Alphatec Cuts 2026 Revenue Outlook After Biologics Miss

The Tip Desk · November 10, 2026 · 2 min read

The spine device maker now sees about $862 million of 2026 sales after third-quarter revenue of $221 million rose 13% and fell short of internal expectations.

Alphatec Holdings (ATEC), a spine-focused medical device company, reported third-quarter revenue of $221 million, up 13% from a year earlier, and said the result fell short of its expectations primarily because of lower biologics attachment.

Year-over-year growth slowed from the second quarter, when total revenue was $214 million, up 15%. Surgical revenue was $202 million, up 14% and $25 million higher than a year earlier, after $196 million, up 17%, in the prior quarter.

Chairman and Chief Executive Officer Pat Miles said the company owned the shortfall and that improving biologics performance is a clear priority. He said demand for procedural solutions remained strong, with hardware revenue growing 17% and contributing $26 million to surgical growth, case volumes growing approximately 20%, and new surgeon adoption increasing 25%. Miles said disciplined execution of biologics is required to realize full procedural revenue translation and to build the foundation for OsteoAdapt (Theradaptive).

GAAP gross margin was 71.5% and non-GAAP gross margin 71.9%, versus 72.2% and 72.5% in the second quarter. GAAP operating expenses were $155 million and non-GAAP operating expenses $137 million.

The company recorded a GAAP net loss of $5 million, or $0.03 a share, versus a $26 million GAAP net loss in the second quarter. Non-GAAP net income was $15 million, or $0.09 a share. Adjusted EBITDA was $38 million, or 17.3% of revenue, expanding 400 basis points year-over-year.

Cash and cash equivalents ended the quarter at $80 million. The company generated $6 million of free cash flow in the quarter and said trailing twelve-month free cash flow remained positive. Inventories were $207 million. Stockholders’ equity was a deficit of $2.3 million.

For fiscal year 2026, Alphatec now expects total revenue of approximately $862 million, including about $789 million of surgical revenue and about $73 million of EOS revenue, representing approximately 13% total revenue growth and approximately 15% surgical revenue growth. That compares with the outlook it reaffirmed after the second quarter of approximately $882 million, including about $805 million of surgical revenue and $77 million of EOS revenue, or about 15% and 17% growth.

The company now expects adjusted EBITDA of approximately $137 million, versus an increased outlook of approximately $140 million after the second quarter. It also expects approximately $10 million of free cash flow for the year, versus a prior expectation of at least $20 million.

Tommy Carls joined the senior leadership team as executive vice president of Data Intelligence and Strategy.