Executives from Alphatec (NASDAQ:ATEC) outlined the company’s strategy for “long-term differentiated growth” during a presentation at a JPMorgan healthcare conference, highlighting recent financial performance, a continued emphasis on procedure-focused product design, and an expanding role for data and software in spine surgery.
Financial results and 2026 outlook
Chairman and CEO Pat Miles said Alphatec finished 2025 with $764 million in revenue, representing 25% growth. He described $91 million as the “floor” for the company’s adjusted EBITDA expectation for 2025, equating to roughly a 12% margin, and said the company expects to be cash-flow positive. Miles also said Alphatec became the third-largest U.S. market share holder during the year.
In Q&A, management discussed the drivers behind the 2026 growth bridge, describing it as roughly $118 million of surgical growth and about $8 million of EOS growth. They also reiterated a longer-term goal of $100 million in EOS revenue in 2027.
Execution track record and long-range targets
Miles pointed to the company’s long-range plan shared in 2024, which followed 2023 revenue of $482 million and negative adjusted EBITDA. At that time, Alphatec committed to reaching $1 billion in revenue and $180 million of adjusted EBITDA (18%) in 2027, along with $65 million in free cash flow. He said the company’s 2025 performance and 2026 guidance demonstrate “consistency of word and deed” and show it is “well on our way” toward those targets.
Proceduralization and informatics as a growth engine
Management repeatedly framed Alphatec’s differentiation around “proceduralization”—building and integrating an “assembly of goods” around a surgical workflow rather than selling individual components. Miles said lateral spine surgery remains a core area of familiarity for the company, with surgeon adoption and utilization rising, including “north of 20%” surgeon growth in 2025.
He argued that spine surgery has historically focused on implant optimization despite relatively high revision rates compared with other orthopedic procedures. In that context, he positioned Alphatec’s strategy as “transformation, not optimization,” with increasing emphasis on data and software to inform decision-making across the care continuum.
Miles highlighted three key technology elements tied to that approach:
- SafeOp: an intraoperative neurophysiology platform used to identify and monitor nerves during lateral surgery. Miles said the company has improved SafeOp over time and expanded its utility by adding the ability to capture motor evoked potentials, which he said is relevant in cervical and deformity procedures.
- EOS and EOS Insight: Alphatec acquired EOS in 2021 and described it as an informatics platform anchored in full-body, standing, biplanar imaging with lower radiation and no stitching. Miles said the company introduced automated alignment measures in 2024 using AI, supports 3D reconstruction to compare to normative values, and has recently added a bone mineral density view from the same scan.
- Valence: a navigation and robotics tool that Miles said is integrated into surgical workflow and designed with a small operating-room footprint and lower cost profile. He said Valence is expected to launch this year, pending an FDA clearance related to navigation.
Deformity, cervical momentum, and evolving seasonality
In the Q&A, management said fourth-quarter growth was about 20% and characterized surgical growth as volume-driven, supported by strong surgeon adoption and same-store sales. They also noted that sequential revenue growth from Q3 to Q4 was lower than their historical norm, attributing part of that shift to the influence of deformity—particularly adolescent idiopathic deformity—where procedure volume tends to be stronger in Q2 and Q3 during the summer.
Miles said deformity remains a contributor to growth and described EOS-enabled planning as a key tool to accelerate the company’s deformity presence. He also said Alphatec had been “under-indexed” in cervical historically, but assembled a procedural offering combining retractors, implants, and neurophysiology, calling 2025 “a great year” for cervical performance.
On seasonality, management said the newer pediatric deformity dynamic could make 2025’s seasonal pattern more representative going forward, particularly with Q2/Q3 strength, while expecting Q4-to-Q1 seasonality to align more closely with broader market patterns.
Market share opportunity, competition, and profitability mechanics
Miles said Alphatec remains underpenetrated in the U.S. spine market despite gains, describing the company as still below a 10% market share overall, while exceeding 30% share in certain well-covered territories. He said that in the top 10 U.S. markets, share is still under 10%, which he cited as evidence of runway. Internationally, he said the company has focused on Australia and New Zealand (about $10 million in revenue and more than 1,000 PTP procedures) and is early in Japan (less than $5 million in revenue) with a lateral launch planned for 2026.
When asked about disruption from large medtech companies spinning or separating spine/orthopedics businesses, Miles said he views disruption as advantageous, particularly in salesforce recruiting, though he did not cite a specific one-time impact in 2025. On competition in lateral surgery, he said the company’s differentiation includes neurophysiology sophistication and the integration of navigation with neuro-monitoring as barriers to entry.
On robotics, Miles said Alphatec’s near-term growth has not been impeded by not having a robot, arguing that robotics largely facilitates screw placement rather than the full objectives of spine surgery. Todd (who joined for Q&A) added that integrating navigation/robotics into the company’s lateral platform could help broaden adoption among surgeons who currently avoid lateral procedures due to confidence operating in the retroperitoneal space.
Management also discussed how profitability and cash flow are expected to scale. They reiterated priorities of continued investment in R&D and the selling channel while leveraging prior infrastructure investments. In discussing the 2026 cash flow framework, management cited approximately $20 million of non-cash E&O within the adjusted EBITDA figure, about $20 million of interest, and ongoing cash needs for sets and inventory, which they said supports confidence in the company’s free cash flow commitment.
About Alphatec (NASDAQ:ATEC)
Alphatec Holdings, Inc (NASDAQ: ATEC) is a medical technology company focused on the design, development and commercialization of products for the surgical correction of degenerative spinal conditions. The company’s portfolio centers on interbody implants, biologics, fixation devices and surgical planning tools intended to improve patient outcomes in spinal fusion procedures. Alphatec’s flagship offerings include customizable interbody cages, bone graft materials and specialized instrumentation designed for minimally invasive and open spinal surgeries.
Founded as Alphatec Spine in 1985 and rebranded as Alphatec Holdings in 2018, the company has grown from a single-product organization into a multi-platform innovator in the spine market.
