Alphatec Holdings Inc (ATEC) 2024 Q1 法說會逐字稿

Good afternoon, everyone, and welcome to the webcast of Atec's first quarter financial results.

大家下午好，歡迎收看 Atec 第一季財務業績的網路廣播。

We would like to remind everyone that participants on the call will make forward-looking statements. 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.

我們想提醒大家，電話會議的參與者將做出前瞻性陳述。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 non-GAAP 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。非公認會計原則措施與美國公認會計原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信息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 Koenig. Now, I will turn the call over to Pat Miles.

今天的電話會議將由 Atec 董事長兼執行長 Pat Miles 和財務長 Todd Koenig 主持。現在，我將把電話轉給帕特·邁爾斯。

Thanks much, Desiree, and welcome, everybody, to the Q1 2024 financial results call. We will be making some forward-looking statements, and so I would ask you to review that at your leisure. So, a quick review of the Q1 2024 highlights. We are establishing a foundation to deliver profitable long-term growth. Pretty clear. $138 million in total revenue, which is a 27% revenue growth, 450 basis points of adjusted EBITDA expansion, 30% surgical revenue growth, 23% surgical volume growth, 6% growth in average surgical revenue per case, and so from an adoption perspective, 150 surgeons trained in the quarter that drove a 21% increase in surgeon adoption. From an investment in revenue-generating assets, we continue to invest in a market that is either apathetic or disrupted. Without an expanded asset volume, you cannot support a market that clearly demands Atec, so we deployed $60 million to enable a growing sales team to serve an expanded surgical volume. So, speaking of the sales team, we are confident in the robustness of the growth as we continue to see outsized growth in especially our established territories, which was 28% growth of same-store sales, so we think that's a great statistic. We often, around here, talk about how the spine market needs Atec and that Atec is different. One of the key drivers of what makes us different is that we are 100% spine-focused. Imagine that. Much like our surgeons, all we concentrate is spine, so being spine-only focused ultimately gets reflected in know-how, and when we talk about know-how, we mean sophistication and we mean unmatched mechanical imaging, navigation, and neuromonitoring expertise. When you have know-how, ultimately what you do is you create clinical distinction, which ultimately compels adoption. It compels adoption from surgeons as well as attracts salespeople that ultimately are interested in being aligned with your efforts. So, what we know to be true is that surgeons desire architecture of procedures, not widgets, and so what we do is we assemble fully contemplated spine procedures from the ground up. The spine world is – the spine surgery is a world where there requires management of many, many variables, and our belief is that objective measure through informatics can bring about an environment where these variables are much better managed. You will find us to be a deliberate bunch, so we always say our best is yet to come and it's no tagline, and so when you start to look at the growth drivers associated with a company, it's very clear that the opportunities are abundant, and so when you look at the graph and you start to look at what our participation in Lateral has been, it has really been the growth driver of our business, and you see everything above that, the EOS Informatics, Valence, International, and the US Salesforce, all are incremental growth drivers to our strategy, so the great thing is things are progressing. Things are progressing as we intended, and our bullishness in terms of perpetuating this growth profile is in front of us, and so what I'd like to do is update each of these areas real quick and kind of give you a perspective as to kind of how we see the landscape, and so I think something to appreciate is Lateral really is the most coveted sub-market in spine. It is why Lateral leadership for us is so important. It's growing faster than the overall spine market, and it's been really verified by 500 peer-reviewed publications that reflect its many advantages. Our team is the group of people that created Lateral Surgery, so we are steeped in the understanding of the technique, and we are committed to the requirements that really best equips us to make for the biggest impact in the space, and so our enthusiasm around Lateral Surgery is significant, and it will continue to be a growth driver. I think when you originate something, you tend to have a much better understanding of its requirements, and the one thing that we know absolutely true is that neuromonitoring, really automated neuromonitoring, is an absolute requirement of Lateral Surgery. When you start to think about the relevant anatomy in Lateral Surgery, what you must know is that when surgeons do Lateral Surgery, their concern is the femoral nerve or the nerve plexus, and what stands between the skin and the spine of concern is the femoral nerve and the plexus, and so when we originated Lateral Surgery, what we did is we used ENGs to identify where the nerve was. That was very important information, but the question becomes is, are you willing to evolve the technique in a way that enables you to not only identify where the nerve is, but monitor the nerve over time, and so when you think about identifying nerve location, that's EMG. When you think about monitoring the nerve over time, that's SSCP. One of the core distinctions of AlphaTech Spine is our perpetuating understanding and application of know-how to evolve neuromonitoring, so what we've done is we've not only automated EMGs, but we've automated SSCPs. It is a clear distinction in addressing the areas of greatest concern of surgeons, and you can see that if you look at the complications profile of Lateral Surgery, it's reflected in neural-related complications. If you're going to continue to get better in that space, you need to draw an objectivity to the very challenges that are associated with the approach. It's fascinating to look at the historical leadership, which was defined by neurophysiology. The challenge is the historical leadership in Lateral Surgery hasn't evolved. The same monitoring modality that a 50% market shareholder uses is the same one they used back in 2003. The opportunity for us to distinguish ourselves in this space has been reflected, and that's why we are so bullish with regard to our continued growth, and also so clear that our growth profile is no coincidence, and so SafeUp is the foundation of the technique and why we are so bullish in terms of moving forward. The reason why other companies haven't done sophisticated things in spine neuromonitoring is that it's very, very hard. SSEPs are very small signals. Interpreting them among the other electrical noise in the OR is profoundly challenging. That is why the algorithms that interpret them are not only well-protected from an IP perspective, but also integrated into the corporate know-how or trade secrets of the company. We have the foremost neuromonitoring design and development expertise in the business. We have greater than 60 neuromonitoring experts continually advancing the technology. We have 11 peer-reviewed clinical publications on SafeUp. We have 52 SafeUp patents granted globally and 45 pending, and so we are steeped in know-how, and we have protected this area because I think we understand its relevance. People often ask me whether someone can copy PTP and LTP. My response is they can copy certain elements of the procedure, but what they can't copy is the sophistication of understanding the technique and how we integrate the tools, but also there is no replicating the neuromonitoring aspect. That is the great distinction. It is the demonstrated proxy for great lateral outcomes and leadership in the space. When you start to think about us as a company, the one thing that we won't do is sit by idle. We have the leading most evolved lateral franchise in the business, but we are nowhere close to being done. We are applying all that we have learned into what is next. We have in excess of 230 product development engineers completely committed to continued innovation. That goes into the EOS platform that will ultimately drive an alignment influence. It will be the Valence, which is our navigation robotic platform that will ultimately elevate the precision. It includes evolving our SafeOp platform with automated MEPs, which will give a better understanding of motor evoked potentials and kind of the motor health of the nerve during the surgery. It also expands the indication. When surgeons initiate the utility of a new technique, oftentimes they start in the most simple application. The beauty of our growth profile forward is the expansion into things like corpectomy and a larger influence in deformity. Just the opportunity to continue to expand the space in a way that from an application standpoint that is completely apparent to someone who has been in this space for a long time. I think the other growth driver is that we have talked about the market size. The lateral market is a place that we're making impact. We consider ourselves in the approximation of a 12% market shareholder in the lateral space. We're also expanding the space in a way that ultimately we are seeing PTP utilized in what historically would be more posterior approach type techniques. The T-LIFT and PLIFT market is being disrupted by PTP in our lateral contribution to surgery. When you create confidence with surgeons by offering them something that they haven't done before, oftentimes what it does is it expands the utilization of other products. This is what we call the halo effect. One of the great things is when you look at the revenue profile of the company, you're seeing that happen. You're seeing a robust utility of our lateral products. What you're seeing is the expansion into, as I say, the halo effect of the other techniques. Another driver, an incremental driver, is EOS. Love what we're doing on the EOS front, cannot be more excited. We have our EOS Insight launch. We committed to Q224, Q224 is coming to fruition. It's a software solution that has been in development for as long as we have owned EOS. We started off defining how to ultimately integrate the tool's relevance in surgery, and that's happening as we speak. Insight is the new feature set that will make possible all the capabilities of not only automated surgical alignment, automated surgical planning, we will integrate patient-specific implants with it, drive the reconciliation into the operating room, and ultimately drive an assessment and follow-up effort. What that drives ultimately is an assembly of data that I think is currently underway, but wildly underappreciated. We recently earned a high-trust attestation that enables data housing and sharing of de-identified data. We're the only company automating and capturing standardized images and clinical data that we believe will improve patient care. We believe that this will bring about a greater predictability. So EOS is also a great moat. It is a technology near impossible to replicate, and we have close to 90 patents granted or pending worldwide. And so at least the way that we think about EOS is much the way we think about SafeOp. From an influence perspective, SafeOp is to lateral what EOS is to alignment. And so we believe that automated neuromonitoring will ultimately provide an objective source of information that drives clinical decision-making. We believe the same with regard to EOS, where the alignment information will drive an objective information to drive improved decision-making. There's way too much gestalt in spine surgery. And so the opportunity to evolve the current standard. If you appreciate the current standard, it's somewhat underwhelming. So most of the alignment planning is literally done by gestalt. If somebody does plan, it's oftentimes time-consuming, it's arduous, it's uninformed. And so what happens in surgery, if you think about alignment surgery being the greatest quota to a long-term successful outcome, and people are utilizing their historical gestalt, there suggests a variable to that effort that is, in our minds, unacceptable. And so what we're bringing to bear with regard to EOS is a standard. And so the opportunity to automate the calculations and to create simplicity so that we alleviate the surgeon's work in creating this alignment opportunity, again, appears like a very apparent opportunity to mitigate some of the variables that ultimately drive predictability. And so we're super excited about that. The key, though, is what you have to do is you have to integrate into the operative experience. And so we have a tool that will ultimately enable us to take the pre-op automated alignment, the surgical plan, and integrate that into the operating room. So the two places that will be affected from an interoperative perspective is we will have patient-specific implants that will have been contemplated via the preoperative plan, but we will also have an automated reconciliation tool in the operating room to assist in refining the alignment to the reflected plan. And then what you'll see is the opportunity to collect all of that data and have it provide a predictive analytic capability that will ultimately, again, drive more objectivity. So if there's one thing that we want you to take away from what we're describing and what we're doing is we're trying to mitigate the gestalt and the guessing and drive a level of objectivity that ultimately reflects in better decision-making and more predictability in surgery. And I think that that's resonating with people, and that's, again, why we're so bullish with regard to the reflective growth profile of the company. Another element that is a tailwind with regard to the incremental effort that we're making is our valence platform. We acquired it about a little over a year ago. We feel great about where we are with regard to the design and development effort. We have already started to place pedicle screws with the system. Ultimately, the ultimate reflected value will be as we integrate it into the workflow of lateral. Our enthusiasm to do that is significantly high. The progress that we've made is exactly what we intended. And so our bullishness with regard to that technology and the incremental benefit to that is very apparent. So another tailwind to our growth is international. The one thing that Todd and I committed to do is to be narrow and deep within markets. If you look at the market that we're participating in, that's exactly the tact that we've taken. Australia and New Zealand is doing outstanding. The team in Australia and New Zealand is outstanding. If you start to look at the demographics, great market size. We started to generate revenue. We have over 40 surgeons attend, in essence, a lateral think tank. We have 20 surgeons trained. I think the great statistic on this page is the 400 PTPs performed to date. And I think it's reflective of going into a marketplace, describing the benefits of a technique, preparing surgeons to have success with it, and reflecting as much in a very narrow way. So we think it's a proxy for Japan. Japan is next. Japan's a large market. We so covet that market. We're super excited about that market. We have our posterior fixation cleared in that market. We have Dr. Pimentas highly regarded in that market. And we expect a large footprint of success to follow. So just another incremental tailwind as we see it. As it relates to the disruption in the marketplace, we face an unprecedented market opportunity. That commenced last fall with industry consolidation, capitulation, and leadership change. As we look at the market, we see it as 35% disrupted. Other than us, the rest apathetic. And so what an opportunity. And so oftentimes we talk about these things and we talk about that they happen over a period of time. There's a great proxy out there with regard to the Stryker K2M. It was a dynamic that transpired over multiple years. I think that everybody expects all the activity to happen overnight. We are making as much progress as we can manage. And we expect this to continue over the coming years and cannot be more excited about it. We also remain in a position to where we have about a third of the US that is still un- or under-covered. So we have so many opportunities that we get to expand into. We have been strategically adding in Southern California, up in the Northwest, part in the Midwest, and clearly up in the Northeast. And so can't be more excited about the walk there. There is a ton of opportunities. There's a ton of local opportunities. We're making progress locally. We so covet the opportunity to have fluidity within the company of people that will ultimately effectuate the strategy of our company. I think also, as you start to look over major market impact, in just two years, we begin to move the needle in New York and Houston and Phoenix and Chicago, just to name a few. It's exceedingly exciting for us. We have about 6% market share in the US, but in our best markets, literally, we have 25% market share. And so we see this as one that is predictive of a broad opportunity that we hope to replicate over the coming years. And so I would tell you that we are well-positioned to create value, and we feel great about what we are, just to remind everybody of the commitments that we made at the LRP. And again, love where we are. We'll continue to remind you guys of these commitments. But what it is, is a billion dollars in 2027, $180 million in adjusted EBITDA, which is an 18% adjusted EBITDA margin, and free cash flow of $65 million. And so what that does is it contemplates a 20% revenue CAGR, 2,000 basis points of margin expansion, and cash flow break-even in 2025. And so with that, I will turn it over to Todd.

非常感謝 Desiree，並歡迎大家參加 2024 年第一季財務業績電話會議。我們將做出一些前瞻性陳述，因此我請您在閒暇時查看。那麼，快速回顧一下 2024 年第一季的亮點。我們正在為實現盈利性長期成長奠定基礎。很清楚。總收入 1.38 億美元，收入增長 27%，調整後 EBITDA 擴張 450 個基點，手術收入增長 30%，手術量增長 23%，每例手術平均收入增長 6%，從採用的角度來看本季度培訓了150 位外科醫生，推動外科醫師採用率增加了21%。從對創收資產的投資，我們繼續投資於一個冷漠或被擾亂的市場。如果不擴大資產規模，就無法支援明確需要 Atec 的市場，因此我們部署了 6,000 萬美元來支援不斷成長的銷售團隊，為擴大的手術量提供服務。因此，說到銷售團隊，我們對成長的穩健性充滿信心，因為我們繼續看到超額成長，特別是在我們已建立的地區，同店銷售額成長了28%，所以我們認為這是一個很好的統計數據。我們經常在這裡談論脊椎市場如何需要 Atec，以及 Atec 的不同之處。我們與眾不同的關鍵驅動力之一是我們 100% 以脊椎為中心。想像一下。就像我們的外科醫生一樣，我們只關注脊柱，因此僅關注脊柱最終會反映在專業知識中，當我們談論專業知識時，我們指的是複雜性，我們指的是無與倫比的機械成像、導航和神經監測專業知識。當您擁有專業知識時，最終您所做的就是創造臨床區別，這最終迫使人們採用。它迫使外科醫生採用，並吸引最終有興趣與您的努力保持一致的銷售人員。因此，我們所知道的是，外科醫生需要手術的架構，而不是小部件，因此我們所做的就是從頭開始組裝經過充分考慮的脊椎手術。脊椎世界是－脊椎手術是一個需要管理許多變數的世界，我們相信，透過資訊學進行客觀測量可以帶來一個可以更好地管理這些變數的環境。你會發現我們是一群深思熟慮的人，所以我們總是說我們最好的尚未到來，這不是口號，所以當你開始關注與公司相關的成長動力時，很明顯機會是充足的，因此，當您在查看圖表並開始了解我們對Lateral 的參與時，它確實是我們業務的成長動力，您會看到除此之外的所有內容，EOS Informatics、Valence、International 和美國Salesforce 都是我們策略的增量成長驅動力，所以最棒的是事情正在取得進展。事情正在按照我們的預期進展，我們對維持這種成長狀況的樂觀態度就在我們面前，所以我想做的是真正快速地更新每個領域，並為您提供一個關於類型的觀點。景觀，所以我認為值得欣賞的是橫向確實是脊椎中最令人垂涎​​的子市場。這就是為什麼橫向領導對我們如此重要。它的成長速度快於整個脊椎市場，並且已經得到 500 份同行評審出版物的真正驗證，反映了它的許多優勢。我們的團隊是創建側方手術的一群人，因此我們對這項技術有著深入的了解，我們致力於滿足真正最適合我們在該領域產生最大影響的要求，因此我們的熱情圍繞側方手術意義重大，並將繼續成為成長動力。我認為當你發起某件事時，你往往會更好地理解它的要求，而我們知道絕對正確的一件事是神經監測，真正的自動化神經監測，是側向手術的絕對要求。當你開始思考側方手術的相關解剖結構時，你必須知道的是，當外科醫生進行側方手術時，他們關心的是股神經或神經叢，而關心的是位於皮膚和脊柱之間的股骨神經。這是非常重要的訊息，但問題是，您是否願意改進這項技術，使您不僅能夠識別神經的位置，還能隨著時間的推移監控神經，因此當您考慮識別神經位置時，這就是肌電圖。當您考慮隨時間監測神經時，這就是 SSCP。AlphaTech Spine 的核心差異之一是我們對發展神經監測技術的持久理解和應用，因此我們所做的不僅是自動化 EMG，而且是自動化 SSCP。這是解決外科醫生最關心的領域的明顯區別，如果您查看側方手術的併發症概況，您會發現它反映在神經相關併發症中。如果您想在該領域繼續取得進步，您需要客觀地對待與該方法相關的挑戰。看看由神經生理學定義的歷史領導力是很有趣的。挑戰在於側方手術的歷史領導地位尚未發展。50% 市場股東使用的監控方式與 2003 年所使用的監控方式相同。我們在這個領域脫穎而出的機會已經得到體現，這就是為什麼我們如此看好我們的持續成長，也非常清楚我們的成長狀況並非巧合，因此 SafeUp 是該技術的基礎，為什麼我們對未來如此樂觀。其他公司之所以沒有在脊椎神經監測方面做複雜的事情，是因為它非常非常困難。SSEP 是非常小的訊號。將它們與手術室中的其他電噪聲一起解釋是極具挑戰性的。這就是為什麼解釋它們的演算法不僅從智慧財產權角度得到了很好的保護，而且還融入了公司的專有技術或商業機密。我們擁有業界最重要的神經監測設計和開發專業知識。我們擁有 60 多名神經監測專家，不斷推動技術進步。我們在 SafeUp 上有 11 篇經過同儕審查的臨床出版品。我們在全球擁有 52 項 SafeUp 專利，還有 45 項正在申請中，因此我們擁有深厚的專業知識，並且我們保護了這一領域，因為我認為我們了解其相關性。人們經常問我是否有人可以複製 PTP 和 LTP。我的回答是他們可以複製程式的某些元素，但他們無法複製的是理解技術的複雜性以及我們如何整合工具，也無法複製神經監測方面。這就是最大的差別。它是該領域偉大橫向成果和領導力的證明代表。當您開始將我們視為一家公司時，我們不會做的一件事就是袖手旁觀。我們擁有業內領先、最先進的橫向特許經營權，但我們離完成還很遠。我們正在將所學到的一切應用到接下來的事情上。我們擁有超過 230 名產品開發工程師，完全致力於持續創新。這將進入 EOS 平台，最終將產生聯盟影響。Valence 是我們的導航機器人平台，最終將提高精度。它包括使用自動化 MEP 來改善我們的 SafeOp 平台，這將有助於更好地了解手術期間運動誘發電位和神經運動健康狀況。它也擴大了適應症。當外科醫生開始使用新技術時，他們通常會從最簡單的應用開始。我們的成長概況的美妙之處在於擴展到椎體切除術等領域，並對畸形產生更大的影響。只是一個繼續擴展空間的機會，從應用的角度來看，這對於在這個領域工作很長時間的人來說是完全顯而易見的。我認為另一個成長動力是我們已經討論過的市場規模。橫向市場是我們正在發揮影響力的地方。我們認為自己在橫向空間中佔有約 12% 的市佔率。我們也正在以某種方式擴展空間，最終我們看到 PTP 用於歷史上更後路類型的技術。T-LIFT 和 PLIFT 市場正因我們對手術的橫向貢獻而受到 PTP 的干擾。當您透過向外科醫生提供他們以前從未做過的事情來建立他們的信心時，通常會擴大其他產品的利用率。這就是我們所說的光環效應。最棒的事情之一是，當你查看公司的收入狀況時，你會看到這種情況的發生。您將看到我們的橫向產品的強大實用性。正如我所說，您所看到的是其他技術的光環效應的擴展。另一個驅動因素，即增量驅動因素，是 EOS。喜歡我們在 EOS 方面所做的事情，非常興奮。我們推出了 EOS Insight。我們致力於Q224，Q224即將實現。自從我們擁有 EOS 以來，這個軟體解決方案就一直在開發。我們開始定義如何最終將該工具的相關性整合到手術中，就在我們說話的時候，這一切正在發生。Insight 是一個新的功能集，它不僅可以實現自動手術對準、自動手術規劃的所有功能，我們還將將患者特定的植入物與其集成，推動手術室的協調，並最終推動評估和後續行動。最終推動的是數據的匯集，我認為這些數據目前正在進行中，但被嚴重低估了。我們最近獲得了高度信任的認證，可以實現資料儲存和共享去識別化資料。我們是唯一一家自動化並捕捉標準化影像和臨床數據的公司，我們相信這將改善患者護理。我們相信這將帶來更大的可預測性。所以EOS也是一條偉大的護城河。這是一項幾乎無法複製的技術，我們在全球擁有近 90 項已授​​予或正在申請的專利。因此，至少我們對 EOS 的看法與我們對 SafeOp 的看法很相似。從影響力的角度來看，SafeOp 是橫向的，就像 EOS 是對準的一樣。因此，我們相信自動化神經監測最終將提供推動臨床決策的客觀資訊來源。我們相信 EOS 也是如此，一致性資訊將驅動客觀訊息，從而推動改進決策。脊椎手術中有太多的格式塔。因此有機會發展當前的標準。如果您欣賞當前的標準，您會發現它有點平庸。所以大部分的對齊規劃其實是由格式塔完成的。如果有人確實做了計劃，那通常是耗時、艱鉅的，而且缺乏資訊。那麼手術中會發生什麼，如果你認為對齊手術是長期成功結果的最大配額，並且人們正在利用他們的歷史格式塔，那麼在我們看來，這種努力的一個變數是不可接受的。因此，我們對 EOS 實施的是一個標準。因此，自動化計算和創建簡單性的機會，以便我們減輕外科醫生在創造這種對齊機會方面的工作，這似乎是一個非常明顯的機會，可以減輕最終推動可預測性的一些變數。所以我們對此感到非常興奮。但關鍵是你必須融入手術經驗。因此，我們擁有一個工具，最終使我們能夠進行術前自動對齊、手術計劃，並將其整合到手術室中。因此，從互通的角度來看，將受到影響的兩個地方是，我們將透過術前計畫考慮到患者特定的植入物，但我們還將在手術室中擁有一個自動協調工具，以幫助完善對準反映的計劃。然後您將看到有機會收集所有這些數據並提供預測分析功能，最終再次提高客觀性。因此，如果我們希望您從我們所描述的和我們正在做的事情中學到一件事，那就是我們正在努力減輕格式塔和猜測，並提高客觀性水平，最終反映在更好的決策中以及手術中的更多可預測性。我認為這引起了人們的共鳴，這也是我們如此看好公司的反思性成長概況的原因。另一個推動我們不斷努力的因素是我們的價平台。我們大約一年多前購買了它。我們對設計和開發工作的進展感到非常滿意。我們已經開始在系統中放置椎弓根螺釘。最終，最終體現的價值就是我們將其融入橫向的工作流程中。我們這樣做的熱情非常高。我們所取得的進展正是我們的預期。因此，我們對該技術及其增量效益的看好是非常明顯的。因此，我們成長的另一個推動力是國際化。托德和我致力於做的一件事就是縮小市場範圍並深入市場。如果你看看我們正在參與的市場，你會發現這正是我們所採取的策略。澳洲和紐西蘭表現出色。澳洲和紐西蘭的團隊非常出色。如果你開始觀察人口統計數據，你會發現市場規模很大。我們開始創造收入。我們有 40 多名外科醫生參加，本質上是一個橫向智囊團。我們有 20 位接受過訓練的外科醫生。我認為此頁面上最重要的統計數據是迄今為止執行的 400 個 PTP。我認為這反映了進入市場、描述一項技術的好處、幫助外科醫生做好使用該技術取得成功的準備，並以非常狹隘的方式反映這一點。所以我們認為它是日本的代表。日本是下一個。日本是一個很大的市場。我們非常覬覦這個市場。我們對這個市場感到非常興奮。我們已經在該市場上清除了後固定。我們的 Pimentas 博士在該市場上享有很高的聲譽。我們期望隨之而來的是巨大的成功。因此，正如我們所看到的，這只是另一個增量順風。由於它涉及市場的顛覆，我們面臨前所未有的市場機會。這種情況始於去年秋天，伴隨著產業整合、投降和領導層更迭。當我們觀察市場時，我們發現 35% 的市場受到了乾擾。除了我們之外，其他人都無動於衷。這是多麼好的一個機會。我們經常談論這些事情，並且談論它們是在一段時間內發生的。關於 Stryker K2M，有一個很棒的代理商。這是多年來發生的動態。我認為每個人都希望所有活動在一夜之間發生。我們正在盡我們所能取得盡可能多的進展。我們預計這種情況將在未來幾年持續下去，我們對此感到非常興奮。我們也發現，美國約有三分之一的地區仍未覆蓋或覆蓋不足。因此，我們有很多機會可以拓展業務。我們一直在策略性地增加南加州、西北地區、中西部的部分地區以及東北地區的業務。因此，去那裡散步真是令人興奮不已。有很多機會。當地有很多機會。我們正在本地取得進展。我們非常渴望有機會在公司內部實現人員的流動性，最終實現我們公司的策略。我還認為，當你開始審視主要的市場影響時，在短短兩年內，我們開始在紐約、休士頓、鳳凰城和芝加哥等地取得進展。這對我們來說非常令人興奮。我們在美國擁有約 6% 的市場份額，但在我們最好的市場中，實際上我們擁有 25% 的市場份額。因此，我們認為這預示著我們希望在未來幾年複製的廣泛機會。因此，我想告訴大家，我們處於創造價值的有利位置，我們對自己的身份感到非常滿意，只是為了提醒大家我們在 LRP 中所做的承諾。再說一次，愛我們現在的處境。我們將繼續提醒你們這些承諾。但實際情況是，2027 年將達到 10 億美元，調整後 EBITDA 為 1.8 億美元，調整後 EBITDA 利潤率為 18%，自由現金流為 6,500 萬美元。因此，它的預期收入複合年增長率為 20%，利潤率擴張 2,000 個基點，現金流在 2025 年達到收支平衡。因此，我會將其交給托德。

Well, thank you, Pat, and good afternoon, everyone. We appreciate you joining us on the call today. I'll begin with revenue. First quarter revenue was $138 million, reflecting 27% growth compared to the prior year and flat sequentially. The $138 million in revenue is comprised of $123 million in surgical revenue and $16 million of EOS revenue. First quarter surgical revenue of $123 million increased 30% over the prior year. This growth was against a strong comparable of 55% in the first quarter of last year. It was the highest growth comparison we have ever lapped aside from a pandemic rebound influence quarter in 2021. And while lateral was again the largest contributor, growth continues to be strong across our entire portfolio. Surgical revenue was driven by robust procedural volume growth of 23%, which is a reflection of an increase in the number of surgeons adopting Atec procedures and an increase in surgeon utilization. Average revenue per case grew 6% year over year, driven by a higher mix of lateral surgeries and increased case complexity, offset to a degree by improving mix of surgical surgeries. EOS revenue in the first quarter was $16 million, up 5% compared to last year. Similar to surgical revenue, EOS lapped a sizable 47% growth comparison, its toughest since the close of the acquisition.

嗯，謝謝你，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。第一季營收為 1.38 億美元，較上年同期成長 27%，與上一季持平。1.38 億美元的收入包括 1.23 億美元的手術收入和 1,600 萬美元的 EOS 收入。第一季手術收入為 1.23 億美元，比去年同期成長 30%。這一增長與去年第一季 55% 的強勁可比增長相比。這是 2021 年疫情反彈影響季度之外我們所經歷過的最高成長比較。雖然橫向再次成為最大的貢獻者，但我們整個投資組合的成長仍然強勁。手術收入增加了 23%，這反映了採用 Atec 手術的外科醫生數量的增加以及外科醫生利用率的提高。由於側向手術組合增加和病例複雜性增加，每例平均收入年增 6%，但在一定程度上被外科手術組合的改善所抵消。EOS第一季營收為1,600萬美元，較去年成長5%。與手術收入類似，EOS 的成長幅度高達 47%，這是自收購結束以來最艱難的成長。

Next I'll turn to results for the remainder of the P&L. First quarter non-GAAP gross margin was 71%, up 50 basis points compared to the prior year. The year over year increase was primarily driven by improved EOS gross margin, which is benefiting from pricing initiatives, a growing US mix, and improved service operations, as well as strong volumes are fueling leverage of our Memphis distribution facility. First quarter non-GAAP R&D was $14 million and approximately 10% of sales, compared to 12 million and 11% of sales in the prior year. The increase on an absolute dollar basis was driven by continued investment in organic innovation and development of Valence, the robotic navigation platform that we acquired in April of 2023. Non-GAAP SG&A was 101 million and approximately 73% of sales in the first quarter, compared to 81 million and 74% of sales in the prior year period, up 90 basis points. Included in SG&A is the expected step up in depreciation related to the purchase of instrument sets, our revenue generating assets. As a percent of sales, depreciation increased about 200 basis points year over year. Excluding that impact, SG&A improved by 300 basis points as a percent of sales. The significant improvement was driven, as expected, by infrastructure leverage and improvements in our variable selling rate. Initial non-GAAP operating expense amounted to $115 million and approximately 83% of sales in the first quarter, compared to $93 million and 85% of sales in the prior year period, demonstrating 200 basis points of operating leverage year over year. Adjusted EBITDA was a loss of $3 million and approximately 2% of sales in the first quarter, compared to a loss of 7 million and 7% of sales in the prior year, a 450 basis point improvement. Leverage was driven primarily by the 300 basis points of SG&A leverage, followed by 100 basis points of R&D leverage, and 50 basis points of gross margin leverage. The consistent adjusted EBITDA margin expansion that we are driving is aligning solidly with our expectations, giving us great confidence in our ability to execute the long-term profitability commitments that we detailed at the long-range plan in March.

接下來我將討論損益表其餘部分的結果。第一季非 GAAP 毛利率為 71%，較上年增加 50 個基點。同比增長主要是由於 EOS 毛利率的提高，這得益於定價舉措、不斷增長的美國組合和服務運營的改善，以及強勁的銷量提高了我們孟菲斯分銷設施的槓桿率。第一季非 GAAP 研發費用為 1,400 萬美元，約佔銷售額的 10%，去年同期為 1,200 萬美元，約佔銷售額的 11%。以絕對美元計算的成長是由於對 Valence 的有機創新和開發的持續投資推動的，Valence 是我們於 2023 年 4 月收購的機器人導航平台。第一季非 GAAP SG&A 為 1.01 億美元，約佔銷售額的 73%，而去年同期為 8,100 萬美元，佔銷售額的 74%，成長了 90 個基點。SG&A 中包括與購買儀器組（我們的創收資產）相關的預計折舊增加。折舊佔銷售額的百分比年增約 200 個基點。排除此影響，SG&A 佔銷售額的百分比提高了 300 個基點。正如預期的那樣，基礎設施槓桿和可變銷售率的改善推動了這一顯著改善。第一季初始非 GAAP 營運費用為 1.15 億美元，約佔銷售額的 83%，而去年同期為 9,300 萬美元，佔銷售額的 85%，這表明營運槓桿同比增加了 200 個基點。第一季調整後 EBITDA 虧損 300 萬美元，約佔銷售額的 2%，而去年同期虧損 700 萬美元，約佔銷售額的 7%，改善了 450 個基點。槓桿率主要由 300 個基點的 SG&A 槓桿驅動，其次是 100 個基點的研發槓桿和 50 個基點的毛利率槓桿。我們正在推動的調整後 EBITDA 利潤率的持續擴張與我們的預期完全一致，這使我們對執行我們在 3 月份的長期計劃中詳細說明的長期盈利承諾的能力充滿信心。

Turning to the balance sheet, we ended the first quarter with $144 million in cash. Debt at carrying value was $527 million. Industry cash use totaled $70 million, with approximately $60 million of that deployed, as planned, into the inventory and instruments that support the expansion of our distribution footprint and the new product launches. The chart at the bottom of this slide depicts that investment into revenue-generating assets has stepped up and has represented the majority of cash flow use over the last several quarters. We raised cash in 2023 to capitalize on industry disruption, equipping our expanding sales team with the assets they needed to serve surgeries and grow their territories. We are now putting that capital to work and will continue to do so throughout the year. We continue to expect cash use to approximate $100 million for the full year, stepping down from Q1 to Q2 and progressing towards cash flow break-even in the second half. The next slide adds context to our revenue-generating asset investments. Generally, the ratio of asset investment to dollars of year one surgical revenue growth is about $0.75 to the dollar. Over their five-year useful lives, those assets investments generated a 3X return. Looking back to 2022, the 75% framework was intact. Adjusted EBITDA was negative, so we needed cash to fund both the negative adjusted EBITDA and the investment in SETs and inventory. In 2023 and 2024, our long-range plan forecasts over $200 million of surgical revenue growth and inflection to positive adjusted EBITDA. Over these two years, we are investing significantly more than we typically would to support accelerated growth in the sales team. The magnitude of asset investment over that timeframe will exceed revenue dollar growth, putting us ahead of the 75% framework. From year end 2025 to 2027, our long-range plan forecasts just under $400 million of revenue growth. Adjusted EBITDA over that time is expected to comfortably surpass the investment in SETs and inventory. That inflection in our financial profile is incredibly important. We are on the cusp of self-sustaining growth, with profit generation poised to more than cover the asset investment that the long-term growth of our business requires. And that explains how we will achieve cash flow breakeven in 2025 and cash flow positivity beyond. Another important point is that with investment exceeding our general 75% framework in 2023 and 2024, we are creating an asset base capable of supporting more revenue than contemplated in the long-range plan. And from an asset standpoint, we are well positioned to support incremental revenue growth.

轉向資產負債表，第一季結束時我們有 1.44 億美元的現金。以帳面價值計算的債務為 5.27 億美元。行業現金使用總額為 7000 萬美元，其中約 6000 萬美元按計劃部署到庫存和工具中，以支持我們擴大分銷範圍和推出新產品。本投影片底部的圖表顯示，對創收資產的投資已經增加，並佔過去幾季現金流使用的大部分。我們在 2023 年籌集了現金，以利用行業顛覆的機會，為我們不斷擴大的銷售團隊配備他們為手術提供服務和擴大業務範圍所需的資產。我們現在正在將這些資金投入使用，並將在全年繼續這樣做。我們仍預計全年現金使用量約為 1 億美元，從第一季下降到第二季度，並在下半年實現現金流收支平衡。下一張投影片新增了我們創收資產投資的背景。一般來說，第一年手術收入成長的資產投資與美元的比率約為0.75美元/美元。在五年的使用壽命內，這些資產投資產生了 3 倍的回報。回顧2022年，75%的框架完好無損。調整後 EBITDA 為負，因此我們需要現金來為負調整 EBITDA 以及 SET 和庫存投資提供資金。到 2023 年和 2024 年，我們的長期計畫預計手術收入將成長超過 2 億美元，並轉為正調整 EBITDA。在這兩年裡，我們為支持銷售團隊的加速成長而進行的投資遠遠多於通常的投資。在此期間，資產投資的規模將超過收入的成長，使我們領先 75% 的框架。從 2025 年底到 2027 年，我們的長期計畫預計營收成長將接近 4 億美元。預計在此期間調整後的 EBITDA 將輕鬆超過 SET 和庫存投資。我們財務狀況的這種變化非常重要。我們正處於自我維持成長的風口浪尖，利潤產生將超過我們業務長期成長所需的資產投資。這解釋了我們將如何在 2025 年實現現金流損益平衡，並在未來實現正現金流。另一個重要的一點是，隨著 2023 年和 2024 年投資超過我們整體的 75% 框架，我們正在創建一個能夠支持比長期計劃中預期更多收入的資產基礎。從資產的角度來看，我們處於有利位置來支持增量收入成長。

Now, turning to our updated outlook for the full year 2024, we expect continued market share expansion to drive total revenue growth of 25% to approximately $601 million. That includes 2024 surgical revenue growth of approximately 27% to $536 million, and EOS revenue of approximately $65 million. Surgical volume growth will be the greatest contributor to surgical revenue growth, and we now expect that to increase at a low 20% rate for the full year, a little higher than we previously expected. Revenue per surgery growth also contributes to surgical revenue growth, and we continue to expect that to increase at a mid-single-digit percent rate for the full year. I'd like to point out that prior to our October capital raise, consensus was around $555 million for the full year 2024. Only six months later, guidance is now north of $600 million, which is $45 million higher than the number prior to our raise. The new reps we are attracting are highly tenured and in strategic geographies. While the benefits of market disruption will not be reflected overnight, it is clear we are executing on the intent of the raise.

現在，轉向我們對 2024 年全年的最新展望，我們預計市場份額的持續擴張將推動總收入成長 25%，達到約 6.01 億美元。其中包括 2024 年手術收入成長約 27% 至 5.36 億美元，EOS 收入約 6,500 萬美元。手術量成長將是手術收入成長的最大貢獻者，我們現在預計全年將以 20% 的低速度成長，略高於我們先前的預期。每次手術收入的成長也有助於手術收入的成長，我們繼續預期全年手術收入將以中個位數百分比的速度成長。我想指出的是，在我們 10 月籌集資金之前，一致認為 2024 年全年的融資額約為 5.55 億美元。僅六個月後，指導值現已超過 6 億美元，比我們籌集資金之前的數字高出 4,500 萬美元。我們吸引的新代表都是長期任職且處於戰略地理位置的。雖然市場混亂的好處不會在一夜之間體現出來，但很明顯，我們正在執行加薪的意圖。

Now turning to profitability progress, sales growth continues to fuel leverage across our business. We now expect full year 2024 adjusted EBITDA of approximately $23 million, which equates to 570 basis points of margin expansion. That implies an approximate 27% drop-through on the year-over-year growth in revenue dollars, an acceleration compared to the 22% drop-through in 2023. The degree of progress that we have already delivered with drivers of expected leverage contributing as planned give us great confidence in the updated profitability commitments that we shared as part of our long-range plan update. Specifically, from 2023 to 2027, we expect to deliver another 2,000 basis points of operating leverage. The majority of that, or about 1,000 basis points, will be driven by contractual time-based variable selling rate improvements. Another 700 basis points will be fueled by SG&A infrastructure leverage, and the remaining 300 basis points will come from R&D improvements as a percent of sales. Note that the R&D will continue to increase on an absolute dollar basis, positioning us to consistently lead spine innovation. That continued operating progress will enable the business to be capsule break-even in 2025. The deliberate increase in profitability will support continued investment into the long-term growth of our business, while powering an inflection to solid capsule generation. Now, I'll close with what sets Atec apart in terms of the value creation opportunity ahead. With a 40% revenue CAGR over the last five years, our growth stands out not just in magnitude, but in consistency, particularly as our revenue base has grown. We have clearly demonstrated execution and in the integrity of demand for Atec clinical distinction. We are the most differentiated, most spine-focused, pure play in a big US spine market. That sizable, consistent revenue growth has opened the door to our next leg of value creation, which is profitability. We have already demonstrated progress and have a clear line of sight to a self-funded future, fueling our long-term financial growth story, our catalysts that make the Atec story especially compelling. We're cultivating our lateral franchise with innovation to continue to earn share of the lateral market and convert more traditional surgeries to lateral surgeries. Our industry is undergoing unprecedented disruption, and we are capitalizing on it. We are readying to launch enabling technology that uniquely integrates into spine workflows, including in deformity, where we are building a procedural solution around EOS, and we are laying a foundation in attractive international markets where we can replicate the US adoption curve. There is truly a lot to be excited about, and I look forward to sharing the progress with you.

現在轉向獲利能力的進步，銷售成長繼續推動我們整個業務的槓桿作用。我們現在預計 2024 年全年調整後 EBITDA 約為 2,300 萬美元，相當於利潤率擴張 570 個基點。這意味著營收年增約下降 27%，與 2023 年 22% 的下降相比有所加速。我們已經在預期槓桿驅動因素按計劃做出貢獻的情況下取得了進展，這讓我們對作為長期計劃更新的一部分所分享的更新後的盈利能力承諾充滿信心。具體來說，從 2023 年到 2027 年，我們預計營運槓桿將再提高 2,000 個基點。其中大部分（即約 1,000 個基點）將由合約中基於時間的可變銷售利率改善所推動。另外 700 個基點將由 SG&A 基礎設施槓桿推動，其餘 300 個基點將來自佔銷售額百分比的研發改善。請注意，研發將繼續以絕對美元為基礎增加，使我們能夠持續引領脊椎創新。持續的營運進度將使該業務在 2025 年實現收支平衡。獲利能力的刻意提高將支持對我們業務長期成長的持續投資，同時推動固體膠囊生產的轉變。現在，我將介紹 Atec 在未來價值創造機會方面的獨特之處。過去五年，我們的營收複合年增長率為 40%，我們的成長不僅在規模上，而且在一致性上都很引人注目，特別是隨著我們收入基礎的成長。我們清楚地證明了 Atec 臨床區分的執行力和完整性需求。我們是美國大型脊椎市場中最具差異化、最專注於脊椎的專業公司。這種可觀且持續的收入成長為我們創造下一個價值階段（即獲利能力）打開了大門。我們已經取得了進展，並對自籌資金的未來有著清晰的願景，這推動了我們的長期財務成長故事，我們的催化劑使 Atec 的故事特別引人注目。我們正在透過創新培育我們的側向特許經營權，以繼續贏得側向市場份額，並將更多傳統手術轉變為側向手術。我們的產業正在經歷前所未有的顛覆，我們正在利用它。我們準備推出能夠獨特地整合到脊椎工作流程中的支援技術，包括在畸形方面，我們正在圍繞EOS 建立程序解決方案，並且我們正在有吸引力的國際市場奠定基礎，在這些市場中我們可以複製美國的採用曲線。確實有很多值得興奮的事情，我期待與您分享進展。

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

這樣，我會將電話轉回給帕特。

Thanks so much, Todd. I think with all the goings on in the spine space, the opportunity to improve spine surgery is significant, and that will be our value driver. When there's revision rates that are reflective of 10 to 15% in degenerative, 25 to 30% in adult deformity, the durability of spine surgery is called into question. Clearly Atec is in a unique position to lead, and we look forward to doing so. And with that, what we'll do is turn the call over for questions.

非常感謝，托德。我認為，隨著脊椎領域發生的所有事情，改進脊椎手術的機會是巨大的，這將是我們的價值驅動力。當退化性畸形的翻修率達到 10% 到 15%，成人畸形的翻修率達到 25% 到 30% 時，脊椎手術的持久性就會受到質疑。顯然，Atec 處於獨特的領導地位，我們期待著這樣做。接下來，我們要做的就是轉交電話詢問問題。

(Operator Instructions) Joshua Jennings, TD Cowen.

（操作員說明）Joshua Jennings，TD Cowen。

Congratulations on a strong start to 2024. Pat, I was hoping to ask about the opportunity in deformity. I know you guys have talked about this multiple times over the last 6 to 12 months, but one, maybe just help us think about Atec's share in deformity may be hard to parse out. And then on top of that, I was hoping to just ask about the evolution of SafeOp and integrating motor evoked potentials into the monitoring platform and how important that it is to deformity procedure. So, one, deformity procedures and Atec's future share taking, and then I have one follow-up on EOS.

恭喜 2024 年取得良好開局。派特，我想問畸形的機會。我知道你們在過去 6 到 12 個月裡多次討論過這個問題，但是，也許只是幫助我們思考 Atec 在畸形中所佔的份額可能很難解析。除此之外，我希望只是詢問 SafeOp 的演變以及將運動誘發電位整合到監測平台中，以及它對畸形手術有多重要。那麼，第一，畸形程序和 Atec 未來的股份持有，然後我對 EOS 進行了一項後續行動。

Yeah. Josh, I think the opportunity to influence deformity is very apparent and opportune. I think the most coveted tool in evaluating deformity is an EOS image, and I think bringing about predictive analytics to a field that completely lacks it is an opportunity to distinguish. And so, it's been so exciting to see the automated measures, the planning, understanding reciprocal change in the levels, bringing that into an operative experience and understanding that you can refine a patient-specific implant, and then you can refine it in the operating room based upon the information you delivered. And then just the ability to take that information and have the exact same image postoperatively is almost predictive analytics by description. And so, you think about the type of revision rates that you see in deformity, and you think about what are the variables that you're trying to control, and we think the great tool to control variables is the EOS image and ultimately how we utilize that in the surgery. And so, we're a bit player in the grand scheme of things in deformity, and we feel like this tool really brings us to the forefront of both adult and idiopathic. We have a long way to go from a design development perspective in terms of some of the implant systems in that realm. We're doing a good job, but we have opportunity abound. And so, I would tell you from a EOS perspective, the most coveted tool in the business, from an implant perspective, I would say good to very good. We will be great. We have the mechanical aptitude to be great. I think the big sleeper is SafeOp, and I think that when you start to especially think about idiopathic deformity and you start to think about how disruptive MEPs are today and the ability to do things like facilitation in a way that you don't need the voltage to ultimately test the motor elements of the cord, and to be able to assess that by not disrupting surgery, we feel like is another significant benefit. And so, we feel like in both the adult and in the idiopathic realm, there are significant opportunities technologically to distinguish ourselves, which ultimately, this is a group that's steeped in research and a group that doesn't make decisions to change easily, but our technology portfolio, I believe, will provide that impetus.

是的。喬什，我認為影響畸形的機會是非常明顯和恰到好處的。我認為評估畸形最令人垂涎​​的工具是 EOS 影像，我認為將預測分析引入完全缺乏它的領域是一個區分的機會。因此，看到自動化測量、規劃、理解水平的相互變化、將其帶入手術體驗並理解您可以改進患者特定的植入物，然後您可以在操作中改進它，真是令人興奮。提供的資訊而定。然後，獲取這些資訊並在術後獲得完全相同的圖像的能力幾乎就是透過描述進行預測分析。因此，您考慮在畸形中看到的修正率類型，並考慮您想要控制的變數是什麼，我們認為控制變數的好工具是 EOS 影像，以及最終我們如何控制變數。因此，我們在畸形問題的宏偉計劃中扮演了一個小角色，我們覺得這個工具確實讓我們站在了成人和特發性畸形的最前線。從設計開發的角度來看，對於該領域的一些植入系統，我們還有很長的路要走。我們做得很好，但我們還有很多機會。因此，我會從 EOS 的角度告訴您，這是業內最令人垂涎​​的工具，從植入的角度來看，我會說好到非常好。我們會很棒的。我們擁有卓越的機械能力。我認為最大的沉睡者是SafeOp，我認為當你開始特別考慮特發性畸形時，你開始思考當今的歐洲議會議員有多麼具有破壞性，以及以一種你不需要的方式做諸如協助之類的事情的能力。因此，我們覺得無論是在成人領域還是在特發性領域，在技術上都有重要的機會讓我們自己脫穎而出，最終，這是一個專注於研究的群體，也是一個不會輕易做出改變決定的群體，但是我相信，我們的技術組合將提供這種動力。

Great. And just one follow-up, another technology question. Just on the interop alignment and automated reconciliation tool, can you just help us understand where you are in that development process? It looks like on one of the slides that there's at least a prototype, or maybe that's already in play and I'm just behind, but how important is that technology? Where are you guys in development there? It looks like it may be the only non-FDA cleared, I guess, piece of the EOS Insight platform, and that may just be an overread by me on the slide. Thanks for helping us out.

偉大的。還有一個後續問題，另一個技術問題。就互通對齊和自動協調工具而言，您能否幫助我們了解您在開發過程中的位置？在其中一張投影片上看起來至少有一個原型，或者可能已經在使用而我只是落後，但這項技術有多重要？你們在哪裡開發？我猜，它看起來可能是 EOS Insight 平台中唯一未經 FDA 批准的部分，而這可能只是我在幻燈片上的過度閱讀。感謝您幫助我們。

No, I think it's the right catch. The interoperative reconciliation is not something that has historically been done. And so we're, in essence, making a market there, and we're early on in the experience with that. We expect FDA clearance by the end of Q2, but I will tell you, this will be a long effort in terms of creating utility and simplicity and a seamlessness in the operating room. So it's our most immature element of the Insight portfolio of goods, but one that we believe to be very, very valuable over time. So I'll look forward to more updates, but your catch is exactly the right one. T

不，我認為這是正確的選擇。歷史上並沒有進行過互通協調。因此，從本質上講，我們正在那裡開拓市場，而且我們很早就有了這方面的經驗。我們預計 FDA 在第二季末獲得批准，但我會告訴您，在創造實用性、簡單性以及手術室的無縫性方面，這將是一項長期的努力。因此，這是我們 Insight 產品組合中最不成熟的元素，但我們相信隨著時間的推移，它會非常非常有價值。所以我期待更多的更新，但你的收穫是完全正確的。時間

hanks a lot, Pat.

非常感謝，帕特。

David Saxon, Needham.

大衛‧撒克遜，李約瑟。

I'd love to talk about the competitive hiring you've seen over the last few quarters, but specifically around what you're seeing in terms of leakage in territories that are covered by those competitive reps, how effective has cross-covering been in regions that are covered by, I guess, non-competes. And then anything to update to the hiring from, I think, it was 50 last year disclosed in mid-March. And then just quickly for Todd, any selling day impact in the quarter? Thanks so much for taking my question.

我很想談談您在過去幾個季度中看到的競爭性招聘，但特別是圍繞您所看到的這些競爭性代表所覆蓋的領域的洩漏情況、交叉覆蓋的有效性如何我猜想，這些區屬於競業禁止範疇。然後，我認為去年 3 月中旬披露了 50 名招募人員的最新情況。對托德來說，本季的銷售日有什麼影響嗎？非常感謝您提出我的問題。

I'll start off and then I'll let Todd, I hate to say clean up, but he'll provide decisions. It's the way we work together. Anyway, the hiring is going very, very well. It's entertaining. I get the opportunity to sit with our sales training class, and I sat in there yesterday with 30 people, men and women, and there is not a company that's not represented in the people who are coming forth to ATAC. And so one of the things that we committed to, and it's almost like the international focus of, hey, we're going to go narrow and deep. We're going to grow our sales force in a very deliberate way. Our sales leader is a very disciplined guy, Dave Sponsel. And I think that he's done a superb job in terms of being methodical with regard to the geographies that we grow into and how many people within those geographies, can we support them from a implant and instrument and a procedural perspective. And so there's a lot of things to bring to bear. And so trying to be deliberate and precise in these efforts is hugely important, but we continue to grow the sales force. There continues to be a lag in terms of their influence, but I would tell you great progress is being made. The difference between, I think, the perspective from a banker investor standpoint is, I think there's an expectation that it happens overnight. And I think I tried to utilize the proxy of the K2 striker as one that would suggest these things take time. And as we look back on them, they're going to feel quick. When you do the work through them, they're not so quick. And so anyway, we remain bullish. It's a long tail and we are super excited about our prospects.

我會開始，然後我會讓托德，我不想說清理，但他會提供決定。這是我們合作的方式。不管怎樣，招募工作進展得非常非常順利。這很有趣。我有機會參加我們的銷售培訓班，昨天我和 30 個人一起參加了培訓班，有男有女，沒有一家公司不參加 ATAC 培訓班。因此，我們致力於做的事情之一，這幾乎就像國際焦點一樣，嘿，我們將走得更窄、更深入。我們將以非常審慎的方式發展我們的銷售團隊。我們的銷售主管 Dave Sponsel 是一位非常自律的人。我認為他在有條不紊地考慮我們成長的地區以及這些地區中有多少人，我們可以從植入物、儀器和程序的角度支持他們方面做得非常出色。因此，有很多事情需要承擔。因此，在這些努力中努力做到深思熟慮和精確非常重要，但我們將繼續擴大銷售團隊。他們的影響力仍然存在滯後，但我可以告訴你正在取得巨大進展。我認為，從銀行家投資者的角度來看，兩者之間的差異在於，我認為這會在一夜之間發生。我想我試圖利用 K2 前鋒的代理作為一個暗示這些事情需要時間的代理。當我們回顧他們時，他們會感覺很快。當你透過它們完成工作時，它們並不那麼快。因此無論如何，我們仍然看漲。這是一條長尾，我們對我們的前景感到非常興奮。

And David, I think I would add to that, clearly we're seeing the impact of the hires that we've made. I referenced that specifically in my prepared comments. And so I think it's clear that those hires have been having an impact in the way that we expect. Everyone's different and everyone's in a unique situation. So there's variability from one geography to another. But I would say nothing outside of the bounds that we would expect. And so I would say very much as planned, to Pat's point, there's a ton of interest. You look at the people who are coming into the building, represents all the major players. And so I think our belief is we're absolutely doing the deal as we laid it out. And the beautiful thing here is that there's much more to come as we look forward to that. And to your specific question on selling days, we're 64 selling days here in the quarter. No impact year over year. And I think it's about two days more than Q4.

大衛，我想我要補充一點，顯然我們正在看到我們所聘用的人員的影響。我在準備好的評論中特別提到了這一點。因此，我認為很明顯，這些招聘已經按照我們預期的方式產生了影響。每個人都是不同的，每個人都處於獨特的情況。因此，不同地理位置之間存在差異。但我不會說任何超出我們預期的事情。所以我想說的是，按照帕特的觀點，按照計劃，人們有很多興趣。你看看那些走進大樓的人，他們代表了所有的主要參與者。所以我認為我們的信念是我們絕對會按照我們的計劃進行交易。這裡美妙的事情是，當我們期待的時候，還會有更多的事情發生。至於您關於銷售天數的具體問題，本季我們有 64 個銷售天數。逐年沒有影響。我認為這比第四季度多了大約兩天。

Great. Thanks so much.

偉大的。非常感謝。

Vik Chopra, Wells Fargo.

維克喬普拉，富國銀行。

So I apologize if we've already been asked. But can you maybe just talk about what you saw, what trends you saw during the quarter with respect to patient volumes? And then add a follow up, please.

如果我們已經被問到了，我深感抱歉。但您能否談談您所看到的情況以及您在本季度看到的患者數量方面的趨勢？然後請新增後續內容。

Yeah, I guess at least this is Pat. I think what we saw is a pretty consistent flow really all the way through the quarter. I think there's some vacations in the back end of March. But again, nothing that would create any discerned interest. So it felt very, very normal.

是的，我想至少這是帕特。我認為我們看到的是整個季度的流程非常穩定。我想三月底會有一些假期。但同樣，沒有任何東西會引起任何明顯的興趣。所以感覺非常非常正常。

And I felt good, Vic, in a way. As you can see, we clearly overachieved relative to our expectations. And also, the exit velocity there gives us a level of competence to raise forward guidance as well, especially on surgical revenue. So I think to Pat's point, you've always got kind of Q1 vacations and timing with different types of holidays. But on the whole, felt very good about the trends and where they're headed.

在某種程度上，我感覺很好，維克。正如您所看到的，我們顯然超出了我們的預期。而且，那裡的退出速度也使我們有能力提高前瞻性指導，特別是在手術收入方面。所以我認為帕特的觀點是，第一季的假期總是有不同類型的假期。但總體而言，我對趨勢及其發展方向感覺非常好。

Okay. Thank you for that, Colin. And then just on a follow up, maybe just talk about the cadence of revenues and margins as we think about the rest of the year, specifically in Q2 and Q3. Thank you very much.

好的。謝謝你，科林。然後，當我們考慮今年剩餘時間，特別是第二季和第三季時，也許只是談論收入和利潤率的節奏。非常感謝。

Yeah, definitely. I think as we kind of look at our overall, you know, really overall revenue growth of 25%, so $601 million, you know, I think ultimately our view is that you look at that being on average just about 25% growth. I think you'll see something similar to that in kind of Q2 and Q3, plus or minus. I think when we look at the guide, you saw us really kind of probably beat our expectation relative to EOS in the first quarter. Fundamentally, I think that's a little bit of timing movement from Q2 to Q1. And then ultimately, when you look at the profitability walk, I think our profitability view is adjusted EBITDA. We raised guidance by $1 million, went from $22 million to $23 million. That $23 million means 570 basis points of margin expansion on the full year. We did 450, and I think as we've been talking about it, the first half of the year will be maybe 100 basis points of margin expansion less than the full year. So kind of 450 to 500. The second half would be probably 100 basis points north of that. So kind of think on total like 650 to 700 in total. So when you kind of boil that out, I think an absolute adjusted EBITDA dollars, you're probably close to break even in the first half and the balance coming in the second half. So I think on the whole, that's how we see the timing of revenue and profitability walking through the year.

是的，絕對是。我認為，當我們審視我們的整體收入時，您知道，整體收入成長了 25%，即 6.01 億美元，我認為最終我們的觀點是，平均成長約為 25%。我想你會在 Q2 和 Q3 中看到類似的東西，無論是加法或減量。我認為，當我們查看指南時，您會發現我們第一季相對於 EOS 的表現可能確實超出了我們的預期。從根本上講，我認為這是從第二季度到第一季的一點時間變化。最終，當你審視獲利能力時，我認為我們的獲利能力觀點是調整後的 EBITDA。我們將指導意見上調了 100 萬美元，從 2,200 萬美元增至 2,300 萬美元。這 2,300 萬美元意味著全年利潤率擴大 570 個基點。我們做了 450 個基點，我認為正如我們一直在談論的那樣，今年上半年的利潤率擴張可能比全年少 100 個基點。大概是 450 到 500 左右。下半年可能會高出 100 個基點。算起來總共有 650 到 700 個。因此，當您將其歸結為絕對調整後的 EBITDA 美元時，您可能會在上半年接近收支平衡，而在下半年實現平衡。所以我認為總的來說，這就是我們如何看待全年收入和盈利能力的時間安排。

Kaitlyn Cronin, Canaccord Genuity.

凱特琳‧克羅寧 (Kaitlyn Cronin)，Canaccord Genuity。

It's George on for Kaitlyn. Thanks for taking our questions. Kind of wanted to dig into more of your EO's guidance. Obviously, you raised your full year guidance, but just any more call you could give in terms of why you reiterated EO's revenues when the quarter looked pretty strong from our end, especially with the insight being launched. Maybe talk about how much of that is based on the expectations and if there's any more upside there. And then I have one follow up.

喬治替凱特琳上場。感謝您回答我們的問題。我有點想深入了解更多 EO 的指導。顯然，您提高了全年指導，但您可以再打電話來解釋為什麼您重申了 EO 的收入，因為從我們的角度來看，該季度看起來相當強勁，尤其是在推出洞察力的情況下。也許可以談談其中有多少是基於預期，以及是否還有更多的上升空間。然後我有一個跟進。

Yeah, I guess I'll start off. The one thing that's an unadulterated truth in capital equipment is there's a lag. And what we haven't done is pre-sold the whole insight platform. And so we have a lot of work to do to go out and sell insight. We are hugely bullish in terms of the long term prosperity that's generated by EO's insight. But candidly, few people know about it. And so our opportunity to ultimately lay the foundation for a future large business, I think, is reflective of our thoughtfulness on the guidance front.

是的，我想我會開始。資本設備的一個不折不扣的事實是存在滯後。我們還沒做的是預售整個洞察平台。因此，我們還有很多工作要做，才能走出去並推銷見解。我們非常看好 EO 的洞察力所帶來的長期繁榮。但坦白說，很少人知道這件事。因此，我認為，我們最終為未來的大型企業奠定基礎的機會反映了我們在指導方面的深思熟慮。

Thanks, Pat. And I think the other thing I would add to that, just a couple of contextual things. The $65 million is a 9% year over year growth. If you recall last year, we had about $2 million of one time buys associated with a market exit. And so when you strip that out kind of on a like for like basis, you get to a mid-teens growth. And so if you look at that $65 million another way, you look at over the last two or three years, we've grown that business 20% year over year. And so underlying strength of the EO's business, I think what we've delivered is quite strong. I will say, when you look at our guide being 65 going into the year and then the performance we had this year, keeping it 65, really, I would tell you that it reflects a level of conservatism associated with the capital equipment market and probably just being a little bit conservative on that point.

謝謝，帕特。我想我還要補充一點，就是一些上下文相關的東西。6500 萬美元年增 9%。如果你還記得去年，我們有大約 200 萬美元的一次性購買與市場退出有關。因此，當你在同類的基礎上剝離掉這一點時，你就會達到十幾歲左右的增長。因此，如果你以另一種方式看待這 6500 萬美元，你會發現在過去的兩三年裡，我們的業務比去年同期成長了 20%。因此，我認為 EO 業務的潛在實力非常強大。我會說，當你看到我們今年的指南是 65，然後是我們今年的表現，保持 65，真的，我會告訴你，這反映了與資本設備市場相關的保守主義水平，並且可能只是在這一點上有點保守。

And from your question relative to how does EO's insight launch impact our view, I think I just point you back to Pat's comments, which is I think that will be reflected ultimately in interest and orders. And if you think about the capital selling cycle being a 12-month cycle, there's some time that I think once we really start to see EO's insight influencing the revenue on EO's, certainly I think we'll start to see some orders matriculate and come through here over time. But that's really how we viewed the 2024 EO's revenue setup.

從你關於 EO 的洞察力發佈如何影響我們的觀點的問題來看，我想我只是讓你回到 Pat 的評論，我認為這最終將反映在興趣和訂單中。如果你認為資本銷售週期是一個 12 個月的周期，那麼我認為，一旦我們真正開始看到 EO 的洞察力影響 EO 的收入，我認為我們肯定會開始看到一些訂單進入並出現。的推移經過這裡。但這確實是我們對 2024 年 EO 收入設定的看法。

Yeah, that's a really great color. And then just one quick one from me, just early days in terms of valence, obviously, but can you talk a little bit about appetite among your existing EO's users and really any insights in how many of your existing EO's users are currently using robots from competitors? Thanks.

是的，這真是一個很棒的顏色。然後是我的一個簡短的介紹，顯然，就價而言，只是早期，但是您能否談談現有 EO 用戶的興趣，以及關於目前有多少 EO 用戶正在使用機器人的任何見解競爭對手？謝謝。

Yeah, that's a tough question. I think our customer base is pretty reflective of just kind of the general audience of robotic users. And I think we've always had a little bit of a disparate view with regard to the value of robotics as they currently are reflected. And so the bullishness of our valence strategy is really in the integration of the technology into lateral surgery and just continue to elevate the precision associated with the technique. And we think that there's a ton of opportunities. They're very apparent to us. A lot of the design and development stuff is going as planned. And we'll share some information in terms of just the utility of the nav robotic stuff just for sake of interest as we get through this year. But next year, I think you'll begin to see the influence clinically, which again, then there will be a bit of a drag numerically. But anyway, it's a nice tailwind that's yet to be reflected.

是的，這是一個很難回答的問題。我認為我們的客戶群很好地反映了機器人用戶的一般受眾。我認為我們對於目前所反映的機器人技術的價值一直有一些不同的看法。因此，我們的價策略的樂觀之處實際上在於將該技術整合到側向手術中，並繼續提高與該技術相關的精確度。我們認為有很多機會。它們對我們來說非常明顯。許多設計和開發工作正在按計劃進行。我們將在今年分享一些有關導航機器人實用性的信息，只是為了引起人們的興趣。但明年，我想你會開始在臨床上看到這種影響，這在數字上也會有一些拖累。但無論如何，這是一個尚未體現出來的良好順風。

Sean Lee, HC Wainwright.

肖恩李，HC 溫賴特。

Just a quick question on the international market. So from the slides, it looks like the full launch of PDP in Japan isn't expected until 2026. So I was just wondering what steps remains to be done before you can launch the product there? And also, do you plan on additional expansions internationally before that?

關於國際市場的一個簡單問題。因此從幻燈片來看，PDP 預計要到 2026 年才會在日本全面推出。所以我只是想知道在那裡推出產品之前還需要完成哪些步驟？另外，在此之前您是否計劃進一步進行國際擴張？

Yeah, I appreciate the question. The dynamic is that the Japanese market is a very careful market. And so the one historical dynamic has been that the JSSR, which is the Japanese Spine Society, opines on the regulatory clearance of companies in the market space. And we were over at the JSSR recently and had a very productive meeting and very exciting. They're going to initially enable us to go in with some more conventional items. We just saw that our Invictus portfolio got cleared and we'll start to go in with that. We'll start with lateral surgery in that marketplace. And our LTP will be really the first thing that Garner's experienced in Japan. And then what they'll do is they'll slowly go in with PTP. So we're just trying to be thoughtful with regard to what our expectations are from a contribution standpoint in that market, realizing that it's a very conservative market and things will go slow. What gives us great excitement is if you look at the, again, we consider Australia such a great proxy, Australia and New Zealand, and you look at the 400 PTPs being done in Australia, it just speaks to the predictability and reproducibility of a technique that gets introduced to a new market space and just our ability to ultimately garner. You don't get 400 if it's not predictable and reproducible. And so our enthusiasm to get into Japan, which is a much larger footprint, and again, a very consistent group of people as the Americans are in terms of just the procedural bent in the interest in applying procedures to pathologies and not being a widget market. So anyway, probably more than you cared for, but that's our enthusiasm. That's the drag. That's why we said 2026 on PTP is it's just going to be a methodical walk.

是的，我很欣賞這個問題。動態是，日本市場是一個非常謹慎的市場。因此，歷史動態之一是 JSSR（即日本脊椎協會）對市場空間中公司的監管許可發表意見。我們最近參加了 JSSR，並舉行了一次非常有成效且非常令人興奮的會議。它們最初將使我們能夠使用一些更傳統的項目。我們剛剛看到我們的 Invictus 投資組合已被清除，我們將開始著手處理。我們將從該市場的橫向手術開始。我們的長期培訓將是加納在日本經歷的第一件事。然後他們要做的就是慢慢採用 PTP。因此，我們只是試圖從該市場貢獻的角度考慮我們的期望，並意識到這是一個非常保守的市場，事情會進展緩慢。讓我們非常興奮的是，如果你再看看我們認為澳大利亞是一個很好的代理，澳大利亞和新西蘭，你看看澳大利亞正在進行的400 個PTP，它只是說明了一項技術的可預測性和可重複性這將被引入一個新的市場空間以及我們最終獲得的能力。如果不可預測且不可重現，您將不會得到 400。因此，我們熱衷於進入日本，日本的足跡更大，而且，像美國人一樣，這是一群非常一致的人，他們只是在程序上傾向於將程序應用於病理學而不是成為一個小部件市場。所以無論如何，可能超出您的關心，但這就是我們的熱情。這就是阻力。這就是為什麼我們在 PTP 上說 2026 年將是一個有條不紊的過程。

That's very helpful. Thanks a lot.

這非常有幫助。多謝。

Young Li, Jefferies.

年輕的李，傑弗里斯。

Sorry, I've been hopping around on calls, but I guess the question is on the top 10 US market chart. Very strong growth in two years from 2% to 6%. Wanted to hear a little bit about some of the top reasons for that growth and penetration. Is it from competitive rep hirings, organic growth, maybe using EOS to open accounts, PTP? Just want to hear a little bit of the reasons for that. And what are some of the other key strategic US markets you're focused on for 2024 and 2025?

抱歉，我一直在接聽電話，但我想問題出在美國十大市場圖表上。兩年內成長非常強勁，從 2% 成長到 6%。想了解成長和滲透的一些主要原因。是來自有競爭力的代表招募、有機成長、也許使用 EOS 開戶、PTP？只是想聽聽其中的一些原因。您在 2024 年和 2025 年關注的其他關鍵策略美國市場有哪些？

Yeah, I'll provide some opinions on the markets where I feel like we're making great progress. I'll probably refrain from describing what markets we expect to be next. Probably the other call that you were on may be listening in. I'm just kidding. It doesn't matter. Probably, at least as I look at the very, very big markets, I look at like Chicago, more organic type of a growth profile, some clear additions of people that have made significant differences in our run rate in, say, a Chicago. New York and New Jersey have been a competitive hiring scenario that has been outstanding. That was a big block of guys that came over in full in the fourth quarter of last year. They're starting to make progress and they're going to be well suited to make a great run for a long period of time in that market. And so I would say the impact in the most immediate or apparent growth spaces of, say, a New York and Chicago, two of the biggies, have been, I would say, inorganic in New York, more organic in Chicago. I would say organic in Los Angeles, starting to see Los Angeles start to demonstrate a growth. Very organic in Houston. Houston is the PTP capital of the world. I think we're just seeing that those people that have experience in this space, especially those that have experience in lateral, have done exceedingly well. Phoenix is another market where we have really an exceptional team. And so where we have people who have bought into the thesis of the company and have engaged deeply into what we're trying to build, we are making significant progress. And I think it's reflective in the top line growth number.

是的，我會就我認為我們正在取得巨大進展的市場提供一些意見。我可能不會描述我們預計接下來會出現的市場。可能您正在接聽的另一通電話正在監聽。我只是在開玩笑。沒關係。可能，至少當我觀察非常非常大的市場時，我會看到像芝加哥這樣的，更有機的成長概況，一些明顯增加的人員對我們的運作率產生了顯著的影響，比如說芝加哥。紐約和新澤西州的招募競爭非常激烈。這是去年第四季全部加入的一大群人。他們開始取得進步，並且非常適合在該市場上長期保持良好的發展。因此，我想說，對紐約和芝加哥這兩個大都市最直接或最明顯的成長空間的影響，我想說，紐約是無機的，而芝加哥是有機的。我想說的是洛杉磯的有機，開始看到洛杉磯開始展現成長。休士頓非常有機。休士頓是世界 PTP 之都。我認為我們只是看到那些在這個領域有經驗的人，尤其是那些在橫向領域有經驗的人，做得非常好。菲尼克斯是另一個市場，我們擁有一支非常出色的團隊。因此，只要我們有人認同公司的理念並深入參與我們正在努力建立的事業，我們就會取得重大進展。我認為這反映在營收成長數字。

I also think it's reflective in kind of the statistics underneath where we continue to see surge in growth, but consistent increased surge in adoption. And I think that reflects the broadening adoption of our core lateral franchise, PTP. Think about how you can apply that to more and more complex pathologies over time as you adopt that. And then you think about the halo effect and ultimately the impact that that has on our ability to just not only dive deeper in a geographical area by adding more surgeons, but to dive deeper within a surgeon's practice.

我還認為這反映在下面的統計數據中，我們繼續看到成長的激增，但採用率的持續成長。我認為這反映了我們的核心橫向特許經營權 PTP 的廣泛採用。考慮一下隨著時間的推移，當你採用這種方法時，如何將其應用於越來越複雜的病症。然後你會想到光環效應，以及它最終對我們的能力產生的影響，我們不僅可以透過增加更多的外科醫生來深入研究某個地理區域，而且還可以更深入地研究外科醫生的實踐。

Yeah. One last point is we have a PTP meeting coming up with more than 50 surgeons in attendance. It's oversubscribed. And it makes me think back about several years ago when we started to talk about this and completely got dismissed by the rest of the marketplace only to be right. And I would tell you that what makes this thing fun is the group of people that have been around spine surgery for years and ultimately are applying their experiences in ways that ultimately create progress. And so we're living in a good time in this business and just can't be more excited about the opportunities forward.

是的。最後一點是我們將召開 PTP 會議，有 50 多名外科醫生參加。已經超額認購了。這讓我回想起幾年前，當我們開始談論這個問題時，卻被市場上的其他人完全駁回，只是因為我們是對的。我想告訴你，讓這件事變得有趣的是一群多年來一直從事脊椎手術的人，並最終以最終創造進步的方式應用他們的經驗。因此，我們正處於這個行業的美好時光，並且對未來的機會感到無比興奮。

All right. Thank you very much. Appreciate the details.

好的。非常感謝。欣賞細節。

Well, I would just say thanks for your interest in Atec. We are just getting started and it ain't just a tagline. So anyway, thanks so much for your interest.

好吧，我只想說感謝您對 Atec 的興趣。我們才剛開始，這不僅僅是一個口號。無論如何，非常感謝您的關注。

Ladies and gentlemen, this concludes today's conference call. You may now disconnect.

女士們、先生們，今天的電話會議到此結束。您現在可以斷開連線。