Alphatec Holdings, Inc. (ATEC) posted a strong Q4 2025 performance, reporting total revenue of $213.2 million—up 25% from $169.2 million in Q4 2024—and a full‑year 2025 revenue of $764.4 million, a 25% increase over the $611 million recorded in 2024. Adjusted EBITDA for the year reached $91 million, giving the company a 13% margin that represents a 200‑basis‑point lift over the first half of 2025. Free‑cash‑flow generation was positive, with Q4 2025 free cash flow expected between $6 million and $8 million, and management projected $20 million in free cash flow for 2026 as the company moves toward deleveraging.
The revenue growth was driven by a 26% increase in surgical revenue—now $805 million—while the EOS (electronic operating system) segment grew to $85 million. Surgical volume rose 24% and average revenue per procedure increased 2%, reflecting a favorable mix shift toward higher‑margin procedures and successful pricing initiatives. The 200‑basis‑point margin improvement was largely due to cost controls in the EOS segment and a higher proportion of high‑margin surgical contracts, offsetting modest increases in raw‑material costs.
Alphatec’s full‑year revenue beat analyst consensus of $760.4 million by $4 million, a 0.5% upside. Q4 revenue also surpassed the consensus of $209.2 million by $4 million, a 1.9% beat. The company’s guidance for 2026—$890 million in revenue and $130 million in adjusted EBITDA—was raised from the prior outlook of $860 million and $120 million, respectively, signaling confidence in continued demand for its integrated spine solutions.
Management emphasized that the upward revision reflects sustained market share gains, a robust pipeline of new product launches, and the recent acquisition of exclusive U.S. distribution rights for Theradaptive’s OsteoAdapt regenerative platform. CEO Patrick Miles stated, “We are achieving results at scale that have not been seen in our industry. Our disciplined focus on procedural ecosystems, supported by data and informatics, is driving this growth.” The company also highlighted its transition from a cash‑burn phase to a self‑funding growth model, underscoring its competitive moat in the spine market.
Investor sentiment was tempered by significant insider selling: CEO Miles sold 100,000 shares and director David R. Pelizzon sold 250,000 shares around the earnings release, raising concerns about leadership confidence. The market also appeared to take profits after a 126% year‑to‑date gain, contributing to a muted reaction despite the strong results.
Looking ahead, Alphatec plans to expand its procedural ecosystem through continued investment in digital health tools and the OsteoAdapt platform, while maintaining disciplined cost management. The company’s guidance indicates a 17% revenue growth for 2026, driven by strong demand in both surgical and EOS segments, and a projected 13% EBITDA margin, suggesting that the company is well positioned to sustain its growth trajectory and deliver long‑term shareholder value.
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