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Alphatec (ATEC)
NASDAQ:ATEC
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Alphatec Holdings
(NASDAQ:ATEC)
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Rating:47Neutral
Price Target:
$14.50
▲(10.18% Upside)
Action:ReiteratedDate:01/16/26
The score is held down primarily by weak financial fundamentals—ongoing losses, negative free cash flow, and very high leverage—alongside soft technical momentum (negative MACD and price below key short-term averages). This is partly offset by a strong and improving operating narrative from the earnings call, including rapid revenue growth, record adjusted EBITDA, positive quarterly free cash flow, and raised guidance.
Positive Factors
Revenue Growth & Adoption
Sustained 30% YoY revenue growth and strong surgical revenue expansion reflect durable demand and expanding clinical adoption. Consistent top-line momentum and rising surgeon users underpin scalable procedure volume, supporting multi-year revenue runway and market share gains.
Improving Cash Generation
Turning operating cash flow positive and posting quarterly free cash flow signals improving cash conversion and operational discipline. This reduces reliance on external financing, enhances funding for R&D and commercialization, and materially strengthens near-term liquidity flexibility.
High Gross Margin & Product Pipeline
A ~69% gross margin provides structural insulation for operating leverage as sales scale. Coupled with an expanding pipeline (proceduralization, Valence system and other spine products), the margin profile supports durable profitability improvement as new offerings gain adoption.
Negative Factors
Very High Leverage
Extremely high leverage and negative ROE constrain financial flexibility and increase refinancing and interest-rate risk. Heavy debt limits ability to invest in growth initiatives without dilutive or costly capital, making the company more vulnerable during slower demand periods.
Historic Free Cash Flow Volatility
Despite recent quarter-level improvement, historically negative and highly volatile free cash flow impairs capacity to self-fund R&D, commercialization, and working capital needs. Persistent FCF weakness raises execution risk on multi-year growth plans.
Tariff and Market Disruption Risk
Ongoing tariff-driven cost pressure and multi-year market disruption increase margin uncertainty and could slow adoption or raise prices. These structural headwinds can compress realized margins and require sustained management focus to preserve profitability as volumes scale.
Alphatec Holdings (ATEC) vs. SPDR S&P 500 ETF (SPY)
Market Cap
$2.01B
Dividend YieldN/A
Average Volume (3M)3.44M
Price to Earnings (P/E)―
Beta (1Y)0.77
Revenue Growth27.11%
EPS Growth17.66%
CountryUS
Employees867
SectorHealthcare
Sector Strength45
IndustryMedical - Devices
Share Statistics
EPS (TTM)0.06
Shares Outstanding148,550,190
10 Day Avg. Volume2,127,102
30 Day Avg. Volume3,436,722
Financial Highlights & Ratios
PEG Ratio0.30
Price to Book (P/B)139.10
Price to Sales (P/S)2.15
P/FCF Ratio-9.52
Enterprise Value/Market Cap1.25
Enterprise Value/Revenue3.44
Enterprise Value/Gross Profit4.97
Enterprise Value/Ebitda-47.97
Forecast
1Y Price Target
$24.33Price Target Upside84.90% Upside
Rating ConsensusStrong Buy
Number of Analyst Covering10
EPS Forecast (FY)N/A
Revenue Forecast (FY)N/A
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)
| 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
Revenue growth and a strong gross margin are positives, and operating cash flow turning positive helps. However, profitability remains weak (negative net income/EBIT), free cash flow is still negative with very weak growth, and the balance sheet is highly leveraged with a very high debt-to-equity ratio and negative ROE.Income Statement
Alphatec Holdings shows a positive revenue growth trend with a 6.71% increase in TTM, indicating potential market expansion. However, the company struggles with profitability, as evidenced by negative net profit and EBIT margins. The gross profit margin is strong at 69.37% in the latest annual report, but the net profit margin remains negative, reflecting ongoing challenges in cost management and operational efficiency.45
Neutral
Balance Sheet
The balance sheet reveals significant leverage with a high debt-to-equity ratio of 51.38 in TTM, posing financial risk. Return on equity is negative, indicating that the company is not generating profit from shareholders' investments. The equity ratio is low, suggesting limited financial stability and a heavy reliance on debt financing.30
Negative
Cash Flow
Cash flow analysis shows improvement in operating cash flow, turning positive in TTM, which is a positive sign. However, free cash flow remains negative, and the free cash flow growth rate is concerning at -99.95%. The operating cash flow to net income ratio indicates some ability to cover net losses, but overall cash flow management needs improvement.40
Negative
| Breakdown | TTM | Dec 2024 | Dec 2023 | Dec 2022 | Dec 2021 | Dec 2020 |
|---|---|---|---|---|---|---|
Income Statement | ||||||
| Total Revenue | 728.02M | 611.56M | 482.26M | 350.87M | 243.21M | 144.86M |
| Gross Profit | 503.99M | 424.26M | 310.20M | 233.06M | 157.76M | 102.50M |
| EBITDA | -52.22M | -53.87M | -110.59M | -102.58M | -106.88M | -54.84M |
| Net Income | -154.96M | -162.12M | -186.64M | -151.29M | -143.03M | -78.99M |
Balance Sheet | ||||||
| Total Assets | 787.25M | 775.71M | 805.21M | 520.97M | 572.05M | 265.22M |
| Cash, Cash Equivalents and Short-Term Investments | 155.74M | 138.84M | 220.97M | 84.70M | 187.25M | 107.77M |
| Total Debt | 591.15M | 609.94M | 541.68M | 395.86M | 355.43M | 43.16M |
| Total Liabilities | 775.74M | 766.28M | 703.49M | 555.63M | 492.63M | 107.74M |
| Stockholders Equity | 11.51M | 9.43M | 101.72M | -34.67M | 79.42M | 157.48M |
Cash Flow | ||||||
| Free Cash Flow | -14.00K | -137.79M | -165.46M | -133.41M | -141.86M | -70.30M |
| Operating Cash Flow | 35.07M | -44.65M | -78.48M | -75.13M | -73.32M | -46.41M |
| Investing Cash Flow | -41.42M | -93.14M | -141.97M | -58.28M | -157.76M | -23.86M |
| Financing Cash Flow | 80.45M | 56.21M | 356.92M | 31.23M | 311.97M | 130.83M |
Alphatec Holdings Technical Analysis
Negative
13.16
Price Trends
17.37
Negative
17.61
Negative
15.42
Negative
Market Momentum
-1.18
Negative
31.23
Neutral
20.25
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 13.16 is below the 20-day moving average (MA) of 14.02, below the 50-day MA of 17.37, and below the 200-day MA of 15.42, indicating a bearish trend. The MACD of -1.18 indicates Negative momentum. The RSI at 31.23 is Neutral, neither overbought nor oversold. The STOCH value of 20.25 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 | $1.90B | 25.83 | 18.31% | ― | 29.47% | 23.24% | |
63 Neutral | $3.68B | -16.93 | -17.63% | ― | 8.97% | -1024.86% | |
61 Neutral | $1.40B | 18.44 | 4.77% | ― | -0.23% | ― | |
61 Neutral | $2.22B | -26.66 | -338.19% | ― | 24.76% | -10.41% | |
59 Neutral | $1.78B | 190.29 | -2.45% | ― | 9.81% | -1067.00% | |
51 Neutral | $7.86B | -0.30 | -43.30% | 2.27% | 22.53% | -2.21% | |
47 Neutral | $2.01B | -12.87 | -540.40% | ― | 27.11% | 17.66% |
* Healthcare Sector Average
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Alphatec Holdings Corporate Events
Executive/Board Changes
Alphatec Holdings Mourns Loss of Board Member
Negative
Nov 7, 2025
On November 7, 2025, Alphatec Holdings announced the passing of Jeffrey P. Rydin, a respected member of its Board of Directors, who died on November 3, 2025, after a lengthy illness. Rydin, who joined ATEC in 2016, played a pivotal role in transforming the company’s sales channel and was instrumental in its turnaround efforts. His contributions were highly valued by the company, and his passing is deeply mourned by the ATEC community, highlighting his significant impact on the company’s culture and momentum.
The most recent analyst rating on (ATEC) stock is a Buy with a $23.00 price target. To see the full list of analyst forecasts on Alphatec Holdings stock, see the ATEC Stock Forecast page.
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.