Alphatec Holdings, Inc.

What they do

Alphatec designs and sells spinal surgery implants—pedicle screws, interbody devices, plates, and tissue-based materials—plus EOS full-body, weight-bearing X-ray imaging equipment and related services. Products are sold through direct representatives and independent sales agents to hospitals and surgical centers. The company integrates its InformatiX platform, including SafeOp nerve monitoring and EOS Insight planning software, into surgical approaches like Prone TransPsoas and Lateral TransPsoas.

Revenue drivers

• Spinal implant products — Includes pedicle screws, interbody devices, plates, and biologics. Surgical revenue was $196 million in Q2 2026, up 17% year-over-year, driven by 20% case volume growth.
• EOS imaging equipment and services — Full-body, weight-bearing X-ray devices used for surgical planning and post-operative assessment. EOS revenue for 2026 is expected to be approximately $77 million.
• Procedural approaches (PTP, LTP, Midline ALIF) — These surgical approaches integrate SafeOp and are designed for single-position lateral surgery, fueling adoption and portfolio-wide utilization.

Recent performance

Q2 2026 total revenue was $214 million, up 15% year-over-year, with GAAP net loss of $26 million and non-GAAP adjusted EBITDA of $36 million (16.8% margin). Full-year 2025 revenue grew 25% to $764 million, though net loss was $143 million and diluted EPS was -$0.96. Operating cash flow turned positive in 2025 at $45.2 million, up from -$44.7 million in 2024. As of June 30, 2026, cash was $119 million, total assets $791 million, and long-term debt $511 million with negative shareholder equity of -$12 million.

Strategy

The company focuses on achieving clinical distinction through its 100% spine focus, developing integrated surgical approaches and expanding its InformatiX platform, including EOS Insight with features like AutoDensity and 3D pediatric modeling. It invests in organic innovation, sales force expansion, and surgeon training (new HQ, Memphis distribution center). Management highlights 'industry-leading market share expansion' driven by surgeon adoption and exclusive sales talent.

Risks

• High competition — Competes with large, well-capitalized companies like Medtronic, Johnson & Johnson, Zimmer Biomet, and Globus Medical, which have more resources and established relationships.
• Persistent net losses — The company has reported net losses for at least five consecutive years, with 2025 net loss of $143 million, and has negative equity, indicating ongoing profitability challenges.
• Debt and convertible notes — Long-term debt of $511 million, including $405 million of 0.75% convertible notes due 2030 and a new $175 million term loan, exposes the company to refinancing and dilution risk.
• Regulatory and market risks — Spine market is subject to rapid technological change, regulatory clearances, and potential reimbursement changes that could impact demand.

Outlook

For fiscal 2026, management reaffirms total revenue of approximately $882 million, up about 15%, including $805 million surgical and $77 million EOS. Adjusted EBITDA guidance was increased to approximately $140 million, and free cash flow is expected to be at least $20 million. Management highlights continued case volume growth, surgeon adoption, and positive free cash flow generation.