Alphatec Holdings Inc (ATEC) 2023 Q4 法說會逐字稿

Good afternoon, everyone, and welcome to the webcast of ATEC's fourth-quarter financial results. We would like to remind everyone that participants on the call will make forward-looking statements.

大家下午好，歡迎收看 ATEC 第四季財務表現的網路廣播。我們想提醒大家，電話會議的參與者將做出前瞻性陳述。

These statements are based on current expectations and are subject to uncertainties that could cause actual results to differ materially. These uncertainties are detailed in documents filed regularly with the SEC.

這些陳述是基於目前的預期，並受到可能導致實際結果存在重大差異的不確定性的影響。這些不確定性在定期向 SEC 提交的文件中有詳細說明。

During this call, you may hear the company refer to non-GAAP or adjusted measures. Reconciliations of these measures to US GAAP can be found in the supplemental financial tables included in today's press release, which identify and quantify all excluded items and provide management's view of why this information is useful to investors.

在這次電話會議中，您可能會聽到該公司提到非公認會計準則或調整後的措施。這些措施與美國公認會計準則的調節可以在今天的新聞稿中包含的補充財務表格中找到，該表格確定並量化了所有排除的項目，並提供了管理層對為什麼這些資訊對投資者有用的看法。

Leading today's call will be ATEC's Chairman and CEO, Pat Miles; and CFO, Todd Koning. Now, I will turn the call over to Pat Miles. Please go ahead.

今天的電話會議將由 ATEC 董事長兼執行長 Pat Miles 主持。和財務長托德·科寧。現在，我將把電話轉給帕特·邁爾斯。請繼續。

Thanks very much, Desiree. Welcome to the Q4 2023 financial results call. Clearly, there will be some forward-looking statements. But I would characterize 2023 as a very good year.

非常感謝，德西麗。歡迎參加 2023 年第四季財務業績電話會議。顯然，會有一些前瞻性的陳述。但我認為 2023 年是非常好的一年。

And a few of the highlights, much of which has been communicated, but revenue of $482 million, which was a 37% total revenue growth; 890 basis points of adjusted EBITDA expansion; 40% surgical revenue growth with a broad contribution; 31% surgical volume growth versus 25% in 2022, which suggest acceleration; greater than 500 surgeons trained; and a lot of work really in three key areas, which is -- beginning with lateral, we launched LTP with the ALIF midline element.

還有一些亮點，其中大部分已經傳達，但收入為 4.82 億美元，總收入增長了 37%；調整後 EBITDA 擴張 890 個基點；手術收入成長 40%，貢獻廣泛；手術量增加 31%，而 2022 年為 25%，這表示手術量成長正在加速；超過 500 名外科醫生接受過培訓；我們在三個關鍵領域做了很多工作，即從橫向開始，我們推出了具有 ALIF 中線元件的 LTP。

We launched expandables in lateral. From an informatic perspective, EOS has really expanded from a developmental perspective. And look forward to talking a little bit about that.

我們推出了橫向擴展。從資訊學的角度來看，EOS確實從發展的角度來看已經擴展了。並期待對此進行一些討論。

We also acquired a navigation-enabled robotic system from an informatic perspective. And from the capital raise, raised $150 million. So I would say a very productive year.

我們也從資訊學角度獲得了支援導航的機器人系統。並從本輪融資中籌集了1.5億美元。所以我想說這是非常有成效的一年。

To put it in context, we've gone from about 1% market share to probably a little north of 5%, depending upon how you calculate it. Again, I think that the interesting elements are the growth rate of 40% over that period from an annual growth rate perspective -- a compound annual growth rate perspective; 17% new surgeon CAGR; a 24% procedural volume CAGR. So people are doing work with us. And then a revenue per case CAGR of 12%, and I'll get into that as well because I think it's such a buy-in to our surgical thesis.

結合上下文來看，我們的市場份額已經從大約 1% 上升到了 5% 左右，具體取決於您如何計算。再說一次，我認為有趣的因素是從年增長率的角度－複合年增長率的角度來看，這段期間40%的成長率；新外科醫師複合年增長率為 17%；程序量複合年增長率為 24%。所以人們正在和我們一起工作。然後每個病例的收入複合年增長率為 12%，我也會討論這一點，因為我認為這是對我們外科論文的認可。

Our priorities have not changed. And really, what we're committed to is earnings share through clinical distinction. And it's interesting -- we've been talking about this since 2018 -- but surgeons adopt technology when there's a reason to and when there's clinical distinction. We attract salespeople when there is clinical distinction. And so our enthusiasm for that continues.

我們的優先事項沒有改變。事實上，我們致力於透過臨床區別來分享收益。有趣的是——我們自 2018 年以來一直在討論這個問題——但是當有理由並且存在臨床區別時，外科醫生就會採用技術。當銷售人員具有臨床特徵時，我們就會吸引他們。因此，我們對此的熱情仍在繼續。

Our opportunity to really kind of initiate the company's resurrection, if you will, was around how do you create clinical distinction? And there's such an expertise within lateral here; that's what we did. And so we've gone from about 1% to about 12% share in lateral. And the ability for us to continue to improve the utility and expand its application is very apparent.

如果你願意的話，我們真正啟動公司復興的機會是如何創造臨床差異？橫向領域有這樣的專業知識；這就是我們所做的。因此，我們的橫向份額從大約 1% 增加到了大約 12%。我們繼續改進實用性和擴展其應用的能力是非常明顯的。

And so we're doing that through, really, fulfilling the surgical requirements and addressing hurdles within the procedure itself. We're integrating SafeOp to avoid the complication most associated with lateral surgery, which really speaks to the whole automated SSEP element, which you don't even -- you don't only determine where the nerve is, but also its health.

因此，我們實際上是透過滿足手術要求並解決手術本身的障礙來做到這一點的。我們正在整合 SafeOp，以避免與側向手術最相關的併發症，這實際上涉及整個自動化 SSEP 元素，您甚至不需要 - 您不僅可以確定神經的位置，還可以確定其健康狀況。

And then one of the other elements was -- when we created PTP, really, what we were able to do was obviate the need to approach from posteriorly with PLIF and TLIF. And so what the essence of that becomes is a lateral franchise that addresses, really, a $3 billion market opportunity versus what was previously a $1 billion market opportunity.

然後其他元素之一是 - 當我們創建 PTP 時，實際上，我們能夠做的是消除使用 PLIF 和 TLIF 從後處理的需要。因此，其本質是橫向特許經營，它實際上解決了 30 億美元的市場機會，而不是以前 10 億美元的市場機會。

So we love that because one of the things that it does is it furthers confidence. So if we do lateral surgery exceedingly well, what we find is that we have access to a greater part of a surgeon's practice. We call that the halo effect.

所以我們喜歡這一點，因為它的作用之一就是增強信心。因此，如果我們將側向手術做得非常好，我們會發現我們可以接觸到外科醫生的大部分實踐。我們稱之為光環效應。

And so if one of our salespeople executes with a surgeon a lateral approach in either the prone or the lateral position, what happens is we often earn trust. And that trust ultimately expands the footprint of what type of surgery we do with that respective surgeon.

因此，如果我們的一位銷售人員與外科醫生一起以俯臥或側臥位進行側向入路，我們通常會贏得信任。這種信任最終擴大了我們與相應外科醫生進行的手術類型的範圍。

We've continued to commit to approximately 8 to 10 products per year. This was a big year for us at 15. And we always look for product launches to ultimately expand the influence of our procedures. And if you look kind of across each of the areas from a lateral standpoint, the expandables was a big one.

我們繼續承諾每年推出約 8 到 10 種產品。對 15 歲的我們來說，這是重要的一年。我們一直在尋找產品發布，以最終擴大我們程序的影響力。如果你從橫向的角度觀察每個區域，你會發現可擴展區域是一個很大的區域。

The other thing that I love that we do is, really, we establish a foundation for what's next. We launched some products in lateral. For thoracic, we will prepare for thoracic corpectomy, as well as we launched an LTP position. We applied our learnings from what we knew in PTP and applied it to LTP, which is lateral transpsoas.

我喜歡我們做的另一件事是，我們確實為下一步奠定了基礎。我們橫向推出了一些產品。胸部方面，我們將準備胸部椎體切除術，並推出了LTP職位。我們將 PTP 中的知識應用到 LTP（即腰外側橫肌）。

From an anterior perspective, access is hugely important to surgeons. We developed an access system for ALIF. And ultimately, that's going to integrate with regard to the procedural vision of L4-S1 with regard to LTP. So super excited about that.

從前面的角度來看，通路對外科醫師來說非常重要。我們為 ALIF 開發了一個存取系統。最終，這將與 L4-S1 的 LTP 程序願景整合。對此非常興奮。

From a posterior perspective, expandables was a big part of our launch profile this year, as well as some tools for stabilization in osteoporotic bone. That's important as it starts to lay the foundation for where we're going on the EOS front with regard to bone quality measure.

從後面的角度來看，可擴展產品以及一些用於穩定骨質疏鬆骨骼的工具是我們今年推出的產品的重要組成部分。這很重要，因為它開始為我們在骨質測量方面在 EOS 方面的發展奠定基礎。

From a cervical standpoint, there's been significant demand of our cervical portfolio. I would say that's reflective of the halo dynamic that we speak of, as well as SafeOp 2 and our biologics portfolio. It's fun to see, not only continue to launch a demineralized bone fiber product, but also start to see the integration of our biologics within the context of our expandables.

從頸椎的角度來看，我們的頸椎產品組合有著巨大的需求。我想說，這反映了我們所謂的光環動態，以及 SafeOp 2 和我們的生物製劑產品組合。很有趣的是，我們不僅繼續推出脫礦骨纖維產品，而且開始看到我們的生物製劑與我們的可擴展產品的整合。

And so when you have an expandable device and you expand it, what you want to do is backfill it with biologic. And to integrate these steps into a workflow that's elegant is part of our proceduralization view.

因此，當您擁有可擴展設備並擴展它時，您要做的就是用生物製品回填它。將這些步驟整合到優雅的工作流程中是我們程式化視圖的一部分。

And so when you start to think about how we garner more surgeons, the surgeon adoption effort is really multifaceted. And so we compel more surgeons because of the clinical distinction. And then we earn more of their cases based upon the confidence it created with their experience.

因此，當你開始思考我們如何招募更多外科醫生時，外科醫生的採用工作實際上是多方面的。因此，由於臨床上的區別，我們需要更多的外科醫生。然後，我們會根據他們的經驗所建立的信心，贏得更多的案例。

And then the more products category sold in each case is, really, in my mind, a buy-in to the procedural architecture or the thesis that we put forth. And so certain procedures are going to have less products per procedure; other surgeries are going to have more products per procedure.

在我看來，每種情況下銷售的更多產品類別實際上是對我們提出的程式架構或論文的認可。因此，某些程序的每個程序的產品將會減少；其他手術每次手術都會有更多的產品。

But we think it's a good proxy for what we're doing with regard to the whole proceduralization effort. So distinction doesn't only compel adoption by the surgeon, but it also attracts salespeople. And so we think that it's continually important to further our distinction.

但我們認為它很好地代表了我們在整個程序化工作方面所做的工作。因此，區別不僅迫使外科醫生採用，而且還吸引了銷售人員。因此，我們認為進一步提升我們的獨特性始終很重要。

And so elevating our distribution network is going to be a constant priority. You will continue to see us do that. As we said earlier, we earned an approximate 5% market share.

因此，提升我們的分銷網絡將成為我們的首要任務。您將繼續看到我們這樣做。正如我們之前所說，我們獲得了大約 5% 的市場份額。

The inspiring thing for us is that in places where we've had distribution in a place that has a number of people within their distributor network, there's places that we have 25% market share. And that just speaks to the application of our portfolio into an expanded utility as well as the confidence of the people in that respective area.

對我們來說，鼓舞人心的是，在我們進行分銷的地方，在經銷商網路中有很多人的地方，我們擁有 25% 的市場份額。這僅僅說明了我們的產品組合在擴大公用事業的應用以及人們對該領域的信心。

We've really never been more enthusiastic with regard to the status of the marketplace in general. We, internally, characterize it as 35% disrupted and 60% apathetic. And I don't know if there's a better place to be when you are sprinting at moving a field than a market that's disruptive and apathetic.

我們對整個市場的狀況確實從未如此熱情過。我們內部將其描述為 35% 的人混亂，60% 的人冷漠。我不知道當你在一個領域衝刺時，是否有比破壞性和冷漠的市場更好的地方。

And so one that would suggest that there are good things happening would be that we have a 36% same-store sales dynamic. And that means that there's a growth rate that clearly far exceeds anybody else from a same-store perspective. And so when people come here, their ability to build a big business is significant.

因此，我們的同店銷售動態達到 36%，這表明正在發生好事。這意味著從同店角度來看，其成長率顯然遠遠超過其他任何人。因此，當人們來到這裡時，他們建立大企業的能力就非常重要。

So the beauty is that we are attracting people who want to play along, those committed to moving the field, surely not the ones interested in a single-year experience or a single-year guarantee. We're in this for the long haul, and I can't be more excited about what we're building.

因此，美妙之處在於，我們吸引了那些想要合作的人，那些致力於推動這個領域的人，當然不是那些對一年經驗或一年保證感興趣的人。我們將長期致力於此，我對我們正在建造的東西感到非常興奮。

When you start to think about our place in the market and our portfolio as we speak, if we wanted to build a good company, we would have stopped right here and we have built a lateral franchise and, candidly, could have been done. It's really what we did at the last company.

當你開始思考我們在市場中的地位和我們的產品組合時，如果我們想建立一家優秀的公司，我們就會在這裡停下來，我們已經建立了橫向特許經營權，坦率地說，本來可以做到的。這確實是我們在上一家公司所做的。

Our aspirations are much greater. And we genuinely want to revolutionize the approach to spine surgery, which we've committed to. So much like we built the first part of the company around the informatic element of SafeOp and performing better lateral surgery, we're doing the same here with regard to deformity.

我們的願望遠大得多。我們真誠地希望徹底改變脊椎手術的方法，這是我們所致力於的。就像我們圍繞 SafeOp 的資訊元素建立了公司的第一部分並進行更好的側向手術一樣，我們在畸形方面也做了同樣的事情。

And so started off building it with the people -- clearly, it's always about the people -- acquired SafeOp, built a lateral franchise. And I think you're seeing the same thing happen again with regard to EOS. And so we can't be more excited about that.

因此，我們開始與人一起建造它——顯然，一切都與人有關——收購了 SafeOp，建立了橫向特許經營權。我認為您會在 EOS 上看到同樣的事情再次發生。所以我們對此感到非常興奮。

And so the value of our informatic set is that it creates an ecosystem. What we've seen is we've seen silos of information. And I think they're less valuable than when you have the opportunity to combine elements.

因此，我們資訊集的價值在於它創造了一個生態系統。我們所看到的是資訊孤島。我認為它們的價值不如你有機會組合元素時的價值。

And it is the proceduralization -- not only mechanically, but informatically -- it's really proceduralization on steroids, the ability to assemble these goods to ultimately improve not only the interoperative element, but the predictive nature of what we're trying to do from an improvement-of-spine-care perspective.

這就是程序化——不僅是機械上的，而且是信息上的——這確實是類固醇的程序化，組裝這些產品的能力最終不僅改善了互操作性元素，而且改善了我們試圖從改善脊柱護理的觀點。

Several years ago, I said that the spine business needs ATEC. And I have never believed it more. And I think that you could look here. And if you think the science is settled when you have a 10% to 15% revision rate within one to three years in short-segment surgery and 25 to 30 in two to five years in deformity surgery, I think you're kidding yourself.

幾年前，我說過脊椎業務需要ATEC。我從未如此相信過。我想你可以看看這裡。如果你認為短節段手術一到三年​​內翻修率達到 10% 到 15%，畸形手術兩到五年內翻修率達到 25% 到 30%，科學就已經確定了，我認為你是在自欺欺人。

And so love being in an area where, clearly, the spine science isn't settled. And I think there's a very clear requirement for spine to have an objective informatic ecosystem. And I think an interesting place to look, really, is that what we're doing here with regard to EOS.

因此，我喜歡待在一個脊柱科學顯然尚未解決的領域。我認為脊椎有一個非常明確的要求，需要有一個客觀的資訊生態系統。我認為一個有趣的地方確實是我們在 EOS 方面所做的事情。

And if you look at the box in the lower left-hand corner, that's what most surgeons see. They see a very focal view. And I think when you pull out, you start to see a more global view, you can see how a limited view really starts to mislead the surgeon.

如果你看一下左下角的方框，你會發現這就是大多數外科醫生看到的。他們看到了非常集中的觀點。我認為當你退出時，你開始看到更全局的觀點，你可以看到有限的觀點如何真正開始誤導外科醫生。

And so one of the beauties of the EOS Insight is that it's going to provide you automation where, at this point, it's alignment measured by hand calculation, which is hugely time-consuming. And it requires software that's, candidly, not very friendly from a workflow perspective.

因此，EOS Insight 的優點之一是，它將為您提供自動化，此時，它的對齊方式是透過手動計算來測量的，這非常耗時。坦白說，從工作流程的角度來看，它需要的軟體不是很友善。

And so when you start to think about spine surgery as being decompression, stabilization, and alignment -- and alignment is the greatest correlative to a long-term successful durable outcome -- and you look back at what the revision rates are with regard to spine surgery, you start to say, gosh, there's a heck of an opportunity to bring objective information into an environment.

因此，當您開始將脊椎手術視為減壓、穩定和對齊時（而對齊是與長期成功持久結果最相關的），您會回顧一下脊椎的翻修率是多少手術後，你開始說，天啊，這是一個將客觀訊息帶入環境的好機會。

And so if science needs to become more settled than it needs to become more settled with data -- and there's not a better source of data than the tool that informs pre-, intra-, and post-op that's completely aligned with surgical goals, back to the surgical goals of decompression, stabilization, and alignment -- you'll love that you have a tool that, ultimately, informs through automated alignment reports, automated surgical planning, pre-bent rods, intraoperative alignment reconciliation, and assessment and follow-up.

因此，如果科學需要變得更加穩定，而不是需要通過數據變得更加穩定，那麼沒有比與手術目標完全一致的為術前、術中和術後提供信息的工具更好的數據來源了，回到減壓、穩定和對齊的手術目標——您會喜歡有一個工具，最終通過自動對齊報告、自動手術計劃、預彎曲桿、術中對齊調節以及評估和跟踪來提供信息。

So it is the data that will provide a pre-, intra-, and post-informatics that will, ultimately, really just provide a richer ecosystem of information. It is very, very straightforward, I think, to be inspired by how it's going to influence deformity.

因此，數據將提供前、內和後資訊學，最終真正提供更豐富的資訊生態系統。我認為，從它將如何影響畸形中獲得靈感是非常非常簡單的。

And data and informatics informs better surgery. Clearly, our opportunity in deformity is apparent. And so in the image respective of an idiopathic deformity, you can see the value that understanding the rotational deformity has with the assembly of the procedure, with the assembly of an understanding of neurologically what's going on, where it's the assembly of the parts that ultimately plays a role.

數據和資訊學為更好的手術提供了資訊。顯然，我們的畸形機會是顯而易見的。因此，在特發性畸形的圖像中，您可以看到理解旋轉畸形對於手術組裝的價值，以及對神經學上正在發生的事情的理解的組裝，其中最終部件的組裝發揮作用。

And so the opportunity within deformity is very clear. And I think it's reflective of the type of demand that ultimately was demonstrated here a few weeks ago at our first annual Deformity Summit. We had 30-plus deformity thought leaders across the field, join us in Carlsbad for the first one and could not be more excited about the understanding and appreciation of the tools that, ultimately, will reflect the sophistication within the field.

因此，畸形中的機會是非常明顯的。我認為這反映了幾週前我們第一屆年度畸形高峰會最終展示的需求類型。我們在該領域擁有 30 多名畸形思想領袖，第一次在卡爾斯巴德加入我們，我們對這些工具的理解和欣賞感到無比興奮，這些工具最終將反映該領域的複雜性。

And so when you start to think about, really, a unique dynamic that sits in a 5% market shareholder's bag is an ecosystem that informs, not only the preoperative element in terms of who to operate on and why, but also the intraoperative element, which enables a procedural understanding of, not only informatic needs, but also the mechanical needs in a workflow that, ultimately, begets predictability; and then informing that again with regard to the post-op information that comes from the exact same image that was taken for the preop and the plan.

因此，當你開始思考時，實際上，5% 市場股東手中的一個獨特動態是一個生態系統，它不僅告知術前要對誰進行手術以及為何進行手術，還告知手術中的要素，這不僅能夠對資訊需求進行程序性理解，而且還能對工作流程中的機械需求進行理解，最終產生可預測性；然後再次告知術後訊息，這些訊息來自為術前和計劃拍攝的完全相同的圖像。

So great year in 2023. Clearly, there's momentum. But the beauty is what's in front of us. And so we will continue to expand our lateral sophistication with regard to new products and broader and deeper sales footprint. We're literally just, I think, starting off in international, had a decent year in Australia and New Zealand and about to get into Japan.

2023 年真是美好的一年。顯然，有動力。但美麗就在我們眼前。因此，我們將繼續擴大新產品的橫向成熟度以及更廣泛、更深的銷售足跡。我認為，我們實際上只是從國際比賽開始，在澳洲和紐西蘭度過了不錯的一年，即將進入日本。

More hospitals are providing us access based upon our clinical distinction. We love, love, love the market dynamics of disruption and apathy.

更多醫院根據我們的臨床特點為我們提供訪問機會。我們熱愛、熱愛、顛覆、冷漠的市場動態。

The integration of a more sophisticated, integrated navigation robotic element into what we're doing laterally, the whole navigation robotics plus neurophysiology in real time, providing informational feedback, we love that. And we're just getting going on the EOS front with regard to the EOS Insight.

將更複雜的整合導航機器人元素整合到我們正在做的橫向工作中，整個導航機器人加上即時的神經生理學，提供資訊回饋，我們喜歡這一點。我們剛開始討論 EOS 前沿的 EOS Insight。

So I would say that there's a lot of momentum, and there's more to come. And so with that, I'll turn it over to Todd.

所以我想說，現在有很大的動力，而且還會有更多的動力。因此，我會將其交給托德。

Well, thanks, Pat, and good afternoon, everyone. We appreciate you joining us on the call today. I'll begin with revenue.

好吧，謝謝帕特，大家下午好。我們感謝您今天加入我們的電話會議。我將從收入開始。

Fourth-quarter total revenue was $138 million, reflecting 30% growth compared to the prior year and a 17% increase compared to the prior quarter. The $138 million in revenue was comprised of $123 million in surgical revenue and $15 million of EOS revenue.

第四季總營收為 1.38 億美元，年增 30%，季增 17%。1.38 億美元的收入包括 1.23 億美元的手術收入和 1,500 萬美元的 EOS 收入。

Fourth-quarter surgical revenue of $123 million increased 34% against a tough 49% previous-year comparison, with strong contribution from our entire portfolio. Underlying that surgical revenue growth was robust procedural volume, which grew 29% this quarter.

第四季手術收入為 1.23 億美元，與去年同期的 49% 相比成長了 34%，這得益於我們整個投資組合的強勁貢獻。手術收入成長的基礎是強勁的手術量，本季成長了 29%。

That is an acceleration compared to the third-quarter procedural volume growth of 24%. The growth reflects both a solid increase in the number of surgeons adopting ATEC procedures and an increase in surgeon utilization.

與第三季 24% 的程式量成長相比，這是一個加速成長。這一增長反映出採用 ATEC 手術的外科醫生數量的穩定增加以及外科醫生利用率的提高。

Average revenue per case grew 4% year over year, driven by increased mix of lateral surgeries and expanding biologics attach rate and greater case complexity. Increasing mix of cervical surgeries is offsetting those tailwinds to some degree. And EOS revenue in the fourth quarter was $15 million, up 5% compared to last year.

由於側向手術組合的增加、生物製劑附著率的擴大以及病例複雜性的增加，每例平均收入年增 4%。子宮頸手術的不斷增加在一定程度上抵消了這些不利因素。EOS第四季營收為1500萬美元，比去年成長5%。

Turning to results for the full-year 2023. Total revenue was $482 million, reflecting 37% growth compared to 2022. That was comprised of $423 million in surgical revenue and $59 million of EOS revenue. Full-year surgical revenue grew 40% compared to the prior year, absolute dollar growth of $120 million.

轉向 2023 年全年業績。總營收為 4.82 億美元，較 2022 年成長 37%。其中包括 4.23 億美元的手術收入和 5,900 萬美元的 EOS 收入。全年手術收入較前一年成長 40%，絕對美元成長 1.2 億美元。

Procedural volume grew 31% year over year, which accelerated compared to the 25% volume growth in 2022. Volume growth in 2023 was underpinned by a 27% increase in surgeon users. Average revenue per case grew 7%, driven by increased mix of lateral surgeries and expanding biologics attach rate and greater case complexity.

程式數量年增 31%，與 2022 年 25% 的數量增長相比有所加快。2023 年銷售成長的基礎是外科醫生用戶增加 27%。由於側向手術組合的增加、生物製劑附著率的擴大以及病例複雜性的增加，每例平均收入增加了 7%。

The increasing mix of cervical surgeries is offsetting those tailwinds to some degree. EOS of $59 million grew 24% over full-year 2022 on continued strong interest in the technology. A geographical mix shift towards the US is also benefiting EOS ASPs.

子宮頸手術的日益增多在一定程度上抵消了這些不利因素。由於人們對這項技術的持續濃厚興趣，EOS 的價值為 5,900 萬美元，比 2022 年全年增長了 24%。地理結構向美國的轉變也使 EOS ASP 受益。

Now, before I work through the remainder of the P&L, I'll spend a moment on the updated definition of non-GAAP that we have adopted. For those of you that have followed the ATEC transformation since its inception, you know that the creation of clinical distinction was our number-one commitment, a priority that catalyzed the complete overhaul of the product portfolio. That overhaul generated material but non-cash excess and obsolete inventory charges or E&O, as legacy product portfolio were obviated and discontinued.

現在，在討論損益表的其餘部分之前，我將花一些時間討論我們採用的非公認會計原則的更新定義。對於那些自 ATEC 轉型以來一直關注其轉型的人來說，您知道創造臨床差異是我們的首要承諾，而這項優先事項促進了產品組合的全面改革。由於遺留產品組合被淘汰和停產，這項改革產生了實質但非現金的過剩和過時的庫存費用或 E&O。

To help investors assess the core performance of our business throughout that process, we determined it was appropriate to exclude E&O charges from our calculation of non-GAAP cost of goods sold. Thankfully, that transition is largely behind us. Now, the E&O charges we are taking are a recurring aspect of our current business operations.

為了幫助投資者評估我們整個流程中業務的核心業績，我們認為在計算非公認會計準則銷售商品成本時排除 E&O 費用是適當的。值得慶幸的是，這種轉變基本上已經過去了。現在，我們收取的 E&O 費用是我們當前業務運營的一個經常性的方面。

As a result, the non-GAAP financial results and guidance for 2024 that we share today include the non-cash charge as part of the calculation for cost of goods sold and adjusted EBITDA. You can see from this reconciliation that the inclusion of E&O and cost of goods sold impacts reported gross profit and thus, adjusted EBITDA by about $4 million in the fourth quarter of 2023.

因此，我們今天分享的 2024 年非 GAAP 財務業績和指引包括非現金費用，作為銷售商品成本和調整後 EBITDA 計算的一部分。從這個調節表中您可以看到，E&O 和銷售成本的納入影響了報告的毛利，因此，2023 年第四季度調整後的 EBITDA 增加了約 400 萬美元。

Fourth-quarter adjusted EBITDA under the previous non-GAAP definition would have been $6 million, drop-through on incremental revenue dollars of 28% and strong performance compared to the $5 million expectations implied by previous guidance.

根據先前的非 GAAP 定義，第四季度調整後 EBITDA 將為 600 萬美元，增量收入下降 28%，與先前指引所暗示的 500 萬美元預期相比，業績表現強勁。

With respect to the full year, the inclusion of E&O and cost of goods sold impacts gross profit and adjusted EBITDA by about $14 million. Full-year 2023 adjusted EBITDA under the previous non-GAAP definition would have been $4 million, reflecting drop-through of 25% on incremental revenue dollars and ahead of the $3 million that we guided to last quarter.

就全年而言，包含 E&O 和銷售成本會影響毛利和調整後 EBITDA 約 1,400 萬美元。 2023年全年根據先前非公認的會計準則定義，調整後的 EBITDA 將為 400 萬美元，反映出增量收入下降了 25%，高於我們上季指導的 300 萬美元。

I'd like to first emphasize, one, this updated definition of non-GAAP does not have a material impact on either the degree of margin expansion reported in 2023 or on the degree of expansion that we expect going forward. Under both the prior definition and the updated definition, 2023 adjusted EBITDA expanded 890 basis points year over year.

我想首先強調，第一，這項更新的非 GAAP 定義不會對 2023 年報告的利潤率擴張程度或我們預期的未來擴張程度產生重大影響。根據先前的定義和更新後的定義，2023 年調整後 EBITDA 年成長 890 個基點。

Second, E&O inventory expense is a non-cash item and has zero impact on our commitment to achieve cash flow breakeven in 2025. We shared a reconciliation of the updated definition on previously reported periods in the appendix of this deck and in a supplementary financial filing. Both documents are accessible from our IR website.

其次，E&O 庫存費用是非現金項目，對我們在 2025 年實現現金流損益平衡的承諾影響為零。我們在本套的附錄和補充財務文件中分享了先前報告期間的更新定義的調節表。這兩份文件均可從我們的 IR 網站存取。

Now, I'll turn to the results for the remainder of the P&L, which incorporates the updated non-GAAP definition I just shared. Fourth-quarter non-GAAP gross margin was 70%, up 310 basis points compared to the prior year.

現在，我將討論損益表其餘部分的結果，其中包含我剛剛分享的更新的非 GAAP 定義。第四季非 GAAP 毛利率為 70%，較上年增加 310 個基點。

The year-over-year increase was primarily driven by improved EOS gross margin, which is benefiting from the execution as we improve service operations and from pricing initiatives. Additionally, surgical revenue mix and operations efficiencies drove margin improvement in the quarter.

年比成長主要是由於 EOS 毛利率的提高，這得益於我們改善服務營運的執行和定價措施。此外，手術收入組合和營運效率推動了本季利潤率的提高。

Fourth-quarter non-GAAP R&D was $13 million and approximately 10% of sales, compared to $11 million and 10% of sales in the prior year. The increase on an absolute dollar basis was driven by continued investment in organic innovation and investment related to Valence, the robotic navigation platform that we acquired in 2023.

第四季非 GAAP 研發費用為 1,300 萬美元，約佔銷售額的 10%，而前一年為 1,100 萬美元，約佔銷售額的 10%。以絕對美元計算的成長是由對有機創新的持續投資以及與我們於 2023 年收購的機器人導航平台 Valence 相關的投資所推動的。

Non-GAAP SG&A was $93 million and approximately 68% of sales in the fourth quarter, compared to $74 million and 70% of sales in the prior-year period. We delivered 230 basis points of net improvement even after investing in both the US and international sales channels. In line with the last several quarters, leverage is being driven by the expected contributors: infrastructure leverage and variable-rate improvements.

非 GAAP SG&A 為 9,300 萬美元，約佔第四季銷售額的 68%，去年同期為 7,400 萬美元，約佔銷售額的 70%。即使在對美國和國際銷售管道進行投資之後，我們仍實現了 230 個基點的淨改善。與過去幾季的情況一致，槓桿率是由預期貢獻者驅動的：基礎設施槓桿率和可變利率改善。

Total non-GAAP operating expenses amounted to $107 million and approximately 77% of sales in the fourth quarter, compared to $85 million and 80% of sales in the prior-year period, demonstrating 270 basis points of operating leverage year over year.

第四季非 GAAP 營運支出總額為 1.07 億美元，約佔銷售額的 77%，而去年同期為 8,500 萬美元，佔銷售額的 80%，營運槓桿較去年同期成長 270 個基點。

Adjusted EBITDA was $2 million and approximately 1% of sales in the fourth quarter, compared to a $6 million loss that represented 5% of sales in the prior year, a 650-basis-point improvement as a percent of sales. The consistent adjusted EBITDA margin expansion that we are driving underscores our confidence in achieving the long-term profitability goals we've committed to.

調整後的 EBITDA 為 200 萬美元，約佔第四季銷售額的 1%，而去年同期虧損 600 萬美元，佔銷售額的 5%，佔銷售額的百分比提高了 650 個基點。我們正在推動的調整後 EBITDA 利潤率的持續擴張凸顯了我們對實現我們承諾的長期獲利目標的信心。

Turning to full-year 2023 results. Non-GAAP gross margin was 70%, up 220 basis points compared to the prior year. Non-GAAP R&D for the full year was $51 million and approximately 11% of sales, compared to $39 million, an improvement of 40 basis points compared to the prior year.

轉向 2023 年全年業績。非 GAAP 毛利率為 70%，較上年增加 220 個基點。全年非 GAAP 研發費用為 5,100 萬美元，約佔銷售額的 11%，去年為 3,900 萬美元，比前一年提高了 40 個基點。

2023 non-GAAP SG&A was $335 million and approximately 70% of sales, compared to $267 million, an improvement of 660 basis points compared to the prior year. Total non-GAAP operating expenses for the full year amounted to $387 million and approximately 80% of sales, compared to $306 million, an improvement of 700 basis points compared to the prior year period.

2023 年非 GAAP SG&A 為 3.35 億美元，約佔銷售額的 70%，去年為 2.67 億美元，比前一年提高了 660 個基點。全年非 GAAP 營運費用總額為 3.87 億美元，約佔銷售額的 80%，而去年同期為 3.06 億美元，比去年同期提高了 700 個基點。

2023 adjusted EBITDA was a loss of $9 million and approximately 2% of sales, an improvement of $29 million and 890 basis points compared to full-year 2022. The magnitude of drop-through or the contribution of incremental revenue dollars to adjusted EBITDA was 22% for the full year and 26% in the second half of 2023.

2023 年調整後 EBITDA 損失 900 萬美元，約佔銷售額的 2%，與 2022 年全年相比增加 2,900 萬美元，增加 890 個基點。全年的下降幅度或增量收入對調整後 EBITDA 的貢獻為 22%，2023 年下半年為 26%。

We demonstrated an ability to grow the top line and significantly expand profitability margins while also investing in the future growth of the business. For example, investments in Valence and international combined comprised almost 110 basis points of adjusted EBITDA for the full-year 2023. These investments will drive growth and profitability in the business beyond 2024.

我們展示了增加收入並顯著擴大利潤率的能力，同時也投資於業務的未來成長。例如，Valence 和 International 的投資總計佔 2023 年全年調整後 EBITDA 的近 110 個基點。這些投資將在 2024 年以後推動業務成長和獲利。

Turning to the balance sheet. We ended the fourth quarter with $221 million in cash, and year-end debt at carrying value was $527 million. Free cash use totaled $51 million, with $35 million of that invested in the inventory and instruments that support our growing distribution footprint and new product launches.

轉向資產負債表。截至第四季末，我們的現金為 2.21 億美元，年末債務帳面價值為 5.27 億美元。自由現金使用總額為 5,100 萬美元，其中 3,500 萬美元投資於庫存和工具，以支援我們不斷增長的分銷足跡和新產品發布。

As you can see on the chart at the bottom of this slide, adjusted EBITDA improvements are benefiting operating cash use. Cash use for revenue-generating assets stepped up in the fourth quarter, as we invested in instruments and inventory to enable recent sales recruitment wins that serve surgeries.

正如您在本投影片底部的圖表中看到的那樣，調整後的 EBITDA 改善有利於營運現金的使用。第四季度創收資產的現金使用增加，因為我們投資了儀器和庫存，以實現最近為手術服務的銷售招聘。

As we communicated previously, our recent raise will fund the revenue-generating assets required for the teams we have already onboarded and those that we will onboard in the future. And that investment has an attractive ROI of about 3 times over the course of five years.

正如我們之前所傳達的，我們最近的融資將為我們已經加入的團隊和未來將加入的團隊所需的創收資產提供資金。該投資在五年內的投資報酬率約為 3 倍，頗具吸引力。

In 2024, we will continue to put that capital to work, expecting to use approximately $100 million of cash for the full year. We anticipate cash use to be front-end loaded, with the magnitude of investment in Q1 stepping up relative to the Q4 2023 and Q2 stepping down relative to Q1 and the second half of the year progressing towards breakeven.

2024 年，我們將繼續運用這些資金，預計全年將使用約 1 億美元的現金。我們預期現金使用將是前端負載，第一季的投資規模相對於 2023 年第四季有所增加，第二季的投資規模相對於第一季有所下降，下半年將逐步實現損益兩平。

Turning to our outlook for the full-year 2024. Consistent with our January pre-release, we expect continued portfolio-wide momentum to drive full-year 2024 total revenue growth of 23%, to approximate $595 million.

轉向我們對 2024 年全年的展望。與我們 1 月預發布的信息一致，我們預計整個投資組合的持續勢頭將推動 2024 年全年總收入增長 23%，達到約 5.95 億美元。

That includes 2024 surgical revenue growth of approximately 25% to $530 million, and EOS revenue of approximately $65 million. Note that EOS revenue in 2023 benefited from purchases related to our decision to exit nonstrategic geographies, creating a tougher growth comparison to 2024.

其中包括 2024 年手術收入成長約 25% 至 5.3 億美元，EOS 收入約 6,500 萬美元。請注意，2023 年的 EOS 收入受益於我們退出非戰略地區的決定相關的購買，與 2024 年相比，成長更加艱難。

As sales growth powers leverage across our business, we expect to achieve continued solid profitability progress. We expect full-year 2024 adjusted EBITDA of approximately $22 million, inclusive of an $18 million E&O inventory provision. Using the prior definition of non-GAAP, 2024 adjusted EBITDA guidance would have approximated $40 million.

隨著銷售成長推動我們整個業務的槓桿作用，我們預計將實現持續穩健的獲利進步。我們預計 2024 年全年調整後 EBITDA 約為 2,200 萬美元，其中包括 1,800 萬美元的 E&O 庫存撥備。使用先前非 GAAP 的定義，2024 年調整後的 EBITDA 指引將約為 4,000 萬美元。

We expect to deliver 560 basis points of adjusted EBITDA margin expansion progress on top of the 890 basis points of progress delivered in 2023. That positions us well to achieve our long-term profitability and free cash flow commitments.

我們預計，在 2023 年實現 890 個基點的進展基礎上，調整後 EBITDA 利潤率擴張進展將達到 560 個基點。這使我們能夠很好地實現長期盈利和自由現金流承諾。

The next few slides provide additional context for 2024 guidance. I'll start with how our expectations for procedural volume and average revenue per surgery growth shape surgical revenue guidance.

接下來的幾張投影片為 2024 年指導提供了更多背景資訊。我將從我們對手術量和每次手術平均收入成長的預期如何影響手術收入指導開始。

The clinical distinction we have created has driven a robust rate of surgeon adoption and utilization. Surgeon user growth has consistently been strong, growing 27% in 2023.

我們創造的臨床優勢推動了外科醫生的採用和使用率的強勁成長。外科醫生用戶成長一直強勁，到 2023 年將成長 27%。

Another possibly less appreciated, yet consistent and sustainable, aspect of volume growth is surgeon utilization. The top middle chart is a testament to the consistent ramp in utilization that our surgeon cohorts demonstrate each year.

體積增長的另一個可能不太受重視但持續且可持續的方面是外科醫生的利用率。頂部中間的圖表證明了我們的外科醫生隊列每年都表現出利用率的持續增長。

Our procedures build surgeon confidence, which inspires loyalty and empowers surgeons to work up the procedural complexity curve, both of which increase utilization. Each new surgeon relationship that we establish typically unlocks a multiyear utilization growth opportunity. We expect these dynamics to fuel about 20% procedure volume growth for the full-year 2024.

我們的手術建立了外科醫生的信心，激發了外科醫生的忠誠度，並使外科醫生能夠提高手術的複雜性曲線，這兩者都提高了利用率。我們建立的每一個新的外科醫生關係通常都會釋放多年的利用率成長機會。我們預計這些動態將推動 2024 年全年手術量成長約 20%。

Average revenue per surgery grows as our mix shifts towards procedures that require more products per surgery, like ETP and LTP, and towards surgeries with greater complexity, all of which feature higher revenue per procedure than our overall average.

隨著我們的組合轉向每次手術需要更多產品的手術（如ETP 和LTP）以及更複雜的手術（所有這些手術的每次手術收入都高於我們的整體平均水平），每次手術的平均收入也在成長。

The increase in procedural complexity and increasing biologics test rate are also tailwinds. The revenue growth that recent cervical innovation is delivering is a slight headwind to average revenue per case, as cervical cases feature a lower-than-average ASP. We expect these dynamics to drive mid-single-digit percent growth in average revenue per case for the full-year 2024.

程序複雜性的增加和生物製劑測試率的提高也是有利因素。最近的子宮頸創新帶來的收入成長對每個病例的平均收入略有阻礙，因為子宮頸病例的平均售價低於平均水平。我們預計這些動態將推動 2024 年全年每箱平均收入實現中個位數百分比成長。

Now turning to our expectations for the adjusted EBITDA guidance. Adjusted EBITDA of $22 million for the full-year 2024 implies 560 basis points of improvement and approximately 28% drop-through on the year-over-year growth in revenue dollars, compared to 26% drop-through in the second half of '23.

現在轉向我們對調整後 EBITDA 指引的預期。2024 年全年調整後 EBITDA 為 2,200 萬美元，意味著營收成長了 560 個基點，營收年增率下降了約 28%，而 2023 年下半年下降了 26% 。

The degree of progress that we have delivered and the drivers of expected leverage contributing as planned give us great confidence in continued operating profitability improvement. We expect the components delivering leverage to continue to be consistent with what we described in our long-range plan that we gave in May of 2022.

我們所取得的進展以及按計劃貢獻的預期槓桿驅動因素使我們對持續改善經營盈利能力充滿信心。我們預計提供槓桿作用的組件將繼續與我們在 2022 年 5 月給出的長期計劃中描述的內容保持一致。

2023 was a remarkable year, a financial reflection of execution. It marked our inflection to profitability. It presented us with an unprecedented competitive opportunity, one that we seized, equipping our balance sheet with cash to invest in the high-return, revenue-generating assets that will fuel growth in the years to come.

2023 年是非凡的一年，是執行力的財務反映。它標誌著我們盈利能力的轉折。它為我們提供了前所未有的競爭機會，我們抓住了這個機會，用現金配置我們的資產負債表，投資於高回報、創收資產，這些資產將推動未來幾年的成長。

The profitability progress we have and will continue to make, along with a well-funded balance sheet, position us to progress toward cash flow breakeven in 2025 and self-funded growth thereafter. That the sector-leading growth that we are driving is dovetailing with the delivery of significant operating leverage is no accident.

我們已經並將繼續取得的獲利進展，加上資金充足的資產負債表，使我們能夠在 2025 年實現現金流盈虧平衡，並在此後實現自籌資金增長。我們所推動的產業領先成長與顯著營運槓桿的實現相吻合並非偶然。

We committed to a financial plan, and we are executing to that plan. And in doing so, we have set the stage for continued value creation. This once-scrappy David-and-Goliath-style spine story continues to shift into a very different kind of story: one of profitable, sustainable, long-term growth. Our best is truly yet to come.

我們制定了一項財務計劃，並且正在執行該計劃。透過這樣做，我們為持續創造價值奠定了基礎。這個曾經鬥志旺盛的大衛與歌利亞式的故事繼續轉變為一個截然不同的故事：一個盈利、可持續、長期增長的故事。我們最好的時刻還沒到來。

And that's a great segue to remind you of our long-range plan update on March 19 in New York City. The event will feature additional detail about our plans for profitable growth, adding two years on to the long-range plan that exists today. If you plan to join us in person, please RSVP through our IR website. And for those that can't physically attend, the event will also be webcast. We hope to see you there.

這是一個很好的延續，旨在提醒您我們 3 月 19 日在紐約市更新的長期計劃。此次活動將詳細介紹我們的獲利成長計劃，為現有的長期計劃增加兩年。如果您計劃親自加入我們，請透過我們的 IR 網站回覆。對於那些無法親自參加的人，該活動也將透過網路直播。我們希望看到你在那裡。

With that, I will turn the call back to Pat.

這樣，我會將電話轉回給帕特。

Thanks much, Todd. I will tell you that what brings us here is our spine-focused momentum. I can't be more deliberate with regard to the value of being focused and aligned with a customer base on a very specific segment of the orthopedic market.

非常感謝，托德。我會告訴你，是什麼把我們帶到了這裡，是我們以脊椎為中心的動力。對於專注於骨科市場特定細分市場的客戶群並與其保持一致的價值，我深思熟慮。

And so that brings about 40% revenue growth. It brings about a huge opportunity forward with a disrupted market. It brings about growth that is profitable from a sales perspective and a lot of momentum driven by the things that I spoke to previously.

這帶來了約 40% 的收入成長。它為混亂的市場帶來了巨大的機會。從銷售角度來看，它帶來了有利可圖的成長，並帶來了我之前談到的事情驅動的大量動力。

So anyway, super excited about 2023. Celebrated a big year with our national sales meeting as of late. And I think we go into 2024 with significant momentum.

無論如何，我對 2023 年感到非常興奮。最近我們透過全國銷售會議慶祝了重要的一年。我認為我們將以強勁的勢頭進入 2024 年。

So with that, we will take questions.

因此，我們將回答問題。

(Operator Instructions) Matthew O'Brien, Piper Sandler.

（操作員說明）Matthew O'Brien、Piper Sandler。

Hey, this is Phil, on for Matt. Thanks for taking our questions, and congrats on the excellent quarter. I was just curious if you could provide an update on the rep hiring cadence you've seen since your last update, I guess, Q3.

嘿，這是菲爾，替馬特發言。感謝您提出我們的問題，並祝賀這個出色的季度。我只是好奇您是否可以提供自上次更新（我想是第三季）以來您所看到的代表招募節奏的最新資訊。

How much disruption is still out there? And you've talked about being under-indexed in certain US geographies in the past. Any update on that front from these adds?

仍然存在多少幹擾？您過去曾談到美國某些地區的指數不足。這些補充在這方面有什麼更新嗎？

I would say 94% of the market is still disrupted. I'm just kidding. We're almost 6%. These things take a long time to play out. And I would say that the approach that we're taking is one of methodical nature.

我想說 94% 的市場仍然處於混亂狀態。我只是在開玩笑。我們幾乎是 6%。這些事情需要很長時間才能發揮出來。我想說的是，我們正在採取的方法是一種有條不紊的方法。

And so we have areas of great need. We have areas of adjacent need. And so what we're trying to do is identify where we're going to get the most expedient influence that we can with the best people that we can.

所以我們有非常需要的領域。我們有鄰近的需求領域。因此，我們要做的就是確定我們將在哪裡與最優秀的人才一起獲得最有利的影響力。

This is going to play itself out over a three- to five-year period. I love those who think it's a 12-month phenomenon. It's not. It will be rewarded by those who play long.

這將在三到五年的時間內自行顯現。我喜歡那些認為這是 12 個月現象的人。它不是。玩久了的人會得到獎勵。

And so the great part is there's plenty to do. Our portfolio becomes richer and richer with regard to its distinction. And I just can't be more enthusiastic with regard to an improving portfolio with probably a best-in-class commission rate.

所以最重要的是有很多事情要做。我們的產品組合因其獨特性而變得越來越豐富。我對不斷改進的投資組合以及可能是同類最佳的佣金率感到無比熱情。

And I thought the kind of reflects all of that stuff that's going on, lots of interest.

我認為這反映了所有正在發生的事情，非常有趣。

That's helpful. And I guess just on that same story line with respect to guidance, is there any guardrails around cadence through the year? As these rep hires and recent rep hires ramp and you're going to continue to hire this quarter as well, do you expect it to ramp fairly uniformly through the year? Or is there going to be a bigger jump in the back half?

這很有幫助。我想就指導而言，在同樣的故事情節上，全年的節奏是否有任何護欄？隨著這些代表的招聘和最近的代表招聘的增加，並且您也將在本季度繼續招聘，您是否預計全年的增長會相當均勻？還是後半段會有更大的跳躍？

Yup. I'll let Todd speak to the numeric reflection if there is one. What, I think, so often happens is revenue is a lag indicator. And it's a lag indicator for bringing people over, getting access to the hospitals, getting the surgeons familiar with the goods.

是的。如果有的話，我會讓托德談談數位反射。我認為，經常發生的情況是收入是一個落後指標。它是讓人們過來、進入醫院、讓外科醫生熟悉產品的落後指標。

But there's a lot that goes into it. And so the immediacy of the influence is somewhat muted. And so my concern always is kind of the overenthusiastic view on someone who just comes over. If we're playing long, our view is that these guys got to help us in the years to come. And we want to prepare them to do so with an unbelievable portfolio and with unbelievable training.

但其中涉及很多內容。因此，影響的直接性有些減弱。所以我擔心的總是對剛來的人過於熱情的看法。如果我們打得很長，我們的觀點是這些人必須在未來幾年幫助我們。我們希望透過令人難以置信的作品集和令人難以置信的培訓來讓他們做好準備。

And Phil, I'd tell you the way we constructed the guidance, really, was reflecting the organization that we have here kind of coming out of the fourth quarter and really, allowing new rep adds to be upside to that, and execution of the underlying business really driving the strength of the guide.

菲爾，我想告訴你我們建立指導的方式，實際上，反映了我們這裡的組織，實際上是從第四季度開始的，允許新的代表增加這一點，並執行底層業務確實是驅動力的引導。

And so I think we've set up the year well in that regard. And as a reminder, our guidance philosophy is to put numbers out there that we believe we can achieve and have a reasonable opportunity to exceed.

所以我認為我們在這方面已經做好了今年的準備。提醒一下，我們的指導理念是列出我們相信可以實現並有合理機會超越的數字。

I think as it relates to cadence, I think as you see normal seasonality cadence, you typically have a step down from Q4 to Q1, a step up to Q2. Kind of Q2 to Q3 is flattish, and then a step up in Q4. And so I think that overall shape of the curve will remain. And I think, fundamentally, where we land overall will really be a reflection of the underlying strength of the business as we go throughout the year.

我認為，由於它與節奏有關，我認為當你看到正常的季節性節奏時，你通常會從第四季度下降到第一季度，然後上升到第二季度。第二季到第三季表現平平，然後第四季有所上升。所以我認為曲線的整體形狀將保持不變。我認為，從根本上說，我們的整體排名確實反映了我們全年業務的潛在實力。

Makes sense. Thanks so much for taking the question.

說得通。非常感謝您提出問題。

Matt Blackman, Stifel.

馬特·布萊克曼，史蒂菲爾。

Hi, this is Emily, on for Matt. Just wondering if you can provide some color on the trainings that you've had thus far this year and expect to have in terms of what you're seeing for demand versus prior years, or anything on the mix of new versus existing ATEC users or lateral versus non-lateral. Anything there you can help us with?

嗨，我是艾米麗，替馬特發言。只是想知道您是否可以提供一些關於您今年迄今為止所接受的培訓的信息，以及您所看到的需求與往年相比的預期，或者有關新ATEC 用戶與現有ATEC 用戶的組合的任何信息，或橫向與非橫向。您有什麼可以幫助我們的嗎？

Yeah. I hope I can help you; I'm not sure I will. The dynamic becomes -- I think people have come here to learn lateral from Luiz Pimenta, Bill Taylor, Vedat Deviren. These guys are unbelievable lateral surgeons. And there's a whole slew of them.

是的。我希望我能幫助你；我不確定我會。我認為人們來這裡是為了向 Luiz Pimenta、Bill Taylor、Vedat Deviren 學習橫向知識。這些人是令人難以置信的側向外科醫生。而且有很多。

And so the dynamic is, I think, surgeons come here to learn lateral. And then I think that they're inspired by the other things. And so the continuation of the expanded indications of the portfolio would indicate that we're going to get some people who are returning because what they're doing is they're expanding their application of, say, PTP.

我認為，動態是外科醫生來這裡學習橫向知識。然後我認為他們受到其他事物的啟發。因此，繼續擴大投資組合的適應症將表明我們將讓一些人回歸，因為他們正在做的是擴大他們的應用，例如 PTP。

We're starting to see the early experience with regard to corpectomy, which is really fun, just from a standpoint of, if you're laying on your stomach, you get to control the back of the spine and the front of the spine in the same sitting. And there's just some real advantages from kind of a big surgery perspective. And so that part of it is great.

我們開始看到有關椎體切除術的早期經驗，這真的很有趣，只是從一個角度來看，如果你趴著，你就可以控制脊椎的後部和脊椎的前部同樣的坐姿。從大手術的角度來看，確實有一些真正的優勢。所以這部分很棒。

And so we're seeing some return, but we're also seeing a ton of new interest. And I think you saw that through the numbers on new surgeon contribution. There's a lot of interest, and there's a lot of geography that we haven't touched yet.

因此，我們看到了一些回報，但我們也看到了大量的新興趣。我想你透過新外科醫生貢獻的數字看到了這一點。有很多興趣，還有很多我們還沒接觸過的地理知識。

And so we feel like it's the right combination of people who have already adopted, who are expanding; new people coming in. And so that's kind of the demographic.

因此，我們覺得這是已經採用、正在擴展的人員的正確組合；新人進來。這就是人口統計。

Okay. Great. And just maybe to expand on that one piece in terms of the expanded indications for lateral. So we've had the $1 billion bucket and the $2 billion bucket of TLIF/PLIF for a while.

好的。偉大的。也許只是在橫向擴展適應症方面擴展這塊。因此，我們已經擁有 10 億美元和 20 億美元的 TLIF/PLIF 桶一段時間了。

Is there any kind of traction moving into that bigger bucket? And would maybe an influx of experienced lateral surgeons that may be new to ATEC accelerate that trend?

是否有任何牽引力進入更大的水桶？經驗豐富的側向外科醫生（可能是 ATEC 新手）的湧入是否會加速這一趨勢？

Yeah. It's a great question, and the answer is yes. And so I think when you start to see, like, more of a newer footprint of surgeons who come over, I think just the familiarity and the comfort in navigating the retroperitoneal space, which is core to the lateral approach, and so no matter what the position, these guys are very comfortable in terms of doing that. And so the opportunity to expand indications is going to be faster.

是的。這是一個很好的問題，答案是肯定的。所以我認為，當你開始看到更多外科醫生過來的新足跡時，我認為導航腹膜後空間的熟悉度和舒適度是橫向入路的核心，所以無論發生什麼就這個職位而言，這些人對此感到非常自在。因此擴大適應症的機會將會更快。

And so if you think about kind of the cadence of our products to engage that space, we wanted to make sure that we built a great procedure with a patient positioner, with a retractor and instruments, and all the necessary elements, but then was super sophisticated on the SafeOp front.

因此，如果您考慮我們的產品融入該空間的節奏，我們希望確保我們使用患者定位器、牽開器和器械以及所有必要的元件構建了一個出色的程序，但隨後是超級SafeOp 方面的複雜性。

And then we thought that would inform us to be able to lock up the indications for surgery. And so you saw a regular static implant, then an expandable implant. Now you're seeing a corpectomy. And so you're seeing the kind of walk-up of sophisticated applications of surgery.

然後我們認為這將使我們能夠鎖定手術適應症。因此，您看到了常規的靜態植入物，然後是可擴展的植入物。現在你看到的是椎體切除術。因此，您將看到複雜的外科手術應用的進展。

And so it's -- the more informed, the more sophisticated the lateral user, the faster they will uptake and the more indications for surgery that they will utilize. And so previously, if there was, like, compressive material in the posterior part of the spine, it would indicate, gosh, I should do a TLIF because I can't do a decompression with the patient in the lateral position.

因此，橫向使用者越了解情況、越老練，他們接受的速度就越快，他們使用的手術適應症就越多。所以以前，如果脊椎後部有壓縮物質，那就表明，天哪，我應該做 TLIF，因為我無法對處於側臥位的患者進行減壓。

The advent of PTP avails the opportunity to do all of what you would normally do with a patient in a prone position and approach from the back and do a direct decompression, but also get all the benefits of lateral in that position. And so that's our enthusiasm with PTP, and that's how we're seeing kind of the utilization. But if you're a lateral surgeon, what we're seeing is a faster uptake.

PTP 的出現使您有機會執行通常對處於俯臥位的患者所做的所有操作，從背部接近並進行直接減壓，同時還可以獲得該位置側臥的所有好處。這就是我們對 PTP 的熱情，這就是我們所看到的利用方式。但如果您是側外科醫生，我們會看到更快的採用速度。

And Emily, it really makes a lot of sense when you look at that and you understand that that kind of translates into more procedures or more products through the procedure. So products per case goes up. Revenue per procedure kind of gets some tailwinds through that.

艾米麗，當你看到這一點並且你明白這會轉化為更多的程序或通過該程序產生更多產品時，這確實很有意義。因此每箱產品的數量有所增加。每個程序的收入因此得到了一些推動。

Plus, as Pat said, when they apply it to more complex pathologies, oftentimes, that means either more procedures within their practice get to use TTP, or there are more levels in that procedure, both of which and all of which really contribute to this great same-store sales growth that you see. Because, ultimately, the utilization of procedures just continues to expand and broaden the more that we offer it and the more they get comfortable with it.

另外，正如Pat 所說，當他們將其應用於更複雜的病理學時，通常意味著他們的實踐中要么有更多的程序使用TTP，要么該程序中有更多的級別，這兩者都真正有助於這一點您看到的同店銷售大幅成長。因為最終，我們提供的程式越多，他們就越適應，程式的使用就會不斷擴大和拓寬。

At a higher price because of the sophistication (inaudible)

由於工藝複雜，價格較高（聽不清楚）

Great. Thanks so much.

偉大的。非常感謝。

Vik Chopra, Wells Fargo.

維克喬普拉，富國銀行。

Hey, good afternoon, and thanks for taking the questions. Just two for me. So you talked about 15 new product launches and line extensions in 2023.

嘿，下午好，感謝您提出問題。對我來說只有兩個。您談到了 2023 年將推出 15 款新產品和產品線擴展。

Can we expect a similar thing in 2024? And maybe just talk about some of the key product launches we should be on the lookout for. And then I had a follow-up, please.

我們可以期待 2024 年會出現類似的情況嗎？也許只是談談我們應該關注的一些關鍵產品發布。然後我有一個後續行動，請。

Yeah. Thanks, Vik. One of the things that I love about the company is that there is an organic innovation machine. There's an authenticity around wanting to move the field. And so we have kind of committed as a cadence of always doing between 8 and 10.

是的。謝謝，維克。我喜歡這家公司的原因之一是它有一個有機的創新機器。想要改變這個領域是有真實性的。因此，我們承諾始終保持 8 到 10 次的節奏。

And some of these things will be line additions, and others will be big new product launches. But I think the things that will start to move the needle is, in 2024, you'll start to see kind of continuation of this expansion of the cervical portfolio, which we think is opportune.

其中一些將是產品線的增加，另一些將是大型新產品的發布。但我認為，到 2024 年，你將開始看到子宮頸產品組合的擴張持續下去，我們認為這是適當的時機。

Because as more people utilize lateral, get confident with this, what they do is they expand the utility within the cervical realm. We want to make sure that we get all of that. And so we continue to expand kind of the sophistication within that realm.

因為隨著越來越多的人使用側向，對此充滿信心，他們所做的就是擴大頸椎領域的用途。我們希望確保我們得到所有這些。因此，我們繼續擴大該領域的複雜程度。

Also, there's so many opportunities for us to continue to build the next foundation. And one of the next foundations for us is, how do we think through things like bone quality as it relates to EOS? And can we translate that bone quality into an implant? And so us becoming sophisticated with 3D printing is very important. So you'll start to see 3D printed implants from us.

此外，我們還有很多機會繼續建立下一個基礎。我們的下一個基礎之一是，我們如何思考與 EOS 相關的骨質等問題？我們可以將這種骨質轉化為植入物嗎？因此，我們在 3D 列印方面變得成熟非常重要。因此，您將開始看到我們的 3D 列印植入物。

And so we love the opportunity for the assembly of goods. I would say another one that's forthcoming that will get a lot of experience this year, but next year will be a big one, will be the integration of the navigated robotic element into PTP.

因此，我們喜歡組裝貨物的機會。我想說的是，今年即將推出的另一項技術將獲得很多經驗，但明年將是一個重要的一年，它將導航機器人元素整合到 PTP 中。

And so just when you start to think about the opportunity for innovation, it's not in a single silo. It's in the assembly of goods. And so for us to understand neurologically where we are with regard to SafeOp, assembled through a navigated robotic element with regard to our Valence platform, those together become the innovation, not one or the other.

因此，當您開始思考創新機會時，您會發現它並不在一個孤島中。這是在貨物的組裝中。因此，為了讓我們從神經學角度了解 SafeOp 的狀況，透過與我們的 Valence 平台相關的導航機器人元件進行組裝，這些共同成為創新，而不是其中之一。

And I think that so often people think, gosh, I'm going to commit to a single technology, and this is going to change everything. Spine is a field of great variables. And so sorry for the diatribe. But it's things of that nature that I think you're going to see a lot of.

我認為人們經常想，天哪，我將致力於單一技術，這將改變一切。脊椎是一個充滿變數的領域。對謾罵感到非常抱歉。但我認為你會看到很多這種性質的事情。

We also have an expandable TLIF implant that's going to be excellent. And so I think there's going to be just a myriad of new products that you're going to see either delivered through a procedure that already exists or elevating the sophistication of a procedure through the utility of assembled goods.

我們還有一個非常出色的可擴張 TLIF 植入物。因此，我認為將會有無數的新產品，您將看到它們要么通過現有的程序交付，要么通過組裝產品的實用性來提高程序的複雜性。

And the pre-bent rod from Insight is a huge add to the --

Insight 的預彎桿對--

Yes. Yes, that's this year. So the whole Insight portfolio is what we are super excited about. The crazy part, though, is if you've been in this business, sadly, as long as I have, what you see is that these things take a little while to, in essence, reflect the value from a revenue perspective.

是的。是的，就是今年。因此，我們對整個 Insight 產品組合感到非常興奮。然而，瘋狂的部分是，可悲的是，如果你一直從事這個行業，只要我一直從事這個行業，你就會看到這些事情需要一段時間才能從本質上反映收入角度的價值。

And so you'll launch these products, you'll train the field on these products, you'll get the hospitals to accept the pricing on these products, and then you'll see the revenue reflection. And so that's why we always say revenue is a lag indicator to the work that we've done 18 to 24 months before. And so anyway, sorry for the diatribe.

因此，您將推出這些產品，對這些產品進行培訓，讓醫院接受這些產品的定價，然後您將看到收入反映。這就是為什麼我們總是說收入是我們 18 到 24 個月前所做工作的滯後指標。無論如何，我對謾罵感到抱歉。

No, not at all. That was great. Thank you. And just my follow-up question, you have your upcoming investor meeting in March. Any hints as to kind of what we can expect at that upcoming Analyst Day? Thank you.

一點都不。那很棒。謝謝。我的後續問題是，你們即將在三月召開投資人會議。對於即將到來的分析師日我們可以期待什麼有什麼暗示嗎？謝謝。

Yes, Vik. And I won't steal the thunder of the meeting. But fundamentally, we're going to give another two years of financial projections, very consistent with how we laid out the story in May of 2022.

是的，維克。我不會搶了這次會議的風頭。但從根本上來說，我們將再給出兩年的財務預測，這與我們在 2022 年 5 月的故事佈局非常一致。

Obviously, we'll have some additional kind of qualitative components to that. But fundamentally, it will be an extension of our financial commitments through the year 2027.

顯然，我們還會有一些額外的定性成分。但從根本上來說，這將是將我們的財務承諾延長至 2027 年。

Josh Jennings, TD Cowen.

喬許·詹寧斯，TD·考恩。

Hi, this is Eric, on for Josh. Thanks for taking the question. I wanted to focus on your opportunity internationally. I understand you guys are just getting going in some markets, like Australia and New Zealand. Specific to 2024, what level of international contribution have you guys factored in the guidance here?

大家好，我是艾瑞克，替喬許發言。感謝您提出問題。我想關注您在國際上的機會。我知道你們剛剛進入一些市場，像是澳洲和紐西蘭。具體到 2024 年，你們在此處的指導中考慮了哪些程度的國際貢獻？

So we haven't broken that out specifically, Eric. I think you'll see us give more granularity on that type of, I guess, insight in our long-range plan update. So maybe stay tuned there.

所以我們還沒有具體說明這一點，艾瑞克。我想您會看到我們在長期計劃更新中提供更詳細的洞察力。所以也許請繼續關注那裡。

But I'd tell you that it's starting to contribute, and we're getting good growth in the Australia and New Zealand markets. Those are really starting to work for us.

但我想告訴你，它已經開始做出貢獻，我們在澳洲和紐西蘭市場取得了良好的成長。這些確實開始為我們發揮作用。

And as Pat said, we'll begin very, very early stages to see a little bit of revenue reflection coming out of Japan later this year. Not material at all, but it will be good to start seeing that. We've really built a great team in both Japan and Australia and New Zealand really, really starting to come on.

正如帕特所說，我們將在非常非常早的階段開始，看看今年晚些時候來自日本的一些收入反映。根本不重要，但開始看到這一點會很好。我們在日本、澳洲和紐西蘭確實建立了一支出色的團隊，真的開始嶄露頭角。

So I think we're very excited about the opportunity. And I think our experience thus far in those markets has reinforced the strategy of going narrow and deep in a very specific geographic footprint that we've laid out. So maybe I'll leave it there, unless, Pat, you've got something to add.

所以我認為我們對這個機會感到非常興奮。我認為，迄今為止，我們在這些市場的經驗強化了我們所製定的在非常具體的地理足跡中縮小和深入的策略。所以也許我會把它留在那裡，除非，帕特，你有什麼要補充的。

The organization has done a ton of work to lay the foundation for future success of international. And that's -- you're most proud of because of -- just the predictable cadence of what's transpiring.

該組織做了大量工作，為國際未來的成功奠定基礎。這就是——你最自豪的——因為——正在發生的事情的節奏是可預測的。

So each of the different teams, I think, is just committed. And then to Todd's point, we have the right team on the ground. And so the translation of that business could be what we intend it to be.

因此，我認為每個不同的團隊都做出了承諾。然後托德指出，我們擁有合適的團隊。因此，該業務的翻譯可能就是我們想要的。

Exactly.

確切地。

That's great. And then maybe thinking about EOS, you guys have talked about the updated platform being slated for a rollout in the not-too-distant future here. I was just curious to hear your expectation for that launch and maybe how many systems you think you could have in the market exiting 2024. Just any sort of launch metrics that we could be expecting would be great. Thank you.

那太棒了。然後也許想到 EOS，你們已經討論過更新的平台將在不久的將來在這裡推出。我只是很好奇您對此次發布的期望，以及您認為 2024 年市場上可以擁有多少系統。我們可以期待的任何類型的啟動指標都會很棒。謝謝。

Yeah. I won't give you any launch metrics, but I will tell you that everything is on track. And I probably blew it in the presentation. I didn't talk about the regulatory clearance of them.

是的。我不會給你任何啟動指標，但我會告訴你一切都步入正軌。我可能在演講中搞砸了。我沒有談論他們的監管許可。

So the impediment, we found them, and it's us. And so we should be on time, is my point. I was just kidding about the impediment. The dynamic is one where I think that there's going to be great demand.

所以障礙是我們找到的，那就是我們。所以我們應該準時，這是我的觀點。我只是在開玩笑說這個障礙。我認為這種動態將會有很大的需求。

The challenge of capital equipment is that you've got to get the dollars allocated. Then you have to get the room ready, and then you have to get the line in terms of getting it placed. And so again, I think that our enthusiasm for the technology is over the moon. I just want to make sure that it's tempered with the practical dynamics associated with getting these systems in place.

資本設備的挑戰在於您必須分配資金。然後你必須準備好房間，然後你必須排隊放置它。再說一次，我認為我們對這項技術的熱情已經高漲。我只是想確保它能夠適應與安裝這些系統相關的實際動態。

And so the technology is everything that we had hoped for and that we had intended. The automation that's ultimately being integrated into the workflow of how we're doing things is exactly what we expected. Again, I think it's creating just a more sophisticated field.

因此，這項技術就是我們所希望和想要的一切。最終整合到我們做事的工作流程中的自動化正是我們所期望的。再說一遍，我認為它正在創建一個更複雜的領域。

And so all of that is coming Q2 '24, as committed. But the dynamics of the influence on the volume of units in the field will be felt in the years to come.

因此，所有這些都將按照承諾在 24 年第二季實現。但對該領域單位數量的影響將在未來幾年內顯現出來。

Understood. Thank you for taking the questions.

明白了。感謝您提出問題。

Yup.

是的。

Brooks O'Neil, Lake Street Capital Markets.

布魯克斯·奧尼爾，湖街資本市場。

Thank you. Good afternoon. I just am kind of intrigued by this notion that you have 25% market share in some markets, but 5% overall in the US spine market.

謝謝。午安.我只是對你們在某些市場擁有 25% 的市場份額，但在美國脊椎市場總體上擁有 5% 的市場份額這一概念感興趣。

And I'm just hoping you could talk a little bit about some of the keys to getting to that 25% in the markets where you have it, whether you're confident that you can get to 25% in the markets where you don't. And are there any structural obstacles to achieving the big share in some key markets around the country now? Thank you.

我只是希望您能談談在您擁有的市場中獲得 25% 份額的一些關鍵因素，無論您是否有信心在您沒有的市場中獲得 25% 的份額。 t。目前在全國一些關鍵市場取得較大份額是否有結構性障礙？謝謝。

That was a tough one, Brooks. I would say the features or kind of the reflection of those people who are at 25% market share oftentimes may have kind of a key center that they have gotten into. And they've gotten into it with lateral surgery, and then the lateral surgery has proliferated amongst the partners. And so there's been a competitive dynamic for people to adopt what we're doing.

那是一場艱難的比賽，布魯克斯。我想說，那些佔據 25% 市場份額的人的特徵或反映通常可能有一個他們已經進入的關鍵中心。他們已經開始進行側向手術，然後側向手術在合作夥伴中激增。因此，人們在採用我們正在做的事情時存在著競爭動力。

And so I would say that there are some great statistics around -- if you have a significant lateral business as a distributor of ours, then the likelihood of you growing at north of 40% is high. And then that ultimately reflects in the 25% market share in their respective geography. And so I would say that that is really kind of the foundation.

所以我想說，有一些很好的統計數據 - 如果您作為我們的經銷商擁有重要的橫向業務，那麼您增長 40% 以上的可能性很高。最終反映在各自地區 25% 的市佔率。所以我想說這確實是一個基礎。

And a lot of the guys who, candidly, have been somewhat familiar to us from previous companies that came over early, and they've been able to establish the business. And then what they've done is they've reaped the reward of the halo effect.

坦白說，我們對早期加入的公司中的許多人有些熟悉，並且他們已經能夠建立業務。然後他們所做的就是獲得了光環效應的回報。

Candidly, one of the great things with regard to people who have just come over as of late in areas where there is kind of a focal EOS field reflection, those guys will ultimately likely, not only build out the lateral space, but also build out the EOS installed base.

坦白說，對於最近剛來到有 EOS 場反射焦點的地區的人們來說，最偉大的事情之一是，這些人最終可能不僅會建造橫向空間，而且還會建造EOS 安裝基礎。

And so when you ask kind of, is there an impediment to long-term growth, there really isn't. This is an interesting business, though, just based upon the demographics of each of the individual geographies. Guys are very slow to change.

因此，當你問長期成長是否有障礙時，答案確實不存在。不過，僅基於每個地區的人口統計數據，這是一項有趣的業務。男人們改變起來非常緩慢。

And what we try to do is provide every reason in the world to change. Our view is the more we can reflect in a wide geography of EOS informatics, the volume of information that we'll provide to create greater predictability will drive people to us.

我們試圖做的是提供世界上所有改變的理由。我們的觀點是，我們越能在 EOS 資訊學的廣泛地理範圍中反映出來，我們為創造更大的可預測性而提供的資訊量將驅使人們轉向我們。

And so that's why I think that the strategy of lateral first, a procedural reflection; EOS second, a procedural reflection -- I hope that 10 years from now nobody's talking about individual products because all they're talking about is what they're doing procedurally.

這就是為什麼我認為橫向優先的策略，程序性的反思； EOS 其次，程序性反思——我希望 10 年後沒有人談論單一產品，因為他們談論的只是他們在程序上所做的事情。

And we feel like that procedural opportunity, informed by something like EOS, and a kind of growing sophistication with the information that's driven at the surgeon, will make for better outcomes. And better outcomes will drive a better day.

我們認為，由 EOS 等資訊提供的程序機會，以及外科醫生驅動的資訊日益複雜，將帶來更好的結果。更好的結果將帶來更好的一天。

And so that's how we're thinking about it, and that's how we're seeing it reflected. Hopefully, that's kind of precise enough to answer your question.

這就是我們如何思考它，這就是我們如何看待它的反映。希望這足夠精確地回答您的問題。

No, that was great, Pat. I really appreciate that. And I'll just tack on one tiny little bit more, not to be greedy, but does deformity give you an opportunity to grow your share in some markets even beyond the current 25%?

不，那太好了，帕特。我真的很感激。我只是再多一點點，不是貪婪，但畸形是否能讓你有機會在某些市場上擴大你的份額，甚至超過目前的 25%？

Yeah. I think it's truly a great question, Brooks. Why you see this being somewhat of a stodgy environment is you see so many places that have committed to a provider for long periods of time. And so to unseat those providers of a long period of time, you have to do something that's unique.

是的。我認為這確實是一個很好的問題，布魯克斯。為什麼您會看到這種環境有點乏味，因為您看到很多地方都長期致力於提供者。因此，要取代那些長期存在的供應商，你必須做一些獨特的事情。

And so the deformity market is a big market. And the reason why the numbers kind of get a little wonky is because it's not as though there's a lateral market and then there's a deformity market. Often, there's times that lateral is used in deformity.

所以畸形市場是一個很大的市場。這些數字之所以有點奇怪，是因為並不存在橫向市場，然後存在畸形市場。通常，有時會使用側向來治療畸形。

But let's just say, it's a very large market. And the ability to ultimately participate in that market is a sign of sophistication. And so, oftentimes, if you do the complex things well, you can do the more straightforward things well.

但我們只能說，這是一個非常大的市場。最終參與該市場的能力是成熟的標誌。因此，很多時候，如果你能把複雜的事情做好，你就能把更簡單的事情做好。

And what's happened is that there's been companies that have long been in this business that have established themselves as deformity providers. We believe that deformity is best approached from an assembly of goods, much like we have with regard to lateral.

實際情況是，有些公司長期從事這一行業，並已將自己定位為畸形提供者。我們認為，解決畸形問題的最佳方法是透過貨物組裝，就像我們處理橫向問題一樣。

It's a different assembly of goods. But the opportunity for us to do a patient positioner in idiopathic scoliosis, where there's a curve that's more flexible, we think is opportune. We think neurophysiology in terms of automating it with regard to facilitated MEPs and even using automated SSEP, is valuable in those cases.

這是不同的貨物組裝。但我們認為，為特發性脊椎側彎患者提供一個更靈活的曲線的機會是合適的。我們認為神經生理學在促進 MEP 方面實現自動化，甚至使用自動化 SSEP 在這些情況下是有價值的。

And then understanding rotational deformity with regard to EOS. When you start to assemble all of those things, that suggests to us a procedural requirement. And that's where I think people have historically used Gestalt. I'm so experienced in this field that I could do it.

然後了解 EOS 的旋轉變形。當你開始組裝所有這些東西時，這向我們提出了程序要求。我認為這就是人們歷史上使用格式塔的地方。我在這個領域非常有經驗，我可以做到。

Our view is how do we provide objective information that ultimately drives behavior. And that's where we think that once that starts to become more commonplace, our ability to reflect and influence in that market is high.

我們的觀點是如何提供最終驅動行為的客觀資訊。這就是我們認為一旦這種情況開始變得更加普遍，我們在該市場的反映和影響力的能力就會很高。

Make total sense to me. I'm looking for $2 billion. Let's go.

對我來說完全有意義。我正在尋找 20 億美元。我們走吧。

Me, too.

我也是。

David Saxon, Needham & Company.

大衛‧撒克遜，李約瑟公司。

Hi, Pat. Hi, Todd. Congrats on the quarter, and thanks for taking my questions. I wanted to start on lateral, specifically for LTP.

嗨，帕特。嗨，托德。恭喜本季度，感謝您回答我的問題。我想從橫向開始，特別是 LTP。

So for a doctor who's doing ALIF -- sorry -- XLIF, is LTP the path of least resistance from an ATEC product perspective? And if so, how does that launch resonate with kind of new doctors? Is that where you're seeing the most traction in that cohort?

那麼，對於正在做 ALIF 的醫生來說——抱歉——XLIF，從 ATEC 產品的角度來看，LTP 是阻力最小的途徑嗎？如果是這樣，該產品的發佈如何引起新醫生的共鳴？這是您在該群體中看到的最有吸引力的地方嗎？

Yeah, completely. So as the poor soul who was in Sao Paulo taping people to beds in the early days of XLIF's creation, to understand the requirements of having a product development group and marketing group that understand them viscerally is so valuable.

是的，完全如此。因此，作為 XLIF 創建之初在聖保羅把人們綁在床上的可憐人，了解擁有一個發自內心地理解他們的產品開發團隊和營銷團隊的要求是非常有價值的。

And so what you're seeing is even -- we clearly communicate that PTP is the next generation to lateral or XLIF. There are still many applications where LTP is super valuable. And so what we've done is we've taken all the learnings that we've had from XLIF from previous years as well as from PTP, and we've combined those. And that gets reflected in terms of like a patient positioner.

所以您所看到的是 - 我們清楚地傳達了 PTP 是橫向或 XLIF 的下一代。LTP 在許多應用中仍然具有巨大的價值。因此，我們所做的就是汲取前幾年從 XLIF 以及 PTP 中獲得的所有經驗教訓，並將這些經驗結合起來。這體現在患者定位器上。

Imagine, we're in 2024, and people are still taping people to beds and suggesting that there's nothing left to do in spine surgery. That is despicable. And then the opportunity to say, hey, I'm a monitoring company. But all I'm doing is telling you where the nerve is, and then the monitoring is not guidable after that.

想像一下，我們已經到了 2024 年，人們仍然將人們綁在床上，並暗示脊椎手術已經無計可施。這是卑鄙的。然後有機會說，嘿，我是一家監控公司。但我所做的只是告訴你神經在哪裡，然後監控就無法指導了。

But people still have side pain because of plexopathy. Because what they're doing is retracting the plexus to them. And so there's many opportunities to continue to make these things -- to improve these procedures.

但由於神經叢病，人們仍會感到側痛。因為他們所做的就是將神經叢收縮到他們身上。因此，有很多機會繼續製造這些東西——改進這些程序。

And I think that we're doing those with regard to the assembly of the technology that we are to lateral. And so when a surgeon comes and tries ATEC lateral, what they see is the next generation of goods.

我認為我們正在做那些與我們橫向技術組裝有關的事情。因此，當外科醫生來嘗試 ATEC 橫向時，他們看到的是下一代產品。

Okay. Great. Super helpful. And then I just wanted to clarify something, Todd, I think you said in the script. For the OpEx cadence, did you say it was supposed to be kind of front-end loaded, higher in the first and second quarter? I just want to make sure whether I heard that correctly or not. Thanks so much.

好的。偉大的。超有幫助。然後我只是想澄清一些事情，托德，我想你在劇本中說過。對於營運支出節奏，您是否說它應該是前端負載，在第一季和第二季更高？我只是想確認一下我聽得是否正確。非常感謝。

Thanks, David. My commentary was specific to the cash flow cadence throughout the year. So we've communicated we're going to spend about $100 million of cash this year as part of the investment in the sets and inventory, the revenue-generating assets that will ultimately fulfill the needs of the sales folks who come and who will come.

謝謝，大衛。我的評論是針對全年現金流節奏的。因此，我們已經表示，今年我們將花費約 1 億美元現金，作為佈景和庫存投資的一部分，這些創收資產最終將滿足前來和將要前來的銷售人員的需求。

And so that's what we're spending it on. We spent some there. Clearly, in the fourth quarter, you can see that.

這就是我們花錢的目的。我們在那裡度過了一些。顯然，在第四季度，你可以看到這一點。

And then ultimately, cash burn in the first quarter will step up from Q4. It will step down in Q2. And in the second half, it will be approaching cash flow breakeven. And so I think, ultimately, that will be the cadence that we're expecting throughout the year with respect to cash burn.

最終，第一季的現金消耗將比第四季增加。它將在第二季下台。下半年，現金流將接近損益兩平。因此，我認為，最終，這將是我們預期全年現金消耗的節奏。

Okay. Great. Thank you.

好的。偉大的。謝謝。

Drew Ranieri, Morgan Stanley.

德魯‧拉涅利，摩根士丹利。

Hi, Pat and Todd. Thanks for taking the questions, and apologies if this has been covered already. But on balance, could you give us an update on how you're thinking about development for the product?

嗨，帕特和托德。感謝您提出問題，如果已經討論過這個問題，我們深感抱歉。但總的來說，您能否向我們介紹一下您對產品開發的最新看法？

And with more competition coming potentially in 2025, just remind us how you're thinking about differentiation of your system, especially as maybe more spine procedures are starting to move towards the ASC. Thanks for taking the question.

隨著 2025 年可能出現更多競爭，請提醒我們您如何考慮系統的差異化，尤其是當更多脊椎手術開始轉向 ASC 時。感謝您提出問題。

Thanks much, Drew. First of all, I guess, I can't be more excited about what's going on with regard to Valence.

非常感謝，德魯。首先，我想，我對瓦朗斯所發生的事情感到非常興奮。

We're getting experience. So it's being utilized, which we suggested as much. That utilization is going to get expanded. It's going to be -- 2024 is going to be more of an evaluation, verification type of a year with regard to -- it's going to be used, like all the other robots, in a relatively conventional way in terms of just placing screws.

我們正在累積經驗。所以它正在被利用，我們也建議這樣做。這種利用率將會擴大。2024 年將更多地是一個評估、驗證類型的一年，就像所有其他機器人一樣，它將以相對傳統的方式使用，即僅放置螺絲。

The launch in 2025 will ultimately be a verified tool that ultimately integrates or assembles with the workflow of, first and foremost, what we're doing in PTP. And so just the ability to assemble neurophysiology with navigation, integrated into that effort will be phenomenal.

2025 年推出的最終產品將是一個經過驗證的工具，最終將與我們在 PTP 中所做的工作的工作流程整合或組裝。因此，將神經生理學與導航結合起來並融入這項工作的能力將是驚人的。

And so making sure that you know where the bones are, you know where the nerves are, and you understand what the health of the nerve is, all of those things are great. One of the virtues of PTP is you have control of both the front of the spine and the back of the spine.

因此，確保您知道骨頭在哪裡，知道神經在哪裡，並且了解神經的健康狀況如何，所有這些都很棒。PTP 的優點之一是您可以控制脊椎的前部和後部。

And so your ability to literally manipulate both those at the same time in a navigated way is fantastic. And so you will start to see that in '25, and that's a unique opportunity for us. And so we have the ability to navigate two things at once here in in the coming years.

因此，您以導航方式同時操縱這兩者的能力真是太棒了。所以你會在 25 年開始看到這一點，這對我們來說是一個獨特的機會。因此，未來幾年我們有能力同時處理兩件事。

When you start to think about ASCs, one of the dynamics is that, oftentimes, they're surgeon-owned. And I've not met a ton of surgeons who love to buy expensive capital. And so what we have done is ultimately create a footprint that accommodates the utility of navigation robotics in a way that's procedural.

當您開始考慮 ASC 時，動態之一是它們通常屬於外科醫生所有。我還沒見過很多喜歡買昂貴資本的外科醫生。因此，我們所做的最終是創建一個足跡，以程式化的方式適應導航機器人的實用性。

And so if we have to bring everything in, the site of service, it's really just not that big a deal. Because our thinking is only around the success of the procedure and the required elements that make for predictability.

因此，如果我們必須把所有東西都帶進來，包括服務站點，那真的沒什麼大不了的。因為我們的思考僅圍繞著程式的成功以及實現可預測性所需的要素。

And so our enthusiasm with regard to the ASC is very high because the footprint of our goods is very limited. And our ability to ultimately execute critical surgery within a small space, where there's not a high enthusiasm for capital, is good. So that's the thinking, and that's where we are from a strategic perspective.

因此，我們對 ASC 的熱情非常高，因為我們的貨物足跡非常有限。我們最終有能力在資本熱情不高的小空間內執行關鍵手術，這是很好的。這就是我們的想法，這就是我們從策略角度來看的情況。

Got it. Thanks, Pat. And maybe just one more. I don't think this was discussed. But just how -- in your 2024 guidance, maybe just talk to us about how you're thinking about competitive rep hiring, and what factor that might have to play in there with any additional hires that you did or will do beyond 2023.

知道了。謝謝，帕特。也許還有一個。我認為沒有討論過這個問題。但是，在您的 2024 年指導中，也許只需與我們談談您如何考慮競爭性銷售代表招聘，以及哪些因素可能會影響您在 2023 年之後已經或將要進行的任何額外招聘。

And lastly, can you just remind us where you are in terms of sales force headcount for year-end? Thanks for taking the questions again.

最後，您能提醒我們一下您年底的銷售人員人數嗎？感謝您再次提出問題。

Yeah, Drew. This is Todd. As we kind of laid out our guidance for 2024, we ultimately said, what organization do we have exiting the year? What's our run rate?

是的，德魯。這是托德。當我們制定 2024 年的指導方針時，我們最終會問，今年結束時我們有哪些組織？我們的運行率是多少？

And so that really is how we built our -- what was our exit rate in '23? That's really how we thought about and built our 2024 guide. So it's really a reflection of the fundamental -- I think, underlying fundamentals of the business and the organization that we have in place.

這就是我們建立我們 23 年退出率的方式？這正是我們思考和發展 2024 年指南的方式。所以這確實反映了我們現有的業務和組織的基本原理。

I think as you know, oftentimes, what we do today really reflects revenue in 12 to 18 months from now. So our view is, as we get more competitive reps on board and as the business may do better than what we have assumed, that might -- that ultimately would be kind of what would drive an upside case to our guidance.

我認為，正如您所知，我們今天所做的事情往往真正反映了從現在起 12 到 18 個月後的收入。因此，我們的觀點是，隨著我們獲得更具競爭力的代表，並且業務可能會比我們假設的做得更好，這最終可能會推動我們的指導出現上行情況。

But fundamentally, we're trying to put guidance out there that we believe we can achieve and have reasonable opportunities to exceed. I think that opportunity to exceed would really probably be on the volumetric side and kind of the core business and/or upside to the amount of reps that kind of come throughout the year. Relative to total sales force, kind of the low-300s, mid-300s, so that's more or less where we're at.

但從根本上說，我們正在努力提供我們相信能夠實現並有合理機會超越的指導。我認為超越的機會實際上可能是在數量方面以及核心業務和/或全年代表數量的上升方面。相對於總銷售人員，大約在 300 人左右、300 人左右，所以這或多或少就是我們所處的情況。

There are no further questions at this time. Mr. Miles, I'll turn the call back over to you.

目前沒有其他問題。邁爾斯先生，我會將電話轉回給您。

Thanks very much, Desiree. And really just thanks, everybody, for your interest in ATEC. We are in this for the long haul, clearly. And we can't be more excited about the momentum that was created in a great year in 2023. Thank you very much.

非常感謝，德西麗。真的只是感謝大家對 ATEC 的興趣。顯然，我們將長期致力於此。我們對 2023 年偉大的一年所創造的勢頭感到無比興奮。非常感謝。

This concludes today's conference call. You may now disconnect

今天的電話會議到此結束。現在您可以斷開連接