29% Surgical Growth in Q2 and No Signs of Slowing Down
Alphatec Breaks Spine Market Share Speed Barrier
3 min read Premium comments
second quarter 2025 earningsPat Miles#alphatec
If you’re in the spine business, it’s time to stop casually watching Alphatec Holdings, Inc. and start paying attention—they’re not just growing, they’re accelerating.
| AlphaTec Holdings, Inc. 2025 Report ($000s): 3 Months Ended 06/30/25 | ||||||
| 3 Month Sales | 6 Month Sales | |||||
| 2024 | 2025 | % Change | 2024 | 2025 | % Change | |
| $145,573 | $185,544 | 27.46% | $284,050 | $354,724 | 24.88% | |
| Op Profit | Op Profit | |||||
| 2024 | 2025 | % Change | 2024 | 2025 | % Change | |
| -$35,307 | -$13,085 | -62.94% | -$78,648 | -$57,376 | -27.05% | |
| -24.25% | -7.05% | -27.69% | -16.17% | |||
| EPS | EPS | |||||
| 2024 | 2025 | % Change | 2024 | 2025 | % Change | |
| -$0.29 | -$0.27 | -6.90% | -$0.63 | -$0.63 | 0.00% | |
| 2026 Sales Estimate | 2025 Sales Estimate | |||||
| Consensus | Change | Consensus | Change | |||
| $866,370 | 312.40% | $732,250 | 19.80% | |||
Source: RRY Publications LLC
In Q2 2025, Alphatec (ATEC) clocked $185.5 million in sales—up a whopping 27% year-over-year—and recorded a 29% jump in surgical revenue growth. Despite an operating loss of $13 million and an EPS miss that ruffled a few analyst feathers, the real headline is this: ATEC is taking share—and fast.
Pat Miles: Spine’s Relentless Architect
During the recent earnings call, Chairman and CEO Pat Miles did what he does best—frame the company’s momentum as both inevitable and intentional.
“This pace of surgeon adoption reflects not just the attractiveness of our portfolio,” he said, “but the coordinated investments we’re making in sales talent to meet that demand.”
Translation: Alphatec isn’t just hiring sales reps—they’re building a surgeon-first commercial engine. And it’s working.
CFO Todd Koning added that the $23 million in adjusted EBITDA this quarter set a company record, and that Alphatec’s same-store sales (agents with more than a year in territory) also grew 29%. That’s not new market entry—that’s wallet share dominance.
Same Store, More Score
Jefferies’ Young Li asked the key question: How much of this growth is from reps added in the past 24 months? In other words, is the strategy working?
Koning didn’t hedge: “What we do today impacts results 12, 18, 24 months from now—and we’re seeing the payoff. But more importantly, surgeon adoption and utilization are strong. That’s the engine.”
In spine, it’s one thing to get a foot in the door. It’s another to earn repeat trays in the OR. ATEC is doing both.
ASC Play: Still Warming Up
Piper Sandler’s analyst wanted the breakdown: Is the surgical growth coming more from ASCs or hospitals?
Short answer: Still hospital-heavy, with ASC mix under 10%. But don’t let that fool you—ATEC’s leadership sees a clear opportunity ahead. Their differentiators? Patient selection, pain control, and EOS Insights as a decision-making tool to guide surgeons pre-op.
If you’re mapping the ASC spine battlefield for 2026 and beyond, expect ATEC to start drawing lines.
The Toolkit Grows: Cervical, Thoracic, SafeOp
While many spine companies are busy fine-tuning what they already sell, Alphatec is still building new lanes. Q2 saw the rollout of:
- A new cervical retractor system
- A segmental cervical plating system
- Corpectomy tools for cervical and thoracic applications
- Expanded SafeOp neuromonitoring capabilities
This isn’t me-too technology. It’s a portfolio designed to win over surgeons who want integrated, efficient, and differentiated tools in the OR.
Raising Guidance? You Bet.
On the strength of Q2’s performance, Alphatec raised its full-year revenue guidance by $8 million to $742 million. And with the kind of surgical volume they’re seeing—and a salesforce built for execution—few are betting against them.
What’s ATEC’s Play?
Alphatec is executing a familiar formula—with uncommon intensity.
- Aggressively expand surgical offerings
- Recruit top sales talent and give them ammo
- Win surgeon loyalty with differentiated tech
- Drive utilization and compounding growth
The kicker? They’re doing all this while still flying under 10% ASC mix—meaning they haven’t even played their full hand.
If you’re leading a spine business, here’s the hard truth: ATEC isn’t taking share because the market is expanding. They’re taking it from someone.
The only question left is—is it you?
React:
Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
Join the conversation
Orthopedic professionals are discussing this. Sign in and upgrade to read every comment and add your voice.