Carlsmed (CARL) Q4 2025 earnings summary

Executive summary

• Achieved rapid growth in 2025, highlighted by an initial public offering raising over $100 million and significant expansion in personalized spine surgery solutions.

• Delivered $50.5 million in revenue for 2025, up 86% year-over-year, with gross margins expanding to 75.3%.

• Achieved fourth quarter revenue of $15.2 million, up 61% year-over-year.

• Net loss widened to $29.6 million for the year, driven by increased operating expenses.

• Launched new products, including the aprevo Cervical and Cora personalized fixation portfolio, and achieved key regulatory milestones such as NTAP from CMS.

Financial highlights

• Q4 2025 revenue reached $15.2 million, a 61% increase year-over-year; full-year revenue was $50.5 million, up from $27.2 million in 2024.

• Gross margins improved to 76.5% in Q4 and 75.3% for the year, driven by lower manufacturing costs and internal efficiencies.

• Total operating expenses for 2025 were $68.6 million, up from $44.2 million in 2024, reflecting investments in R&D and commercial expansion.

• Adjusted EBITDA was negative $28.4 million for 2025.

• Cash and investments at year-end totaled $109.9 million, with $15.6 million outstanding on a $50 million debt facility.

Outlook and guidance

• 2026 revenue guidance is $70–$75 million, representing 44% annual growth at the midpoint.

• Gross margins expected to remain in the mid-70% range, with ongoing operating leverage anticipated from prior investments.

• Continued improvement in adjusted EBITDA projected as revenue grows and expense base leverages.