Alphatec Holdings Stock Earnings Reports

ATEC reported Q1 2026 revenue of $192M, up 14% YoY, with surgical revenue of $178M (up 17% YoY) but below internal expectations due to weaker-than-expected EOS (imaging platform) system deliveries. Key drivers: surgeon adoption (+23% new surgeon users) and case volume (+21%), with continued strength and ASP expansion in core procedural markets (lateral, ALIF, cervical). EOS revenue was $14M, down $3M YoY; management attributes the shortfall to installation/execution timing and has added sales, downstream marketing and support resources. Gross margin expanded to 71.6% (120+ bps YoY improvement); non-GAAP operating expenses grew only ~6% YoY, demonstrating operating leverage. Adjusted EBITDA was $21M (11% margin), nearly doubling YoY, with 45% drop-through on incremental revenue. Cash: ~$140M; Q1 free cash use ~$11M; invested ~$33M in inventory/instruments to support growth. Company closed a new Term Loan A / revolver refinancing (SOFR + 275bps) that extends maturities to 2031 and reduces interest expense materially (est. ~$35M savings over life). Updated 2026 guidance: total revenue ~$882M (15% growth), surgical revenue ~$805M (17% growth, unchanged), EOS revenue now ~$77M (reduced); adjusted EBITDA target maintained at ~$134M and minimum free cash flow of $20M. Management reiterates confidence in long-term strategy: procedural-focused model, scaling via surgeon adoption and data platform (EOS Insight), and believes EOS Insight creates a durable data moat and meaningful implant pull-through (management cited ~30% revenue lift per surgeon after Insight adoption). Near-term risks: EOS installation timing/construct challenges causing lumpiness and mix-driven pressure on revenue per case (Q1 R/Case down ~3% YoY driven by more cervical mix, stronger international mix, and lower biologics attachment rate). Management expects EOS recovery to contribute more meaningfully in H2 and maintains full-year surgical guidance supported by surgeon additions, improving April trends, seasonality (deformity season), and increased international contribution.