Alphatec (ATEC) Q4 2025 earnings summary

Executive summary

• Achieved Q4 2025 revenue of $213 million, up 20% year-over-year, and full-year revenue of $764 million, a 25% increase, driven by increased surgical volume and surgeon adoption.

• Adjusted EBITDA for Q4 was $33 million (up 61% year-over-year, 16% margin), and $93 million for the full year (12% margin), marking significant profit margin expansion.

• Free cash flow turned positive for the first full year, with $8 million in Q4 and $3 million for 2025, an improvement of $131 million year-over-year.

• Net new surgeon users grew 23% in Q4 and 20% for the year, supporting durable growth and continued leadership in lateral and deformity spine procedures.

• Maintained leadership in spine-focused procedural innovation, launching new platforms and expanding the procedural ecosystem.

Financial highlights

• Q4 revenue: $213 million (+20% year-over-year); surgical revenue $190 million (+21%), EOS revenue $23 million (+14%).

• Full-year revenue: $764 million (+25% year-over-year); surgical revenue $687 million (+26%), EOS revenue $77 million (+15%).

• Q4 non-GAAP gross margin: 71%; full-year non-GAAP gross margin: 70%.

• Q4 Adjusted EBITDA: $33 million (16% margin); full-year Adjusted EBITDA: $93 million (12% margin).

• Ended Q4 with $161 million in cash and $60 million undrawn credit, totaling $221 million in available liquidity.

Outlook and guidance

• 2026 revenue guidance: $890 million (+17% year-over-year), with $805 million surgical and $85 million EOS revenue.

• 2026 Adjusted EBITDA guidance raised to $134 million (15% margin), up from $130 million.

• Expected 2026 free cash flow of at least $20 million, with continued investment in inventory and PP&E.

• Gross margin expected to approach 71% by end of 2026; operating expenses to grow ~11% vs. 17% revenue growth, driving ~400 bps operating margin improvement.

• Revenue growth algorithm driven by continued surgeon adoption and utilization, with existing surgeons supporting a significant portion of 2026 volume.