Key Takeaways
- Alphatec fell 36% after third-quarter revenue of $221 million missed its own plan and it cut its 2026 revenue outlook to about $862 million.
- Cases grew about 20%, so the selloff looks overdone for a shortfall that came down to biologics.
- Revenue per case fell about 5%, and $80 million of cash leaves little room for another miss.
- Alphatec also cited softer thoracolumbar volumes, which Globus Medical’s and Medtronic’s next reports will test.
Alphatec Holdings (ATEC) fell 36% today after the spine company missed its own third-quarter revenue plan and cut its full-year outlook after Thursday’s close.
CEO Pat Miles said: “Third-quarter revenue fell short of our expectations, primarily due to lower biologics attachment.”
On the call, he added that “we saw slower thoracolumbar procedure volumes that we believe reflect broader market trends.” If he’s right, the slowdown in mid- and lower-back surgeries should show up at Globus Medical (GMED) and Medtronic (MDT) too.
What exactly happened
- Revenue of $221 million, up 13%
- Case volumes up about 20%
- 2026 revenue outlook cut to about $862 million, from the $882 million it reaffirmed in August
Here’s its quarterly revenue:
The grafts are the problem
Biologics are the bone grafts surgeons use alongside implants, and Alphatec sells both.
Hardware added $26 million this quarter and surgical revenue $25 million, so biologics slipped about $1 million while cases grew 20%. Revenue per case fell about 5%.
That reads like an execution problem to me, and the adjusted EBITDA margin still widened 4 points to 17%.
The rest of spine reports soon
Globus said U.S. Spine grew 7% in the second quarter, its fifth straight quarter ahead of the market. If that holds in next week’s report, Alphatec’s slowdown looks more like its own.
Medtronic’s Cranial & Spinal Technologies grew 13% in the quarter ended July 31, with an extra week’s help. Medtronic also sells the Infuse bone graft, so its mid-November report could show whether Alphatec’s lost graft sales went to rivals.
TIKR tracks 14 analysts on Alphatec Holdings. How many say “Buy”?
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Thin cushion
Alphatec ended September with $80 million of cash, half its year-end 2025 balance, and now expects about $10 million of free cash flow this year, from $20 million in January. Here’s that cash against its debt:
Here’s its forward price-to-sales multiple, which today’s drop takes lower still:
My take: the drop looks overdone for a business still growing cases 20% and widening its margins. Of course, the fourth-quarter report early next year will show whether biologics turned around.
So what is Alphatec stock actually worth?
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