Alphatec (NASDAQ: ATEC) grows Q1 2026 revenue 14% but posts net loss
Alphatec Holdings reported Q1 2026 revenue of $192.1 million, up 14% from $169.2 million a year earlier, driven by higher procedure volume and broader adoption of its spine surgery portfolio. Net loss narrowed to $33.9 million from $51.9 million as litigation expenses fell sharply.
Operating loss improved to $22.6 million versus $44.3 million, while interest expense increased due to the 0.75% Convertible Senior Notes due 2030. Cash and cash equivalents were $139.9 million and operating cash flow was modestly positive at $1.3 million.
Total debt included $405.0 million of 2030 convertible notes, $63.3 million of 2026 convertible notes, a $200.0 million Braidwell term loan and a $15.1 million revolving credit balance. After quarter-end, Alphatec replaced the Braidwell and MidCap facilities with a new $175.0 million term loan and $125.0 million revolver from JP Morgan maturing in 2031.
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Insights
Alphatec grew revenue 14% and narrowed losses, but remains highly leveraged.
Alphatec delivered Q1 2026 revenue of $192.1M, up 14%, as surgeon adoption and new spine products expanded use of its platform. Operating loss improved to $22.6M from $44.3M, mainly because prior-year litigation expenses of $12.2M dropped to $0.5M.
Despite better operating results, the capital structure is debt-heavy. The company carries $405.0M of 0.75% Convertible Senior Notes due 2030, $63.3M of 0.75% notes due 2026, a $200.0M term loan and a $15.1M revolver. Net interest expense rose 49% year over year to $11.7M, and total other expense increased accordingly.
Liquidity is supported by $139.9M of cash and slightly positive operating cash flow of $1.3M in the quarter. A key development after quarter-end is a new JP Morgan term loan of $175.0M and a $125.0M revolver maturing in 2031, which refinanced the Braidwell term loan and MidCap revolver. Actual long-term impact will depend on detailed terms and future operating performance.
Key Figures
Key Terms
0.75% Convertible Senior Notes due 2030 financial
capped call transactions financial
Term SOFR financial
right-of-use asset financial
contract liabilities financial
stock-based compensation financial
Table of Contents
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM
(Mark One)
For the quarterly period ended
OR
For the transition period from to
Commission File Number:
(Exact name of registrant as specified in its charter)
( State or other jurisdiction of incorporation or organization) |
(I.R.S. Employer |
(Address of principal executive offices) |
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Registrant’s telephone number, including area code: (
Securities registered pursuant to Section 12(b) of the Act:
Title of each class |
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Name of each exchange on which registered |
Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days.
Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files).
Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company” and “emerging growth company” in Rule 12b-2 of the Exchange Act.
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Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act) Yes ☐ No
As of April 28, 2026, there were 153,789,305 shares of the registrant’s common stock outstanding.
Table of Contents
ALPHATEC HOLDINGS, INC.
QUARTERLY REPORT ON FORM 10-Q
March 31, 2026
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PART I – FINANCIAL INFORMATION |
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Controls and Procedures |
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PART II – OTHER INFORMATION |
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Risk Factors |
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Unregistered Sales of Equity Securities and Use of Proceeds |
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Exhibits |
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Table of Contents
PART I. FINANCIAL INFORMATION
Item 1. Financial Statements
ALPHATEC HOLDINGS, INC.
CONDENSED CONSOLIDATED BALANCE SHEETS
(In thousands, except for par value data)
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December 31, |
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Assets |
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Current assets: |
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Prepaid expenses and other current assets |
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Total current assets |
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Property and equipment, net |
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Right-of-use assets |
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Goodwill |
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Intangible assets, net |
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Other assets |
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Total assets |
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Liabilities and Stockholders’ (Deficit) Equity |
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Current liabilities: |
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Accounts payable |
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Accrued expenses and other current liabilities |
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Contract liabilities |
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Short-term debt |
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Current portion of operating lease liabilities |
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Total current liabilities |
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Long-term debt |
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Commitments and contingencies (Note 8) |
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Total stockholders’ (deficit) equity |
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Total liabilities and stockholders’ (deficit) equity |
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See accompanying notes to unaudited condensed consolidated financial statements.
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Table of Contents
ALPHATEC HOLDINGS, INC.
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS
(UNAUDITED)
(In thousands, except per share amounts)
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March 31, |
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2026 |
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2025 |
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Revenue from products and services |
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Cost of sales |
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Gross profit |
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Operating expenses: |
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Research and development |
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Sales, general and administrative |
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Litigation-related expenses |
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Amortization of acquired intangible assets |
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Restructuring expenses |
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Total operating expenses |
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Operating loss |
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Other expense, net: |
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Interest expense, net |
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Loss on debt extinguishment |
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Gain on derivative liability |
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Other income, net |
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Total other expense, net |
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Net loss before taxes |
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Income tax provision (benefit) |
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Net loss |
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Net loss per share, basic and diluted |
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Weighted average shares outstanding, basic and diluted |
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See accompanying notes to unaudited condensed consolidated financial statements.
4
Table of Contents
ALPHATEC HOLDINGS, INC.
CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS
(UNAUDITED)
(In thousands)
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Three Months Ended |
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March 31, |
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2026 |
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2025 |
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Net loss |
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Foreign currency translation adjustments |
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Comprehensive loss |
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See accompanying notes to unaudited condensed consolidated financial statements.
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Table of Contents
ALPHATEC HOLDINGS, INC.
CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS’ (DEFICIT) EQUITY
(UNAUDITED)
(In thousands)
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Common stock |
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Additional |
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Treasury |
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Accumulated other |
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Accumulated |
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Total |
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Par Value |
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capital |
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stock |
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loss |
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deficit |
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Balance at December 31, 2025 |
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Stock-based compensation |
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Common stock issued for stock option exercises |
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Common stock issued for vesting of |
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Foreign currency translation adjustments |
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Net loss |
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Balance at March 31, 2026 |
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$ |
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Table of Contents
ALPHATEC HOLDINGS, INC.
CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS’ (DEFICIT) EQUITY
(UNAUDITED)
(In thousands)
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Common stock |
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Additional |
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Treasury |
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Accumulated other |
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Accumulated |
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Total |
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Shares |
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Par Value |
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capital |
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stock |
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loss |
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deficit |
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(deficit) equity |
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Balance at December 31, 2024 |
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$ |
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$ |
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Stock-based compensation |
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Common stock issued for stock option exercises |
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Common stock issued for vesting of |
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Purchase of capped calls |
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Foreign currency translation adjustments |
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Net loss |
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Balance at March 31, 2025 |
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$ |
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$ |
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See accompanying notes to unaudited condensed consolidated financial statements.
7
Table of Contents
ALPHATEC HOLDINGS, INC.
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
(UNAUDITED)
(In thousands)
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2026 |
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2025 |
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Operating activities: |
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Net loss |
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Adjustments to reconcile net loss to net cash provided by (used in) operating activities: |
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Depreciation and amortization |
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Stock-based compensation |
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Amortization of debt discount and debt issuance costs |
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Amortization of right-of-use assets |
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Write-down for excess and obsolete inventories |
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Loss on disposal of assets |
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Loss on debt extinguishment |
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Gain on derivative liability |
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Other |
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Changes in operating assets and liabilities: |
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Accounts receivable |
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Inventories |
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Prepaid expenses and other current assets |
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Other assets |
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Accounts payable |
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Accrued expenses |
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Lease liabilities |
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Contract liabilities |
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Other long-term liabilities |
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Net cash provided by (used in) operating activities |
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Investing activities: |
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Purchase of property and equipment |
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Note receivable |
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Purchase of intangible assets |
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Other |
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Net cash used in investing activities |
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Financing activities: |
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Repayment of revolving credit facility |
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Proceeds from revolving credit facility |
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Payments related to tax witholdings for share-based compensation |
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Proceeds from issuance of convertible notes, net |
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Repurchase of convertible notes |
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Purchase of capped calls |
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Other |
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Net cash (used in) provided by financing activities |
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Effect of exchange rate changes on cash |
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Net change in cash and cash equivalents |
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Cash and cash equivalents at beginning of period |
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Cash and cash equivalents at end of period |
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Supplemental disclosure of cash flow information: |
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Cash paid for interest |
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Supplemental disclosure of noncash activities: |
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Purchases of property and equipment in accounts payable and accrued expenses |
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Purchase of intangible assets in accrued expenses and other long-term liabilities |
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Financed insurance |
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Recognition of lease liability |
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Recognition of derivative liability |
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See accompanying notes to unaudited condensed consolidated financial statements.
8
Table of Contents
ALPHATEC HOLDINGS, INC.
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
1. Organization and Significant Accounting Policies
The Company
Basis of Presentation and Principles of Consolidation
The accompanying condensed consolidated financial statements include the accounts of the Company and its wholly owned subsidiaries. The Company translates the financial statements of its foreign subsidiaries using end-of-period exchange rates for assets and liabilities and average exchange rates during each reporting period for results of operations. All intercompany balances and transactions have been eliminated in consolidation.
The accompanying condensed consolidated financial statements have been prepared pursuant to the rules and regulations of the Securities and Exchange Commission (“SEC”). Pursuant to these rules and regulations, the Company has condensed or omitted certain information and footnotes it normally includes in its annual consolidated financial statements prepared in accordance with generally accepted accounting principles in the United States of America (“U.S. GAAP”). The unaudited interim condensed consolidated financial statements reflect all adjustments, including normal recurring adjustments which, in the opinion of management, are necessary for a fair presentation of the financial position and results of operations for the periods presented. These unaudited condensed consolidated financial statements should be read in conjunction with the Company’s audited consolidated financial statements for the year ended December 31, 2025, which are included in the Company’s Annual Report on Form 10-K that was filed with the SEC. Operating results for the three months ended March 31, 2026 are not necessarily indicative of the results that may be expected for the full year or any other future periods.
Use of Estimates
Fair Value Measurements
The carrying amount of financial instruments consisting of cash and cash equivalents, accounts receivable, prepaid expenses and other current assets, other assets, accounts payable, accrued expenses, and short-term debt included in the Company’s condensed consolidated financial statements are reasonable estimates of fair value due to their short maturities.
Authoritative guidance establishes a three-tier fair value hierarchy, which prioritizes the inputs used in measuring fair value as follows:
Level 1: Quoted prices in active markets for identical assets or liabilities.
Level 2: Inputs other than Level 1 that are observable, either directly or indirectly, such as quoted prices for similar assets or liabilities, quoted prices in markets that are not active; or other inputs that can be corroborated by observable market data for substantially the full term of the assets or liabilities.
Level 3: Unobservable inputs that are supported by little or no market activity and that are significant to the fair value of the assets or liabilities.
9
Table of Contents
Excess and Obsolete Inventory
Most of the Company’s inventory is comprised of finished goods, which is primarily produced by third-party suppliers. Specialized implants, fixation products, biologics, and imaging equipment are determined by utilizing a standard cost method that includes capitalized variances which approximates the weighted average cost. Component parts related to the imaging equipment are valued at weighted average cost. Inventories are stated at the lower of cost or net realizable value. The Company reviews the components of its inventory on a periodic basis for excess and obsolescence and adjusts inventory to its net realizable value as necessary.
The Company records a lower of cost or net realizable value (“LCNRV”) inventory reserve for estimated excess and obsolete inventory based upon its expected use of inventory on hand. The Company’s inventory, which consists primarily of specialized implants, fixation products, and biologics is at risk of obsolescence due to the need to maintain substantial levels of inventory. In order to market its products effectively and meet the demands of interoperative product placement, the Company maintains and provides surgeons and hospitals with a variety of inventory products and sizes. For each surgery, fewer than all components will be consumed. The need to maintain and provide a wide variety of inventory causes inventory to be held that is not likely to be used.
The Company’s estimates and assumptions for excess and obsolete inventory are reviewed and updated on a quarterly basis. The estimates and assumptions are determined primarily based on current usage of inventory and the age of inventory quantities on hand. Additionally, the Company considers recent sales experience to develop assumptions about future demand for its products, while considering product life cycles and new product launches. Increases in the LCNRV reserve for excess and obsolete inventory result in a corresponding charge to cost of sales.
Revenue Recognition
The Company recognizes revenue from product sales in accordance with Financial Accounting Standards Board (“FASB”) Accounting Standards Codification ("ASC") Revenue from Contracts with Customers (“Topic 606”). This standard applies to all contracts with customers, except for contracts that are within the scope of other standards, such as leases. Under Topic 606, an entity recognizes revenue when its customer obtains control of promised goods or services, in an amount that reflects the consideration that the entity expects to receive in exchange for those goods or services. To determine revenue recognition for arrangements that an entity determines are within the scope of Topic 606, the entity performs the following five steps: (i) identify the contract(s) with a customer; (ii) identify the performance obligations in the contract; (iii) determine the transaction price; (iv) allocate the transaction price to the performance obligations in the contract; and (v) recognize revenue when (or as) the entity satisfies a performance obligation. The Company only applies the five-step model to contracts when it is probable that the entity will collect the consideration it is entitled to in exchange for the goods or services it transfers to the customer.
Sales are derived primarily from the sale of spinal implant products, imaging equipment, and related services to hospitals and medical centers. Revenue is recognized when obligations under the terms of a contract with customers are satisfied, which occurs with the transfer of control of products to customers, either upon shipment of the product or delivery of the product to the customer depending on the shipping terms, or when the products are used in a surgical procedure (implanted in a patient). Revenue from the sale of imaging equipment is recognized as each distinct performance obligation is fulfilled and control transfers to the customer, beginning with shipment or delivery, depending on the contract terms. Revenue from other distinct performance obligations, such as maintenance on imaging equipment and other imaging-related services, is recognized in the period the service is performed, and makes up less than
To the extent that the transaction price includes variable consideration, such as discounts, rebates, and customer payment penalties, the Company estimates the amount of variable consideration that should be included in the transaction price utilizing either the expected value method or the most likely amount method depending on the nature of the variable consideration. Variable consideration is included in the transaction price if, in the Company's judgment, it is probable that a significant future reversal of cumulative revenue under the contract will not occur. Estimates of variable consideration and determination of whether to include estimated amounts in the transaction price are based largely on an assessment of the Company’s anticipated performance and all information that is reasonably available, including historical, current, and forecasted information.
10
Table of Contents
The Company records a contract asset when one or more performance obligations have been completed and revenue has been recognized, but the customer's payment is contingent on the satisfaction of additional performance obligations. The Company records a contract liability, or deferred revenue, when it has an obligation to provide a product or service to the customer and payment is received in advance of its performance. When the Company sells a product or service with a future performance obligation, revenue is deferred on the unfulfilled performance obligation and recognized over the related performance period. Generally, the Company estimates the selling price of promised services included in the equipment sales price using an expected cost plus a margin approach and/or the separately observable price of such service, if available. The transaction price for a contract’s various performance obligations is allocated using the relative standalone selling price method. The use of alternative estimates could result in a different amount of revenue deferral.
Recently Adopted Accounting Pronouncements
In September 2025, the FASB issued Accounting Standards Update ("ASU") No. 2025-06, Targeted Improvements to the Accounting for Internal-Use Software (Subtopic 350-40). ASU 2025-06 removes references to prescriptive and sequential development stages, requiring companies to capitalize internal-use software costs when management commits to funding the software project and it is probable the project will be completed. ASU 2025-06 is effective for all entities for fiscal years beginning after December 15, 2027, and for interim periods within those annual reporting periods.
Recently Issued Accounting Pronouncements
In November 2024, the FASB issued ASU No. 2024-03, Income Statement-Reporting Comprehensive Income-Expense Disaggregation Disclosures (Topic 220-40). Additionally, in January 2025, the FASB issued ASU 2025-01 to clarify the effective date of ASU 2024-03. The standard provides guidance to expand disclosures related to the disaggregation of income statement expenses. The standard requires, in the notes to the financial statements, disclosure of specified information about certain costs and expenses, which includes purchases of inventory, employee compensation, depreciation and intangible asset amortization included in each relevant expense caption. This guidance is effective for fiscal years beginning after December 15, 2026, and interim periods within annual reporting periods beginning after December 15, 2027, on a retrospective or prospective basis, with early adoption permitted. The Company is in the process of assessing the impact of this standard on its consolidated financial statements and related disclosures.
In December 2025, the Financial Accounting Standards Board (the “FASB”) issued Accounting Standards Update (“ASU”) No. 2025-11 Interim Reporting (Topic 270). ASU No. 2025-11 clarifies interim disclosure requirements and the applicability of Topic 270. The objective of the amendments is to provide clarity about the current requirements, rather than evaluate whether to expand or reduce interim disclosure requirements. This ASU clarifies the applicability of Topic 270, the types of interim reporting, and the form and content of interim financial statements in accordance with U.S. GAAP. ASU 2025-11 is effective for fiscal years beginning after December 15, 2027, and early adoption is permitted. Entities may apply the guidance prospectively or retrospectively. The Company is currently evaluating the impact the standard will have on its interim consolidated financial statements and related disclosures.
2. Fair Value Measurements
Assets and liabilities measured at fair value on a recurring basis include the following as of March 31, 2026, and December 31, 2025 (in thousands):
|
March 31, 2026 |
|
|||||||||||||
Assets: |
Level 1 |
|
|
Level 2 |
|
|
Level 3 |
|
|
Total |
|
||||
Cash equivalents: |
|
|
|
|
|
|
|
|
|
|
|
||||
Money market funds |
$ |
|
|
|
— |
|
|
|
— |
|
|
$ |
|
||
Total cash equivalents |
$ |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
|
||
|
|
|
|
|
|
|
|
|
|
|
|
||||
|
December 31, 2025 |
|
|||||||||||||
Assets: |
Level 1 |
|
|
Level 2 |
|
|
Level 3 |
|
|
Total |
|
||||
Cash equivalents: |
|
|
|
|
|
|
|
|
|
|
|
||||
Money market funds |
$ |
|
|
|
— |
|
|
|
— |
|
|
$ |
|
||
Total cash equivalents |
$ |
|
|
|
— |
|
|
|
— |
|
|
$ |
|
||
11
Table of Contents
The Company did not have any transfers of assets and liabilities between the levels of the fair value measurement hierarchy during the periods presented.
Fair Value of Convertible Debt
The fair value, based on a quoted market price (Level 1), of the Company’s outstanding
The fair value, based on a quoted market price (Level 1), of the Company’s outstanding
3. Inventories
Inventories reported at the lower of cost or net realizable value consist of the following (in thousands):
|
|
March 31, |
|
|
December 31, |
|
||
Raw materials |
|
$ |
|
|
$ |
|
||
Finished goods |
|
|
|
|
|
|
||
Inventories |
|
$ |
|
|
$ |
|
||
4. Property and Equipment, net
Property and equipment, net consist of the following (in thousands, except as indicated):
|
|
Useful lives |
|
March 31, |
|
|
December 31, |
|
||
Surgical instruments |
|
|
$ |
|
|
$ |
|
|||
Machinery and equipment |
|
|
|
|
|
|
|
|||
Computer equipment |
|
|
|
|
|
|
|
|||
Office furniture and equipment |
|
|
|
|
|
|
|
|||
Leasehold improvements |
|
|
|
|
|
|
|
|||
Construction in progress |
|
n/a |
|
|
|
|
|
|
||
|
|
|
|
|
|
|
|
|
||
Less: accumulated depreciation |
|
|
|
|
( |
) |
|
|
( |
) |
Property and equipment, net |
|
|
|
$ |
|
|
$ |
|
||
Total depreciation and amortization expense was $
5. Goodwill and Intangible Assets
Goodwill
The change in the carrying amount of goodwill during the period ended March 31, 2026, includes the following (in thousands):
December 31, 2025 |
|
$ |
|
|
Foreign currency fluctuation |
|
|
( |
) |
March 31, 2026 |
|
$ |
|
12
Table of Contents
Intangible assets, net
Intangible assets, net consist of the following (in thousands, except as indicated):
|
|
Remaining Avg. |
|
Gross |
|
|
Accumulated |
|
|
Intangible |
|
|||
March 31, 2026: |
|
(in years) |
|
Amount |
|
|
Amortization |
|
|
Assets, net |
|
|||
Developed product technology |
|
|
$ |
|
|
$ |
( |
) |
|
$ |
|
|||
Internally developed software |
|
|
|
|
|
|
( |
) |
|
|
|
|||
Trademarks and trade names |
|
|
|
|
|
|
( |
) |
|
|
|
|||
Customer relationships |
|
|
|
|
|
|
( |
) |
|
|
|
|||
Distribution network |
|
– |
|
|
|
|
|
( |
) |
|
|
— |
|
|
Total amortized intangible assets |
|
|
|
|
|
|
|
( |
) |
|
|
|
||
|
|
|
|
|
|
|
|
|
|
|
|
|||
Software in development |
|
n/a |
|
|
|
|
|
— |
|
|
|
|
||
In-process research and development |
|
n/a |
|
|
|
|
|
— |
|
|
|
|
||
Total intangible assets |
|
|
|
$ |
|
|
$ |
( |
) |
|
$ |
|
||
|
|
|
|
|
|
|
|
|
|
|
|
|||
|
|
Remaining Avg. |
|
Gross |
|
|
Accumulated |
|
|
Intangible |
|
|||
December 31, 2025: |
|
(in years) |
|
Amount |
|
|
Amortization |
|
|
Assets, net |
|
|||
Developed product technology |
|
|
$ |
|
|
$ |
( |
) |
|
$ |
|
|||
Internally developed software |
|
|
|
|
|
|
( |
) |
|
|
|
|||
Trademarks and trade names |
|
|
|
|
|
|
( |
) |
|
|
|
|||
Customer relationships |
|
|
|
|
|
|
( |
) |
|
|
|
|||
Distribution network |
|
– |
|
|
|
|
|
( |
) |
|
|
— |
|
|
Total amortized intangible assets |
|
|
|
|
|
|
|
( |
) |
|
|
|
||
|
|
|
|
|
|
|
|
|
|
|
|
|||
Software in development |
|
n/a |
|
|
|
|
|
— |
|
|
|
|
||
In-process research and development |
|
n/a |
|
|
|
|
|
— |
|
|
|
|
||
Total intangible assets |
|
|
|
$ |
|
|
$ |
( |
) |
|
$ |
|
||
Total amortization expense attributed to intangible assets was $
Future amortization expense related to intangible assets is as follows (in thousands):
Remainder of 2026 |
|
$ |
|
|
2027 |
|
|
|
|
2028 |
|
|
|
|
2029 |
|
|
|
|
2030 |
|
|
|
|
Thereafter |
|
|
|
|
|
|
$ |
|
13
Table of Contents
6. Contract Assets and Contract Liabilities
Contract assets included within prepaid expenses and other current assets in the condensed consolidated balance sheets are as follows (in thousands):
|
|
March 31, |
|
|
December 31, |
|
||
Contract assets |
|
$ |
|
|
$ |
|
||
The non-current contract liabilities balance is included in other long-term liabilities on the condensed consolidated balance sheets. The Company’s contract liabilities are as follows (in thousands):
|
|
March 31, |
|
|
December 31, |
|
||
Contract liabilities |
|
$ |
|
|
$ |
|
||
Less: Non-current portion of contract liabilities |
|
|
|
|
|
|
||
Current portion of contract liabilities |
|
$ |
|
|
$ |
|
||
The Company recognized $
7. Debt
0.75% Convertible Senior Notes due 2030
In March 2025, the Company issued $
The 2030 Notes are convertible into shares of the Company’s common stock based upon an initial conversion rate of
Holders of the 2030 Notes have the right to convert their notes in certain circumstances and during specified periods. Prior to the close of business on the business day immediately preceding September 17, 2029, holders may convert all or a portion of their 2030 Notes only under the following circumstances: (1) during any calendar quarter (and only during such calendar quarter) if the last reported sale price of the Company’s common stock for at least
The 2030 Notes are redeemable, in whole or in part, at the Company’s option at any time, and from time to time, on or after March 20, 2028 and on or before the 60th scheduled trading day immediately before the maturity date, at a cash redemption price equal to the principal amount of the 2030 Notes to be redeemed, plus accrued and unpaid interest, if any, but only if the last reported sale price per share of the Company’s common stock exceeds
14
Table of Contents
If a fundamental change occurs prior to the maturity date, holders may require the Company to repurchase all or a portion of their 2030 Notes for cash at a price equal to
At the time of issuance, the Company determined that the 2030 Notes had an embedded conversion option that met the criteria to be bifurcated and accounted for separately from the 2030 Notes. The Company initially recorded the fair value of the embedded conversion option as a derivative liability and the principal amount of the 2030 Notes as a long-term liability, net of debt discount and deferred issuance costs. In June 2025, conditions necessary for separate accounting of the conversion option as a derivative liability were not met. Accordingly, the conversion option derivative liability was remeasured as of the date of the change and subsequently reclassified to additional paid-in capital on the Company’s condensed consolidated statements of shareholders’ (deficit) equity. The annual effective interest rate for the 2030 Notes is
The outstanding principal amount and carrying value of the 2030 Notes consists of the following (in thousands):
|
|
March 31, |
|
|
|
Principal |
|
$ |
|
|
|
Unamortized debt discount and debt issuance costs |
|
|
( |
) |
|
Net carrying value |
|
$ |
|
|
|
2030 Capped Call Transactions
In connection with the offering of the 2030 Notes, the Company entered into privately negotiated capped call transactions (the “2030 Capped Call Transactions”) with certain financial institutions. The 2030 Capped Call Transactions are expected generally to reduce the potential dilution and/or offset the cash payments the Company is required to make in excess of the principal amount of the 2030 Notes upon conversion of the 2030 Notes in the event that the market price per share of the Company’s common stock is greater than the strike price of the 2030 Capped Call Transactions with such reduction and/or offset subject to a cap. The 2030 Capped Call Transactions have an initial cap price of $
The 2030 Capped Call Transactions are separate transactions and are not part of the terms of the 2030 Notes and will not affect any holder’s rights under the 2030 Notes. Holders of the 2030 Notes will not have any rights with respect to the 2030 Capped Call Transactions.
The 2030 Capped Call Transactions meet all of the applicable criteria for equity classification, and as a result, the related $
Term Loan
On January 6, 2023, the Company entered into a $
In conjunction with the issuance of the Braidwell Term Loan, the Company incurred $
15
Table of Contents
The Braidwell Term Loan is secured by substantially all of the Company’s assets with the priority interest of the lenders in the Braidwell Term Loan and the Revolving Credit Facility, as defined below, subject to terms of a customary intercreditor agreement, which provides that the lenders under the Revolving Credit Facility have a priority with respect to the Company's accounts receivable, inventory, medical instruments, and items related to the foregoing, and the lenders under the Braidwell Term Loan have priority with respect to the remainder of the Company's assets. The loan agreement contains customary representations and warranties and affirmative and negative covenants. Under the loan agreement, the Company is required to maintain a minimum level of liquidity. The loan agreement also includes certain events of default, and upon the occurrence of such events of default, all outstanding loans under the Braidwell Term Loan may be accelerated and/or the lenders’ commitments terminated. The Company is in compliance with all required financial covenants as of March 31, 2026.
Revolving Credit Facility
In September 2022, the Company entered into a revolving credit facility (the “Revolving Credit Facility”) with entities affiliated with MidCap Financial Trust (“MidCap”). The Revolving Credit Facility originally provided up to $
In conjunction with obtaining the Revolving Credit Facility, the Company incurred $
The outstanding loans under the Revolving Credit Facility bear interest at the sum of Term SOFR plus
The Revolving Credit Facility contains a lockbox arrangement clause requiring the Company to maintain a lockbox bank account. If the revolving loan availability is less than
16
Table of Contents
The Revolving Credit Facility is secured by substantially all of the Company’s assets with the priority interest of the lenders subject to terms of a customary intercreditor agreement in connection with the Braidwell Term Loan, as described above. The loan agreements and other ancillary documents contain customary representations and warranties and affirmative and negative covenants. Under the loan agreements, the Company is required to maintain a minimum level of liquidity. The loan agreements also include certain events of default, and upon the occurrence of such events of default, all outstanding loans under the Revolving Credit Facility may be accelerated and/or the lenders’ commitments terminated. The Company is in compliance with all required financial covenants as of March 31, 2026.
0.75% Convertible Senior Notes due 2026
In August 2021, the Company issued $
The 2026 Notes are convertible into shares of the Company’s common stock based upon an initial conversion rate of
Holders of the 2026 Notes have the right to convert their notes in certain circumstances and during specified periods. Prior to the close of business on the business day immediately preceding February 2, 2026, holders may convert all or a portion of their 2026 Notes only under the following circumstances: (1) during any calendar quarter (and only during such calendar quarter) if the last reported sale price of the Company’s common stock for at least
The 2026 Notes are redeemable, in whole or in part, at the Company’s option at any time, and from time to time, on or after
If a fundamental change occurs prior to the maturity date, holders may require the Company to repurchase all or a portion of their 2026 Notes for cash at a price equal to
The 2026 Notes, net of unamortized debt issuance costs, are classified as short-term debt on the consolidated balance sheets as of March 31, 2026. The annual effective interest rate for the 2026 Notes is
17
Table of Contents
The outstanding principal amount and carrying value of the 2026 Notes consists of the following (in thousands):
|
|
March 31, |
|
December 31, |
|
||
Principal |
|
$ |
|
$ |
|
||
Unamortized debt issuance costs |
|
|
( |
) |
|
( |
) |
Net carrying value |
|
$ |
|
$ |
|
||
2026 Capped Call Transactions
In connection with the offering of the 2026 Notes, the Company entered into privately negotiated capped call transactions (the “Capped Call Transactions”) with certain financial institutions. The Capped Call Transactions are expected generally to reduce the potential dilution and/or offset the cash payments the Company is required to make in excess of the principal amount of the 2026 Notes upon conversion of the 2026 Notes in the event that the market price per share of the Company’s common stock is greater than the strike price of the Capped Call Transactions with such reduction and/or offset subject to a cap. The Capped Call Transactions have an initial cap price of $
The Capped Call Transactions are separate transactions and are not part of the terms of the 2026 Notes and will not affect any holder’s rights under the 2026 Notes. Holders of the 2026 Notes will not have any rights with respect to the Capped Call Transactions.
Other Debt Agreements
The Company has
Total Indebtedness
Principal payments remaining on the Company's debt are as follows as of March 31, 2026 (in thousands):
Remainder of 2026 |
|
$ |
|
|
2027 |
|
|
|
|
2028 |
|
|
|
|
2029 |
|
|
|
|
2030 |
|
|
|
|
Thereafter |
|
|
|
|
Total |
|
|
|
|
Less: unamortized debt discount and debt issuance costs |
|
|
( |
) |
Total |
|
|
|
|
Less: current portion of long-term debt |
|
|
( |
) |
Long-term debt |
|
$ |
|
8. Commitments and Contingencies
Leases
The Company determines if an arrangement is a lease at inception by assessing whether there is an identified asset and whether the contract conveys the right to control the use of the identified asset in exchange for consideration over a period of time. If both criteria are met, the Company records the associated lease liability and corresponding right-of-use asset (“ROU asset”) upon commencement of the lease using a discount rate based on the incremental borrowing rate of interest that the Company would borrow on a collateralized basis for an amount equal to the lease payments in a similar economic environment.
18
Table of Contents
The Company leases office and storage facilities and equipment under various operating and financing lease agreements. The initial terms of these leases range from
Future minimum annual lease payments for all operating leases of the Company are as follows as of March 31, 2026 (in thousands):
Remainder of 2026 |
|
$ |
|
|
2027 |
|
|
|
|
2028 |
|
|
|
|
2029 |
|
|
|
|
2030 |
|
|
|
|
Thereafter |
|
|
|
|
Total undiscounted lease payments |
|
|
|
|
Less: imputed interest |
|
|
( |
) |
Operating lease liabilities |
|
|
|
|
Less: current portion of operating lease liabilities |
|
|
( |
) |
Operating lease liabilities, less current portion |
|
$ |
|
The Company’s weighted average remaining lease term and weighted average discount rate as of March 31, 2026 and December 31, 2025 are as follows:
|
|
March 31, |
|
|
December 31, |
|
||
Weighted-average remaining lease term (years) |
|
|
|
|
|
|
||
Weighted-average discount rate |
|
|
% |
|
|
% |
||
Information related to the Company’s operating leases is as follows (in thousands):
|
|
Three Months Ended |
|
|||||
|
|
2026 |
|
|
2025 |
|
||
Rent expense |
|
$ |
|
|
$ |
|
||
Cash paid for amounts included in measurement of lease liabilities |
|
$ |
|
|
$ |
|
||
Purchase Commitments
The Company is obligated to meet certain minimum purchase commitment requirements with a third-party supplier through December 2026. As of March 31, 2026, the remaining minimum purchase commitment required by the Company under the agreement is $
19
Table of Contents
Litigation
The Company is and may become involved in various legal proceedings arising from its business activities. While management is not aware of any litigation matter that in and of itself would have a material adverse impact on the Company’s condensed consolidated results of operations, cash flows or financial position, litigation is inherently unpredictable, and depending on the nature and timing of a proceeding, an unfavorable resolution could materially affect the Company’s future consolidated results of operations, cash flows or financial position in a particular period. The Company assesses contingencies to determine the degree of probability and range of possible loss for potential accrual or disclosure in the Company’s condensed consolidated financial statements. An estimated loss contingency is accrued in the Company’s condensed consolidated financial statements if it is probable that a liability has been incurred and the amount of the loss can be reasonably estimated. Because litigation is inherently unpredictable and unfavorable resolutions could occur, assessing contingencies is highly subjective and requires judgments about future events. When evaluating contingencies, the Company may be unable to provide a meaningful estimate due to a number of factors, including the procedural status of the matter in question, the presence of complex or novel legal theories, and/or the ongoing discovery and development of information important to the matters. In addition, damage amounts claimed in litigation against the Company may be unsupported, exaggerated or unrelated to reasonably possible outcomes, and as such are not meaningful indicators of the Company’s potential liability.
Indemnifications
In the normal course of business, the Company enters into agreements under which it occasionally indemnifies third-parties for intellectual property infringement claims or claims arising from breaches of representations or warranties. In addition, from time to time, the Company provides indemnity protection to third-parties for claims relating to past performance arising from undisclosed liabilities, product liabilities, environmental obligations, representations and warranties, and other claims. In these agreements, the scope and amount of remedy, or the period in which claims can be made, may be limited. It is not possible to determine the maximum potential amount of future payments, if any, due under these indemnities due to the conditional nature of the obligations and the unique facts and circumstances involved in each agreement.
In October 2017, NuVasive, Inc. filed a lawsuit in Delaware Chancery Court against Mr. Miles, the Company’s Chairman and CEO, who was a former officer and board member of NuVasive. The Company itself was not initially a named defendant in this lawsuit; however, in June 2018, NuVasive amended its complaint to add the Company as a defendant. In October 2018, the Delaware Court ordered that NuVasive advance legal fees for Mr. Miles’ defense in the lawsuit, as well as Mr. Miles’ legal fees incurred in pursuing advancement of his fees, pursuant to an indemnification agreement between NuVasive and Mr. Miles. In February 2025, the Delaware Chancery Court entered final judgment in favor of both Mr. Miles and the Company on all remaining claims, which the Delaware Supreme Court affirmed on January 16, 2026. As of March 31, 2026, no liability related to this matter has been recorded. The Company considers the matter terminated.
Royalties
The Company has entered into various intellectual property agreements requiring the payment of royalties based on the sale of products that utilize such intellectual property. These royalties primarily relate to products sold by Alphatec Spine and are based on fixed fees or calculated either as a percentage of net sales or on a per-unit sold basis. Royalties are included on the accompanying condensed consolidated statements of operations as a component of cost of sales.
9. Stock-Benefit Plans and Equity Transactions
Stock-Based Compensation
The Company has stock-based compensation plans under which it grants stock options, restricted stock units ("RSUs"), and performance restricted stock units ("PRSUs") to officers, directors and third parties. Total stock-based compensation for the periods presented is as follows (in thousands):
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Three Months Ended |
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|||||
|
|
March 31, |
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|||||
|
|
2026 |
|
|
2025 |
|
||
Cost of sales |
|
$ |
|
|
$ |
|
||
Research and development |
|
|
|
|
|
|
||
Sales, general and administrative |
|
|
|
|
|
|
||
Total |
|
$ |
|
|
$ |
|
||
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Table of Contents
As of March 31, 2026, there was $
Restricted Stock Units and Performance Based Restricted Stock Units Awards
The Company issued approximately
Employee Stock Purchase Plan
Employees are eligible to participate in the Employee Stock Purchase Plan ("ESPP") approved by its shareholders. During the three months ended March 31, 2026 and 2025, there were
The Company estimates the fair value of shares issued to employees under the ESPP using the Black-Scholes option-pricing model. The assumptions used to estimate the fair value of stock options granted and stock purchase rights under the ESPP are as follows:
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Three Months Ended |
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|||||
|
|
March 31, |
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|||||
|
|
2026 |
|
|
2025 |
|
||
Risk-free interest rate |
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|
% |
|
|
|||
Expected dividend yield |
|
|
— |
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|
|
— |
|
Expected term (years) |
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|
|
|
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||
Volatility |
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% |
|
|
% |
||
Warrants Outstanding
Squadron Medical Warrants
In connection with debt financing entered into with Squadron Medical Finance Solutions, LLC ("Squadron Medical") in 2018, and amended in 2019 and 2020, the Company issued common stock warrants to Squadron Medical and a participant lender (the “Squadron Medical Warrants”). The Squadron Medical Warrants expire in
Executive Warrants
The Company issued warrants to its Chairman and Chief Executive Officer (the “Executive Warrants”). The Executive Warrants had a
A summary of all outstanding warrants for common stock as of March 31, 2026, is as follows (in thousands, except for strike price data):
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|
Number of |
|
|
Strike Price |
|
Expiration |
||
2018 Squadron Medical Warrants |
|
|
|
|
$ |
|
|||
2019 Squadron Medical Warrants |
|
|
|
|
$ |
|
|||
2020 Squadron Medical Warrants |
|
|
|
|
$ |
|
|||
Executive Warrants |
|
|
|
|
$ |
|
|||
Other1 |
|
|
|
|
$ |
|
|||
Total |
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|
|
|
|
|
|
||
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All outstanding warrants were deemed to qualify for equity classification under authoritative accounting guidance.
10. Business Segment and Geographic Information
The Company operates in
Net revenue and property and equipment, net, by geographic region are as follows (in thousands):
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Revenue |
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|
Property and equipment, net |
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||||||||||
|
|
Three Months Ended |
|
|
March 31, |
|
|
December 31, |
|
|||||||
(in thousands) |
|
2026 |
|
|
2025 |
|
|
2026 |
|
|
2025 |
|
||||
United States |
|
$ |
|
|
$ |
|
|
$ |
|
|
$ |
|
||||
International |
|
|
|
|
|
|
|
|
|
|
|
|
||||
Total |
|
$ |
|
|
$ |
|
|
$ |
|
|
$ |
|
||||
11. Net Loss Per Share
Basic net loss per share is calculated by dividing the net loss available to common stockholders by the weighted-average number of common shares outstanding for the period. If applicable, diluted net loss per share attributable to common stockholders is calculated by dividing net loss available to common stockholders by the diluted weighted-average number of common shares outstanding for the period, determined using the treasury-stock method and the if-converted method for convertible debt. For purposes of this calculation, common stock subject to repurchase by the Company, common stock issuable upon conversion or exercise of convertible notes, preferred shares, options, and warrants are considered to be common stock equivalents and are only included in the calculation of diluted earnings per share when their effect is dilutive. Due to the Company’s net loss position, the effect of including common stock equivalents in the earnings per share calculation is anti-dilutive, and therefore not included.
The following table presents the computation of basic and diluted net loss per share (in thousands, except per share amounts):
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Three Months Ended |
|
|||||
|
|
2026 |
|
|
2025 |
|
||
Numerator: |
|
|
|
|
|
|
||
Net loss |
|
$ |
( |
) |
|
$ |
( |
) |
Denominator: |
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|
|
|
|
|
||
Weighted average common shares outstanding |
|
|
|
|
|
|
||
Net loss per share, basic and diluted: |
|
$ |
( |
) |
|
$ |
( |
) |
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The following potentially dilutive shares of common stock were excluded from the calculation of diluted net loss per share because their effect would have been anti-dilutive for the periods presented (in thousands):
|
|
As of |
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|||||
|
|
2026 |
|
|
2025 |
|
||
Options to purchase common stock and employee stock purchase plan |
|
|
|
|
|
|
||
Unvested restricted stock unit awards |
|
|
|
|
|
|
||
Warrants to purchase common stock |
|
|
|
|
|
|
||
2026 Notes |
|
|
|
|
|
|
||
2030 Notes |
|
|
|
|
|
|
||
Total |
|
|
|
|
|
|
||
12. Income Taxes
To calculate its interim tax provision, at the end of each interim period the Company estimates the annual effective tax rate, adjusted for discrete items arising in that quarter. The computation of the annual estimated effective tax rate at each interim period requires certain estimates and significant judgment including, but not limited to, the estimated annual taxable income or loss for the year and projections of the proportion of income earned and taxed in foreign jurisdictions. The accounting estimates used to compute the provision for income taxes may change as new events occur, additional information is obtained, or the tax environment changes.
The Company’s effective tax rate from operations was
13. Related Party Transactions
The Company purchases inventory from an affiliate of Squadron Capital, LLC (the “Squadron Supplier Affiliate”). David Pelizzon, President and Director of Squadron Capital, LLC, currently serves on the Company’s Board of Directors. For the three months ended March 31, 2026 and 2025, the Company purchased inventory in the amounts of $
14. Subsequent Event
On May 1, 2026, the Company entered into a credit agreement with JP Morgan Chase Bank, consisting of (i) a senior secured term loan in an aggregate principal amount of $
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Table of Contents
Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations
You should read the following management's discussion and analysis of our financial condition and results of operations in conjunction with our unaudited condensed consolidated financial statements and the related notes thereto that appear elsewhere in this Quarterly Report on Form 10-Q and the audited consolidated financial statements and notes thereto and under the heading "Management's Discussion and Analysis of Financial Condition and Results of Operations" in our Annual Report on Form 10-K filed with the Securities and Exchange Commission (“SEC”). In addition to historical information, the following management’s discussion and analysis of our financial condition and results of operations includes forward-looking information that involves risks, uncertainties, and assumptions. Our actual results and the timing of events could differ materially from those anticipated by these forward-looking statements as a result of many factors, such as those set forth under “Risk Factors” in our Annual Report on Form 10-K for the year ended December 31, 2025, and any updates to those risk factors filed from time to time in our subsequent periodic and current reports filed with the SEC.
Overview
We are a medical technology company, headquartered in Carlsbad, California, focused on the design, development, and advancement of technology for better surgical treatment of spine disorders. By applying our unique, 100% spine focus and deep, collective industry know-how, we aim to revolutionize the approach to spine surgery through clinical distinction. The sophisticated approaches that we create from the ground up are designed to integrate with our expanding InformatiX™ product platform to objectively inform surgery and achieve the goals of spine surgery more predictably and more reproducibly. We have a comprehensive product portfolio designed to address the spine’s various pathologies, and are perpetually innovating to accomplish our ultimate vision, which is to be the standard bearer in spine.
The application of our team’s deep spine know-how, coupled with a willingness to invest holistically in the technologies integrated into our procedural approaches continues to increasingly compel surgeons and sales talent to partner with us. That adoption-driven validation has been the source of industry-leading market share expansion, which has delivered an approximately 35% revenue compound annual growth rate since our transformation commenced in 2018.
We market and sell our products through a network of independent sales agents and direct sales representatives. To deliver consistent, predictable growth, we have added, and intend to continue to add, clinically astute and exclusive sales team members to reach untapped surgeons, hospitals, and national accounts and better penetrate existing accounts and territories.
Revenue and Expense Components
The following is a description of the primary components of our revenue and expenses:
Revenue. We derive our revenue primarily from the sale of spinal surgery implants used in the treatment of spine disorders as well as the sale of medical imaging equipment which is used for surgical planning and post-operative assessment. Spinal implant products include pedicle screws and complementary implants, interbody devices, plates, and tissue-based materials. Medical imaging equipment includes our EOS full-body and weight-bearing x-ray imaging devices, and related services. Our revenue is generated by our direct sales force and independent sales agents. Our products are shipped and invoiced to hospitals and surgical centers. Currently, most of our business is conducted with customers within markets in which we have experience and with payment terms that are customary to our business. We may defer revenue until the time of collection if circumstances related to payment terms, regional market risk or customer history indicate that collectability is not certain.
Cost of sales. Cost of sales consists primarily of direct product costs, royalties, service labor hours, and parts. Our product costs consist primarily of raw materials, component parts, direct labor, and overhead. The product costs of certain of our biologics products include the cost of procuring and processing human tissue. We incur royalties related to the technologies that we license from others and the products that are developed in part by surgeons with whom we collaborate in the product development process.
Research and development expenses. Research and development expenses consist of costs associated with the design, development, testing, and enhancement of our products. Research and development expenses also include salaries and related employee benefits, research-related overhead expenses, and fees paid to external service providers and development consultants in the form of both cash and equity.
Sales, general and administrative expenses. Sales, general and administrative expenses consist primarily of salaries and related employee benefits, sales commissions and other variable costs, depreciation of our surgical instruments, regulatory affairs, quality assurance costs, professional service fees, travel, medical education, trade show and marketing costs, and insurance expenses.
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Table of Contents
Litigation-related expenses. Litigation-related expenses consist of costs incurred for our ongoing and settled litigation.
Amortization of acquired intangible assets. Amortization of acquired intangible assets consists of intangible assets acquired in business combinations and asset acquisitions.
Restructuring expenses. Restructuring expenses are primarily associated with the realignment of our operations and geographical footprint to achieve synergies, in which we incur one-time costs related to exiting and/or relocating our facilities, and personnel related expenses including severance and other costs.
Total interest expense and other expense, net. Total interest expense and other expense, net includes interest income, interest expense, gains and losses from foreign currency exchanges, loss on debt extinguishment, gain on derivative liability, and other non-operating gains and losses.
Income tax provision (benefit). Income tax provision (benefit) primarily consists of an estimate of federal, state, and foreign income taxes based on enacted state and foreign tax rates, as adjusted for allowable credits, deductions, uncertain tax positions, changes in the valuation of our deferred tax assets and liabilities, and changes in tax laws.
Critical Accounting Policies and Estimates
Our discussion and analysis of our financial condition and results of operations is based upon our unaudited condensed consolidated financial statements, which have been prepared in accordance with generally accepted accounting principles in the United States of America. The preparation of these financial statements requires us to make estimates and assumptions that affect the reported amounts of assets, liabilities, revenues, expenses, and related disclosures. On an on-going basis, we evaluate our estimates and assumptions, including those related to revenue recognition, allowances for accounts receivable, inventories, intangible assets, stock-based compensation, and income taxes. We base our estimates on historical experience and on various other assumptions that we believe to be reasonable under the circumstances, the results of which form the basis for making judgments about the carrying values of assets and liabilities that are not readily apparent from other sources. Actual results may differ from these estimates under different assumption conditions.
Critical accounting policies are those that, in management’s view, are most important in the portrayal of our financial condition and results of operations. Management believes there have been no material changes during the three months ended March 31, 2026, to the critical accounting policies discussed in the Management’s Discussion and Analysis of Financial Condition and Results of Operations section of our Annual Report on Form 10-K for the year ended December 31, 2025, filed with the SEC.
Results of Operations
Total revenue
|
|
Three Months Ended |
|
|
Change |
|
||||||||||
(in thousands, except %) |
|
2026 |
|
|
2025 |
|
|
$ |
|
|
% |
|
||||
Revenue from products and services |
|
$ |
192,108 |
|
|
$ |
169,180 |
|
|
$ |
22,928 |
|
|
|
14 |
% |
Revenue from products and services increased $22.9 million, or 14%, during the three months ended March 31, 2026, compared to the same period in 2025. The increase was primarily due to an increase in product volume that was due to the increase in our surgeon user base, continued expansion of our new product portfolio, and increasing adoption of our technology.
Cost of sales
|
|
Three Months Ended |
|
|
Change |
|
||||||||||
(in thousands, except %) |
|
2026 |
|
|
2025 |
|
|
$ |
|
|
% |
|
||||
Cost of sales |
|
$ |
55,632 |
|
|
$ |
53,184 |
|
|
$ |
2,448 |
|
|
|
5 |
% |
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Table of Contents
Cost of sales increased $2.4 million, or 5%, for the three months ended March 31, 2026, compared to the same period in 2025. The increase was primarily due to an increase in product volume offset by a decrease in stock-based compensation.
Operating expenses
|
|
Three Months Ended |
|
|
Change |
|
||||||||||
(in thousands, except %) |
|
2026 |
|
|
2025 |
|
|
$ |
|
|
% |
|
||||
Operating expenses: |
|
|
|
|
|
|
|
|
|
|
|
|
||||
Research and development |
|
$ |
17,560 |
|
|
$ |
16,582 |
|
|
$ |
978 |
|
|
|
6 |
% |
Sales, general and administrative |
|
|
137,057 |
|
|
|
127,017 |
|
|
|
10,040 |
|
|
|
8 |
% |
Litigation-related expenses |
|
|
525 |
|
|
|
12,214 |
|
|
|
(11,689 |
) |
|
|
(96 |
)% |
Amortization of acquired intangible assets |
|
|
3,915 |
|
|
|
4,103 |
|
|
|
(188 |
) |
|
|
(5 |
)% |
Restructuring expenses |
|
— |
|
|
|
371 |
|
|
|
(371 |
) |
|
|
(100 |
)% |
|
Total operating expenses |
|
$ |
159,057 |
|
|
$ |
160,287 |
|
|
$ |
(1,230 |
) |
|
|
(1 |
)% |
Research and development expenses. Research and development expenses increased $1.0 million, or 6%, for the three months ended March 31, 2026, compared to the same period in 2025. The increase was primarily due to an increase in compensation expense.
Sales, general and administrative expenses. Sales, general and administrative expenses increased $10.0 million, or 8%, during the three months ended March 31, 2026, compared to the same period in 2025. The increase was primarily due to higher compensation-related costs and variable selling expenses associated with the increase in revenue, and our continued investment in building our strategic distribution channel.
Litigation-related expenses. Litigation-related expenses decreased $11.7 million, or 96%, for the three months ended March 31, 2026, compared to the same period in 2025. The decrease was primarily related to a litigation settlement during the three months ended March 31, 2025.
Amortization of acquired intangible assets. Amortization of acquired intangible assets remained consistent for the three months ended March 31, 2026, compared to the same period in 2025.
Restructuring expenses. Restructuring expenses decreased $0.4 million, or 100%, during the three months ended March 31, 2026, compared to the same period in 2025. The decrease in restructuring expenses is primarily due to personnel related expenses in the prior period that did not recur.
Total interest expense and other expense, net
|
|
Three Months Ended |
|
|
Change |
|
||||||||||
(in thousands, except %) |
|
2026 |
|
|
2025 |
|
|
$ |
|
|
% |
|
||||
Other expense, net: |
|
|
|
|
|
|
|
|
|
|
|
|
||||
Interest expense, net |
|
$ |
(11,721 |
) |
|
$ |
(7,841 |
) |
|
$ |
(3,880 |
) |
|
|
49 |
% |
Loss on debt extinguishment |
|
|
— |
|
|
|
(17,576 |
) |
|
|
17,576 |
|
|
|
(100 |
)% |
Gain on derivative liability |
|
|
— |
|
|
|
17,400 |
|
|
|
(17,400 |
) |
|
|
(100 |
)% |
Other income, net |
|
|
446 |
|
|
|
337 |
|
|
|
109 |
|
|
|
32 |
% |
Total other expense, net |
|
$ |
(11,275 |
) |
|
$ |
(7,680 |
) |
|
$ |
(3,595 |
) |
|
|
47 |
% |
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Table of Contents
Interest expense, net, increased $3.9 million, or 49%, during the three months ended March 31, 2026, compared to the same period in 2025. The increase in interest expense, net, was primarily due the amortization of debt discount associated with the 2030 Notes. Net cash interest was $4.9 million for the three months ended March 31, 2026. Net non-cash interest was $6.8 million for the three months ended March 31, 2026.
Loss on debt extinguishment decreased $17.6 million, or 100%, during the three months ended March 31, 2026, compared to the same period in 2025. The decrease in loss on debt extinguishment relates to the redemption of 80% of the 2026 Notes in March 2025.
Gain on derivative liability decreased $17.4 million, or 100%, during the three months ended March 31, 2026, compared to the same period in 2025. The decrease in gain on derivative liability relates to the change in the valuation of the derivative liability associated with 2030 Notes from inception to March 31, 2025. As of June 12, 2025 the conditions necessary for separate accounting of the conversion option as a derivative liability were no longer met.
Other income, net, increased $0.1 million, or 32%, during the three months ended March 31, 2026, compared to the same period in 2025. The increase in other income, net, during the three months ended March 31, 2026, was primarily due to fluctuations in foreign currency rates.
Income tax provision
|
|
Three Months Ended |
|
|
Change |
|
||||||||||
(in thousands, except %) |
|
2026 |
|
|
2025 |
|
|
$ |
|
|
% |
|
||||
Income tax provision (benefit) |
|
$ |
50 |
|
|
$ |
(64 |
) |
|
$ |
114 |
|
|
|
(178 |
)% |
The change in the income tax provision (benefit) for the three months ended March 31, 2026, compared to the same period in 2025, was primarily related to the recognition of income taxes in several jurisdictions.
Liquidity and Capital Resources
Our principal sources of liquidity are our existing cash and cash equivalents, our Revolving Credit Facility and cash from operations. Our liquidity and capital structure are evaluated regularly within the context of our annual operating and strategic planning process. We consider the liquidity necessary to fund our operations, which includes working capital needs, investments in research and development, investments in inventory and instrument sets to support our customers, as well as other operating costs. Our future capital requirements will depend on many factors including our rate of revenue growth, the timing and extent of spending to support development efforts, the expansion of sales, marketing and administrative activities, the timing of introductions of new products and enhancements to existing products, and the international expansions of our business.
As current borrowing sources become due, we may be required to access the capital markets for additional funding. If we are required to access the debt markets, we expect to be able to secure reasonable borrowing rates. As part of our liquidity strategy, we will continue to monitor our current level of spending and cash use as well as our ability to secure additional credit facilities, term loans, or other similar arrangements in light of our spending levels and general financial market conditions.
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Table of Contents
A substantial portion of our operations are in the United States ("U.S."), and most of our net sales have been made in the U.S. Accordingly, we do not have material exposures to foreign currency rate fluctuations from operations. However, as our business in markets outside of the U.S. continues to increase, we will be exposed to foreign currency exchange risk related to our foreign operations.
We do not have any material financial exposure to one customer or one country, outside of the United States, that would significantly hinder our liquidity. We are and may become involved in various legal proceedings arising from our business activities. While we have no material, undisclosed accruals for pending litigation or claims, litigation is inherently unpredictable, and depending on the nature and timing of a proceeding, an unfavorable resolution could materially affect our future consolidated results of operations, cash flows or financial position in a particular period. We assess contingencies to determine the degree of probability and range of possible loss for potential accrual or disclosure in our condensed consolidated financial statements. An estimated loss contingency is accrued in our condensed consolidated financial statements if it is probable that a liability has been incurred and the amount of the loss can be reasonably estimated. Assessing contingencies is highly subjective and requires judgments about future events because litigation is inherently unpredictable, and unfavorable resolutions could occur. When evaluating contingencies, we may be unable to provide a meaningful estimate due to a number of factors, including the procedural status of the matter in question, the presence of complex or novel legal theories, and/or the ongoing discovery and development of information important to the matters. In addition, damage amounts claimed in litigation against us may be unsupported, exaggerated, or unrelated to reasonably possible outcomes, and as such are not meaningful indicators of our potential liability. We have disclosed all material accruals for pending litigation or investigations in Note 8, Commitments and Contingencies, in the Notes to Condensed Consolidated Financial Statements included in this Quarterly Report on Form 10-Q.
Cash and cash equivalents were $139.9 million and $160.8 million at March 31, 2026, and December 31, 2025, respectively. We believe that our existing funds, cash generated from our operations and our existing sources of and access to financing are adequate to satisfy our needs for working capital, capital expenditure and debt service requirements, and other business initiatives we plan to strategically pursue.
Summary of Cash Flows
|
|
Three Months Ended March 31, |
|
|||||
(in thousands) |
|
2026 |
|
|
2025 |
|
||
Cash (used in) provided by: |
|
|
|
|
|
|
||
Operating activities |
|
$ |
1,291 |
|
|
$ |
(5,039 |
) |
Investing activities |
|
|
(19,894 |
) |
|
|
(11,612 |
) |
Financing activities |
|
|
(1,774 |
) |
|
|
30,759 |
|
Effect of exchange rate changes on cash |
|
|
(517 |
) |
|
|
296 |
|
Net increase (decrease) in cash and cash equivalents |
|
$ |
(20,894 |
) |
|
$ |
14,404 |
|
Operating Activities
Operating activities provided net cash of $1.3 million for the three months ended March 31, 2026, which is primarily related to cash collections offset by costs associated with the continued expansion of our business and inventory purchases.
Investing Activities
We used cash of $19.9 million in investing activities for the three months ended March 31, 2026, which is primarily related to the purchase of surgical instruments to support the growth of our business and commercial launch of new products and a $5.0 million note receivable.
Financing Activities
Financing activities used cash of $1.8 million for the three months ended March 31, 2026, which is primarily related to cash paid for net settlement of shares, offset by proceeds from financed insurance.
Debt and Commitments
As of March 31, 2026, we had $200.0 million outstanding under the Braidwell Term Loan. The outstanding loans under the Braidwell Term Loan bear interest at the sum of Term SOFR plus 5.75% per annum. The Braidwell Term Loan matures on January 6, 2028.
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As of March 31, 2026, we had $15.1 million outstanding under the Revolving Credit Facility. The outstanding loans under the Revolving Credit Facility bear interest at the sum of Term SOFR plus 3.5% per annum. The Revolving Credit Facility matures on September 29, 2027.
As of March 31, 2026, we had $63.3 million outstanding under the 2026 Notes. The 2026 Notes accrue interest at a rate of 0.75%, payable semi-annually in arrears on February 1 and August 1 of each year. Prior to maturity in August 2026, the holders of the 2026 Notes may, under certain circumstances, choose to convert their notes into shares of our common stock. Based on the terms we have the option to pay or deliver cash, shares of our common stock, or a combination thereof, when a conversion notice is received.
As of March 31, 2026, we had $405.0 million outstanding under the 2030 Notes. The 2030 Notes accrue interest at a rate of 0.75%, payable semi-annually in arrears on March 15 and September 15 of each year. Prior to maturity in March 2030, the holders of the 2030 Notes may, under certain circumstances, choose to convert their notes into shares of our common stock. Based on the terms we have the option to pay or deliver cash, shares of our common stock, or a combination thereof, when a conversion notice is received.
As of March 31, 2026, we had $1.6 million in other debts that are due in monthly and quarterly installments through maturity in 2027.
We have an inventory purchase commitment agreement with a third-party supplier, where we are obligated to meet certain minimum purchase commitment requirements through December 2026. As of March 31, 2026, the remaining minimum purchase commitment under the agreement was $3.7 million.
Contractual obligations and commercial commitments
As of March 31, 2026, there have been no material changes, outside the normal course of business, in our outstanding contractual obligations from those disclosed within the “Management’s Discussion and Analysis of Financial Condition and Results of Operations” in our Annual Report on Form 10-K for the fiscal year ended December 31, 2025.
Off-Balance Sheet Arrangements
We do not have any off-balance sheet arrangements.
Recent Accounting Pronouncements
Aside from the changes disclosed in Note 1 to the Notes to Condensed Consolidated Financial Statements (Unaudited) under the heading “Recently Issued Accounting Pronouncements,” if any, there have been no new accounting pronouncements or changes to accounting pronouncements during the three months ended March 31, 2026, as compared to the recent accounting pronouncements described in our Annual Report on Form 10-K for the year ended December 31, 2025, that was filed with the SEC.
Forward Looking Statements
This Quarterly Report on Form 10-Q incorporates a number of forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended (the “Securities Act”) and Section 21E of the Securities Exchange Act of 1934, as amended (the “Exchange Act”), including statements regarding:
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Any or all of our forward-looking statements in this Quarterly Report on Form 10-Q may turn out to be wrong. They can be affected by inaccurate assumptions and/or by known or unknown risks and uncertainties. Many factors mentioned in our discussion in this Quarterly Report on Form 10-Q will be important in determining future results. Consequently, no forward-looking statement can be guaranteed. Actual future results may vary materially from expected results.
We also provide a cautionary discussion of risks and uncertainties under “Risk Factors” in our Annual Report on Form 10-K for the year ended December 31, 2025, and any updates to those risk factors filed from time to time in our subsequent periodic and current reports filed with the SEC. These are factors that we think could cause our actual results to differ materially from expected results. Other factors besides those listed there could also adversely affect us.
Without limiting the foregoing, the words “believe,” “anticipate,” “plan,” “expect,” “estimate,” “may,” “will,” “should,” “could,” “would,” “seek,” “intend,” “continue,” “project,” and similar expressions are intended to identify forward-looking statements. There are a number of factors and uncertainties that could cause actual events or results to differ materially from those indicated by such forward-looking statements, many of which are beyond our control, including the factors set forth under “Risk Factors” in our Annual Report on Form 10-K for the year ended December 31, 2025 and any updates to those risk factors filed from time to time in our subsequent periodic and current reports filed with the SEC. In addition, the forward-looking statements contained herein represent our estimate only as of the date of this filing and should not be relied upon as representing our estimate as of any subsequent date. While we may elect to update these forward-looking statements at some point in the future, we specifically disclaim any obligation to do so to reflect actual results, changes in assumptions or changes in other factors affecting such forward-looking statements.
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Item 3. Quantitative and Qualitative Disclosures About Market Risk
We have evaluated the information required under this item that was disclosed under Item 7A in our Annual Report on Form 10-K for the year ended December 31, 2025, and there have been no significant changes to this information.
Item 4. Controls and Procedures
Disclosure Controls and Procedures
We maintain disclosure controls and procedures that are designed to ensure that information required to be disclosed in our reports under the Securities Exchange Act of 1934, as amended, or the Exchange Act, is recorded, processed, summarized and reported within the time lines specified in the SEC’s rules and forms, and that such information is accumulated and communicated to our management, including our Chief Executive Officer and Chief Financial Officer, as appropriate, to allow timely decisions regarding required disclosure. In designing and evaluating the disclosure controls and procedures, management recognized that any controls and procedures, no matter how well designed and operated, can only provide reasonable assurance of achieving the desired control objectives, and in reaching a reasonable level of assurance, management necessarily was required to apply its judgment in evaluating the cost-benefit relationship of possible controls and procedures. Under the supervision and with the participation of our management, including our Chief Executive Officer and our Chief Financial Officer, we carried out an evaluation of the effectiveness of our disclosure controls and procedures (as defined in SEC Rules 13a - 15(e) and 15d - 15(e)) as of March 31, 2026. Based on such evaluation, our management has concluded that as of March 31, 2026, our disclosure controls and procedures are effective.
Changes in Internal Control over Financial Reporting
During the three months ended March 31, 2026, there have been no changes that have materially affected, or are reasonably likely to materially affect, our internal control over financial reporting. Our process for evaluating controls and procedures is continuous and encompasses constant improvement of the design and effectiveness of established controls and procedures.
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PART II. OTHER INFORMATION
Item 1. Legal Proceedings
For a description of our material legal proceedings, refer to Note 8 of our Notes to Condensed Consolidated Financial Statements included in this Quarterly Report on Form 10-Q, which is incorporated herein by reference.
Item 1A. Risk Factors
There have been no material changes to the risk factors described under Item 1A of our Annual Report on Form 10-K for the fiscal year ended December 31, 2025, filed with the SEC on February 24, 2026.
Item 2. Unregistered Sales of Equity Securities and Use of Proceeds
During the three months ended March 31, 2026, we issued unregistered shares of common stock as described in the following table:
Date Issued |
Number of Shares |
Grant Date Fair Value |
|
|
January 2, 2026 |
50,626(1) |
$ |
20.76 |
|
January 2, 2026 |
45,287(2) |
$ |
20.76 |
|
January 5, 2026 |
6,250(3) |
$ |
21.20 |
|
January 14, 2026 |
1,035,499(1) |
$ |
15.95 |
|
January 14, 2026 |
1,468(2) |
$ |
15.95 |
|
March 16, 2026 |
40,000(1) |
$ |
12.60 |
|
March 27, 2026 |
53,334(1) |
$ |
10.93 |
|
(1) Pursuant to Development Services Agreements for the development of products and intellectual property.
(2) Pursuant to consulting services rendered to the Company.
(3) Pursuant to independent sales agent services rendered to the Company.
(4) Based on the market price of common stock on the issuance date.
The issuances of the foregoing securities were made in reliance on the exemption from registration provided by Section 4(a)(2) of the Securities Act of 1933, as amended, as there was no general solicitation and the transactions did not involve a public offering.
Item 5. Other Information
Adoption, Modification or Termination of Trading Arrangements
A portion of the compensation of our directors and officers is in the form of equity awards, and, from time to time, directors and officers engage in open-market transactions with respect to the securities they acquire pursuant to such equity awards we have issued.
Transactions in our securities by directors and officers are required to be made in accordance with our insider trading policy, which requires that the transactions comply with applicable U.S. federal securities laws that prohibit trading while in possession of material nonpublic information. Rule 10b5-1 under the Exchange Act provides an affirmative defense that enables directors and officers to prearrange transactions in our securities in a manner that avoids concerns about initiating transactions while in possession of material nonpublic information.
The following table describes the contracts, instructions or written plans for the purchase or sale of securities adopted by our directors or officers (as defined in Rule 16a-1(f) under the Exchange Act) during the three months ended March 31, 2025, that are intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). No other Rule 10b5-1 trading arrangements or “non-Rule 10b5-1 trading arrangements” (as defined by S-K Item 408(c)) were
Name |
Title of Director or Officer |
Action |
Date |
Total Shares to be Sold |
|
Expiration Date |
|
|
|
||||||
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|
|
|
|
|
|
|
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Item 6. Exhibits
Exhibit |
|
Number Exhibit Description |
|
|
|
10.1 |
|
Form of Confirmation of Credit Agreement dated May 1, 2026 (1) |
|
|
|
31.1 |
|
Certification of Principal Executive Officer Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002. |
|
|
|
31.2 |
|
Certification of Principal Financial Officer Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002. |
|
|
|
32 |
|
Certification Pursuant to Section 906 of the Sarbanes-Oxley Act of 2002. |
|
|
|
101 |
|
The following materials from the Alphatec Holdings, Inc. Quarterly Report on Form 10-Q for the Three months ended March 31, 2026, formatted in iXBRL (Inline eXtensible Business Reporting Language): (i) Condensed Consolidated Balance Sheets (Unaudited) as of March 31, 2026 and December 31, 2025, (ii) Condensed Consolidated Statements of Operations (Unaudited) for the Three months ended March 31, 2026 and 2025, (iii) Condensed Consolidated Statements of Comprehensive Loss (Unaudited) for the Three months ended March 31, 2026 and 2025, (iv) Condensed Consolidated Statements of Stockholders’ (Deficit) Equity (Unaudited) for the Three months ended March 31, 2026 and 2025, (v) Condensed Consolidated Statements of Cash Flows (Unaudited) for the Three months ended March 31, 2026 and 2025, and (vi) Notes to Condensed Consolidated Financial Statements (Unaudited). |
|
|
|
104 |
|
Cover Page Interactive Data File (formatted as Inline XBRL and contained in Exhibit 101.INS) |
(1) Incorporated by reference to Exhibit 10.1 to our Current Report on Form 8-K filed with the SEC on May 5, 2026.
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SIGNATURES
Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.
|
ALPHATEC HOLDINGS, INC. |
|
|
|
|
|
By: |
/s/ Patrick S. Miles |
|
|
Patrick S. Miles |
|
|
Chairman and Chief Executive Officer |
|
|
(principal executive officer) |
|
|
|
|
By: |
/s/ J. Todd Koning |
|
|
J. Todd Koning |
|
|
Executive Vice President and Chief Financial Officer |
|
|
(principal financial officer and principal accounting officer) |
Date: May 5, 2026
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