Alphatec (ATEC) Q4 2025 earnings summary

Executive summary

• Full-year 2025 revenue increased 25% year-over-year to $764 million, with Q4 revenue of $213 million, driven by increased surgical volume, surgeon adoption, and procedural innovation.

• Adjusted EBITDA reached $33 million in Q4 (up 61% year-over-year, 16% margin) and $93 million for the year (12% margin), marking a 3x increase.

• Achieved positive free cash flow in Q4 ($8 million) and for the full year ($3 million), marking the first full year of cash generation and a $131 million improvement year-over-year.

• Net new surgeon users grew 23% in Q4 and 20% for the year, fueling procedural volume growth and supporting durable expansion.

• Launched new 3D-printed implants, the ValenceⓇ intraoperative platform, and expanded the EOS InsightⓇ ecosystem.

Financial highlights

• Q4 2025 revenue: $213 million (20% growth year-over-year), with $190 million surgical (up 21%) and $23 million EOS revenue.

• Full-year 2025 revenue: $764 million, with $687 million from surgical (up 26%) and $77 million from EOS (up 15%).

• Non-GAAP gross margin: 71% in Q4, 70% for the year; GAAP gross margin: 70% for both periods.

• Adjusted EBITDA margin: 16% in Q4, 12% for the year; Q4 margin up 390–580 bps year-over-year.

• SG&A as % of sales improved to 55% in Q4 and 59% for the year; R&D as % of sales: 6.5% in Q4, 7–7.4% for the year.

Outlook and guidance

• 2026 revenue guidance raised to $890 million (17% growth), with $805 million surgical and $85 million EOS revenue.

• Adjusted EBITDA guidance increased to $134 million (15% margin), up from $130 million; free cash flow expected at least $20 million.

• Gross margin expected to approach 71% by end of 2026; operating expenses to grow 11% vs. 17% revenue growth.

• Seasonality expected to follow 2025 patterns, with Q1 at ~22% of annual sales.