Alphatec Holdings reported third-quarter revenue of $221 million, up 13% from a year earlier, while acknowledging that the result fell short of management’s expectations. The spine-surgery company attributed the shortfall primarily to weaker-than-expected biologics attachment, even as surgical hardware sales, procedure volumes and new surgeon adoption grew strongly.
The company expects full-year 2026 revenue of about $862 million and adjusted EBITDA of about $137 million. It also highlighted a new addition to its senior leadership team.
Key details
- Surgical revenue was $202 million, up 14% year over year. Hardware revenue grew 17% and contributed $26 million to surgical growth.
- Procedure demand indicators were strong: case volumes increased about 20%, and net new surgeon users rose 25%.
- Biologics attachment weighed on results. CEO Pat Miles said the revenue shortfall was primarily due to lower biologics attachment and called improving performance in that area a clear priority. He said disciplined execution in biologics is needed to translate procedural demand more fully into revenue.
- Profitability measures showed a mixed picture. Alphatec recorded a GAAP net loss of $5 million, compared with non-GAAP net income of $15 million. Adjusted EBITDA was $38 million, or 17.3% of revenue; the company said its adjusted EBITDA margin expanded by 4 percentage points from a year earlier.
- Gross margin was 71.5% on a GAAP basis and 71.9% on a non-GAAP basis. GAAP operating expenses were $155 million, versus $137 million on a non-GAAP basis.
- Cash generation remained positive. The company generated $6 million of free cash flow in the quarter, reported positive free cash flow over the trailing 12 months, and ended September with $80 million in cash.
- Full-year 2026 outlook: Alphatec expects approximately $862 million in total revenue, including $789 million of surgical revenue and $73 million from EOS. Those figures imply growth of about 13% in total revenue and 15% in surgical revenue. The company also expects adjusted EBITDA of about $137 million and approximately $10 million in free cash flow.
- Leadership addition: Tommy Carls joined the senior leadership team as executive vice president of Data Intelligence & Strategy.
What it means
Alphatec’s reported results point to a gap between strong procedural activity and the revenue it is currently converting from that demand, with management specifically identifying biologics attachment as the issue. The quarter also showed a GAAP loss alongside positive non-GAAP net income and adjusted EBITDA, while the company maintained positive free cash flow. Management cited its OsteoAdapt opportunity, associated with Theradaptive, as a longer-term part of its strategy.