Document:

EX-10.39

 Exhibit 10.39 

CONSENT TO, REAFFIRMATION OF AND FIRST AMENDMENT TO 

INTERCREDITOR AGREEMENT 

This CONSENT TO, REAFFIRMATION OF AND FIRST AMENDMENT TO INTERCREDITOR AGREEMENT (this “Agreement”) is dated as of April 13,
2017, by and among Cortland Capital Market Services LLC, in its capacity as agent under 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. 
 R E C I T A L S: 

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 Credit Agreement dated as of April 29, 2016 (as 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 “Original 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 Borrowers; 

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, 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 Borrowers; 

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, Borrower and the other Obligors are to enter into that certain Amended
and Restated Credit Agreement (the “Amended and Restated Credit Agreement”; the Amended and Restated Credit Agreement, as 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 Original Credit Agreement shall be amended and restated in its entirety, without constituting a novation, and the First Lien Lenders will
extend certain financial accommodations to the Borrowers; 
 WHEREAS, on the date hereof, Second Lien Agent, the Second Lien Creditors and
the Obligors are to enter into that certain Amendment No. 1 to the Second Lien Note Purchase Agreement (the “Second Lien Amendment”; the Second Lien Amendment together with the Existing Second Lien Loan Agreement, as 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 Borrowers; 

  
 1 

 WHEREAS, as a condition precedent to the effectiveness of the Amended and Restated Credit
Agreement, 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 Amended and Restated Credit Agreement, (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: 

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.    Amendments to Intercreditor Agreement. 

(a)    The following definitions set forth in Section 1.1 of the Intercreditor Agreement are hereby amended and
restated in their entireties to read as follows, respectively: 
 “Maximum First Lien Principal Amount”: the
sum of (a) the excess of (x) $82,680,000 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 and 110% of the
principal amount of all Incremental Term Loans (as defined in the First Lien Loan Agreement on the date hereof) made, 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. 

  
 2 

 (b)    Section 4.1 of the Intercreditor Agreement is hereby amended by
replacing the reference to “November 29, 2022” with “November 13, 2023”. 

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 Amended and Restated Credit Agreement, (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 Amended and Restated Credit Agreement 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 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 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 

  
 3 

 
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 Borrowers, 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. 
 [Signature Pages Follow] 

  
 4 

 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/ Ashley G. Medio
  

 

	Name:	 	Ashley G. Medio
	Title:	 	Duly Authorized Signatory

 Consent to, Reaffirmation of and First 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/ Polina Arsentyeva

	Name:	 	Polina Arsentyeva
	Title:	 	Associate Counsel

 Consent to, Reaffirmation of and First 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
	
	SPINE SELECT ACQUISITION, INC.
		
	By:	 	 /s/ Christopher Anderson

	Name:	 	Christopher Anderson
	Title:	 	President

  
 Consent to, Reaffirmation of and First
Amendment to Intercreditor Agreement 

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

 

	Name:	 	Christopher Anderson
	Title:	 	Vice President

  
 Consent to, Reaffirmation of and First
Amendment to Intercreditor AgreementEX-10.40

 Exhibit 10.40 

EXECUTION VERSION 

CONSENT TO, REAFFIRMATION OF AND SECOND AMENDMENT TO 

INTERCREDITOR AGREEMENT 

THIS CONSENT TO, REAFFIRMATION OF AND SECOND AMENDMENT TO INTERCREDITOR AGREEMENT (this “Agreement”) is entered into as of
July 12, 2018 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, 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, 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 Forbearance Agreement and First Amendment to Amended and Restated Credit Agreement (the “Forbearance and Amendment 

 
Agreement”; the Existing Credit Agreement, as amended, modified and supplemented by the Forbearance and Amendment Agreement, 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. 2 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 Forbearance and Amendment Agreement, 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 Forbearance and
Amendment Agreement, (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.    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) $97,680,000 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 and 110% of the principal amount of all Incremental Term Loans (as defined in the First Lien Loan Agreement on the date hereof) made, 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. 
 (b)    Section 4.2 of the
Intercreditor Agreement is hereby amended and restated to read in its entirety as follows: 
 4.2    Amendments to
Second Lien Documents. Until the Discharge of First Lien Obligations has occurred, and notwithstanding anything to the contrary contained in the Second Lien Documents, the Second Lien Creditors shall not, without the prior written consent of the
First Lien Agent, amend, restate, supplement, modify, substitute, renew or Refinance any or all of the Second Lien Documents to (a) directly or indirectly increase the applicable interest rates in respect of the Second Lien Obligations
(excluding, without limitation, fluctuations in underlying rate indices and imposition of a default rate of 2.0% per annum) by more than 3.0% per annum, (b) shorten the maturity or weighted average life to maturity of the Second Lien
Obligations, require that any payment on the Second Lien Obligations be made earlier than the date originally scheduled for such payment or that any commitment expire any earlier than the date originally scheduled therefor, or add or make more
restrictive any 

 
mandatory prepayment, redemption, repurchase, sinking fund or similar requirement, (c) add or modify in a manner adverse in any material respect to any Obligor or any First Lien Creditor any
covenant, agreement or event of default under the Second Lien Documents (except to the extent necessary to conform to changes made to the First Lien Documents, excluding changes related to the first priority status of the First Lien Obligations and
subject to the preservation of cushions on financial covenant levels and dollar amounts consistent with those contained in the First Lien Documents in effect prior to such addition or modification), (d) restrict the amendment of the First Lien
Documents except as set forth in Section 4.1, (e) increase the principal amount of the Second Lien Obligations in excess of the Maximum Second Lien Principal Amount (other than, subject to clause (a) above, as a result
of interest thereon having been paid in-kind or capitalized), (f) amend or modify (directly or indirectly) the provisions of Section 1.3(b)(i) or Section 1.3(b)(ii) of the Second Lien Loan Agreement
(or any of the defined terms used directly or indirectly therein) in a manner which permits the payment of cash interest with respect to the Second Lien Loans or any other Second Lien Obligations on any date which is not an Interest Payment Date
that constitutes a Payment Reinstatement Date (as such term is defined in the Second Lien Loan Agreement), or (g) amend or modify (directly or indirectly) the definition of Payment Reinstatement Date (as defined in the Second Lien Loan
Agreement) in manner adverse to any First Lien Creditor. 
 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 Forbearance and Amendment Agreement, (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 Forbearance and Amendment Agreement 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 Forbearance and Amendment Agreement 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. 

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] 

 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 Second 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 Second 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 Second 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 Second Amendment to Intercreditor Agreement]

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