Alphatec Holdings, Inc. Q4 FY2025 earnings call

• Patrick Miles emphasized the 100% spine focus, leading in lateral, deformity leadership, and the impact of EOS Insight. Mentioned Q4 and full - year financial highlights like revenue growth, adjusted EBITDA, and free cash flow. Also highlighted procedural advancements in 2025 such as the release of various products. - J. Todd Koning detailed fourth - quarter and full - year financial metrics including revenue breakdown, gross margin, R&D, SG&A, and balance sheet details. Discussed 2026 outlook with revenue growth expectations, adjusted EBITDA guidance, and focus on clinical distinction through proceduralization, unrivaled leadership in lateral, and ecosystem development in deformity surgery. - Patrick Miles and J. Todd Koning also spoke about expanding and elevating the sales force, neuromonitoring platform as a moat, exclusive distribution partnership with Theradaptive, and long - term growth strategy.

Fourth quarter revenue was $213,000,000 (20% growth); surgical revenue $190,000,000 (21% growth in Q4); EOS revenue $23,000,000 (14% growth). Full year revenue $764,000,000 (25% growth); surgical revenue $687,000,000 (26% growth); EOS revenue $77,000,000 (15% growth). Q4 adjusted EBITDA $33,000,000 (61% year - over - year growth); full year adjusted EBITDA $93,000,000 (12% of revenue). Q4 free cash flow $8,000,000; full year free cash flow $3,000,000.

• 2026 revenue expected to be approximately $890,000,000 (17% growth), including surgical revenue ~$805,000,000 and EOS revenue ~$85,000,000. - Adjusted EBITDA guidance for 2026 increased to $134,000,000, with an adjusted EBITDA margin of 15%. - Expect to generate at least $20,000,000 of free cash flow in 2026.

Q: Good afternoon, everybody. Can you hear me okay? Yeah, we have you loud and clear, Matt. Great. Thanks, Todd, and I apologize. I am going to ask two questions. I am sorry for breaking the rules right out of the gate. The first one, if you will just indulge me: the shares are trading off after the market. I just want to make sure I am not missing something. So just to recap, Q4, you had already preannounced the revenues, came in in line. EBITDA was a new input, and that came in about 10% higher than consensus. Then 2026, you had already preannounced the revenue guidance of $890,000,000 in that same release in January, but you have now taken up the EBITDA guidance for 2026. I just want to make sure I am capturing all the moving parts and not missing something.

A: That is all correct, Matt.

Q: Maybe, Todd, if you could, you did mention in your prepared remarks that a complex contribution may be changing the seasonal patterns. I was hoping you could help us with the cadence for 2026, maybe even just starting with the first quarter. I think consensus is about $202,000,000 revenues, $90,000,000 in EBITDA. Is that the right spot to be? And any commentary on how the rest of the year should play out? And I will leave it at that, I swear.

A: Yeah, I think if you look at the full - year growth of 17% and think, as we think about the seasonality of our revenue—and I think you look at the increased seasonality in Q2 and Q3—I am kind of looking at 2025 as being probably where I would like to get folks in terms of the revenue seasonality. And so if you think about the first quarter was about 22.1% of sales in 2025, 24.5% in Q2, and about 25.5% in Q3. And so I think those are kind of the starting point that we are thinking about just to respect the seasonality that we saw on the basis of the guidance that we have.

Q: Okay, and the EBITDA pattern should be similar as well?

A: Yeah, I think so. I mean, I think it is probably a little bit more drop - through in the first quarter over the average, and probably a little bit lower than that in the balance of the year to kind of get you to the 32% overall.

Q: Good afternoon, gentlemen. Thanks for taking the question. Just curious on what you are seeing out in the field in terms of attracting the sales folks that you want. Are you still getting the pick of the litter? And then any territories you are seeing particular strength or penetration in that maybe had not been bright spots in the past?

A: Yeah, Ben, this is Patrick. I would say that we have a very clear hiring algorithm, and it is going exactly as one would expect. I would tell you, when we say things like we are the preferred destination, it is our subtle desire to send the message that people are coming our way. And so, without getting into specifics in terms of territorial dynamics, I would tell you that there is great demand for our portfolio both via the surgeons and the people who want to sell it.