (z) agrees that the Intercreditor Agreement, the lien
subordination effected thereby and the rights and obligations of Second Lien Agent, the Second Lien Creditors, First Lien Agent, the First Lien Creditors and the Obligors arising thereunder shall not be affected, modified or impaired in any manner
or to any extent by the First Lien Amendment or the transactions contemplated thereby, except to the extent herein set forth. 

4.    Consent and Reaffirmation of First Lien Agent. First Lien Agent acknowledges and
agrees that (a) it has received a copy of the Second Lien Amendment and, in its capacity as First Lien Agent, hereby consents to the execution, delivery and performance of the terms thereof, respectively, by the Second Lien Creditors, Second
Lien Agent and the Obligors, (b) all references to the “First Lien Loan Agreement” contained in the Intercreditor Agreement are deemed to refer to the Credit Agreement, and (c) all references to the “Second Lien Loan
Agreement” contained in the Intercreditor Agreement are deemed to refer to the Second Lien Loan Agreement. First Lien Agent, on behalf of the First Lien Creditors, hereby (x) ratifies and reaffirms the continued lien subordination of the
Second Lien Agent and the Second Lien Creditors in accordance with the terms of, and its agreements under, the Intercreditor Agreement, (y) acknowledges that Second Lien Agent does not waive, diminish or limit any term or condition contained in
the Intercreditor Agreement, and (z) agrees that the Intercreditor Agreement, the lien subordination effected thereby and the rights and obligations of First Lien Agent, the First Lien Creditors, Second Lien Agent, the Second Lien Creditors and
the Obligors arising thereunder shall not be affected, modified or impaired in any manner or to any extent by the Second Lien Amendment or the transactions contemplated thereby, except to the extent herein set forth. 

5.    Representations and Warranties. Each of the First Lien Agent and Second Lien
Agent represents and warrants that (a) it is duly organized, validly existing and in good standing under the laws of the jurisdiction of its organization and has all requisite power and authority to execute and deliver this Agreement and
perform its obligations hereunder, (b) this Agreement has been duly executed and delivered by such party and constitutes a legal, valid and binding obligation of such party, enforceable in accordance with its terms, except as such
enforceability may be limited by bankruptcy, insolvency, reorganization, receivership, moratorium or similar laws relating to or limiting creditors’ rights generally or by equitable principles relating to enforceability and (c) the
execution, delivery and performance by such party of this Agreement (i) do not require any consent or approval of, registration or filing with or any other action by any governmental authority and (ii) will not violate any provision of
law, statute, rule or regulation, or of the certificate or articles of incorporation or other constitutive documents or by-laws of such party or any order of any governmental authority or any provision of any
material indenture, material agreement or other material instrument binding upon such party. 

  
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 6.    Miscellaneous. Except as expressly set forth
herein, all of the remaining terms and conditions of the Intercreditor Agreement remain in full force and effect. This Agreement shall inure to the benefit of and be binding upon First Lien Agent, the First Lien Creditors, Second Lien Agent, the
Second Lien Creditors, the Obligors and their respective successors and assigns. Second Lien Agent, on behalf of the Second Lien Creditors, shall, at any time and from time to time, after the execution and delivery of this Agreement, upon the
request of First Lien Agent and at the expense of the Obligors, promptly execute and deliver such further documents and do such further acts and things as First Lien Agent from time to time may reasonably request in order to effect fully the
purposes of this Agreement. This Agreement may be executed in one or more counterparts, each of which shall be deemed to be an original, but all of which taken together shall be one and the same instrument. Sections 8.5, 8.6 and 8.7 of the
Intercreditor Agreement are hereby incorporated by reference herein. 
 [Remainder of Page Left Intentionally Blank]

  
 5 

 IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed as
of the date first above written. 
  

			
	FIRST LIEN AGENT:
	
	ANTARES CAPITAL LP, as First Lien Agent
		
	By:	 	 /s/ Heidi Rinehart

	Name:	 	Heidi Rinehart
	Title:	 	Duly Authorized Signatory

  

  
 [Signature Page to
Consent to, Reaffirmation of and Third Amendment to Intercreditor Agreement] 

 IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be
executed as of the date first above written. 
  

			
	SECOND LIEN AGENT:
	
	CORTLAND CAPITAL MARKET SERVICES LLC, as Second Lien Agent
		
	By:	 	 /s/ Matthew Trybula

 

	Name:	 	Matthew Trybula
	Title:	 	Associate Counsel

  
 [Signature Page to
Consent to, Reaffirmation of and Third Amendment to Intercreditor Agreement] 

 Each of the undersigned hereby acknowledges and agrees to the foregoing terms and
provisions. 
  

			
	KAMD BUYER, INC.
		
	By:	 	 /s/ Christopher Anderson

 

	Name:	 	Christopher Anderson
	Title:	 	President

  

			
	AMENDIA, INC.
		
	By:	 	 /s/ Christopher Anderson

 

	Name:	 	Christopher Anderson
	Title:	 	Vice President

 
			
	
	CUSTOM SPINE ACQUISITION, INC.
		
	By:	 	 /s/ Christopher Anderson

 

	Name:	 	Christopher Anderson
	Title:	 	President
	
	DIRECT SPINE SOURCE, LLC
		
	By:	 	 /s/ Christopher Anderson
  

 

	Name:	 	Christopher Anderson
	Title:	 	President
	
	OMNI ACQUISITION, INC.
		
	By:	 	 /s/ Christopher Anderson

 

	Name:	 	Christopher Anderson
	Title:	 	President
	
	SPINE ASSOCIATION FOR EDUCATION, INC.
		
	By:	 	 /s/ Christopher Anderson
  

 

	Name:	 	Christopher Anderson
	Title:	 	President

  
 [Signature Page to
Consent to, Reaffirmation of and Third Amendment to Intercreditor Agreement] 

			
	SPINE SELECT ACQUISITION, INC.
		
	By:	 	 /s/ Christopher Anderson
  

 

	Name:	 	Christopher Anderson
	Title:	 	President

  

			
	SPINAL ELEMENTS, INC.
		
	By:	 	 /s/ Christopher Anderson
  

 

	Name:	 	Christopher Anderson
	Title:	 	Vice President

  
 [Signature Page to
Consent to, Reaffirmation of and Third Amendment to Intercreditor Agreement]EX-10.42

 Exhibit 10.42 

EXECUTION VERSION 

UCONSENT TO, REAFFIRMATION OF AND FOURTH AMENDMENT TO 

INTERCREDITOR AGREEMENT 

THIS CONSENT TO, REAFFIRMATION OF AND FOURTH AMENDMENT TO INTERCREDITOR AGREEMENT (this “Agreement”) is entered into as of
March 13, 2020 by and among Cortland Capital Market Services LLC, in its capacity as agent for the Second Lien Creditors under the Second Lien Loan Documents, including its successors and assigns in such capacity from time to time (“Second
Lien Agent”), and Antares Capital LP, in its capacity as agent for the First Lien Creditors under the First Lien Documents, including its successors and assigns in such capacity from time to time (“First Lien Agent”), as
acknowledged and agreed by the Borrower and the other Obligors acknowledging this Agreement. 
 RECITALS 

WHEREAS, Spinal Elements, Inc., a Delaware corporation (f/k/a Amendia, Inc.) (the “Borrower”), the other Obligors from time
to time party thereto, the First Lien Lenders and First Lien Agent are parties to that certain Amended and Restated Credit Agreement dated as of April 13, 2017 (as amended by that certain Forbearance Agreement and First Amendment to Amended and
Restated Credit Agreement dated as of July 12, 2018, that certain Second Amendment to Amended and Restated Credit Agreement dated as of May 3, 2019, that certain Third Amendment to Amended and Restated Credit Agreement dated as of June 7, 2019, that
certain Fourth Amendment to Amended and Restated Credit Agreement dated as of June 13, 2019, that certain Fifth Amendment to Amended and Restated Credit Agreement dated as of June 20, 2019, and as further amended, restated, supplemented or otherwise
modified from time to time in accordance with the terms of the Intercreditor Agreement (as defined below) prior to the date hereof, the “Existing Credit Agreement”), pursuant to which the First Lien Lenders have made and will from
time to time make loans and provide other financial accommodations to the Borrower; 
 WHEREAS, the Borrower, the other Obligors from time
to time party thereto, the Second Lien Creditors and Second Lien Agent are parties to that certain Second Lien Note Purchase Agreement dated as of April 29, 2016 (as amended by that certain Amendment No. 1 to the Second Lien Note Purchase
Agreement dated as of April 13, 2017, that certain Amendment No. 2 to the Second Lien Note Purchase Agreement dated as of July 12, 2018, that certain Amendment No. 3 to the Second Lien Note Purchase Agreement dated as of May 3, 2019, that
certain Amendment No. 4 to the Second Lien Note Purchase Agreement dated as of June 7, 2019, that certain Amendment No. 5 to the Second Lien Note Purchase Agreement dated as of June 13, 2019, that certain Amendment No. 6 to the Second Lien
Note Purchase Agreement dated as of June 20, 2019, and as further amended, restated, supplemented or otherwise modified from time to time in accordance with the terms of the Intercreditor Agreement prior to the date hereof, the
“Existing Second Lien Loan Agreement”), pursuant to which the Second Lien Creditors have extended, and may from time to time extend, credit to the Borrower; 

WHEREAS, First Lien Agent, on behalf of the First Lien Creditors, and Second Lien Agent, on behalf of the Second Lien Creditors, are parties
to, and the Obligors have acknowledged, that certain Intercreditor Agreement dated as of April 29, 2016 (as amended, restated, supplemented or otherwise modified from time to time, including pursuant to this Agreement, the “Intercreditor
Agreement”), pursuant to which Second Lien Agent, on behalf of the Second Lien Creditors, 

 
agreed, among other things, that the obligations of the Obligors under the First Lien Documents are to be secured on a first priority basis and the obligations under the Second Lien Documents are
to be secured on a second priority basis, in each case, upon the terms and subject to the conditions set forth therein; 
 WHEREAS, on the
date hereof, First Lien Agent, the First Lien Lenders signatory thereto, Borrower and the other Obligors are to enter into that certain Sixth Amendment to Amended and Restated Credit Agreement (the “First Lien Amendment”; the
Existing Credit Agreement, as amended, modified and supplemented by the First Lien Amendment, and as further amended, restated, supplemented or otherwise modified from time to time in accordance with the terms of the Intercreditor Agreement, the
“Credit Agreement”), pursuant to which, among other things, the Existing Credit Agreement shall be amended, without constituting a novation, and the First Lien Lenders will extend certain financial accommodations to the Borrower;

 WHEREAS, on the date hereof, Second Lien Agent, the Second Lien Creditors and the Obligors are to enter into that certain Amendment
No. 7 to the Second Lien Note Purchase Agreement (the “Second Lien Amendment”; the Existing Second Lien Loan Agreement, as amended, modified and supplemented by the Second Lien Amendment, and as further amended, restated,
supplemented or otherwise modified from time to time in accordance with the terms of the Intercreditor Agreement, the “Second Lien Loan Agreement”), pursuant to which, among other things, the Existing Second Lien Loan Agreement
shall be amended, without constituting a novation, and the Second Lien Lenders will extend certain financial accommodations to the Borrower; 

WHEREAS, as a condition precedent to the effectiveness of the First Lien Amendment, First Lien Agent and the First Lien Creditors have
required the execution, delivery and performance of this Agreement by the parties hereto; and 
 WHEREAS, as a condition precedent to the
effectiveness of the Second Lien Amendment, Second Lien Agent and the Second Lien Creditors have required the execution, delivery and performance of this Agreement by the parties hereto. 

NOW, THEREFORE, (i) in order to induce First Lien Agent and the First Lien Lenders to enter into and deliver the First Lien Amendment,
(ii) in order to induce Second Lien Agent and the Second Lien Creditors to enter into and deliver the Second Lien Amendment, and (iii) for other good and valuable consideration, the receipt and sufficiency of which hereby are acknowledged,
the parties hereto agree as follows: 
 NOW, THEREFORE, for good and valuable consideration, receipt of which is hereby acknowledged, the
parties agree as follows: 
 1.    Definitions. All capitalized terms used but not elsewhere defined
herein shall have the respective meanings ascribed to such terms in the Intercreditor Agreement. 

  
 2 

 2.    Amendments to Intercreditor Agreement. 

(a)    The definition of “Maximum First Lien Principal Amount” set forth in Section 1.1 of the Intercreditor
Agreement is hereby amended and restated in its entirety to read as follows: 
 ““Maximum First Lien Principal
Amount”: the sum of (a) the excess of (x) $146,080,000.00 plus an amount equal to 110% of the principal amount of all Incremental Revolving Loan Commitments (as defined in the First Lien Loan Agreement on the date hereof)
established after March 13, 2020 (the “First Lien Amendment Effective Date”) and 110% of the principal amount of all Incremental Term Loans (as defined in the First Lien Loan Agreement on the date hereof) made after the First Lien
Amendment Effective Date, in each case under the First Lien Loan Agreement as in effect on the date hereof over (y) the sum of (1) principal payments applied to term loans under the First Lien Loan Agreement that are First Lien
Obligations, (2) permanent reductions of commitments under the revolving credit facility provided for in the First Lien Loan Agreement (including any permanent reductions in such commitments in accordance with the provisions of
Section 1.8(b)(iii) of the First Lien Loan Agreement as in effect on the First Lien Amendment Effective Date but excluding any permanent reductions in such commitments resulting from the commencement of any Insolvency Proceeding or resulting
from the exercise by any or all of the First Lien Creditors of their right to reduce or terminate such commitments following the occurrence and during the continuance of any First Lien Default) (for the avoidance of doubt, excluding the Term Loan
Conversion), so long as the principal amount of any revolving credit loans in excess of the revolving credit commitments as so reduced, and accrued, unpaid interest thereon, have been paid in full, excluding, in the case of (1) and (2) above,
reductions resulting from a Refinancing or a “roll-up” of such Obligations in connection with a DIP Financing that is otherwise permitted in accordance with the terms of this Agreement, plus
(b) amounts in respect of interest, fees, costs and premium (if any), in each case above accruing in respect of or attributable to, but only accruing in respect of or attributable to, the aggregate principal amount of the First Lien Obligations
(including the undrawn amount of all Letters of Credit constituting First Lien Obligations and the aggregate original principal amount of any term loan that is a First Lien Obligation) at any one time not to exceed the amount referred to in clause
(a) above, in each case that have been paid in-kind or capitalized plus (c) Obligations owing by Obligors to the First Lien Creditors under Cash Management Agreements (provided that the amount of
such Obligations under such Cash Management Agreements at no time exceeds $500,000) or Secured Hedge Agreements.” 

(b)    Section 4.1 of the Intercreditor Agreement is hereby amended by amending and restating clause (a) thereof
to read in its entirety as follows: 
 “(a)    The First Lien Creditors may at any time and from time to time and
without consent of or notice to any Second Lien Creditor, without incurring any liability to any Second Lien Creditor and without impairing or releasing any rights or obligations hereunder or otherwise,

  
 3 

 
amend, restate, supplement, extend, modify, waive, substitute, renew or replace any or all of the First Lien Documents; provided that without the consent of the Requisite Second Lien
Creditors, the First Lien Creditors shall not amend, restate, supplement, extend, modify, substitute, renew or Refinance any or all of the First Lien Documents to (i) directly increase the interest rate margins on the First Lien Obligations to
an amount greater than 3.0% per annum on a weighted average basis above the applicable interest rate margins on the First Lien Obligations in effect on the date hereof (excluding, without limitation, fluctuations in underlying rate indices or
pursuant to a pricing grid mechanic and imposition of a default rate of 2.0% per annum), (ii) extend the final maturity date of the First Lien Obligations to a date later than November 13, 2023, (iii) restrict the amendment of the Second Lien
Documents except as set forth in Section 4.2, (iv) increase the principal portion of the First Lien Obligations in excess of the Maximum First Lien Principal Amount, (v) shorten the scheduled amortization or shorten the weighted
average life to maturity of any First Lien Obligations, or (vi) amend, waive, consent to any departure from or otherwise modify (directly or indirectly) the provisions of Section 1.8(b)(iii) of the First Lien Loan Agreement (as in effect
on the First Lien Amendment Effective Date), or any of the defined terms used directly or indirectly therein.” 

3.    Consent and Reaffirmation of Second Lien Agent. Second Lien Agent, on behalf of the Second Lien
Creditors, acknowledges and agrees that (a) it has received a copy of the First Lien Amendment, (b) notwithstanding the provisions of Section 4.1 of the Intercreditor Agreement or any other limitation on modifications to the First
Lien Loan Agreement or any other First Lien Document set forth therein, Second Lien Agent, on behalf of the Second Lien Creditors, hereby consents to the execution, delivery and performance of the terms of the First Lien Amendment and the other
First Lien Documents executed in connection therewith, (c) all references to the “First Lien Loan Agreement” contained in the Intercreditor Agreement are deemed to refer to the Credit Agreement, and (d) all references to the
“Second Lien Loan Agreement” contained in the Intercreditor Agreement are deemed to refer to the Second Lien Loan Agreement. Second Lien Agent, on behalf of the Second Lien Creditors, hereby (x) ratifies and reaffirms the continued
lien subordination in accordance with the terms of, and its agreements under, the Intercreditor Agreement, (y) acknowledges that First Lien Agent does not waive, diminish or limit any term or condition contained in the Intercreditor Agreement,
and (z) agrees that the Intercreditor Agreement, the lien subordination effected thereby and the rights and obligations of Second Lien Agent, the Second Lien Creditors, First Lien Agent, the First Lien Creditors and the Obligors arising
thereunder shall not be affected, modified or impaired in any manner or to any extent by the First Lien Amendment or the transactions contemplated thereby, except to the extent herein set forth. 

4.    Consent and Reaffirmation of First Lien Agent. First Lien Agent acknowledges and
agrees that (a) it has received a copy of the Second Lien Amendment and, in its capacity as First Lien Agent, hereby consents to the execution, delivery and performance of the terms thereof, respectively, by the Second Lien Creditors, Second
Lien Agent and the Obligors, (b) all references to the “First Lien Loan Agreement” contained in the Intercreditor Agreement are deemed to refer to the Credit Agreement, and (c) all references to the “Second Lien Loan
Agreement” contained in the Intercreditor Agreement are deemed to refer to the Second Lien Loan Agreement. First Lien Agent, on behalf of the First Lien Creditors, hereby (x) ratifies and reaffirms the continued lien subordination of the
Second Lien Agent and the Second Lien Creditors in accordance with the terms of, and its agreements under, the Intercreditor Agreement, (y) acknowledges that Second Lien Agent does not waive, diminish or limit any term or condition

  
 4 

 
contained in the Intercreditor Agreement, and (z) agrees that the Intercreditor Agreement, the lien subordination effected thereby and the rights and obligations of First Lien Agent, the
First Lien Creditors, Second Lien Agent, the Second Lien Creditors and the Obligors arising thereunder shall not be affected, modified or impaired in any manner or to any extent by the Second Lien Amendment or the transactions contemplated thereby,
except to the extent herein set forth. 
 5.     Representations and Warranties. Each of the First
Lien Agent and Second Lien Agent represents and warrants that (a) it is duly organized, validly existing and in good standing under the laws of the jurisdiction of its organization and has all requisite power and authority to execute and
deliver this Agreement and perform its obligations hereunder, (b) this Agreement has been duly executed and delivered by such party and constitutes a legal, valid and binding obligation of such party, enforceable in accordance with its terms,
except as such enforceability may be limited by bankruptcy, insolvency, reorganization, receivership, moratorium or similar laws relating to or limiting creditors’ rights generally or by equitable principles relating to enforceability and
(c) the execution, delivery and performance by such party of this Agreement (i) do not require any consent or approval of, registration or filing with or any other action by any governmental authority and (ii) will not violate any
provision of law, statute, rule or regulation, or of the certificate or articles of incorporation or other constitutive documents or by-laws of such party or any order of any governmental authority or any
provision of any material indenture, material agreement or other material instrument binding upon such party. 

6.     Miscellaneous. Except as expressly set forth herein, all of the remaining terms and conditions
of the Intercreditor Agreement remain in full force and effect. This Agreement shall inure to the benefit of and be binding upon First Lien Agent, the First Lien Creditors, Second Lien Agent, the Second Lien Creditors, the Obligors and their
respective successors and assigns. Second Lien Agent, on behalf of the Second Lien Creditors, shall, at any time and from time to time, after the execution and delivery of this Agreement, upon the request of First Lien Agent and at the expense of
the Obligors, promptly execute and deliver such further documents and do such further acts and things as First Lien Agent from time to time may reasonably request in order to effect fully the purposes of this Agreement. This Agreement may be
executed in one or more counterparts, each of which shall be deemed to be an original, but all of which taken together shall be one and the same instrument. Sections 8.5, 8.6 and 8.7 of the Intercreditor Agreement are hereby incorporated by
reference herein. 
 [Remainder of Page Left Intentionally Blank] 

  
 5 

 IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed as
of the date first above written. 
  

			
	FIRST LIEN AGENT:
	
	ANTARES CAPITAL LP, as First Lien Agent
		
	By:	 	 /s/ Heidi Rinehart

 

	Name:	 	Heidi Rinehart
	Title:	 	Duly Authorized Signatory

  
 [Signature Page to
Consent to, Reaffirmation of and Fourth Amendment to Intercreditor Agreement] 

 IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed as
of the date first above written. 
  

			
	SECOND LIEN AGENT:
	
	CORTLAND CAPITAL MARKET SERVICES LLC, as Second Lien Agent
		
	By:	 	 /s/ Winnalynn N. Kantaris

 

	Name:	 	Winnalynn N. Kantaris
	Title:	 	Associate General Counsel

  
 [Signature Page to
Consent to, Reaffirmation of and Fourth Amendment to Intercreditor Agreement] 

 Each of the undersigned hereby acknowledges and agrees to the foregoing
terms and provisions. 
  

			
	KAMD BUYER, INC.
		
	By:	 	 /s/ Christopher Anderson

	Name:	 	Christopher Anderson
	Title:	 	President

  

			
	SPINAL ELEMENTS, INC.
		
	By:	 	 /s/ Ted Jeon

	Name:	 	Ted Jeon
	Title:	 	Secretary

 
			
	
	CUSTOM SPINE ACQUISITION, INC.
		
	By:	 	 /s/ Christopher Anderson

 

	Name:	 	Christopher Anderson
	Title:	 	President
	
	DIRECT SPINE SOURCE, LLC
		
	By:	 	 /s/ Christopher Anderson

 

	Name:	 	Christopher Anderson
	Title:	 	President
	
	OMNI ACQUISITION INC.
		
	By:	 	 /s/ Christopher Anderson

 

	Name:	 	Christopher Anderson
	Title:	 	President

  

			
	SPINE ASSOCIATION FOR EDUCATION, INC.
		
	By:	 	 /s/ Christopher Anderson
  

 

	Name:	 	Christopher Anderson
	Title:	 	President

  
 [Signature Page to
Consent to, Reaffirmation of and Fourth Amendment to Intercreditor Agreement] 

 
			
	SPINE SELECT ACQUISITION, INC.
		
	By:	 	 /s/ Christopher Anderson

 

	Name:	 	Christopher Anderson
	Title:	 	President

  

  
 [Signature Page to
Consent to, Reaffirmation of and Fourth Amendment to Intercreditor Agreement]

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