Education
About Us
Working with TipRanks
Follow Us
Alphatec Holdings (ATEC)
NASDAQ:ATEC
Top Page
Alphatec Holdings
(NASDAQ:ATEC)
Select Model
Select Model
Rating:51Neutral
Price Target:
$14.00
▼(-0.28% Downside)
Action:ReiteratedDate:02/25/26
The score is held back primarily by weak financial performance (ongoing losses and prior balance-sheet stress) and bearish technicals (below key moving averages with negative MACD). Offsetting these, the latest earnings call featured upbeat guidance for growth, margin expansion, and positive free cash flow, providing a meaningful support to the overall score despite valuation being constrained by negative earnings.
Positive Factors
Procedure & surgeon adoption
Consistent double‑digit procedural volume growth and meaningful net new surgeon additions indicate durable clinical adoption and expanding addressable market. A growing surgeon base supports recurring implant and instrument sales, reinforces installed‑base revenue visibility, and strengthens long‑term surgeon loyalty and market share.
High and expanding margins
Substantial adjusted EBITDA expansion and improving margins reflect that the company sells differentiated, high‑margin products and is beginning to capture operating leverage. Sustained ~70% gross margins and rising EBITDA margins support durable profitability as scale increases and improve long‑term cash generation potential.
Product & technology roadmap
A integrated procedural ecosystem (Valence navigation/robotics, EOS imaging/Insight) plus pipeline products creates structural differentiation that can increase share per procedure and deepen surgeon lock‑in. The technology roadmap and partnerships expand long‑term revenue channels and competitive moats.
Negative Factors
Historical leverage & equity weakness
Past negative equity and very high 2024 leverage signal capital‑structure fragility and raise refinancing and covenant risk. Even with 2025 repair, historical leverage and ongoing losses limit financial flexibility and increase vulnerability to slower growth or macro shocks over the medium term.
Modest and volatile free cash flow
Although operating cash improved, free cash flow remains thin and volatile relative to reinvestment needs. Limited FCF cushions constrain the company’s ability to fund growth, pay down debt, or pursue M&A without external capital, making long‑term plans sensitive to cash‑generation consistency.
Large absolute SG&A and reinvestment needs
A substantial absolute SG&A base reflects heavy reinvestment in sales and infrastructure. Margin expansion therefore depends on sustained high revenue growth; any slowdown would quickly pressure profitability and cash flow, making long‑term margin durability contingent on continued scale.
Alphatec Holdings (ATEC) vs. SPDR S&P 500 ETF (SPY)
Market Cap
$2.07B
Dividend YieldN/A
Average Volume (3M)2.98M
Price to Earnings (P/E)―
Beta (1Y)0.76
Revenue Growth27.11%
EPS Growth17.66%
CountryUS
Employees867
SectorHealthcare
Sector Strength45
IndustryMedical - Devices
Share Statistics
EPS (TTM)0.06
Shares Outstanding151,356,610
10 Day Avg. Volume2,407,871
30 Day Avg. Volume2,979,353
Financial Highlights & Ratios
PEG Ratio1.46
Price to Book (P/B)87.63
Price to Sales (P/S)4.13
P/FCF Ratio1.14K
Enterprise Value/Market Cap0.96
Enterprise Value/Revenue2.61
Enterprise Value/Gross Profit3.89
Enterprise Value/Ebitda-60.91
Forecast
1Y Price Target
$24.64Price Target Upside75.50% Upside
Rating ConsensusStrong Buy
Number of Analyst Covering11
EPS Forecast (FY)0.22
Revenue Forecast (FY)$890.38M
Alphatec Holdings Business Overview & Revenue Model
Company DescriptionAlphatec Holdings, Inc., a medical technology company, designs, develops, and advances technologies for the surgical treatment of spinal disorders. The company offers SafeOp Neural InformatiX System, an Alpha InformatiX product platform designed to reduce the risk of intraoperative nerve injury; Sigma transforaminal lumbar interbody fusion pedicle-based access system that provides direct visualization of anatomical landmarks; Sigma PTP Access and Patient Positioning System; squadron lateral retractor designed to maximize patient outcomes; Invictus Spinal Fixation System, a thoracolumbar fixation system to treat a range of pathologies; and Invictus MIS SingleStep System that provides minimally invasive pedicle screw placement. It also provides Invictus Modular Fixation Systems designed to increase adaptability with the power of screw modularity; OsseoScrew system to restore the integrity of the spinal column; Arsenal spinal fixation system, a comprehensive thoracolumbar fixation platform to fix a range of degenerative to deformity pathologies and surgical procedures; Aspida Anterior Lumbar Plating System, a fixation system for anterior lumbar interbody fusion; AMP Anti-Migration Plate; OCT Spinal Fixation System; trestle luxe anterior cervical plate system; and Insignia Anterior Cervical Plate System. In addition, the company offers IdentiTi Porous Ti, Transcend Lateral, and Battalion Posterior Interbody Implants; and biologics consisting of Cervical Structural Allograft Spacers, 3D ProFuse Demineralized Bone Scaffold, Neocore Osteoconductive Matrix, Alphagraft Demineralized and Cellular Bone Matrix, and Amnioshield Amniotic Tissue Barrier, as well as EOS imaging products. It sells its products through a network of independent distributors and direct sales representatives in the United States. The company was founded in 1990 and is headquartered in Carlsbad, California.
How the Company Makes MoneyAlphatec Holdings generates revenue primarily through the sale of its spinal surgery products, which include surgical implants, instruments, and biologics. The company operates on a model that combines direct sales to hospitals and healthcare providers with partnerships with distributors and surgical centers. Key revenue streams include sales of spinal fusion devices, motion preservation products, and surgical instruments used in various spinal procedures. Additionally, ATEC may benefit from strategic partnerships with healthcare professionals and institutions that facilitate the adoption of its products in clinical settings, leading to increased sales and market penetration.
Alphatec Holdings Earnings Call Summary
Earnings Call Date:Feb 24, 2026
(Q4-2025)
| % Change Since: |
Next Earnings Date:Apr 30, 2026
Earnings Call Sentiment Positive
The call portrayed a company with strong top‑line momentum, expanding profitability, improving gross margins, meaningful surgeon adoption, and a rich product and pipeline roadmap. Key positives include double‑digit revenue growth (20% Q4, 25% FY), substantial adjusted EBITDA expansion (61% Q4, +$63M FY), a solid cash position, and upgraded 2026 EBITDA guidance. Near‑term headwinds are limited and mostly operational or structural: modest full‑year free cash flow in 2025, international mix lowering per‑case revenue, a shift in seasonality that may complicate quarter‑to‑quarter cadence, and some investor pushback reflected in after‑hours trading. Overall, the highlights materially outweigh the lowlights.Q4-2025 Updates
Positive Updates
Strong Top-Line Growth (Q4 and Full Year)
Q4 2025 revenue of $213,000,000, up 20% year‑over‑year and up $16,000,000 sequentially; full‑year 2025 revenue of $764,000,000, up 25% year‑over‑year (a $153,000,000 increase).
Surgical Revenue Momentum
Q4 surgical revenue of $190,000,000, up 21% year‑over‑year; full‑year surgical revenue of $687,000,000, up 26% year‑over‑year. Procedural volume growth of 21% in Q4 and 22% for the full year; net new surgeon users increased 23% in Q4 and surgeon user base grew ~20% in 2025.
Profitability and Margin Expansion
Q4 adjusted EBITDA of $33,000,000, up 61% year‑over‑year and representing a 16% exit adjusted EBITDA margin; full‑year adjusted EBITDA of $93,000,000 (12% of sales), an increase of $63,000,000 year‑over‑year and +720 basis points versus 2024.
Improving Gross Margin and Operating Leverage
Non‑GAAP gross margin ~70.5% in Q4 (up 80 basis points YoY) and 70.2% for the full year; non‑GAAP SG&A improved as a percent of sales to ~55% in Q4 and ~59% for the year, reflecting operating leverage from revenue growth.
Cash Position and Quarter Cash Generation
Ended Q4 with $161,000,000 cash on hand and $60,000,000 undrawn revolver (total available cash $221,000,000). Generated $8,000,000 free cash flow in Q4 and $21,000,000 of cash from operations in the quarter. Full‑year operating cash flow was $45,000,000.
Product and Procedural Advancements
Multiple new product and capability releases in 2025: EOS Insight and bone mineral density test, EOS pediatric tools, cervical retractor and SPS plating system, full line of 3D‑printed implants, corpectomy device, biologics, and a strengthened neuromonitoring platform (SafeOp).
Strategic Technology Roadmap (Valence & EOS)
Valence (navigation + robotically controlled precision) slated for controlled release in 2026; EOS Edge installed base growth driving access and implant usage increases, with EOS Insight still underpenetrated (growth opportunity).
Partnership and Pipeline Opportunities
Signed exclusive distribution partnership with Theradaptive for a next‑generation BMP with faster bone formation and projected higher safety margin—represents a meaningful long‑term pipeline opportunity in a large BMP market.
Upgraded 2026 Profitability Guidance
2026 revenue guidance of approximately $890,000,000 (17% growth) and raised adjusted EBITDA guidance to $134,000,000 (15% margin). Company expects at least $20,000,000 of free cash flow in 2026 and continued margin expansion toward ~71% gross margin exit.
Negative Updates
Full‑Year Free Cash Flow Remains Modest
Full‑year 2025 free cash flow was only $3,000,000 despite positive operating cash flow and investments; while Q4 was positive ($8,000,000), FY FCF remains relatively small as the business continues to reinvest in instruments and inventory.
International Mix Headwind
U.S. ARPC strength was partially offset by international mix, which imposed a ~120 basis point headwind to revenue per case in the quarter because international cases carry a lower average revenue per procedure.
Average Revenue per Procedure Flat in Q4
Average revenue per procedure was flat in Q4 overall (despite a U.S. increase of 1.4%), with procedural mix shifting toward cervical cases partially offsetting per‑case gains.
Seasonality Shift and Near‑Term Cadence Variability
Growth in deformity and EOS‑driven volumes changed historical seasonality (Q2 and Q3 were stronger in 2025), making Q4 sequential uplift less pronounced and potentially complicating short‑term revenue cadence expectations.
Investor Reaction / Share Price Weakness After Hours
Management noted that shares were trading off after hours following the release despite revenue in line and EBITDA upside, indicating possible investor concern over cadence/seasonality or other expectations.
Elevated Absolute SG&A Spend (Though Improved as % of Sales)
Non‑GAAP SG&A was $118,000,000 in Q4 (~55% of sales) and $449,000,000 for the year (~59% of sales) — improved as a percent of sales but still a substantial absolute expense base as the company continues to invest in sales expansion and infrastructure.
Company Guidance
Management guided 2026 revenue of approximately $890 million (up ~17%), split into roughly $805 million of surgical revenue—driven by mid‑teens procedural volume growth and low single‑digit revenue‑per‑surgery gains—and about $85 million of EOS revenue; they raised full‑year adjusted EBITDA to $134 million (15% margin), expect gross margins to approach ~71% by year‑end, and project operating expense growth of ~11% versus 17% revenue growth to drive ~400 basis points of operating margin expansion versus 2025; cash guidance includes roughly $110 million of operating cash before incremental asset investment, at least $20 million of free cash flow, and an expected ~$0.75 of instrument/inventory investment per dollar of growth (the Q4 exit adjusted EBITDA margin was 16% and supports this outlook).Alphatec Holdings Financial Statement Overview
Summary
Strong multi-year revenue growth and healthy gross margins are outweighed by persistent operating/net losses and historically stressed equity/leverage metrics (including negative equity in 2022 and very high leverage in 2024). Cash flow improved meaningfully with positive operating cash flow and slightly positive free cash flow in 2025, but durability is still uncertain and recent-period data quality appears inconsistent.Income Statement
Revenue expanded strongly from 2020–2024, indicating solid demand momentum, and gross margins were consistently healthy in those years (~64–71%). However, profitability remains a major issue: operating results and net income were deeply negative across the period, with only modest improvement in net margin from 2021 to 2024 (still materially loss-making). The 2025 annual revenue shown as zero alongside substantial gross profit suggests reporting/data irregularities, which reduces confidence in the latest period’s trend.28
Negative
Balance Sheet
Leverage and equity quality have been volatile. Debt relative to equity was extremely elevated in 2024 (very thin equity base), and equity was negative in 2022—both are meaningful risk signals. Positively, 2025 shows a much lower debt-to-equity level and a more substantial equity base, suggesting recapitalization and/or balance sheet repair. Still, returns on equity are sharply negative due to ongoing losses, keeping overall balance sheet strength below average.34
Negative
Cash Flow
Cash flow trends improved materially in the most recent year: 2025 shows positive operating cash flow and slightly positive free cash flow, a notable turnaround from 2020–2024 when both were consistently negative. That said, free cash flow has been volatile and thin relative to the scale of losses, and prior years show the business required ongoing cash support. Overall, the direction is encouraging, but durability remains unproven.45
Neutral
| Breakdown | Dec 2025 | Dec 2024 | Dec 2023 | Dec 2022 | Dec 2021 |
|---|---|---|---|---|---|
Income Statement | |||||
| Total Revenue | 764.15M | 611.56M | 482.26M | 350.87M | 243.21M |
| Gross Profit | 531.89M | 424.26M | 310.20M | 233.06M | 157.76M |
| EBITDA | -39.70M | -53.87M | -110.59M | -102.58M | -106.88M |
| Net Income | -143.36M | -162.12M | -186.64M | -151.29M | -143.03M |
Balance Sheet | |||||
| Total Assets | 791.21M | 775.71M | 805.21M | 520.97M | 572.05M |
| Cash, Cash Equivalents and Short-Term Investments | 160.81M | 138.84M | 220.97M | 84.70M | 187.25M |
| Total Debt | 619.95M | 609.94M | 541.68M | 395.86M | 355.43M |
| Total Liabilities | 755.18M | 766.28M | 703.49M | 555.63M | 492.63M |
| Stockholders Equity | 36.03M | 9.43M | 101.72M | -34.67M | 79.42M |
Cash Flow | |||||
| Free Cash Flow | 2.78M | -137.79M | -165.46M | -133.41M | -141.86M |
| Operating Cash Flow | 45.23M | -44.65M | -78.48M | -75.13M | -73.32M |
| Investing Cash Flow | -53.41M | -93.14M | -141.97M | -58.28M | -157.76M |
| Financing Cash Flow | 30.02M | 56.21M | 356.92M | 31.23M | 311.97M |
Alphatec Holdings Technical Analysis
Negative
14.04
Price Trends
17.11
Negative
17.61
Negative
15.43
Negative
Market Momentum
-0.96
Negative
42.26
Neutral
61.02
Neutral
Evaluating momentum and price trends is crucial in stock analysis to make informed investment decisions. For ATEC, the sentiment is Negative. The current price of 14.04 is above the 20-day moving average (MA) of 13.87, below the 50-day MA of 17.11, and below the 200-day MA of 15.43, indicating a neutral trend. The MACD of -0.96 indicates Negative momentum. The RSI at 42.26 is Neutral, neither overbought nor oversold. The STOCH value of 61.02 is Neutral, not indicating any strong overbought or oversold conditions. Overall, these indicators collectively point to a Negative sentiment for ATEC.
Alphatec Holdings Risk Analysis
Alphatec Holdings disclosed 39 risk factors in its most recent earnings report. Alphatec Holdings reported the most risks in the "Finance & Corporate" category.
Finance & Corporate - Financial and accounting risks. Risks related to the execution of corporate activity and strategy
Latest Risks Added 0 New Risks
Alphatec Holdings Peers Comparison
UnderperformOutperform
Sector (51)
Name | Overall Rating | Market Cap | P/E Ratio | ROE | Dividend Yield | Revenue Growth | EPS Growth |
|---|---|---|---|---|---|---|---|
75 Outperform | $1.86B | 27.37 | 17.82% | ― | 29.47% | 23.24% | |
68 Neutral | $3.77B | ― | -19.24% | ― | 8.97% | -1024.86% | |
67 Neutral | $2.32B | -44.98 | -338.19% | ― | 24.76% | -10.41% | |
59 Neutral | $1.69B | 179.17 | -2.45% | ― | 9.81% | -1067.00% | |
56 Neutral | $1.20B | -17.58 | -4.62% | ― | -0.23% | ― | |
51 Neutral | $7.86B | -0.30 | -43.30% | 2.27% | 22.53% | -2.21% | |
51 Neutral | $2.07B | -14.63 | -630.66% | ― | 27.11% | 17.66% |
* Healthcare Sector Average
ATEC
Alphatec Holdings
14.04
1.92
15.84%
AORT
Artivion
35.78
10.42
41.09%
UFPT
Ufp Technologies
240.16
8.15
3.51%
LIVN
LivaNova
70.29
29.36
71.73%
AHCO
AdaptHealth
9.33
-1.76
-15.87%
ESTA
Establishment Labs Holdings
78.29
35.76
84.08%
Glossary
BuyA stock rated as a "Buy" is expected to perform better than the overall market or a specific benchmark over the near-to-medium term. This rating suggests the stock is likely to deliver higher returns compared to other stocks in the same sector or market index. Note: This is not investment advice; please consult a financial advisor before making investment decisions.
HoldA stock rated as a "Hold" is expected to perform in line with the overall market or a specific benchmark. This rating indicates that the stock is neither particularly compelling nor unfavorable for investment. Note: This is not investment advice; please consult a financial advisor before making investment decisions.
SellA stock rated as a "Sell" is expected to perform worse than the overall market or a specific benchmark over the near-to-medium term. This rating suggests the stock may deliver lower returns compared to other stocks in the same sector or market index. Note: This is not investment advice; please consult a financial advisor before making investment decisions.
Disclaimer
This AI Analyst Stock Report is automatically generated by our AI systems using advanced algorithms and publicly available financial, technical, and market data. While the information provided aims to be accurate and insightful, it is intended for informational purposes only and should not be considered financial advice. Any content created by an AI (Artificial Intelligence) system may contain inaccuracies and/or contain errors. Investing in stocks carries inherent risks, and past performance is not indicative of future results. This report does not account for your personal financial circumstances, objectives, or risk tolerance. Always conduct your own research or consult with a qualified financial advisor before making investment decisions. The analysis and recommendations provided are based on historical and current data and may not fully reflect future market conditions or unexpected developments. Neither the creators of this report nor its affiliated entities guarantee the accuracy, completeness, or reliability of the information presented. Use this report at your own discretion and risk.