Earnings call transcript: Alphatec Holdings Q2 2025 shows robust growth

Alphatec Holdings Inc. (ATEC) reported a strong performance in its Q2 2025 earnings call, with total revenue reaching $186 million, a 27% increase year-over-year. The company’s stock rose by 4.38% during regular trading, closing at $13.24. In aftermarket trading, the stock saw a slight decline of 1.06% to $13.10. With a market capitalization of $2.03 billion and impressive year-to-date returns of over 50%, ATEC has shown remarkable momentum. The company raised its full-year revenue guidance to $742 million, reflecting confidence in its growth trajectory. InvestingPro analysis suggests the stock is currently trading above its Fair Value, with 8 additional exclusive insights available to subscribers.

Key Takeaways

• Alphatec’s revenue grew by 27% year-over-year, driven by strong surgical and EOS revenue.
• The company achieved its first quarter of non-GAAP net income, reporting $3 million.
• Full-year revenue guidance was increased to $742 million, signaling positive future expectations.
• The stock experienced a 4.38% increase during regular trading, followed by a 1.06% dip in aftermarket trading.

Company Performance

Alphatec Holdings demonstrated robust growth in Q2 2025, with a total revenue of $186 million, marking a 27% increase from the previous year. The company maintains a healthy gross profit margin of 68.81% and strong liquidity with a current ratio of 2.88. The company’s focus on innovation and product development, such as the launch of a new cervical retractor system, contributed to this growth. Alphatec is currently the third-largest spine player in the U.S., growing 5-6 times faster than the overall market.

Financial Highlights

• Revenue: $186 million, up 27% year-over-year
• Surgical revenue: $168 million, increased by 29%
• EOS revenue: $17 million, up 11%
• Adjusted EBITDA: $23 million, a fourfold improvement from last year
• Non-GAAP net income: $3 million
• Positive free cash flow: $5 million

Outlook & Guidance

Alphatec raised its full-year revenue guidance to $742 million, with a surgical revenue projection of $666 million and EOS revenue of $76 million. The company expects to achieve an adjusted EBITDA of $83 million and aims for an 18% adjusted EBITDA margin by 2027, targeting $1 billion in revenue. Positive free cash flow is anticipated for Q3 and Q4. Analyst consensus remains bullish, with price targets ranging from $14 to $23 per share. For detailed financial analysis and comprehensive valuation metrics, explore the full InvestingPro Research Report, part of our coverage of 1,400+ US stocks.

Executive Commentary

CEO Pat Miles emphasized the company’s growth potential, stating, "The spine market needs ATEC." He also highlighted the company’s commitment to innovation, saying, "We are just getting started. Our ecosystem has years to reflect in improvement and our best is truly yet to come."

Risks and Challenges

• High revision rates in the spine market pose a potential challenge for sustained growth.
• Market volatility could impact investor sentiment despite positive earnings results.
• The company’s ability to maintain growth momentum amid increasing competition in the spine industry.

Q&A

During the earnings call, analysts inquired about Alphatec’s upcoming product launches, particularly the Valence navigation robotics system set for early 2026. Questions also focused on the growth drivers for lateral and non-lateral procedures and the impact of EOS technology on surgical planning. With 4 analysts recently revising earnings estimates upward, InvestingPro subscribers can access detailed analyst forecasts, comprehensive financial health scores, and exclusive investment insights to make informed decisions about ATEC’s growth potential.

Full transcript - Alphatec Holdings Inc (ATEC) Q2 2025:

Mark, Conference Call Moderator: Good afternoon everyone and welcome to the webcast of ATEC’s second quarter financial results. We would like to remind everyone that participants on the call will make forward-looking statements. These statements are based on the current expectations and are subject to uncertainties that could cause actual results to differ materially. These uncertainties are detailed in documents filed regularly with the SEC. During this call you may hear the company refer to non-GAAP or adjusted measures. Reconciliations of these measures to U.S. GAAP can be found in the supplemental financial tables included in today’s press release, which identify and quantify all excluded items and provide management’s views of why this information is useful to investors. Leading today’s call will be Alphatec Holdings Inc. Chairman and CEO Pat Miles and CFO Todd Koning. I will now turn the call over to Pat Miles. Please go ahead sir.

Pat Miles, Chairman and CEO, Alphatec Holdings Inc.: Hey, thanks Mark. Really appreciate it. Welcome to the Q2 2025 financial results call from Alphatec Holdings Inc. There will be some forward-looking statements, so read that at your leisure. I would consider this a good to great quarter. Q2 2025 financial results: the surgical revenue growth of 29%, which is about 6 times the market. I would think that that’s growth leadership. $23 million in adjusted EBITDA, which is a record for the U.S. and 13% of revenue. It improved 880 basis points year over year, which inflects us in that $5 million in free cash flow. The profitable revenue growth leadership has.

Todd Koning, CFO, Alphatec Holdings Inc.: Continued.

Pat Miles, Chairman and CEO, Alphatec Holdings Inc.: The profitable growth continues. At $186 million in total revenue, the total revenue growth was 27%. As I said, the surgical revenue growth at 29%. The way we look at same-store sales, revenue growth in established territories was 29%. That tells you that the demand in the areas where we have established distributors has continued to grow. It’s not just adding people. The surgeon user growth of 21% I think speaks for itself and suggests that we’re compelling adoption. I mentioned that $23 million of adjusted EBITDA marks the fifth consecutive quarter of positive adjusted EBITDA. It’s a 4x improvement over last year’s same quarter. We are clearly well past the inflection point on profitability. We are not only leveraging infrastructure investments we’ve made, but we’re seeing the fruits of the changes implemented last year and around expense control.

We have an infrastructure in place to support over a billion dollars in revenue, and improving EBITDA performance combined with heightened attention on asset management has produced $5 million in free cash flow. Again, I’m very proud of the team and what they’ve done. We have $217 million of cash and access to cash. We are profitable from a non-GAAP net income perspective and our voracious growth has made us the third in market share in the U.S. I would say that that’s a good quarter, and what I’ll do is turn it over to Todd, let him get into the details of it.

Todd Koning, CFO, Alphatec Holdings Inc.: All right, thank you Pat, and good afternoon everybody. I’ll begin today with the second quarter 2025 P&L highlights. Total revenue was $186 million, up $40 million year over year. That’s 27% growth compared to the prior year. The $186 million in revenue was comprised of $168 million in surgical revenue and $17 million of EOS revenue. Our first quarter surgical revenue of $168 million grew 29% compared to the prior year period. That represents $38 million in year over year growth. We saw no selling day difference year over year, as we do include Good Friday in our selling day calculation because history has shown that surgical volume on that day is typically in line with other Fridays. Procedural volume growth was 28%, driven by strong surgeon adoption of 21% and increased utilization of 6%.

Surgeon adoption at this pace reflects both the attractiveness of our portfolio and the coordinated investments we’re making in sales talent to meet that demand. Average revenue per procedure growth is 1% and that reflects the strong comp we saw from average revenue per case in the second quarter of 2024. Our same-store sales in the U.S., which are sales that come from sales agents that have been in territory for a year or more, grew 29% year over year, which demonstrates that we continue to grow significantly in the markets where we are already established. Our strong surgeon adoption, increased utilization, and same-store sales growth results are testament to us growing both our share of wallet with existing surgeons and new surgeon adoption within territory. We know that clinical distinction drives surgeon adoption in the first half of the year.

We furthered our clinical distinction by expanding our procedural offering. This includes a new cervical retractor system and unique segmental cervical plating system, corpectomy solutions for cervical and thoracic applications, and meaningful new applications for SafeOp in MEPs. We continue to invest in the organic innovation machine, the foundation for future growth. EOS revenue increased $17 million in the first quarter, up 11% compared to last year. Demand in the U.S. market, where we have a strong presence with our implant sales force, continues to be the biggest driver of growth in both deliveries and new orders, which positions us for strong system installations and the accompanied implant pull through in coming years.

Turning to the remainder of the P&L, first quarter non-GAAP gross margin was 70%, flat sequentially and down 130 basis points compared to the previous year, primarily driven by increased biologic detach rate and product mix associated with the strength in our cervical business. Non-GAAP R&D was $14 million in the second quarter, up in absolute dollars both sequentially and year over year, reflecting our continuing investment in the long-term growth of the business. Non-GAAP R&D expense was approximately 8% of sales in the quarter with top line growth driving 170 basis points of leverage. Non-GAAP SG&A of $108 million was approximately 58% of sales in the second quarter. SG&A was down $4 million sequentially and the absolute increase in SG&A year over year was driven by variable costs related to our 29% increase in surgical revenue. The remaining non-variable SG&A was down in absolute dollars year over year.

These reductions in absolute dollars of SG&A spend reflect the changes we’ve made to how we operate the business, increased emphasis on driving profitability and cash flow. SG&A improved nearly 1,100 basis points year over year with 800 basis points coming from both variable expense rate improvement and infrastructure leverage. Approximately 300 basis points of improvement came from leveraging depreciation associated with our prior year instruments investment. We reported total non-GAAP operating expense of $122 million, which was approximately 66% of sales. By maintaining discipline as we support strategic growth initiatives, we delivered a modest 7% increase in operating expenses while continuing to invest in the growth drivers of the business. Those efforts, along with our durable top line growth, drove over 1,100 basis points of expansion in operating margin year over year.

I’ll turn next to adjusted EBITDA, which was $23 million or 13% of sales in the second quarter compared to $6 million and 4% of sales in the prior year period, an $18 million increase. This is the best performance we’ve had since the start of ATEC’s transformation. The quarter also marks our third consecutive period with an over 40% drop-through on year over year revenue growth to adjusted EBITDA, reflecting both infrastructure scalability and an improving variable selling expense profile. You can see in the chart on this slide that the profit margin expansion that we are executing has been both significant and consistent. Our trailing 12 months of adjusted EBITDA now sits at $62 million. We’re driving meaningful margin expansion that aligns with the priorities outlined in our long range plan and is a result of disciplined execution.

These deliberate results give us great confidence in our ability to continue delivering on our financial commitments and translate revenue growth into profit and cash flow. Turning to the balance sheet, we ended the first quarter with $157 million in cash on hand. Additionally, we had access to $60 million of available borrowing on our revolving line of credit, which was undrawn at quarter end, making our total cash and available cash $217 million. Our positive free cash flow of $5 million was again at the favorable end of the $0 to $5 million range that we previously communicated. A record $16 million in cash generated from operating activities allowed us to continue investing in surgical instruments while still delivering positive free cash flow and increasing our overall cash balance sequentially by $4 million.

We can clearly see the company’s inflection to cash flow generation is taking shape with our trailing 12 months of cash use improving to $22 million this quarter. This year we are seeing the benefit of the operational improvements we’ve been making. Everything from how we plan our inventory purchases to our hiring plans to the operational standards for field assets. I’m very proud of the cross functional teamwork and results we’ve delivered in this area across our company. Execution against those goals contributed to our positive free cash flow in the second quarter and the underlying dynamics of the business reinforce our confidence that we will be cash flow positive for the full year. Given the magnitude and increasing trend of EBITDA we are generating, our laser focus on managing assets efficiently, and the strength of our cash position, it is clear we will not need additional financing.

Our financial outlook for this year expects continued strong revenue growth to drive incremental profit margin expansion. We are increasing our full year revenue guidance by $8 million to $742 million as a result of the strong Q2 performance in our surgical business. Our revenue outlook for the full year 2025 expects adoption of our unique procedural approach to drive surgical revenue of approximately $666 million, and we expect EOS revenue of approximately $76 million. As it relates to free cash flow, our second quarter performance further reinforces our confidence in delivering positive free cash flow for the full year 2025.

With respect to the cadence of our cash flows for the remainder of 2025, we expect the third quarter free cash flow to range from a positive $1 million to positive $5 million, with the fourth quarter generating additional positive cash flow resulting in us being cash flow positive for the full year 2025. Turning to the outlook for the full year 2025 adjusted EBITDA, we expect sales growth to continue to leverage the infrastructure we’ve built, contributing to an adjusted EBITDA of $83 million, a $5 million increase versus our prior guidance of $78 million. Notably, our trailing 12 months of adjusted EBITDA of $62 million as of the second quarter speaks to our ability to deliver on our full year commitment of $83 million. As a reminder, our adjusted EBITDA guidance includes us absorbing the impact of expected tariffs in the second half of the year.

We continue to estimate the impact of tariffs on our cost of goods sold to be in the low single-digit millions of dollars for the full year.

Pat Miles, Chairman and CEO, Alphatec Holdings Inc.: We are off to a great start.

Todd Koning, CFO, Alphatec Holdings Inc.: At the half year mark and have confidence we can deliver on our commitments in the back half of the year. The chart on the slide depicts the consistency of the profitability progress we are making and the tremendous power of our business model to drive future profitability. Our adjusted EBITDA guidance of $83 million will generate an adjusted EBITDA margin of 11%. That implies a 40% drop through of the incremental growth in revenue dollars to adjusted EBITDA. This trajectory positions us well to achieve our 2027 adjusted EBITDA margin goal of 18% at $1 billion in revenue. Now, reflecting on where our financial results are at the midweek point through the year, I’d highlight a few things. First, we continue to grow at 56 times that of the overall market.

Second, we’ve generated $62 million of adjusted EBITDA over the last 12 months and are at 13% of sales in the second quarter. Third, we have our first quarter of non-GAAP net income at $3 million and fourth, we have delivered free cash flow of $5 million this quarter. I think it is safe to say we’ve passed the inflection to profitability. It’s exciting to see the team’s hard work paying off as we’ve arrived as a profitable growth company. With that I’ll turn the call back to Pat.

Pat Miles, Chairman and CEO, Alphatec Holdings Inc.: Thanks, Todd, greatly appreciate it. I want to give you some meaningful reflection as to where the growth is coming from and why the growth is. I would say that the strategy is steadfast, our execution relentless. We are executing and fulfilling the commitments. The pillars of our business are really: Are we doing something better clinically? Are we creating clinical distinction? Clinical distinction does compel surgeons, and we are compelling surgeon adoption. I think it’s reflective of the 21% new surgeon growth. We continue to expand and elevate the sales force. I think under the auspices of those three pillars, a lot of good things are going on. I want to explain a little bit. We’ve made statements in the past of things like the spine market needs ATEC, and that is not a boastful comment.

What it does is it’s intended to express just how unsettled the spine market is. If you have 10 spine surgeons address the same patient, you’ll get 10 different answers. The reason for this is that spine is highly complex. It is raw with a myriad of variables that undermine durability. When you start to look at the revision rate in spine surgery versus total joints, you’re going to find that the spine revision rates are multiples of total joints. Looking at the graphic, you can see total hip surgery in 10 years is around 5%, total knee surgery in five years is 3%, and then you’re getting 15% to 25% to 30% in short and long segment spine surgery. I would suggest that is a reflection of a lot of variables that need controlling.

Historically, industry’s response has been more widgets or tools to increase the placement precision of the widgets. I would suggest that’s not enough. It’s why our view is that the challenges are much more complex, and the solutions require greater sophistication. That is what drove the design and development of our ecosystem that not only addresses intraoperative challenges, but also improves care of data-driven decision making. When you look at what we’ve built, we have built an ecosystem that’s scalable for a long run. It is why we previously invested in a technology infrastructure that will fuel durable long-term growth and profitability. Having previously made these investments enables us to focus our R&D efforts on magnifying the value of each individual technology and then integrate them into a fully comprehensive system.

Our end-to-end ecosystem enables influence not only in the intraoperative phase of spine surgery, which has historically been where spine companies focus, but also informs preoperative decision-making as well as postoperative analytics, outcomes, and trends. All of this information is fed into the Insight portal that uses AI and machine learning models to better inform decision-making. We believe that these are profoundly important elements that drive a long-term growth profile based upon the many challenges in spine surgery. Our foundational informatic investments several years ago in SafeOp, Valence, and EOS enable our ecosystem to really come to life. We are in the process of architecting informatics and spine procedures into the very best integrated experience, something else that’s not been done in spine surgery. Recall the goals of spine surgery: decompression, stabilization, and alignment. Providing information about the nerves is of foundational importance with SafeOp.

Be it the location of the nerve, the health of the nerve, the status of the nerve, these are foundational elements of a successful intraoperative experience, assuring precision during implant placement or stabilization. With navigation robotics through Valence, it is a piece of the pie, not the whole pie, but another foundation of foundational importance as it relates to the goals of spine surgery. Providing not only alignment parameters and tools for intraoperative assessment and reconciliation for which to align the spine, as well as providing patient-specific implant as required. Since Valence is the next piece of the puzzle to be launched, I want to spend just a moment on how we will approach the market. First and foremost, Alphatec Holdings Inc. is a procedure company. Valence will be integrated directly into the step-by-step workflow of our proprietary spine procedures, things like PTP.

Navigating the front of the spine, the anterior column, with both neurophysiology from a neural perspective and navigation is elegance. Using the robot to assist in screw placement in the back will be the first fully integrated system. What this does is it democratizes the technique to a much broader surgeon audience who have previously been apprehensive because either they did not train or are just unfamiliar with lateral surgery. We see this as another catalyst. The system will have a very small footprint, which we want to again take up little room in the operating room. Lastly, we will be very, very aggressive in terms of how we place them. Our goal is the very best integrated system possible. If you look at what we’re doing, really what we’re doing is utilizing objective measure that enables variable mitigation.

I think where others approach the industry through the proliferation of widgets, we’re taking the approach of variable mitigation through objective measures. We’re objectifying the spine experience. That means bringing measure and supplying more scientific tools to the surgeon versus just relying upon surgical experience or gestalt like so many other fields. By bringing objectivity, we will further the predictability and impact the durability so much needed. A key to this strategy is automation. We must be able to collect and translate data that will improve surgery in an automated way. History has demonstrated that it won’t get done until it requires a manual process. We’re in the very early stages of informing our spine procedure through data mined from our ecosystem, so a good ways to go. The interest is to make sure that one appreciates why we say that the spine market needs ATEC.

When you appreciate the unacceptably high revision rates in spine, you have to realize that our approach to variable mitigation is resonating with customers, the numbers suggest as much, as well as attracting the best salespeople. That is why we say the spine market needs ATEC. It should not be a surprise that after six plus years of growing at multiples of the rest of the market, we are now the third largest U.S. spine player. We have and will continue to benefit from the dislocation and disruption in the spine market. However, our ecosystem and procedural strategy will continue to fuel our outsized profitable growth. As we’ve said for some time, we will continue to be rewarded by focus.

With 100% focus on spine, combined with a team that has unmatched clinical know-how and expertise added to a perpetuating effort to create the very best sales team in the business, makes ATEC far and away the preferred destination. I remind you that we are just getting started. Our ecosystem has years to reflect in improvement and our best is truly yet to come. A quick thanks to the ATEC faithful. It is them that’s creating this juggernaut. With that, we will take questions.

Mark, Conference Call Moderator: We will now open the floor up for questions. In consideration of others, please limit yourself to one question. The first question comes from the lineup. Matt Miksic with Barclays. Matt, please go ahead.

Hey, thanks so much. Really appreciate you taking the question. Let me just congratulate you on a really strong quarter. Top line and the direction of cash flows is really encouraging and impressive. Congrats. I wanted to ask a little bit about Pat, your question that I get as well as everything is going, of course, you know, things going well, folks start asking for something else. As strong as the top line has been, as robust as the lateral and prone lateral has been, on the enabling technology side and sort of digital side, maybe, you know, two parts of one question.

What do you anticipate to make, you know, the robot different when you do start to put that out in front of folks more and we get, you know, a more routine look at it, and then also what kinds of investments are you having to make or have you made to kind of support the integration of, as you point out, like, you know, a turnkey front to back solution, imaging to automation and enabling technology. Thanks.

Pat Miles, Chairman and CEO, Alphatec Holdings Inc.: Yeah. You know, Matt, it’s cathartic for me to look back on some of our original discussions on robotics.

It’S.

Fascinating to me that historically speaking, I recall when we assembled multiple products to make for a procedure, the response of the marketplace was hey, we have a retractor, we have a neurophysiology piece in our ENT group, and we have an implant, a bunch of implants. One of the problems when you look at the unacceptably high revision rates in spine surgery is that nothing has been designed and developed for the requisite utility within a specific patient population. Because there’s such a volume of variables in spine, what happens is that everybody just creates generalized equipment. I think what makes us different is the procedural architecture of very specific application. One of the real opportunities in navigation robotics is to integrate these elements into the workflow of a spine procedure. It’s amazing, right?

It’s like here’s us coming out with lateral surgery and we have a tremendous run rate. The reason we have a tremendous run rate is because there’s a unique know how in terms of the assembly of goods. I would say it’s the same thing with regard to navigation robotics. I could care less about navigation robotics. What I care about is the reproducibility associated with a surgical experience. It requires precision. If navigation is a tool that provides us increased precision without radiation, I want to integrate that in, in an unbelievably elegant way. Where we see the reward in navigation robotics is in the integration of the workflow associated with the spine procedure. We have an intraoperative camera.

That intraoperative camera has a very unique ability to be moved around during the case, such that it gets the best view and there’s no one standing in front of it in the operating room. If you guys in the investment community could stand in the operating room, you would appreciate the chaos that exists. To create an elegant workflow where it’s all about execution using all of the EOS elements, about how you’re going to do something based upon creating a surgical plan, integrating that surgical plan and all elements into it, such that the robotic piece becomes informed by what the plan is and understands angulation, pedicle volume and all the other elements, such that the operating room just becomes an execution place.

Our view is that these things just become part of procedures that ultimately get wrapped into a workflow and that what we have the opportunity to do is make the operating room something that just is all about execution and not about on time clinical decision making. We want that to be done before the surgery starts and then we’ll assess how we did after. We think that that’s how the ecosystem informs better surgery. Sorry for the diatribe.

Mark, Conference Call Moderator: That’s great.

That’s super helpful. Thank you.

Pat Miles, Chairman and CEO, Alphatec Holdings Inc.: Yes, sir.

Mark, Conference Call Moderator: Your next question comes from the line of Young Li with Jefferies. Young, please go ahead.

All right, great. Thanks for taking the question.

I guess.

Todd Koning, CFO, Alphatec Holdings Inc.: To start, just kind of.

Curious, you know, really strong same-store sales growth. Was wondering, you know, how much of the contribution is from the reps added maybe two years ago, and how much is being helped by the availability of more instrument sets from last year’s investments, as well as some of the efficiency initiatives with these instruments and instrument utilization.

Pat Miles, Chairman and CEO, Alphatec Holdings Inc.: Let me start off with the subjective and give Todd a harder job on the objective. First of all, half the time I think to myself, are we communicating the success of the internal teams thoughtfully enough? That’s where I would tell you we’ve evolved as an operational institution and you start to think about the utility of assets and we have matured immensely. I would tip my hat to the team who ultimately is responsible for that effort. I would tell you that the same store sales dynamic is we’re compelling people and you could believe it or not, all you’re going to see is continued growth profile from elevated sophistication in the field and will continue to compel people. We love adding people who are relevant and also people who buy into the surgical thesis. I can’t quantify it.

I’ll defer to Todd’s view with regard to the increase. That’s why we love the same store sales so much, because it’s reflective of a demand profile that when we say, gosh, we’re creating clinical distinction, there becomes a proxy for compelling adoption. It’s just not us popping off with regard to more and more people are doing it and young.

Todd Koning, CFO, Alphatec Holdings Inc.: I think there’s a couple ways to think about it. I mean, clearly the people we’ve brought on board for the last 12, 18, 24 months have been significant contributors to our growth. We know that’s true because as we say, what we do today impacts results 12 to 18 to 24 months from here, and I know it’s true because I can see the data. I think what’s more important, or the way I like to think about it, is it’s really about the surgeon adoption and the surgeon utilization. You saw both utilization and surgeon adoption be very strong in the quarter. I think that speaks to the penetration story. It’s kind of tied to Pat’s commentary about same-store sales being strong. Clearly we’re getting greater utilization with our existing surgeon base as well, which I think we’ve talked a lot about.

As people get comfortable with our procedures, they apply those procedures to more complex procedures, and we kind of get a greater share of wallet over time. I see. I think we’re seeing that play out as it relates to our efficiency and the utilization of our instruments. Clearly, as we’ve bought forward, I think that buyforward certainly has enabled us to continue to lean into our growth opportunities. We continue to do that. I think the operational sophistication that Pat speaks to has been another leg to that, another degree of freedom for us to really be placing assets and instruments where there’s opportunities. What we’re doing is we’re monitoring the progress of the success of those opportunities better so that we are ensuring that we’re getting the kind of utilization of the assets that we need.

We’ve elevated our operational sophistication significantly, which has continued to really enable our outsized growth that we’ve seen.

All right, great.

Very helpful. I’ll just keep it to one. Congrats on taking the third share.

Pat Miles, Chairman and CEO, Alphatec Holdings Inc.: In the U.S., yeah, thanks. Thanks, Joe.

Mark, Conference Call Moderator: Your next question comes from the line of Vik Chopra with Wells Fargo. Please go ahead.

Pat Miles, Chairman and CEO, Alphatec Holdings Inc.: Good afternoon and congrats on a nice quarter.

Thanks for taking the questions for me.

Mark, Conference Call Moderator: You know, you got to over 20% organic growth this year. Maybe just talk about any puts and takes to consider as we build out our models for Q3 and for the rest of the year. I had a quick follow up.

Please.

Todd Koning, CFO, Alphatec Holdings Inc.: Yeah, I think when I look at where we came into the year, I think we guided to $732 million. We’re now halfway through. We’re at $742 million, so it’s a $10 million increase since we initially guided into the year. We feel pretty good about that. I think the normal cadence of some sequential step down Q2 to Q3 is typical. I think that’s kind of where the second half modeling will probably shake out relative to seasonality, if you will. That help?

Yeah, that does help.

Mark, Conference Call Moderator: Thanks very much. Maybe just a quick update on your robot launch plans, and you know, are you still on track for early 2026.

Will we see it at NASS?

Thank you.

Pat Miles, Chairman and CEO, Alphatec Holdings Inc.: The answer is yes and yes. No. It’s kind of much like I was going through my diatribe with Matt. It’s, you know, we are doing the alpha on the robotic piece and it continues in earnest. You’ll see the navigation piece added. We’ll be doing cases by the end of this year with a combined system in the market, and then expect the influence to be 2026.

Mark, Conference Call Moderator: But.

Pat Miles, Chairman and CEO, Alphatec Holdings Inc.: I guess as much as anything, I’m just, I’m super proud of what the reflective utility looks like. To see the PTP, which clearly is something that’s near and dear, and watch it through a navigated and robotic experience, it’s exceedingly elegant. It provides me nothing but confidence in its influence of a broadened footprint. One of the really nice things is just because the footprint is not very big, the influence can be very big. We love the fact that we’re not pushing in a monster piece of equipment that oftentimes is delivered in a semi truck. What we’re doing is bringing in something that could be delivered in a suitcase. The key is the influence clinically.

I think that based upon the design sophistication of our guys in Colorado and our guys in San Diego who have been awesome, I think it’s an extremely sophisticated small footprint tool that ultimately is going to be exceedingly effectual, and we’re going to try to put it in as many places and be as disruptive as we can possibly be.

Mark, Conference Call Moderator: Your next question comes from the line of Matthew O’Brien with Piper Sandler. Matthew, please go ahead.

Hi there. This is Anna on for Matt. Thanks for taking your question. You had another quarter of strong surgical volume growth, I think 28%. I’m just wondering if you could give a bit more color as to really what drove that. Maybe if you could split that out between what you’re seeing in the ASC versus the hospital, sort of the trends there and your expectations going forward. Thanks.

Todd Koning, CFO, Alphatec Holdings Inc.: Yeah, I think when you look at, maybe I’ll take the second question first to get it out of the way. You know, our ASC mix is certainly sub 10%. I mean, it’s not big at this stage, but certainly an opportunity, I think, for spine in general to kind of grow and influence for sure. I think we’re well positioned for that because oftentimes the ASC is really about patient selection. I think when you think about patient selection, you think about how do you select those patients. I think EOS and EOS Insights are a great tool for that. It’s about controlling pain too.

Pat Miles, Chairman and CEO, Alphatec Holdings Inc.: It is one of these things with a morbidity dynamic. I think all of our minimally invasive stuff is right for that. I think it becomes a courage dynamic for who should be selected within that realm.

Todd Koning, CFO, Alphatec Holdings Inc.: I think that’s the answer on the ASC. The question we had on our growth in the quarter and what really drove the organic sales growth. Clearly, volume was a big piece of that. I think in this quarter we saw a bit more utilization contribution than we have in quarters past and feel good about that. I think the overall dynamic is we continue to compel surgeons and we’re continuing to fuel that or support that surgical interest, that surgical adoption with the right sales force. I think oftentimes people kind of get it backwards. It’s like, oh, I’m going to go hire the sales guy and he’s going to drive this, drive adoption. In reality, I think people are drawn to what we’re doing.

Clearly, disruption in the market from a company standpoint has made fertile hunting ground for finding the right people to support the adoption and the demand from a surgical standpoint that exists. We really feel good about the dynamics of the marketplace. We love our portfolio. We’re making, we continue to make investments in the portfolio. I talked about a number of areas that we launched in the first half of this year that should continue to be tailwinds into the second half in terms of specific portfolio additions. We feel like we’re in a good spot at the halfway mark.

Great, thanks. Congrats on the quarter again.

Thank you.

Mark, Conference Call Moderator: Your next question comes from the line of Joshua Thomas Jennings with TD Cowen. Josh, please go ahead.

Hi. Thank you. Echo the congrats on the strong print. Maybe a follow up to the last question just to build on your answer. Pat, just on the drivers of the growth. I mean the PTP, LTP, the lateral franchise seems like continuing to gain share in the U.S. lateral market. You have these new products as you’ve called out with the cervical retractor, segmental cervical plating, corpectomy solutions. I think deformity. Maybe just help us through the outperformance so far in the first half of the year. Has it been more weighted towards, driven more by the lateral business or some of these new product introductions? On top of that, maybe talk about the halo effect that you’re experiencing with non-lateral products.

Pat Miles, Chairman and CEO, Alphatec Holdings Inc.: Yeah, I would say it’s a bit like you described. I think, you know, kind of the initiation of people’s interest in ATEC has been in the lateral realm. There’s a sophistication with surgeons like, you know, Luis Permins and Bill Taylor and the people who originally built the lateral franchise, who are kind of the foundational leaders of what we built here. I think that there’s such a sophistication that becomes the original and that’s really kind of been the growth driver. To your point, what we’re seeing now is that much like SafeOp has informed lateral surgery, we’re seeing EOS informing deformity. Now we’re starting to see, gosh, these guys are starting to integrate the information that comes out of EOS into not only the surgical plan, but the deformity structure of what they’re trying to build from a long construct perspective.

What we’re seeing and what makes us so bullish is just the relevance of the ecosystem. Candidly, I don’t think that we’ve even begun to see our EOS influence yet. Clearly we haven’t even launched Valence. I think that there’s two elements that will ultimately be a very integrated ecosystem that haven’t even started. We see those things taking place and we understand the relevance of the technology and we see that playing out with confidence. That confidence drives things like cervical that are more difficult to distinguish. What we’re seeing is an opportunity to distinguish ourselves in those realms. Again, the distinguishment may be slightly more sophisticated, slightly less grand, but there’s still meaningful surgical distinctions that ultimately drive a confidence surgically that people are applying the goods.

I think that the term coined of the halo effect is a great one because it’s reflective of just an expanded confidence.

Todd Koning, CFO, Alphatec Holdings Inc.: In what we’re trying to build.

Great. My follow up is related and really just looking at the surgeon user growth acceleration 2Q versus 1Q. Are you attributing that to, clearly, the success in the market portfolio build out? Similar kind of frame up is, are you seeing more lateral surgeons come in, or is the expansion of the portfolio driving that surgeon user growth acceleration because more surgeons are coming in for non-lateral ATEC procedures and products? Thanks for taking the questions.

Yeah, Josh, I actually think when you look at it, it’s that we’re just garnering broader interest, and we’re getting just a broader level of influence and attracting a broader set of surgeons. I think, you know, we internally could point to a number of them.

Pat Miles, Chairman and CEO, Alphatec Holdings Inc.: You know what’s been fascinating, and I think you’ll appreciate this, Josh, is that if you look at our market share and then you look at our market share where there is an EOS, it’s meaningfully bigger. I don’t want to get into the numbers of it, but I will tell you, we’ve not yet reflected the value of it in the ecosystem description as we have outlined it. It’s still like all of these things are coming to fruition. We’re seeing an outsized market here in those places where we have an EOS park because guys are utilizing, guys are interested in our goods, our ability to infiltrate those counts is high. I would say that we’ve never had a bigger interest from academic institutions as we have in the last half year.

I think it just speaks to, we’re getting in front of more fellows, we’re being more relevant from an academic perspective, and we continue to see an expanse in the volume of surgeons interested in what we’re doing.

Makes sense. Thanks so much.

Thank you so much.

Mark, Conference Call Moderator: Your next question comes from the line of Benjamin Charles Haynor with Lake Street Capital Markets. Ben, please go ahead.

Todd Koning, CFO, Alphatec Holdings Inc.: Good afternoon, gentlemen.

Thanks for taking the questions. First off, just on the penetration story and some of the EOS commentary that you just mentioned there, can you maybe talk about what you’ve seen from some of the geographies that you’ve historically or recently been under indexed? It clearly seems like there’s a tipping point where you got compel adoption with individual surgeons, individual facilities. How does that play out on a kind of a geographic basis? Is there a concentration that kind of gets you, gets the adoption accelerating?

Yeah.

Pat Miles, Chairman and CEO, Alphatec Holdings Inc.: Let me take a shot at just kind of the generalities around it. Those of you who’ve been in spine for a long time appreciate that the EOS image is far and away the most coveted image in spine. It’s not even, it’s undeniable. Having an active position, a weight bearing position and understanding in space where I need to fix someone from an alignment perspective is of substantial value. What we’ve seen is historically a lot of academic institutions utilize that technology in a way that ultimately they’re yearning for some translation ability too. They see us bringing a translation tool to that effort and they become enthusiastic with regard to where it could go. When you start to think about the volume of variables that undermine the durability of spine surgery and you say what is missing? What’s missing becomes the informatic or the predictive nature of things.

What EOS provides is a foundational standard, a standard by which you can ultimately create a predictive environment. Their enthusiasm is for us to push the envelope from an informatic perspective such that we can get to a predictive state. That’s where I would tell you what’s the value of a company that ultimately furthers the durability of an environment from 25% to 10% or less and then 5% or less. I think that’s real value creation and that’s how we’re serving the interest of this space and that’s why we see the academic institutions run towards.

Mark, Conference Call Moderator: Your next question comes from the line of Caitlin Cronin with Canaccord. Caitlin, please go ahead.

Hey guys, it’s Mikayla on for Caitlin. Congrats on the strong quarter and thanks for taking the questions. There are two from us, but maybe I’ll ask them together. You raised guidance a bit more than the beats.

Pat Miles, Chairman and CEO, Alphatec Holdings Inc.: Can you maybe give a little bit.

More color on where we can expect the increased expectation in the second half, and then two, if there are any changes to free cash flow generation expectations and the timing of the cash through this year.

Todd Koning, CFO, Alphatec Holdings Inc.: Yeah, Mikayla, thank you for your question. Relative to the guide, I think you look at where we came into the year at $732 million. We’re now sitting here at $742 million on the full year. To your point, we did raise the second quarter guidance here, or the guidance here in the second quarter for the full year, by a bit more than the beat. We would expect that to kind of land in the third quarter. As I shared earlier, we would expect a sequential step down in absolute revenue Q2 to Q3, and that Q3 though still is probably a bit higher than where the Street’s at today relative to the points I just made in terms of where we’d expect. Expect that back half raise to show up as it relates to cash flows.

Our expectation for the third quarter would be a range of plus $1 million to plus $5 million, and then positive again in the fourth quarter so that we would be again positive on the full year. What I would tell you is we haven’t really changed our cash flow guidance. We continue to land on the favorable end of the range, and that continues to give us confidence that we can deliver on the commitments we’ve made. I think just overall guidance philosophy, as you’ve probably experienced, has been we try to put numbers out there that we believe we can achieve and have a reasonable opportunity to exceed. That’s how you should think about the guidance.

Pat Miles, Chairman and CEO, Alphatec Holdings Inc.: Got it.

Thanks so much, and congrats again.

Thank you.

Mark, Conference Call Moderator: Your next question comes from the line of David Saxon with Needham. David, please go ahead.

Pat Miles, Chairman and CEO, Alphatec Holdings Inc.: Oh, great.

Good afternoon, Pat and Todd. Thanks for taking my questions and congrats on the quarter. Juggling a couple calls. I’ll just keep it high level and hopefully this hasn’t been asked. Excuse me, just on the portfolio. Motion preservation is something you don’t have. I think you’ve talked about it in the past, but just given your focus on lateral and PTP, I guess how critical is filling that gap just to your overall growth outlook? Thanks so much.

Yeah, I would say, I think motion preservation in a well-selected patient is good surgery, but the reality is we have so much work to do with regard to our current ecosystem, and I think there’s so much promise in terms of what we’re doing. We’re going to let the other guys do the motion preservation stuff for a while, and what we’re going to do is we’re going to exploit an asset base that is best in class. There’s so much opportunity to run with that we can’t be more enthusiastic. The level of sophistication in our neurophysiology group is outlandish. The level of sophistication in our navigation robotic group, outlandish. The sophistication in the imaging group is unbelievable. Same with the mechanical side. It’s like let’s exploit what we do unbelievably well. That’s kind of who we’re going to be.

For as far as the eye can see at this point, that’s who we are, and it’s been reflective of a reasonably good runway.

Great.

Thanks so much.

Mark, Conference Call Moderator: Your next question comes from the line of Jason Hart Wittes with ROTH Capital Partners. Jason, please go ahead.

Hi, thanks for taking the questions and congrats on solid performance. First off, maybe just a financial question in terms of CAPEX spend for the year. I guess we can back into it, but sort of modeling this going forward, I mean, what’s your philosophy on CAPEX? It sounds like you guys are committed pretty much from here on to positive free cash flow. How does the CAPEX kind of work into that assumption?

Todd Koning, CFO, Alphatec Holdings Inc.: Yeah, Jason, I think the bulk of our CAPEX spend is in instrumentation to support surgical growth. As we’ve talked about it, and we laid this out in our long range plan construct, for every dollar of year over year surgical growth, we invest $0.75 into inventory and instrumentation. That instrumentation part, of course, in the cash flow statement shows up in PP&E. Obviously, the inventory stuff shows up in working capital and inventory and operating cash. That’s where it shakes out. I made the comment in my prepared remarks that we generated $16 million of operating cash, inclusive of our investment in inventory, and then spent about $9 or $10 million in surgical instruments, and we netted out $5 million of positive cash flow. That should give you a sense for how that shakes out within our cash flow. You can kind of look at that line historically.

I think as we think about growth, the inventory and the instrumentation is a $0.75 on the dollar ratio of dollar growth year over year.

That’s very helpful, thank you. Maybe just one quick other question. On EOS, in terms of the revenue you’re reporting, that’s, I assume, that’s specifically for capital sales, but can you give us a sense of how much of your business is capital sales versus some kind of purchase agreement type arrangement at this point with EOS and how that’s sort of shaped.

The way it shakes out is about $5 million a quarter or so is in a recurring revenue stream, maintenance and warranty and the like, and then the balance is capital.

In terms of your sales or your approach to the market, are you selling most of your systems?

Yeah, we primarily sell the systems.

Okay, that answers my question.

Thanks.

I’ll jump back in queue. Thanks very much, guys.

Thanks, Jason.

Mark, Conference Call Moderator: Your next question comes from the line of Sean Lee with H.C. Wainwright. Sean, please go ahead.

Hey, good afternoon, guys. Congrats on a great quarter and thanks for taking my question. As I was wondering, a main pillar of the company’s growth strategy is to expand the surgeon user base into new procedures that these surgeons have never tried before, whether PTP or deformity. I was wondering, do you have any evidence, maybe anecdotal stories on how many of these new surgeons have you seen that are trying the new procedures? Among the ones that come in for training?

Pat Miles, Chairman and CEO, Alphatec Holdings Inc.: Yeah, I guess just from an anecdotal perspective, I think one of the frustrations of lateral surgery historically has been if the goals of spine surgery are decompression, stabilization, and alignment, the lateral position is a more difficult position for which to realign a patient. Additionally, it’s a very difficult position to place pedicle screws. What’s happened with regard to PTP, or prone transpsoas, is they’re in a much better position by which to garner alignment or lordosis as well as to have access to both the front and the back of the spine. What we’ve seen is people who have historically dismissed lateral as a surgical tool, I think, get reinvigorated by the fact that there are so many options provided by a prone position lateral approach that they, in essence, increment their way back into a level of interest.

One of the things that it feels like is we’ve inspired a fair amount of enthusiasm around the PTP thing. There are certain people who have not trained in lateral surgery who I think will be healthcare assisted by navigation. To be able to take navigation and integrate it with neurophysiology into the workflow of surgery, we feel like that just opens up or democratizes more people’s interest in that technique. I don’t think that anybody doesn’t want to have that in their armamentarium of tools to apply to patients. It’s more a matter of where are they comfortable. The ways that we can make people comfortable through technology is what our interest is. We’re seeing that being played out in real time. Anecdotally, that’s how we think.

Thanks for that.

Todd Koning, CFO, Alphatec Holdings Inc.: That’s very helpful.

That’s all I have.

Mark, Conference Call Moderator: There’s no further questions at this time. I will now hand it over to Pat Miles for closing remarks. Pat?

Pat Miles, Chairman and CEO, Alphatec Holdings Inc.: Yeah, I would just end like the last slide says. Our best is yet ahead, and we have a heck of a run in front of us. We want to be the preferred location or destination to the best of the best salespeople to translate the type of things that are going on in here. Anyway, thanks everybody for your support and interest in Alphatec.

Mark, Conference Call Moderator: That concludes today’s conference call. You may now disconnect.

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