Free cash flow has shown an improving trajectory, moving from a $72.1 million deficit in 2024Q1 to a positive $9.6 million in 2025Q4.
| Metric | TTM | Dec'25 | Dec'24 | Dec'23 | Dec'22 | Dec'21 | Dec'20 | Dec'19 | Dec'18 | Dec'17 | Dec'16 | Dec'15 | Dec'14 | Dec'13 | Dec'12 | Dec'11 | Dec'10 | Dec'09 | Dec'08 | Dec'07 | Dec'06 | Dec'05 | Dec'04 |
|---|
| Cash from Operations | 51.56M | 45.23M | -44.65M | -78.48M | -75.13M | -73.32M | -46.41M | -33.12M | -25.61M | -8.73M | -9.96M | 10.12M | -20.27M | 7.81M | 11.59M | 13.41M | -14.83M | -5.55M | -19.48M | -13.24M | -8.59M | -8.24M | 1.28M |
| Operating CF Margin % | - | 5.92% | -7.3% | -16.27% | -21.41% | -30.15% | -32.04% | -29.2% | -27.93% | -8.58% | -8.28% | 5.46% | -9.79% | 3.81% | 5.91% | 6.78% | -8.64% | -4.2% | -19.23% | -16.54% | -11.61% | -19.47% | 7.19% |
| Operating CF Growth % | 821.44% | 201.3% | 43.11% | -4.46% | -2.48% | -57.97% | -40.13% | -29.34% | -193.37% | 12.35% | -198.37% | 149.94% | -359.65% | -32.66% | -13.54% | 190.39% | -167.36% | 71.52% | -47.16% | -54.04% | -4.29% | -742.8% | - |
| Net Income | -125.36M | -143.36M | -162.12M | -186.64M | -151.29M | -143.03M | -78.99M | -57M | -28.98M | -2.29M | -29.93M | -178.68M | -12.88M | -82.23M | -15.46M | -22.18M | -14.36M | -13.29M | -29.29M | -20.2M | -25.82M | -14.05M | 509.45K |
| Depreciation & Amortization | 88.73M | 105.08M | 83.32M | 59.68M | 43.93M | 30.17M | 11.63M | 8.51M | 6.79M | 7.48M | 12.36M | 19.03M | 18.39M | 26.28M | 23.79M | 19.88M | 17.25M | 11.96M | 8.73M | 10.62M | 9.02M | 3.54M | 633.85K |
| Stock-Based Compensation | 75.06M | 73.72M | 73.28M | 81.24M | 40.56M | 36.45M | 17.66M | 10.96M | 5.3M | 3.9M | 1.63M | 2.64M | 4.55M | 4.08M | 3.69M | 2.42M | 3.18M | 3.57M | 2.94M | 314K | 8.83M | 0 | 0 |
| Deferred Taxes | 0 | 0 | 0 | 0 | 0 | 0 | 9K | -438K | -1.41M | -36K | 10K | -333K | 251K | 816K | -3.42M | -4.34M | -1.95M | 141K | 401K | 32K | 285K | -3.07M | 0 |
| Other Non-Cash Items | 41.61M | 29.92M | 28.15M | 21.41M | 15.61M | 28.15M | 19.23M | 13.23M | 2.39M | -7.48M | 8.46M | 168.34M | 12.78M | 13.89M | 10.94M | 15.83M | 5.87M | 5.59M | 4.45M | 3.17M | 8.83M | 8.03M | 279.85K |
| Working Capital Changes | -28.48M | -20.13M | -67.27M | -54.18M | -23.94M | -25.05M | -15.95M | -8.38M | -9.71M | -10.3M | -2.49M | -882K | -43.35M | 44.98M | -7.95M | 1.8M | -24.82M | -13.51M | -6.7M | -7.17M | -905K | -2.68M | -141.38K |
| Change in Receivables | -21.84M | -21.88M | -14.59M | -12.79M | -18.83M | -10.14M | -7.48M | -1.3M | -396K | 4.15M | 8M | 1.2M | -1.03M | -1.94M | 382K | -5M | -2.18M | -6.05M | -5.27M | -1.47M | -1.27M | 0 | 0 |
| Change in Inventory | 15.91M | 13.54M | -54.66M | -45.56M | -20.7M | -27.75M | -18.19M | -14.71M | -6.02M | 258K | -5.74M | -5.46M | -4.35M | -4.41M | -7.85M | 1.08M | -14.66M | -7.27M | -6.59M | -7.38M | -4.55M | 346.4K | -741.95K |
| Change in Payables | 963K | -11.16M | 9.67M | 6.99M | 9.8M | 757K | 7.13M | 6M | 16K | -2.59M | -4.87M | 3.21M | -1.04M | -3.85M | -1.8M | 2.54M | -5.2M | -1.82M | 1.91M | -253K | 1.72M | 0 | 0 |
| Cash from Investing | -61.69M | -53.41M | -93.14M | -141.97M | -58.28M | -157.76M | -23.86M | -13.03M | -21.67M | -6.5M | 61.96M | -12.25M | -11M | -19.1M | -19.4M | -9.52M | -14.41M | -12.73M | -9.14M | -8.94M | -10.75M | -80.99M | -598.47K |
| Capital Expenditures | -44.61M | -42.45M | -93.14M | -80.51M | -49.45M | -68.54M | -23.13M | -13.03M | -6.91M | -7.6M | -9.15M | -12.25M | -11.3M | -15.1M | -17.4M | -8.9M | -16.33M | -13.18M | -13.39M | -7.98M | -9.7M | -4.26M | -598.47K |
| CapEx % of Revenue | 7.5% | 5.56% | 15.23% | 16.69% | 14.09% | 28.18% | 15.97% | 11.49% | 7.54% | 7.47% | 7.61% | 6.61% | 5.46% | 7.38% | 8.86% | 4.5% | 9.51% | 9.97% | 13.22% | 9.98% | 13.11% | 10.06% | 3.36% |
| Acquisitions | 0 | 0 | 0 | -55M | 0 | -83.23M | 0 | 0 | -15.1M | 1.1M | 69.79M | 0 | 0 | -4M | -2M | -620K | 1.92M | 0 | 0 | 258K | 49K | -76.74M | 0 |
| Investments | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
| Other Investing | -17.08M | -10.96M | 0 | -6.47M | -8.83M | 0 | -728K | 0 | 348K | 1.1M | 1.32M | 0 | 300K | -750K | -3.75M | 0 | -382K | 60K | 4.26M | -3.79M | -1.05M | 0 | 0 |
| Cash from Financing | -2.52M | 30.02M | 56.21M | 356.92M | 31.23M | 311.97M | 130.83M | 64.18M | 53.88M | 17.82M | -43.39M | -6.53M | 30.73M | 10.69M | 8.48M | -6.92M | 43.06M | 10.27M | 21.41M | 31.32M | 33.77M | 90.99M | 109.96K |
| Debt Issued (Net) | -1.1M | 74.81M | 58.8M | 149.66M | 35M | 271.25M | 19.85M | 8.36M | 1.98M | -6.57M | -43.51M | -6.91M | 30.71M | 10.68M | 8.4M | -7.02M | -6.33M | 324K | 21.39M | -2.98M | -1.52M | 513.29K | 158.44K |
| Equity Issued (Net) | -54K | 0 | -560K | 212.12M | 0 | 100.86M | 111.04M | 55.83M | 51.9M | 24.39M | 228K | 375K | 26K | 0 | 0 | 0 | 49.66M | 9.91M | -48K | 33.35M | 35.31M | 91.61M | 10K |
| Dividends Paid | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Share Repurchases | 0 | 0 | 0 | 0 | 0 | -30.96M | 0 | 0 | 0 | 0 | 0 | 0 | -3K | 0 | 0 | 0 | 0 | 0 | -48K | 0 | -35.15M | 0 | 0 |
| Other Financing | -1.36M | -44.8M | -2.03M | -4.86M | -3.77M | -60.15M | -58K | 0 | 0 | 24.39M | -114K | 0 | 0 | 8K | 76K | 104K | -267K | 38K | 70K | 952K | -10K | -1.13M | -58.48K |
| Net Change in Cash | -13.33M | 21.97M | -82.13M | 136.27M | -102.55M | 79.48M | 60.65M | 18.06M | 6.59M | 2.84M | 8.52M | -8.51M | -1.61M | -896K | 1.57M | -2.5M | 13.08M | -8.23M | -7.53M | 8.9M | 14.76M | 1.68M | 802.91K |
| Free Cash Flow | 6.95M | 2.78M | -137.79M | -165.46M | -133.41M | -141.86M | -70.3M | -46.15M | -32.52M | -16.32M | -19.11M | -2.12M | -31.57M | -7.29M | -5.8M | 4.51M | -31.16M | -18.72M | -32.87M | -21.22M | -18.3M | -12.5M | 683.31K |
| FCF Margin % | 1.17% | 0.36% | -22.53% | -34.31% | -38.02% | -58.33% | -48.53% | -40.69% | -35.47% | -16.05% | -15.89% | -1.15% | -15.25% | -3.56% | -2.96% | 2.28% | -18.16% | -14.17% | -32.45% | -26.52% | -24.72% | -29.53% | 3.83% |
| FCF Growth % | 108.61% | 102.01% | 16.72% | -24.02% | 5.95% | -101.8% | -52.32% | -41.91% | -99.22% | 14.56% | -799.95% | 93.28% | -332.78% | -25.71% | -228.61% | 114.48% | -66.42% | 43.04% | -54.9% | -15.99% | -46.39% | -1928.92% | - |
| FCF per Share | 0.05 | 0.02 | -0.96 | -1.36 | -1.29 | -1.47 | -1.05 | -0.88 | -0.92 | -1.23 | -2.23 | -0.26 | -3.88 | -0.91 | -0.77 | 0.61 | -4.76 | -4.56 | -8.52 | -6.83 | -8.06 | -10.62 | 0.85 |
| FCF Conversion (FCF/Net Income) | -0.06x | -0.32x | 0.28x | 0.42x | 0.50x | 0.51x | 0.59x | 0.58x | 0.88x | 3.81x | 0.33x | -0.06x | 1.57x | -0.09x | -0.75x | -0.60x | 1.03x | 0.42x | 0.67x | 0.66x | 0.33x | 0.59x | 2.52x |
| Interest Paid | 0 | 0 | 20.32M | 17.27M | 3.86M | 5.03M | 6.33M | 5.97M | 5.14M | 4.7M | 7.37M | 7.63M | 5.88M | 3.97M | 2.59M | 2.32M | 4.25M | 0 | 1.32M | 686K | 0 | 0 | 0 |
| Taxes Paid | 0 | 0 | 275K | 333K | 272K | 223K | 190K | 161K | 134K | 107K | 920K | 621K | 565K | 1.78M | 989K | 523K | 426K | 0 | 501K | 93K | 0 | 0 | 0 |
Persistent operating cash burn
As reported in recent financial filings, ATEC's operating cash flow frequently decouples from net losses, with the company recording a $20.7 million operating cash inflow in 2025Q4 despite a $21.7 million net loss, highlighting a reliance on non-cash adjustments to bridge the profitability gap.
The persistent gap between net income and operating cash flow suggests that ATEC's reported losses are significantly mitigated by non-cash charges, primarily stock-based compensation and depreciation. Investors should monitor whether this conversion quality remains sustainable as the company attempts to transition toward positive GAAP earnings.
Based on the provided quarterly data, ATEC has demonstrated a notable shift in free cash flow trajectory, moving from a $72.1 million deficit in 2024Q1 to a positive $9.6 million in 2025Q4, suggesting an improving ability to fund operations through internal cash generation.
This trend indicates that the company's aggressive investment phase may be moderating, allowing for a more favorable cash flow profile. However, the volatility in these figures warrants caution, as the path to consistent, self-sustaining free cash flow remains sensitive to ongoing operational scaling requirements.
According to historical cash flow statements, ATEC's capital expenditure as a percentage of revenue has compressed from 24.3% in 2024Q1 to 5.3% in 2025Q4, reflecting a strategic pivot toward optimizing existing instrument sets rather than the rapid, front-loaded deployment seen in earlier periods.
The reduction in capital intensity suggests that the company is successfully leveraging its existing installed base of surgical instruments. This shift is critical for margin expansion, as lower relative capex requirements reduce the burden on free cash flow and improve the overall return on invested capital.
Analysis of recent SEC filings indicates that stock-based compensation remains a substantial non-cash expense, averaging over $19 million per quarter throughout 2025, which effectively masks the true cash cost of maintaining a competitive sales force in the highly fragmented spine surgery market.
While these equity-based incentives are essential for talent retention, they represent a significant dilution risk that is not fully captured in traditional cash flow metrics. Analysts should adjust for these recurring non-cash charges to better understand the company's underlying cash burn and long-term shareholder value creation.
Quick answers to the most common questions about buying ATEC stock.
Alphatec Holdings, Inc. (ATEC) generated $45.2M in net cash from operating activities in 2025. This reflects the cash generated directly from core business operations.
Alphatec Holdings, Inc. (ATEC) generated $2.8M in free cash flow in 2025. Free cash flow is the cash left over after capital expenditures, which can be used to pay dividends, repurchase shares, or pay down debt.
Alphatec Holdings, Inc. (ATEC) spent $42.5M on capital expenditures in 2025. CapEx represents the cash invested in physical assets like property, plant, and equipment to maintain or grow the business.