Carlsmed (CARL) Q4 2025 earnings summary

Executive summary

• Achieved rapid growth in 2025, highlighted by an initial public offering raising over $100 million and significant expansion in personalized spine surgery solutions.

• Delivered $50.5 million in revenue for 2025, up 86% year-over-year, with gross margins of 75.3%.

• Launched new products and platforms, including the bilateral posterior aprevo procedure, Cora personalized fixation portfolio, aprevoⓇ cervical system, and myaprevoⓇ ecosystem, expanding addressable markets.

• Added 101 new surgeon users in 2025, reflecting strong clinical adoption and robust surgeon education initiatives.

• Net loss widened to $29.6 million for 2025, driven by increased operating expenses.

Financial highlights

• Q4 2025 revenue reached $15.2 million, a 61% increase year-over-year; full-year revenue was $50.5 million, up from $27.2 million in 2024.

• Gross margins improved to 76.5% in Q4 and 75.3% for the year, driven by lower manufacturing costs and operational efficiencies.

• Total operating expenses for 2025 were $68.6 million, up from $44.2 million in 2024, reflecting investments in R&D and commercial expansion.

• Adjusted EBITDA was negative $28.4 million for 2025.

• Cash and investments at year-end totaled $109.9 million.

Outlook and guidance

• 2026 revenue guidance is $70–$75 million, representing 44% growth at the midpoint over 2025.

• Gross margins expected to remain in the mid-70% range, with ongoing operating leverage anticipated from prior investments.

• Continued improvement in adjusted EBITDA projected as revenue grows and expense base leverages.