Alphatec (ATEC) Q4 2024 earnings summary

Executive summary

• Achieved 28% total revenue growth in Q4 2024, four times the market rate, with $177 million in quarterly revenue and $612 million for the full year, up 27% year-over-year, and first positive cash flow quarter since transformation.

• Adjusted EBITDA reached $21 million in Q4 and $31 million for FY 2024, with Q4 margin at 12% of sales, up over 1,000 basis points year-over-year.

• Five-year revenue CAGR stands at 40%, with 19% CAGR in adoption and 25% CAGR in procedural volume.

• Strategic focus on clinical distinction, innovation, and operational discipline is driving durable growth and profitability.

• Expanded internationally with first surgery in Japan and increased new surgeon users by 20%.

Financial highlights

• Q4 2024 revenue was $177 million, up 28% year-over-year and 17% sequentially; surgical revenue was $157 million (+28%), EOS revenue $20 million (+32%).

• Full-year 2024 revenue reached $612 million, up 27% year-over-year; EOS segment contributed $67 million, up 8%.

• Q4 non-GAAP gross margin was 70%, flat year-over-year; non-GAAP R&D was $13 million (8% of sales); non-GAAP SG&A was $105 million (60% of sales).

• Full-year 2024 Adjusted EBITDA was $31 million (5% of sales), a $40 million and 690 basis point improvement over 2023.

• Free Cash Flow was $9 million in Q4; ended year with $139 million in cash and $590 million in debt.

Outlook and guidance

• 2025 revenue expected to grow 20% to ~$732 million, with surgical revenue up 21% to ~$657 million and EOS revenue ~$75 million.

• 2025 Adjusted EBITDA projected at $75 million, implying a 37% drop-through of incremental revenue and supporting positive free cash flow.

• Positive cash flow expected for full-year 2025, with Q1 as the largest cash use period ($15–$20 million expected cash use).

• Long-range plan targets $1 billion revenue and 18% Adjusted EBITDA margin by 2027.

• Mid-teens surgical volume growth and mid-single-digit average revenue per case growth anticipated for 2025.