Carlsmed (NASDAQ:CARL) reported rapid growth in the fourth quarter and full year 2025, highlighting record revenue, gross margin expansion, and increasing surgeon adoption as the company scaled its personalized spine surgery platform following its July initial public offering.
2025 highlights: revenue growth, margin expansion, and IPO
Chief Executive Officer and Chairman Mike Cardonnier said 2025 was a “rapid-growth year” for the company, emphasizing the completion of Carlsmed’s IPO in July, which raised more than $100 million. Management said it is deploying those resources toward “patient-centric innovation, surgeon education, and commercial execution.”
Cardonnier also pointed to progress in the company’s digital production system, which he said has improved productivity and reduced lead times for the aprevo Lumbar and aprevo Cervical patient-specific interbody portfolio. Carlsmed said it has brought lead time down to six business days.
Clinical data and reimbursement updates
Management highlighted published clinical evidence supporting its platform. Cardonnier cited two-year data from a retrospective cohort study published in the Global Spine Journal, which showed a 74% reduction in reoperation rates among adult spinal deformity patients receiving aprevo Lumbar implants compared with a separately published cohort receiving conventional stock implants.
On reimbursement, the company said it has an established foundation in lumbar surgery supported by three MS-DRG codes covering single-level and multi-level lumbar fusion surgeries for degenerative and deformity conditions. Cardonnier also noted that in October 2024, the Centers for Medicare & Medicaid Services granted a new technology add-on payment (NTAP) for aprevo cervical spine fusion, providing up to $21,125 of additional reimbursement per inpatient cervical procedure for hospitals using the patient-specific devices.
Product development and platform expansion
Carlsmed discussed several recent product and platform initiatives. In November, the company launched its next-generation myaprevo Ecosystem, designed to integrate mobile and web-based applications into surgeons’ preoperative and postoperative workflows.
Cardonnier also described new developments aimed at expanding the portfolio:
- First-in-human bilateral posterior aprevo procedure performed at the University of Colorado. The FDA-cleared technology is intended to address degenerative disease conditions posteriorly through a minimally invasive approach, with Carlsmed initiating a limited market evaluation and targeting a second-half 2026 launch.
- Cora personalized fixation portfolio, including a first-in-human personalized Cora cervical plate procedure performed at UCSF. Cardonnier said the FDA 510(k)-cleared Cora cervical plates are personalized to the patient’s anatomy to support fixation for the aprevo cervical interbody, with a planned second-half 2026 launch.
Responding to a question about market impact, Cardonnier said the bilateral aprevo lumbar approach is expected to help accelerate adoption in the posterior surgery portion of the lumbar fusion market, which he described as about 8% of the total lumbar fusion market. On Cora, he said it represents the company’s “first foray outside of the disc space,” adding personalization to cervical plates as part of the broader cervical portfolio plan.
Commercial progress and cervical launch
Carlsmed said surgeon adoption continued to expand. In 2025, the company added 101 new fully trained surgeons who performed one or more aprevo procedures during the year. Cardonnier said the company doubled its U.S. sales regions and that its direct sales team partnered with more than 100 contracted sales agents.
Carlsmed launched aprevo Cervical in December at the Cervical Spine Research Society meeting. Cardonnier said early traction has been encouraging, and he highlighted a focus on potential benefits for patients with osteoporosis or osteopenia, noting that about a third of cervical spine fusion patients have poor bone quality. During the Q&A, management said it was “weeks into the launch” but was seeing positive response from surgeons and hospitals, supported by NTAP reimbursement. The company said it had trained about 10% of its total users on cervical in a short period of time.
Financial performance, balance sheet, and 2026 outlook
Chief Financial Officer Leo Greenstein said fourth-quarter revenue growth was driven by expansion in surgeon users and utilization rates, while average revenue per procedure was consistent year over year. He attributed fourth-quarter gross margin improvement to lower contract manufacturing costs and internal efficiencies in case design. Greenstein said supply chain productivity investments reduced lead time from eight business days in Q3 to six business days, measured from surgeon approval of the digital plan to kit delivery to the operating room.
Fourth-quarter operating expenses totaled $20.9 million, up from $11.7 million a year earlier, reflecting increases across R&D, sales and marketing, and general and administrative expenses. Carlsmed reported a fourth-quarter GAAP net loss of $8.6 million and adjusted EBITDA (adjusted for stock-based compensation) of negative $8.4 million. For the full year, Carlsmed posted a GAAP net loss of $29.6 million and adjusted EBITDA of negative $28.4 million.
On the balance sheet, Greenstein said cash and investments totaled $109.9 million as of Dec. 31, 2025. The company had $15.6 million outstanding under a $50 million debt facility maturing in October 2030, which Greenstein described as “low-cost, non-dilutive standby capital.” Cash used in operating activities was $29 million in 2025.
Looking ahead, Carlsmed issued 2026 revenue guidance of $70 million to $75 million, representing 44% growth at the midpoint versus 2025. In response to analyst questions, management said it aimed to be prudent with guidance as a newly public company while citing continued momentum in training and adoption across lumbar and cervical. Greenstein also said the company expects gross margins to be maintained in the mid-70% range into 2026 and suggested operating leverage over time, with G&A declining as a percentage of revenue as the business grows.
About Carlsmed (NASDAQ:CARL)
We are a commercial-stage medical technology company pioneering AI-enabled personalized spine surgery solutions with a mission to improve outcomes and decrease the cost of healthcare for spine surgery and beyond. We are focused on becoming the standard of care for spine fusion surgery. The aprevo Technology Platform consists of artificial intelligence (“AI”)-enabled software solutions, and interbody implants that we custom design for each patient’s unique pathology and vertebral bone topography, and single-use surgical instruments (the “aprevo Technology Platform”).
