Carlsmed (NASDAQ:CARL) posted second-quarter 2026 revenue of $18.9 million, a 57% increase year-over-year, driven by the rapid expansion of its aprevo lumbar platform and the successful integration of its new cervical product line.
Surgeon Adoption and Growth Drivers
CEO Mike Cordonnier reported that the company’s surgeon user base expanded by over 60% compared to the previous year. This growth is attributed to a combination of new surgeon onboarding, higher utilization rates among established clients, and rising demand for aprevo in high-acuity spinal fusion procedures. Cordonnier noted that an increasing number of surgeons are now adopting both lumbar and cervical offerings, fueling a faster rate of user acquisition.
Raised Revenue Guidance for 2026
Following a strong performance in the first half of the year, Carlsmed has upwardly revised its full-year 2026 revenue guidance to a range of $74 million to $78 million. CFO Leo Greenstein described this forecast as prudent, noting that while first-half growth hit 57%, the guidance anticipates a 45% growth rate for the second half of 2026.
Medicare Reimbursement and Long-Term Strategy
Management highlighted a significant regulatory development from the Centers for Medicare & Medicaid Services (CMS). Effective October 1, 2026, the new Inpatient Prospective Payment System rule will implement three specific MS-DRG codes (523, 524, and 525) for aprevo lumbar procedures, replacing 11 legacy codes. While the company expects this to simplify coding and improve hospital access, management does not anticipate a material financial impact on the remainder of 2026, viewing the rule primarily as a growth catalyst for 2027 and beyond.
Operational Efficiency and Margin Expansion
Gross margins saw a notable improvement, rising to 76.8% from 73.4% in the same quarter last year. Greenstein credited this expansion to reduced contract-manufacturer costs and increased efficiencies within the firm’s digital production system. Looking ahead, the company aims to push margins toward the low 80% range over the next two years through continued technological refinements.
Operating expenses increased to $25.6 million, reflecting strategic investments in R&D—specifically AI initiatives and product development—as well as expanded sales personnel and marketing efforts. The company reported a GAAP net loss of $10.5 million, with adjusted EBITDA at negative $8.6 million.
Pipeline and Clinical Evidence
As of June 30, Carlsmed maintained a solid liquidity position with $89.3 million in cash and investments against $34 million in total liabilities. The company continues to prepare for upcoming commercial launches:
- aprevo Bilateral: Scheduled for a Q4 commercial launch, with early feedback highlighting the system’s 3D planning and visualization capabilities.
- Corra Cervical Plating System: Also slated for a Q4 launch, intended to enhance the average revenue per cervical procedure.
Furthermore, the company is advancing its clinical data collection with the ACE (aprevo Cervical Effectiveness) multicenter registry, set to begin enrollment in the fourth quarter. These efforts are supported by recent data, including a study in the Global Spine Journal demonstrating a 74% reduction in reoperations for patients treated with aprevo personalized implants.
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