ATEC — Alphatec Holdings, Inc.

Summary of Alphatec Holdings, Inc. Q4 2025 Earnings Call

1. Key Financial Results and Metrics:

• Q4 2025 Revenue: $213 million, a 20% increase year-over-year.
• Surgical Revenue: $190 million, up 21% year-over-year; 7% sequential growth.
• EOS Revenue: $23 million, a 14% increase year-over-year.
• Adjusted EBITDA: $33 million, representing a 61% year-over-year increase and a margin of 16%.
• Full Year 2025 Revenue: $764 million, a 25% increase from 2024.
• Full Year Adjusted EBITDA: $93 million, approximately 12% of sales.
• Free Cash Flow: $8 million in Q4; $3 million for the full year.

2. Strategic Updates and Business Highlights:

• Alphatec is focused exclusively on spine surgery, with advancements in lateral surgery and deformity leadership.
• Key product releases in 2025 included a bone mineral density test, EOS Insight pediatric tools, and a full line of 3D-printed implants.
• The company reported strong surgeon adoption, with a 23% increase in new surgeon users in Q4.
• The launch of the Valence platform is expected to enhance surgical precision and integration into spine procedures.
• An exclusive distribution partnership with Theradaptive aims to introduce a new bone morphogenetic protein (BMP) product, projected to be a significant market player.

3. Forward Guidance and Outlook:

• For 2026, Alphatec expects revenue growth of 17%, targeting approximately $890 million, with surgical revenue projected at $805 million.
• Adjusted EBITDA guidance for 2026 is set at $134 million, reflecting a 15% margin.
• The company anticipates continued strong growth driven by surgeon adoption and utilization, with an expected improvement in gross margins to around 71%.

4. Bad News, Challenges, or Points of Concern:

• There are indications of changing seasonal patterns in revenue, which may affect quarter-to-quarter performance.
• The international business has presented a mix headwind, impacting average revenue per case.
• Despite strong overall growth, the year-over-year growth rate in Q4 was lower than in previous quarters, raising concerns about potential deceleration.
• Competitive pressures remain, particularly in the deformity surgery market, where success is contingent on a comprehensive ecosystem approach.

5. Notable Q&A Insights:

• Analysts expressed concerns about stock performance post-earnings, despite positive results and guidance. CFO Todd Koning confirmed that all reported metrics were in line with expectations.
• Questions about sales force recruitment revealed that Alphatec is attracting top talent, indicating a strong market position.
• The company is experiencing robust demand for its portfolio, with particular strength noted in territories that were previously underperforming.

Overall, Alphatec Holdings, Inc. demonstrated strong financial performance in Q4 2025 and for the full year, with promising growth prospects for 2026, although some challenges and market dynamics warrant close monitoring.