Alphatec Holdings Inc (ATEC) 2024 Q3 法說會逐字稿

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

大家下午好，歡迎收聽Atec第三季財務業績網路直播。我們想提醒大家，電話會議的參與者將做出前瞻性的陳述。這些聲明是基於當前預期，並受不確定因素的影響，可能導致實際結果大不相同。這些不確定性在定期提交給美國證券交易委員會的文件中詳細說明。

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. Leading today's call will be Atec's Chairman and CEO, Pat Miles; and CFO, Todd Koning.

在此次電話會議中，您可能會聽到公司提及非公認會計準則或調整後的指標。非公認會計準則指標與美國公認會計準則的對帳表可在今天的新聞稿中的補充財務表中找到，其中識別和量化了所有排除的項目，並提供了管理層對這些資訊對投資者有用的原因的看法。今天的電話會議主持人將是 Atec 的董事長兼首席執行官 Pat Miles；和財務長 Todd Koning。

And now I will turn the call over to Pat Miles.

現在我將電話轉給帕特·邁爾斯。

Thank you, Kathleen. So really a great Q3. So super excited about what's going on here. We've outgrown everyone in the spine business again by at least 2x, I'm expecting more. And our focus is on perpetuating profitable growth. And so just a couple of stats from a Q3 highlight perspective, $151 million in total revenue, which is 27% growth. 30% surgical revenue growth, excited about that, means a lot of volume. So 20% surgical volume. 9% growth in revenue per procedure, 19% in new surgeon users, so that's back up and good.

謝謝你，凱瑟琳。所以這確實是一個非常棒的第三季。我對這裡發生的事情感到非常興奮。我們的規模已經超越了脊椎業務領域的其他公司至少兩倍，我預計還會更多。我們的重點是保持獲利成長。從第三季的亮點來看，有幾個數據值得關注：總營收 1.51 億美元，成長 27%。手術收入增加 30%，令人興奮，這意味著很大的數量。因此手術量為20%。每台手術的收入增加了 9%，新外科醫生用戶增加了 19%，所以這是很好的成長。

Increase -- we did over 200 surgeon training engagements. EOS Insight is launched and we have a record number of orders year-to-date. The profitability is good at $7.4 million in adjusted EBITDA, greater than 50% sequential reduction in cash burn. So we're on track to generate cash in Q4 ‘24, and we increased our term loan capacity by $50 million. So that's helpful.

增加—我們進行了超過 200 次外科醫生培訓。EOS Insight 已經推出，今年迄今為止我們的訂單數量創下了歷史新高。調整後的 EBITDA 獲利能力良好，達到 740 萬美元，現金消耗比上一季減少 50% 以上。因此，我們預計在 2024 年第四季產生現金，並且我們的定期貸款能力增加了 5,000 萬美元。這很有幫助。

Our value creation and cash generation is really the focus of what we're doing. So as a spine focused company, creating value clearly is our intention. And so we're accomplishing this through multiple means. And the first one is, and I think that nobody questions our capacity to do this because we've done it for five straight years, which is really lead in revenue generation. And so by leading in revenue generation and increasing profitability, clearly, it will reflect in cash flow.

我們所做的重點確實是創造價值和產生現金。因此，作為一家專注於脊椎的公司，創造價值顯然是我們的意圖。因此，我們透過多種方式實現這一目標。第一個是，我認為沒有人質疑我們的能力，因為我們已經連續五年這樣做了，在創造收入方面確實處於領先地位。因此，透過引領創收和提高獲利能力，顯然它會反映在現金流上。

And so what I want to do is provide you why we are so confident in this walk. And so as it relates to revenue, as I said, it's been five years of growth at multiples of anybody in the spine industry. Three years of organic growth greater than $100 million. Our procedural strategy is absolutely the right one and it's driving industry high ASPs, 20% surgical volume, 19% new surgeon growth. So that's being well accepted.

所以我想告訴你們為什麼我們對這次行動如此有信心。至於收入，正如我所說，五年來，我們的收入成長速度是脊椎行業其他公司的數倍。三年的有機成長超過 1 億美元。我們的程序策略絕對正確，它推動了該行業的高 ASP、20% 的手術量和 19% 的新外科醫生成長。因此這被廣泛接受。

Our sales force continues to expand rapidly. We have record EOS orders year-to-date. And what that does is lay the foundation for future growth. So can't be more excited about that. 25% growth guidance in ‘24 with 27% growth in Q3 and 26% year-to-date. So I would tell you that no one feels better about the perpetuating revenue growth leadership that we have taken on over the last five years.

我們的銷售團隊繼續迅速擴大。我們今年迄今的 EOS 訂單量創下了歷史新高。這為未來的發展奠定了基礎。我對此感到非常興奮。 24 年成長預期為 25%，第三季成長 27%，年初至今成長 26%。因此，我想告訴你們，沒有人對我們過去五年來所承擔的持續收入成長領導責任感到更滿意。

I think the focus on increasing profitability is hugely important. Third consecutive quarter of flat operating expenses, second consecutive quarter of adjusted EBITDA positive greater than expectation, 10% adjusted EBITDA margin implied for Q4 '24. When you start to think about what leverage you can pull to impact profitability, improving efficiency of asset and inventory is a big one. This is a people and a sets and instrument business. And so we are -- when you look at kind of the approach we're taking on the people side, we're taking a very focal effort in people investment. So if you're a sales guy or you're a product development guy, we like your chances in terms of joining the family. We're keeping a very focused effort with regard to hiring.

我認為，注重提高獲利能力非常重要。連續第三個季度營業費用持平，連續第二季調整後 EBITDA 正值大於預期，24 年第四季調整後 EBITDA 利潤率預計為 10%。當您開始思考可以利用哪些槓桿來影響獲利能力時，提高資產和庫存的效率是一個重大問題。這是一項涉及人員、設備和儀器的業務。所以，當你看看我們在人才方面採取的方法時，你會發現我們非常注重人才投資。因此，如果您是銷售人員或產品開發人員，我們希望您有機會加入我們的大家庭。我們在招募方面非常專注。

As of late, we've strategically narrowed our organizational structure. We have to be lean and mean and who and what we're doing is making sure that we streamline the organization. We are closer now to the end user as we have ever been, and we are aiming to keep it that way. All these things ultimately reflect in cash flow. So we have an infrastructure in place with all of our facilities to ultimately scale this business and that was the intention from the beginning.

最近，我們從策略上縮小了組織結構。我們必須精簡人員，我們正在做的事情就是確保組織得以精簡。我們現在比以往任何時候都更接近最終用戶，而我們的目標是保持這種狀態。所有這些最終都會反映在現金流中。因此，我們擁有完善的基礎設施和所有設施，最終可以擴大業務規模，這是我們從一開始就打算做的。

We are positioned with sets and inventory to fuel expansive growth. We have a lot of sets and inventory to grow into. Our adjusted EBITDA in Q4 ‘24 will continue to contribute and our sustained inflection of positive cash flow beginning in Q2 ‘25 will continue. So we love it and we love the flexibility that the $50 million expansion our existing term loan has provided us and we have great partners in Braidwell and Pharmakon that we can't be more thrilled about.

我們擁有成套設備和庫存，可以推動擴張性成長。我們有大量的套裝和庫存可供擴充。我們 2024 年第四季的調整後 EBITDA 將繼續做出貢獻，並且從 2025 年第二季開始的持續正現金流拐點也將持續。所以我們喜歡它，我們喜歡現有定期貸款 5000 萬美元擴張給我們帶來的靈活性，而且我們在 Braidwell 和 Pharmakon 擁有優秀的合作夥伴，我們對此感到無比興奮。

So I would say that we are aligned and focused on achieving our long term financial commitments. We said back in '23, we do a $1 billion in '27 in revenue, we'd have an adjusted EBITDA of $180 million, our margin would be 18% and we’d have free cash flow of $65 million. Nothing has changed with regard to our goal to fulfill our LRP. We are on our way.

因此我想說，我們的立場一致，並致力於實現我們的長期財務承諾。我們早在 23 年就說過，27 年我們的營收將達到 10 億美元，調整後的 EBITDA 將達到 1.8 億美元，利潤率為 18%，自由現金流將達到 6,500 萬美元。對於我們實現 LRP 的目標來說，沒有任何改變。我們正在路上。

Let me turn it over to Todd to provide you some financial detail.

讓我把這個交給托德來向你提供一些財務細節。

Thank you, Pat. And good afternoon, everyone. We appreciate you joining us today. I'll begin with revenue. Third quarter total revenue was $151 million, up 27% compared to the prior year and up 4% sequentially. The $151 million in revenue was comprised of $135 million in surgical revenue and $15 million of EOS revenue. Third quarter surgical revenue of $135 million increased $32 million, 30% growth over the prior year. Procedural volume growth was 20%, a reflection of strong surgeon adoption and utilization. We saw strong contributions across the portfolio, particularly in our lateral and expandable implant technologies, which contributed to the 9% growth in average revenue per procedure.

謝謝你，帕特。大家下午好。感謝您今天加入我們。我先從收入開始。第三季總營收為 1.51 億美元，比上年成長 27%，比上一季成長 4%。1.51 億美元的收入包括 1.35 億美元的手術收入和 1500 萬美元的 EOS 收入。第三季的手術收入為 1.35 億美元，比上年增加 3,200 萬美元，成長 30%。手術量增加了 20%，反映出外科醫生的大力採用和利用。我們看到整個產品組合做出了巨大貢獻，特別是我們的側向和可擴展植入技術，這促進了每例手術平均收入成長 9%。

Third quarter results grew $5 million sequentially as we benefited from the increased product availability and new territory additions. EOS revenue in the third quarter was $15 million, up 7% compared to last year. Notably, our year-to-date EOS order volume has been the strongest we've ever seen, which is encouraging for Q4 and 2025.

由於我們受益於產品可用性的提高和新地區的擴張，第三季業績環比增長了 500 萬美元。EOS第三季營收為1,500萬美元，較去年同期成長7%。值得注意的是，我們今年迄今的 EOS 訂單量是有史以來最強勁的，這對第四季和 2025 年來說是一個令人鼓舞的消息。

Next, I'll turn to results for the remainder of the P&L. Third quarter non-GAAP gross margin was 69%, down 60 basis points compared to the prior year due to the impact of product mix. Third quarter non-GAAP R&D was $13 million and approximately 9% of sales compared to $13 million and 11% of sales in the prior year. We continue to invest in innovation and future growth of the business while top line growth drove 250 basis points of leverage.

接下來，我將討論損益表剩餘部分的結果。第三季非公認會計準則毛利率為69%，受產品組合的影響，較前一年下降60個基點。第三季非 GAAP 研發費用為 1,300 萬美元，約佔銷售額的 9%，去年同期為 1,300 萬美元，佔銷售額的 11%。我們繼續對業務的創新和未來成長進行投資，同時營收成長推動了 250 個基點的槓桿率。

Non-GAAP SG&A was $100 million and approximately 67% of sales in Q3 compared to $80 million and 68% of sales in the prior year period, an improvement of 150 basis points. Now included in this period's SG&A is a step in depreciation related to the purchase of instrument sets. As a percent of sales, depreciation increased about 180 basis points year-over-year. So excluding that impact, SG&A improved 330 basis points, driven primarily by infrastructure leverage.

第三季非公認會計準則銷售、一般及行政支出為 1 億美元，約佔銷售額的 67%，而去年同期為 8,000 萬美元，佔銷售額的 68%，提高了 150 個基點。現在，本期的銷售、一般及行政費用中包含了與購買儀器組相關的折舊步驟。以銷售額的百分比計算，折舊年增了約 180 個基點。因此，排除此影響，銷售、一般及行政開支提高了 330 個基點，主要得益於基礎設施槓桿。

Total non-GAAP operating expense amounted to $114 million and approximately 75% of sales in the third quarter compared to $94 million and 79% of sales in the prior year period, demonstrating 390 basis points of operating leverage year-overyear. And in the third quarter, we achieved our second consecutive quarter of positive adjusted EBITDA, which was $7.4 million, a 5% margin. That compares to a loss of $400,000 and 0% of sales in the prior year, a 530 basis point improvement. Drop through of the year-over-year growth in revenue dollars to adjusted EBITDA was 24%. Adjusted EBITDA improvement was driven by 330 basis points of SG&A leverage and 250 basis points of R&D leverage and slightly offset by 60 basis points of gross margin impact.

第三季非公認會計準則總營業費用為 1.14 億美元，約佔銷售額的 75%，而去年同期為 9,400 萬美元，佔銷售額的 79%，年比上升了 390 個基點。第三季度，我們連續第二季實現調整後 EBITDA 為正，為 740 萬美元，利潤率為 5%。相較之下，前一年的虧損為 40 萬美元，銷售額為 0%，改善了 530 個基點。調整後 EBITDA 與去年同期相比下降了 24%。調整後的 EBITDA 改善是由 330 個基點的銷售、一般及行政費用槓桿和 250 個基點的研發槓桿推動的，並略微被 60 個基點的毛利率影響所抵消。

The chart on the next slide depicts the deliberate substantial profitability execution that we have demonstrated since the beginning of 2022. Adjusted EBITDA has increased from a loss of $13 million and 18% of sales to a contribution of $7 million and 5% of sales here in the Q3 of 2024, a 2,300 basis points improvement. The drivers of that progress have contributed as we expected with the improvement driven by variable selling rate followed by SG&A infrastructure leverage and R&D leverage.

下一張投影片中的圖表描繪了我們自 2022 年初以來所展示的刻意大幅獲利執行情況。調整後的 EBITDA 從虧損 1,300 萬美元、佔銷售額的 18% 增至 2024 年第三季的貢獻 700 萬美元、佔銷售額的 5%，提高了 2,300 個基點。正如我們預期的那樣，推動這一進展的因素包括可變銷售率的提高、銷售、一般及行政開支（SG&A）基礎設施槓桿和研發槓桿。

In fact, our non-GAAP operating expenses have been flat sequentially for the last three quarters, resulting in adjusted EBITDA growth and guidance that implies Q4 adjusted EBITDA of $17 million or 10% of sales. The considerable margin expansion that the business has produced gives us great confidence in our ability to deliver on our financial commitments and translate revenue growth into cash generation.

事實上，我們的非 GAAP 營業費用在過去三個季度中保持持平，導致調整後的 EBITDA 成長和指引意味著第四季度調整後的 EBITDA 為 1700 萬美元或占銷售額的 10%。這項業務帶來的利潤率大幅成長使我們對履行財務承諾和將收入成長轉化為現金創造的能力充滿信心。

Turning to the balance sheet, we ended the third quarter with $81 million in cash that carrying value was $538 million. As we begin to move past the phase of intense growth investment, we reduced free cash use in the third quarter by over 50% sequentially to $21 million. That was net of approximately $30 million in cash that was directed toward inventory and instruments to support distribution expansion and new product launches.

談到資產負債表，我們在第三季結束時擁有 8,100 萬美元現金，帳面價值為 5.38 億美元。隨著我們開始走出密集成長投資階段，我們將第三季的自由現金使用量環比減少了 50% 以上，至 2,100 萬美元。這是約 3000 萬美元現金的淨額，這些現金用於購買庫存和儀器，以支援分銷擴張和新產品的發布。

The chart at the bottom of this slide depicts the linear progression towards cash generation as we exit 2024 with the improving cash use trend from Q1 leading to an inflection in cash generation in the fourth quarter. The improvement from the third quarter to the fourth quarter is primarily driven by reduced instrument and inventory spend and an increase in adjusted EBITDA, partially offset by working capital. We continue to expect cash used to range between $125 million and $135 million for the full year of 2024.

本投影片底部的圖表描繪了 2024 年後現金產生的線性進展，第一季現金使用趨勢的改善導致第四季現金產生的轉折點。第三季到第四季的改善主要得益於儀器和庫存支出的減少以及調整後的 EBITDA 的增加，部分被營運資本所抵消。我們繼續預計 2024 年全年現金使用量將在 1.25 億至 1.35 億美元之間。

In conjunction with the financial results released today, we announced an increase in our term loan of $50 million, bringing the total term loan to $200 million. Through this transaction, we have added another strong lending partner in Pharmakon. The key terms of the loan are the same as the original facility bearing an interest rate of SOFR plus 5.75% and interest only payments until its maturity in 2028. With this incremental capital, our pro form a cash at close is $128 million. Upon close of the transaction, we used proceeds to pay down our revolver balance. Exiting the year, we expect to have access to cash and liquidity of $145 million, which we believe provides us with ample liquidity going into 2025 where we expect to be cash flow breakeven.

結合今天發布的財務結果，我們宣布增加定期貸款 5000 萬美元，使定期貸款總額達到 2 億美元。透過此次交易，我們在 Pharmakon 又增加了一個強大的貸款合作夥伴。該貸款的主要條款與原始貸款相同，利率為 SOFR 加 5.75%，且在 2028 年到期前僅支付利息。加上這筆增量資本，我們的收盤現金預計為 1.28 億美元。交易結束後，我們使用收益來償還循環信貸餘額。今年結束時，我們預計將獲得 1.45 億美元的現金和流動資金，我們相信這將為我們在 2025 年提供充足的流動資金，我們預計到 2025 年將實現現金流收支平衡。

I'd also like to share our thoughts for the $316 million convertible notes that mature in August 2026. While we won't rule out doing a convert if the equity is at the right price, we expect the material improvement in EBITDA over the next few years to allow us to refinance without dilution. As we progress towards our 2027 long range plan financial targets when we expect a $1 billion in revenue with 18% adjusted EBITDA margins and cash flowing, the company will have a different level of access to financing alternatives.

我還想分享我們對 2026 年 8 月到期的 3.16 億美元可轉換票據的看法。如果股權價格合適，我們不會排除轉換的可能性，但我們預計未來幾年 EBITDA 的大幅改善將使我們能夠在不稀釋股權的情況下進行再融資。隨著我們逐步實現 2027 年長期計畫財務目標，預計營收將達到 10 億美元，調整後 EBITDA 利潤率和現金流將達到 18%，公司將獲得不同程度的融資替代方案。

Turning to our increased outlook for the full year 2024, the strong surgeon adoption and large volume of surgeon training are great indicators of durable revenue growth and are a testament (inaudible) Atec clinical distinction. We expect that the fuel total revenue growth of 25% to approximately $605 million. That includes surgical revenue growth of 28% to approximately 4 -- $540 million and EOS revenue of approximately $65 million. That implies surgical volume grows at a high teens rate and revenue per surgeon growth at a high single digit rate for the full year.

談到我們對 2024 年全年的展望，外科醫生的大力採用和大量的外科醫生培訓是持久收入增長的重要指標，也是 Atec 臨床區別的證明（聽不清楚）。我們預計燃料總收入將成長25%至約6.05億美元。其中包括手術收入成長 28% 至約 45.4 億美元，以及 EOS 收入約 6,500 萬美元。這意味著全年手術量將以高十幾倍的速度成長，而每位外科醫生的收入將以高個位數的速度成長。

Sales growth is powering leverage, and with the third quarter adjusted EBITDA outperformance, we are raising full year adjusted EBITDA guidance to approximately $27 million, which equates to 640 basis points of margin expansion. That implies a 30% drop through of the year-over-year growth in revenue dollars, a material acceleration compared to 2020 -- compared to 22% drop through in 2023. We continue to expect cash used to range between $125 million and $135 million for the full year 2024. Our expectations for cash flow breakeven in 2025 remain unchanged. We expect the cadence next year to include seasonal cash used in the first quarter, followed by positive free cash flow in quarters two through four.

銷售成長推動了槓桿率，隨著第三季調整後 EBITDA 的優異表現，我們將全年調整後 EBITDA 預期上調至約 2,700 萬美元，相當於利潤率擴大 640 個基點。這意味著收入同比增長將下降 30%，與 2020 年相比有實質加速——而 2023 年則下降了 22%。我們繼續預計 2024 年全年現金使用量將在 1.25 億至 1.35 億美元之間。我們對 2025 年現金流損益兩平的預期保持不變。我們預計明年的節奏將包括第一季的季節性現金使用，然後是第二季至第四季的正自由現金流。

I'll close today with reinforcing how well we are positioned for growth in 2025 and why that translates to cash flow breakeven. When you look at this year, our adjusted EBITDA is expected to be $27 million. We will have invested $140 million in CapEx and inventory and $17 million in interest and other working capital. In 2025, our expectation is that we will have [$70 million] of adjusted EBITDA consistent with our long range plan assumption. Because we come into the year with an asset base from the 2024 investment that will support 2025 revenue growth, the required investment effect in inventory in 2025 is $50 million. We will also expect to see a step up in interest and other working capital to $25 million. That all adds up to a cash flow breakeven year.

今天最後，我想強調我們在 2025 年的成長定位，以及為什麼這意味著現金流損益兩平。回顧今年，我們的調整後 EBITDA 預計為 2700 萬美元。我們將投資 1.4 億美元用於資本支出和庫存，並投資 1,700 萬美元用於利息和其他營運資金。到 2025 年，我們預計調整後的 EBITDA 將達到 [7000 萬美元]，與我們的長期計劃假設一致。由於我們今年的資產基礎來自 2024 年的投資，將支持 2025 年的收入成長，因此 2025 年所需的庫存投資效應為 5,000 萬美元。我們也預計利息和其他營運資金將增加至 2,500 萬美元。所有這些加起來就是現金流收支平衡的一年。

We recognize that execution on cash generation is crucial to rebuilding shareholder value. As such, we are focused on growing revenue and expanding profitability to generate cash, which has informed how we are attracting investments and the realignment of internal resources. Those efforts are complete and strengthen our position as we progress towards cash generation. Our organization has a lot of work to do and a lot to be excited about. As we seek to rebuild shareholder value know that this leadership team is confidently aligned. We know what needs to be prioritized and the work is underway.

我們認識到，現金創造的執行對於重建股東價值至關重要。因此，我們專注於增加收入和擴大盈利能力以產生現金，這決定了我們如何吸引投資和重新調整內部資源。這些努力已經完成，並在我們朝著現金創造的方向前進的過程中加強了我們的地位。我們的組織有很多工作要做，也有很多值得興奮的事情。當我們尋求重建股東價值時，要知道這個領導團隊是充滿信心的。我們知道需要優先考慮什麼，並且工作正在進行中。

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

說完這些，我將把電話轉回給帕特。

Thanks, Todd. Our best is yet to come. We are actually focused on value creating long term objectives and our objectives are bettering this environment, so creating clinical distinction. That means distinguishing Atec through procedures and informatics. I think we're well on our way on that front. Also compelling surgeon adoption, earning surgeon users by improving surgery. There's a lot to do in the spine business and we're thrilled about engaging to do it. And then expand and elevate our sales force, strengthening sales teams and enhancing our operations. And clearly, we know something that others don't.

謝謝，托德。我們最好的尚未到來。我們實際上專注於創造價值的長期目標，我們的目標是改善這種環境，從而創造臨床差異。這意味著透過程序和資訊來區分 Atec。我認為我們在這方面已經取得了進展。同時也吸引了外科醫生的採用，透過改進手術贏得了外科醫生用戶。脊椎業務方面有很多事情要做，我們很高興參與其中。然後擴大和提升我們的銷售隊伍，加強銷售團隊並加強我們的營運。顯然，我們知道一些別人不知道的事。

So I love this picture. It's from the most recent North American Spine Society meeting. At this time, about -- not even about, exactly five years ago, Dr. Clemente presented PTP, our prone transpsoas approach to an empty room. This year, his PTP demonstration was standing room (technical difficulty). So we are thousands of surgeries into the experience and continue to apply our learnings. We know we are still early in the -- are in the early phase of our lateral reconstructive spine surgery journey with a heck of a lot of opportunity forward.

所以我很喜歡這張照片。這是來自最近的北美脊椎學會會議的報告。大約在這個時候，甚至不是大約五年前，克萊門特博士在一個空房間裡展示了 PTP，即俯臥經腰肌入路。今年，他的 PTP 演示活動座無虛席（技術難度）。因此，我們已經累積了數千次手術的經驗，並將繼續應用我們所學到的知識。我們知道，我們仍處於側位重建脊椎手術的早期階段，未來將有大量的機會。

So by looking at this picture and appreciating our historical performance, it would be a great mistake to not realize our following and lateral probe surgery. So as always, plenty of work to do. But I think that this is indicative of who we are and power further distancing Atec in lateral. The way we further distance ourselves is really investing in the approach. So that means to continue to integrate informatics into improving precision, like the case in Valence. We will also further minimize the potential for neural complications with the expanded applications and feature set of SafeOp, as well as increasing predictability and alignment with EOS.

因此，透過查看這張圖片並欣賞我們的歷史表現，如果我們沒有意識到我們的追蹤和橫向探測手術將是一個巨大的錯誤。因此一如既往，還有很多工作要做。但我認為這表明了我們是誰，以及我們有能力進一步拉開 Atec 的距離。我們進一步拉開距離的方式其實就是在投資方法。所以這意味著要繼續整合資訊學來提高精確度，就像 Valence 的情況一樣。我們還將透過擴展 SafeOp 的應用程式和功能集進一步降低神經併發症的可能性，並提高可預測性和與 EOS 的一致性。

So we're attracting new users with our informatic platform and expanding applications and utility across the board, that means more users and more reasons to utilize. If you could see in the right hand side, the opportunity to increase complexity with things like corpectomy, multilevel deformity, there's a lot going on with regard to lateral. I think there's every reason to be profoundly confident in our perpetuating growth profile.

因此，我們利用我們的資訊平台吸引新用戶，並全面擴展應用程式和實用性，這意味著更多的用戶和更多的使用理由。如果您可以在右側看到，透過椎體切除術、多層畸形等增加複雜性的機會，在橫向方面有很多事情發生。我認為我們有充分的理由對我們持續的成長前景充滿信心。

It is the growth segment and it is the most coveted piece of thoracolumbar spine in the business. And so when you think about our growing business in lateral, much like NASS, SRS was also standing (inaudible). SRS is the most influential society in the treatment of spine deformity. There was probable enthusiasm for our prospective deformity influence with AI informed EOS Insight. I would tell you, it was the bell of the ball. So Atec has the only AI informed automated tool that is an adjunct to clinical decision making.

這是一個成長環節，也是業界最令人垂涎​​的胸腰椎部分。因此，當你想到我們在橫向業務方面不斷成長時，就像 NASS 一樣，SRS 也處於（聽不清楚）。 SRS是脊椎畸形治療領域最具影響力的協會。人們可能對我們利用人工智慧 (AI) 感知的 EOS Insight 來影響畸形的可能性充滿熱情。我會告訴你，那是舞會的鈴聲。因此，Atec 擁有唯一的 AI 自動化工具，可作為臨床決策的輔助。

We talk about variable mitigation incessantly and this tool is absolutely foundational to that. The decision making is informed by EOS Insight and also gets reflected in our implants. And so it's not lost on us that these decision making tools ultimately get driven through implant utility and can't be more excited about that.

我們不斷地討論變數緩解，而這個工具絕對是這項討論的基礎。決策由 EOS Insight 提供信息，並反映在我們的植入物中。因此，我們不會忘記，這些決策工具最終是透過植入物的效用來驅動的，並且對此感到非常興奮。

So with the launch of EOS Insight, it literally turns the most coveted image in spine surgery into information. The early sites are very enthusiastic about the experience and screams of another unique technology that provides valuable information that drives improved surgery. Everything from the pre op auto alignment tool that happens in virtual real time, to the opportunity to create a 3D surgical planning effort to patient specific implants, to the interoperative ability to reconcile what the plan is, to the objective data reflected in the post op sequence. And so we love this tool, we cannot be more excited about where we are today, it's the reflection of future growth. Like Dr. Lockey said, EOS Insight streamlines our workflow and enhances our ability to track outcomes.

因此，隨著 EOS Insight 的推出，它實際上將脊椎手術中最令人垂涎​​的圖像轉化為資訊。早期的網站對於這種體驗非常熱衷，並且大聲宣揚另一種獨特的技術，它提供了推動手術改進的寶貴資訊。從術前虛擬即時自動對準工具，到創建 3D 手術計劃的機會，到針對特定患者的植入物，到協調計劃的手術間能力，到術後序列中反映的客觀數據。我們非常喜歡這個工具，我們對現在的狀況感到無比興奮，它反映了未來的成長。正如 Lockey 博士所說，EOS Insight 簡化了我們的工作流程並增強了我們追蹤結果的能力。

Everything is automated. The reason that outcomes have not been consistently captured in spine surgery is because it wasn't automated. All these things are automated. And as he says, it ultimately improves patient care. So totally excited about what's going on there. We continue to compel surgeon adoption reflected in a 19% growth in surgeon users with over 200 surgeons trained.

一切都是自動化的。脊椎手術之所以不能一致地記錄結果，是因為它不是自動化的。所有這些事情都是自動化的。正如他所說，它最終改善了患者護理。我對那裡發生的事情感到非常興奮。我們繼續鼓勵外科醫生採用，這反映在外科醫生用戶增長了 19%，接受培訓的外科醫生超過 200 名。

Clearly, people want to come into the company. One of the things that we're doing is we're improving on focusing on yield. So the more surgeons come in, the more users we can create and the better yield that can have, the more business will impact by doing so. So we are committed -- continue to drive clinical predictability through improved training. So when you look at a proxy for continued growth, this is one of them. And training and education has been a hallmark of what we believe in terms of preparing surgeons for application of our clinical distinction, which again will continue to power our growth leadership.

顯然，人們想進入這家公司。我們正在做的事情之一就是更加關注收益。因此，外科醫生越多，我們能夠創造的用戶就越多，收益就越好，這樣做對業務的影響就越大。因此，我們致力於透過改進培訓繼續提高臨床可預測性。因此，當你查看持續成長的代理商時，這就是其中之一。培訓和教育一直是我們所堅信的標誌，為外科醫生做好應用我們臨床特色的準備，這將再次繼續推動我們的成長領導力。

Moving on to the sales force. It's another source of significant confidence. We're completely confident in the growth leadership based upon not only the people who are there today but the people who are forthcoming. And so when you start to look at the demographics of our sales, you start to say, lateral as a percentage of business, for our top 10 agencies is 30%. I will tell you, you want that mix, it's a protectable mix based upon the suite of technology that we have. That compares to 13% of our US lateral share. So clearly, there is a head start with the people who are performing best.

轉向銷售團隊。這是另一個重要信心來源。我們對領導力的成長充滿信心，這不僅基於現有的人才，也基於未來的人才。因此，當您開始查看我們的銷售人口統計資料時，您會發現，對於我們的前 10 家代理商而言，橫向銷售佔業務的百分比為 30%。我會告訴你，你想要那個組合，它是基於我們擁有的技術套件的可保護組合。相比之下，我們在美國橫向份額為 13%。顯然，表現最好的人已經佔據了先機。

We have a 25% growth rate in established territories. Again, that suggests a lot of momentum with people who have been with us for a little while. And then in certain markets, what we call benchmark territories, we have a 25% market share, that compares to a 5% in most places. It does nothing but reek of a forward growth profile that, again, we have been completely consistent on for five years. And so our confidence is perpetuated by robust growth in established territories and the whole leading of -- with lateral, ramping in new major or in major new US territories, bringing new people on, we're starting to contribute, putting 2024 set and inventory investments to work. We've got a ton of inventory in 2024. It's being put to work in the way that we intended.

我們在成熟地區的成長率達到 25%。再次，這表明與我們在一起已有一段時間的人們擁有很大的發展動力。在某些市場，也就是我們所謂的基準地區，我們的市佔率為 25%，而大多數地方的市佔率為 5%。它只不過散發出前瞻性成長的氣息，而我們五年來一直堅持這一成長趨勢。因此，我們的信心源於成熟地區的強勁增長以及整個行業的橫向發展，在新的主要地區或美國主要的新地區的擴張，引進新人才，我們開始做出貢獻，將 2024 年的設定和庫存投資付諸實踐。2024 年我們有大量庫存。它正按照我們預期的方式投入工作。

Improving efficiency of set and inventory utility. We know this business, as I said, is people and it sets an inventory. You got to be efficient with your sets and inventory and we're doing that and aligning sales and sets it with operational requirements. We recently had an agent meeting. I don't think we've ever been more aligned with regard to our sprint forward. And so, completely excited about our alignment.

提高設定和庫存利用效率。正如我所說，我們知道這項業務是針對人的，並且它設置了庫存。你必須有效率地管理你的設備和庫存，我們正在這樣做，並使銷售和設備與營運要求保持一致。我們最近召開了一次代理商會議。我認為，我們在向前衝刺的過程中從未如此團結。因此，我們對於我們的結盟感到非常興奮。

And then strong talent funnel to further US footprint expansion and elevation. So there's a lot of good people out there and a lot of people that we want to attract to this business and we can't be more excited about the prospective growth profile and business profile of Atec. So the undeniable truth is that spine needs Atec. When you start to look at the revision rates associated with our field, people that increment in this business don't make any difference in this business. We're going at this in an aggressive way. And it needs to be going after at an aggressive way because spine surgery needs to be improved and we're doing that. We're going to go from a 5% market share holder to a low double digits in the coming years and just cannot be more bullish as it relates to what we're creating.

然後強大的人才管道將進一步擴大和提升美國的影響力。所以有很多優秀人才，我們也想吸引很多人來從事這項業務，我們對 Atec 的未來成長前景和業務狀況感到無比興奮。因此，不可否認的事實是脊椎需要 Atec。當你開始查看與我們的領域相關的修訂率時，你會發現在這個行業中增加的人數不會對這個行業產生任何影響。我們會積極地處理此事。我們需要採取積極的方式，因為脊椎手術需要改進，而我們正在這樣做。未來幾年，我們的市佔率將從 5% 上升至兩位數，對於我們正在創造的一切，我們充滿信心。

And so with that, I will turn it over and take questions.

因此，我將把它轉過來並回答問題。

(Operator Instructions)

（操作員指令）

Brooks O'Neil, Lake Street Capital Markets.

布魯克斯‧歐尼爾 (Brooks O’Neil)，湖街資本市場 (Lake Street Capital Markets)。

Thank you very much, and congratulations on a terrific quarter guys. I have one question for you and that is, appreciate your enthusiasm, appreciate your track record, but investors still seem to believe you're going to outspend your resources. How can you convince us that that is not going to happen?

非常感謝大家，恭喜你們度過了一個美好的季度。我要問您一個問題，那就是，感謝您的熱情，感謝您的業績記錄，但投資者似乎仍然相信您會投入超出您資源的資金。您怎麼能讓我們相信這種事不會發生呢？

Let me start and then I'll let, Todd, jump in. And so the one thing that I will tell you is we are committed to building a monstrosity. And to build a monstrosity, you have to be self funding. And when we start to demonstrate consecutive quarters of flat operating expenses, when we start to talk about adjusted EBITDA above expectations, when we start to talk about breakeven next year.

讓我先開始，然後讓托德插話。所以我要告訴你們的一件事是，我們致力於建立一個龐然大物。而要建造一個龐然大物，你必須自籌資金。當我們開始顯示連續幾季的營運費用持平時，當我們開始談論調整後的 EBITDA 超出預期時，當我們開始談論明年的盈虧平衡時。

And I got to tell you, we're taking kind of the internal, not kind of, we're taking the internal moves necessary to make sure that we're streamlining the organization. If people and sets and inventory are the spend profile of these companies, we're narrowing the spend profile associated with people. We've done that internally. We've made challenging moves. We're getting closer to the business. But also as it relates to the efficient utility of the assets, we've made a ton of progress in that realm. And so when I start to think about leverage, those are the areas that I think about and I see this stuff happen in real time and it provides me significant content.

我必須告訴你，我們正在採取某種內部措施，不是那種內部舉措，我們正在採取必要的內部舉措，以確保精簡組織機構。如果人員、佈景和庫存是這些公司的支出概況，那麼我們正在縮小與人員相關的支出概況。我們內部已經這麼做了。我們已經採取了具有挑戰性的措施。我們正在逐漸接近業務。但在與資產的有效利用相關的方面，我們在這個領域取得了巨大進步。因此，當我開始考慮槓桿時，這些就是我考慮的領域，我看到這些事情實時發生，這為我提供了重要的內容。

And Brooks, I would add to that. I think, clearly, this is a business of growth. That growth is generating incremental profitability through adjusted EBITDA. And as we think about the actions we've recently taken to ultimately narrow the organization, we also have done a significant deep dive in the operation to really root out discretionary spending and to really ultimately reduce our overall spend in that area as well. And so I think we're being very thoughtful and very diligent about where we're placing our resources and overall reducing that resource consumption today.

我想補充一下布魯克斯。我認為，這顯然是一項成長的業務。這種成長透過調整後的 EBITDA 產生了增量獲利能力。當我們考慮最近為最終縮小組織規模而採取的行動時，我們也對營運進行了深入研究，以真正根除可自由支配的開支，並最終減少我們在該領域的整體開支。因此我認為，我們在考慮如何分配資源以及總體減少當前的資源消耗時，是非常慎重和勤勉的。

As you think about next year and I think that gives you confidence in our ability to continue to expand our profit margins. So I think that was one of the reasons I laid out the adjusted EBITDA path that we've seen over the last probably two, two and half years. It's been a deliberate walk of expanding EBITDA margins over that time period. And that has happened as a result of the way that we've built the company. And that gives us confidence that we can ultimately continue to expand those profit margins into 2025 and beyond.

當你想到明年時，我認為這會讓您對我們繼續擴大利潤率的能力充滿信心。所以我認為這就是我列出過去兩年或兩年半以來我們看到的調整後 EBITDA 路徑的原因之一。這是該公司在這段時間內刻意提高 EBITDA 利潤率的舉措。這是我們建設公司的方式的結果。這使我們有信心最終能夠在 2025 年及以後繼續擴大利潤率。

Then the second component, so I think that's the profitability piece. The second component of where our investments go is in the sets and inventory. And I think as we laid out on the call, we made a significant investment in sets and inventory in 2024. And there are a level of inventory and sets that exist today that will contribute to 2025's growth. And therefore, the required amount of investment in sets and inventory in 2025 is, as we've described it, in the order of magnitude of $50 million.

然後是第二個組成部分，我認為這是盈利能力部分。我們的投資的第二個部分是佈景和庫存。我認為，正如我們在電話會議上所述，我們在 2024 年對設備和庫存進行了大量投資。目前存在的一定水準的庫存和設備將有助於2025年的成長。因此，正如我們所描述的，2025 年需要在設備和庫存方面進行的投資金額約為 5,000 萬美元。

And so when you think about cash flow, you think about $75 million of adjusted EBITDA, spending about $50 million on sets and inventory and then a step up of about $25 million of investment in additional working capital and interest, that really gets you to breakeven. And I think that ultimately is where our confidence comes from. And then going into next year with a further enhanced balance sheet that also just gives you more and more confidence that we can run the play that we've outlined.

因此，當您考慮現金流時，您會想到 7500 萬美元的調整後 EBITDA，花費約 5000 萬美元用於設備和庫存，然後再增加約 2500 萬美元的投資用於額外營運資金和利息，這才真正讓您實現收支平衡。我想，這正是我們信心的根本來源。然後進入明年，我們將擁有進一步增強的資產負債表，這也會讓你越來越有信心，我們可以實現我們所概述的策略。

Perfect. Thank you very much and again, congratulations on a terrific quarter.

完美的。非常感謝您，並再次祝賀您度過了一個美好的季度。

Thanks, Brooks.

謝謝，布魯克斯。

Matt Blackman, Stifel.

馬特·布萊克曼（Matt Blackman），Stifel。

Good afternoon, everybody. Can you hear me? Okay.

大家下午好。你聽得到我嗎？好的。

I got you.

我接到你了。

Okay. Maybe Todd, if I could start with you, just a couple of housekeeping questions. And we're asking this to everybody this quarter, so not saving it specifically for you. But anything notable in terms of hurricane exposure? And you've also been hearing some anecdotes of institutions delaying elective procedures due to the IV solution shortages. So just I appreciate any impact from both would be transient, but are you or what are you hearing from the field, if anything? And is there anything baked into the implied 4Q guidance as a headwind? And then I've got one follow-up.

好的。也許托德，如果我可以從你開始，只是幾個基本問題。本季我們會向所有人提出這個問題，因此不會專門為你保留它。但從颶風暴露方面來看有什麼值得注意的嗎？您還會聽到一些關於機構因靜脈注射液短缺而推遲選擇性手術的傳聞。因此，我明白兩者的影響都是暫時的，但是您是否聽到了來自該領域的任何消息？那麼，第四季指引中是否存在什麼不利因素呢？然後我還有一個後續問題。

As it relates to hurricanes, really no impact in the third quarter. And while we did see a little bit in the first half of the month, we're seeing that recover now. So really our guidance assumes that we're going to catch up all of that, and we feel very good about that as a base case. And so I think that's from a hurricane standpoint. And really no impact we're seeing on the IV side. And maybe Pat, you can give your perspective on elective surgeries and spine surgery and how that's probably less elective than maybe people think.

就颶風而言，它對第三季確實沒有影響。雖然我們在上半月確實看到了一些跡象，但現在我們看到它正在恢復。因此，我們的指導實際上是假設我們將會趕上所有這些，並且我們對此作為基本情況感到非常滿意。我認為這是從颶風的角度來看的。我們在 IV 方面確實沒有看到任何影響。也許帕特，您可以談談您對選擇性手術和脊椎手術的看法，以及這些手術可能沒有人們想像的那麼選擇性。

Yes, no impact.

是的，沒有影響。

No, I appreciate that. Maybe and then --

不，我很感激。也許然後--

I also think the deductible for now also works in everybody's favor here.

我還認為目前的免賠額對每個人都有好處。

Amazing.

驚人的。

Yeah. Okay. Got it. And then my follow-up, maybe hoping you could put a little bit finer point on where sort of new rep, new distributor productivity is today. You gave us a lot of great stuff in the slides. But is there a way to frame or relative to what inning we're in, in terms of how they're ramping? And I guess the other question is, it sounds like -- I just want to make sure that the new folks are sort of at full fighting weight in terms of their ability to access sets, but also the broadest range of implants? Thank you. Appreciate it.

是的。好的。知道了。然後我的後續問題是，也許希望您可以更詳細地說明目前新銷售代表、新經銷商的生產力水平。您在幻燈片中給了我們很多精彩的內容。但是，有沒有辦法可以框架或相對於我們所處的局面，根據他們如何提升？我想另一個問題是，這聽起來像是——我只是想確保新員工在獲取設備的能力方面具有充分的戰鬥力，而且還能獲得最廣泛的植入物？謝謝。非常感謝。

Yeah. Let me give a little bit of the subjectivity and Todd, as objectivity he can add. It's fascinating. We actually have inventory available to them. These are always ramps. And what happens is you walk away from one group who has been there that wasn't very good that wasn't going to scale the business as you intend and you enter a new group. And then so you walk away from all that business and then you jump into new business. And it's not like it all comes on on day one.

是的。讓我給一點主觀性，Todd 可以加入一點客觀性。這很有趣。我們確實有庫存可供他們使用。這些始終都是坡道。而接下來會發生的情況是，你離開一個曾經存在但表現不佳、無法如你預期擴大業務規模的團隊，然後加入一個新團隊。然後，您便會放棄所有業務，轉而從事新業務。這一切並不是第一天就發生的。

So what we're seeing is we're putting together the sales force that we intend. And I still believe it to be a very effective sales force, effective in pockets. And we have geographies that are mature that are reflective of the growth profile of the company and then we have others that are just getting going. And so what keeps me very, very bullish is the same store sales continue to ramp at the way that we intend and it hasn't even taken into account the new areas that ultimately are starting to ramp.

因此，我們的設想是，我們正在組建我們想要的銷售團隊。我仍然相信，這是一支非常有效的銷售隊伍，在各方面都很有成效。我們的地區已經很成熟，可以反映公司的成長情況，而其他地區則剛起步。因此，讓我非常非常樂觀的是，同一家商店的銷售額繼續按照我們預期的方式成長，這甚至還沒有考慮到最終開始成長的新領域。

And the ramp is mushy, right? It's like you lose the revenue on the previous distributor or the previous little group if we had a group there and then you start to grow the bill, you get access to the hospital. And one of the things I've always said and I know that people hate to hear this but -- so this is such a 12 to 18 to 24 month business, which is you make these investments in people and the reality is they don't get reflected for 18 to 24 months. And so the reality is we're seeing continued perpetuation of same store and we're starting to see the engagement of many of the new guys.

斜坡很軟，對嗎？這就像你失去了以前的分銷商或以前小團體的收入（如果我們在那裡有一個團體），然後你開始增加賬單，你就可以進入醫院。我一直在說的一件事，我知道人們不願意聽到這個，但是——這是一項需要 12 到 18 到 24 個月的業務，也就是說，你在人才身上進行了這些投資，但現實是，這些投資在 18 到 24 個月內不會得到反映。所以現實情況是我們看到同一家店的持續存在，我們開始看到許多新人的參與。

And Matt, I would add to that. We've been adding coverage continuously for the last six years, however, long we've been doing this. And so we're seeing the investments we've made over the last 12 to 18 months begin to contribute. I think one good example of that is just the $5 million sequential step up Q2 to Q3. Clearly, some of that was product contribution but also some of that was the reflection of those investments beginning to ramp in an easier way. And so I think that's a good proof point for the effectiveness of the investment in those territories.

馬特，我想補充一點。然而，過去六年來，我們一直在不斷增加覆蓋範圍，我們已經這樣做了很長時間。因此我們看到過去 12 到 18 個月所做的投資開始產生貢獻。我認為一個很好的例子就是第二季到第三季連續增加 500 萬美元。顯然，其中一些是產品貢獻，但也有一些是這些投資開始以更簡單的方式增加的反映。所以我認為這是對這些地區投資有效性的一個很好的證明。

Yeah. And just to add something to that. I just think it is relevant is, somebody will come on and they will have a non-compete, either they will sit out or will do something whereby they operate in a different territory. So it's everything from somebody coming on, having a non-compete, serving a non-compete, entering into a different geography that first 12 months and then coming off a non-compete. And we only see a little bit of a boost after that. And so it's one of these things where there's so many puts and takes to these things, like it's tough to provide you the exact because, again, there's a lot of different ins and outs as we continue to evolve the business.

是的。只是想補充一些內容。我只是認為，相關的是，有人會加入，他們會有競業禁止協議，要么他們會袖手旁觀，要么他們會做一些在不同的領域開展業務的事情。所以這一切都是從一個人的加入，到一個擁有競業禁止協議，到一個履行競業禁止協議，到一個在前 12 個月進入不同的地區，再到一個結束競業禁止協議的過程。此後，我們只看到了一點提升。因此，這是其中之一，其中有很多投入和產出，例如，很難為您提供確切的信息，因為隨著我們繼續發展業務，會出現很多不同的細節。

No, I appreciate that. But I guess the point is is that we're ramping up that productivity curve and we still have a ways to go.

不，我很感激。但我想重點是我們正在提高生產力曲線，但我們還有很長的路要走。

We still have a ways to go. Yes, we're a nominal player in this business. There's 95% to go. It's -- we're a 5% market shareholder. But clearly, we're growing aggressively. And I got to tell you, we're the bell of the ball. You look at what we're doing procedurally with the lateral, what's going on with regard to EOS. And it's not a secret to the industry that there's a lot going on here with regard to evolving care and people want to be associated with it.

我們還有很長的路要走。是的，我們是這個行業名義上的參與者。還剩 95% 的路要走。我們是 5% 的市佔率股東。但顯然，我們正在快速發展。我得告訴你們，我們是舞會上的領頭羊。您可以看看我們在橫向程式上所做的工作，以及與 EOS 相關的進展。對於這個行業來說，在不斷發展的護理方面有很多事情發生，人們希望參與其中，這不是什麼秘密。

Thank you, so much.

太感謝了。

Matt Miksic, Barclays.

巴克萊銀行的馬特‧米克西克 (Matt Miksic)。

Hey, thanks so much and congrats on a really great quarter. Nice to see you. Turning the corner here in terms of cash use and continued growth. One question that I wanted to ask, Pat, is one that I get sometimes often. I think it's sort of part of the Alphatec story as folks look at what's happening with robots, look at where your robot is in the pipeline and ask the question, why isn't competing with a robot today more of a challenge. Maybe if you could talk about your growth drivers today and how the robot and imaging kind of dovetails with that as you get into the 12, 18, 24 month period? And then I have one follow-up.

嘿，非常感謝，並祝賀您度過了一個非常出色的季度。很高興見到你。就現金使用和持續成長而言，這裡正出現一個轉折點。派特，我想問的一個問題是我常被問到的問題。我認為這是 Alphatec 故事的一部分，當人們觀察機器人的發展、機器人在流程中的位置並問自己一個問題：為什麼今天與機器人競爭不再具有更大的挑戰性。也許您可以談談今天的成長動力，以及在未來 12、18、24 個月內機器人和成像將如何與之契合？然後我還有一個後續問題。

Yeah, thanks Matt. I love this question, just because it's -- our intention is to have a profound influence on spine care. And if you were to prioritize the challenges and the variables that influence spine care, placing screws would not be at the top. And at this point, the robot helps place screws, which again, I think is fantastic.

是的，謝謝馬特。我喜歡這個問題，只是因為我們的目的是對脊椎護理產生深遠的影響。如果您要對影響脊椎護理的挑戰和變數進行優先排序，那麼放置螺絲就不會是最重要的。此時，機器人會幫助放置螺絲，我認為這太棒了。

And fantastic enough for us to spend $50 million on a tool that ultimately will do that and help do that. And so what I think is hugely valuable is an information piece that says, hey, the highest likelihood for a patient to get better from this type of intervention is this pathology and be able to pre-correlatives that drive decision making and behavior by surgeons. And so I think that that's at the top of the list and that was the rationale behind the EOS.

這真是太棒了，我們花費 5000 萬美元購買一個最終可以實現這一點並幫助實現這一點的工具。因此，我認為非常有價值的資訊是，病人透過這種幹預措施康復的可能性最高，這種病理能夠預先決定外科醫生的決策和行為。所以我認為這是最重要的，這也是 EOS 背後的理由。

And what happens is it becomes the foundation of the ecosystem that ultimately drives better decision making. Within the context of the intervention is the opportunity to improve the variables within the intervention. And that's where a robot comes in and that's where navigation comes in. And so all of our work has been how do we architect a procedure that's reflective of a step-by-step execution where we can provide interoperative information to drive predictable outcomes, that is our strategy.

它將成為生態系統的基礎，最終推動更好的決策。在介入的脈絡下，有改善介入內變數的機會。這就是機器人發揮作用的地方，也是導航發揮作用的地方。因此，我們所有的工作都是如何設計一個能夠反映逐步執行的程序，我們可以提供互通資訊來推動可預測的結果，這就是我們的策略。

And so when you start to assemble those technologies and you create an ecosystem, I got to tell you, you better love the foundation of that ecosystem. And the foundation of that ecosystem is the most coveted image in all of spine care, which is EOS. And so translating that image throughout the experience, through the surgical plan into the operative experience is the magic.

所以當你開始整合這些技術並創建一個生態系統時，我必須告訴你，你最好熱愛這個生態系統的基礎。該生態系統的基礎是整個脊椎護理中最令人垂涎​​的圖像，即 EOS。因此，將整個體驗中的影像透過手術計劃轉化為手術體驗是神奇的。

And so our enthusiasm is all about monumental evolution in spine care, because it needs it in the hands of the masses. And that's where it's like again, we love robotics, we love navigation. We're in the process of integrating it. We're doing cases today literally with our robotic tool. But the reality of it is it's the assembly of tools that ultimately is the answer to these, it's not just a single tool. So that would be my diatribe, and probably I didn't answer the question you intended.

因此，我們的熱情在於脊椎護理的巨大進步，因為它需要大眾的參與。這就是我們熱愛機器人、熱愛導航的原因。我們正處於整合過程中。我們今天實際上是使用機器人工具來處理案件。但事實上，工具的組裝才是最終解決這些問題的答案，而不僅僅是單一的工具。這就是我的長篇大論，也許我沒有回答你想問的問題。

Yeah. No, that is helpful. And I have one follow-up. Maybe on the way that you're guiding, the way you're thinking about the EBITDA and cash deployment comments that you've made in terms of titrating or the level of deployment and capital and some of the inefficiencies that you had earlier in the year. I guess, how you feel about that and how you feel about where in the bell curve you're sort of guiding us? And what maybe you're doing a little differently in the way you're communicating and planning for Q4, Q1 and going forward?

是的。不，這很有幫助。我還有一個後續問題。也許在您指導的方式上，您對 EBITDA 和現金部署的評論的思考方式，您在滴定或部署和資本水平以及您今年早些時候遇到的一些低效率方面所做的評論。我想，您對此有何感受？您在第四季、第一季及未來季度的溝通和規劃方式上可能做了哪些不同的事情？

Yes, Matt, thanks for the question. When you look at how we described our inventory challenges in the second quarter call, we really had a mix challenge more or less. And so the way that works its way out is and if you remember, it was really one of timing where we had stuff we needed at that point, or we did have stuff in the end and we had stuff we didn't necessarily need.

是的，馬特，謝謝你的提問。當你看到我們在第二季電話會議上如何描述庫存挑戰時，你會發現我們或多或少確實面臨混合挑戰。所以，如果你還記得的話，解決問題的方法就是，這實際上是一種時間問題，我們當時有需要的東西，或者我們最終有東西，但我們有的東西並不一定需要。

And so ultimately, when you grow into a level of revenue that ultimately is supported by the inventory that we have today. So my point being is the inventory that we had in the second quarter and we have today that is less sufficient than it needs to be, that ultimately supports a revenue growth number next year, meaning you don't have to buy a certain amount of sets and inventory to support some portion of next year's growth.

因此，最終，當您的收入增長到一定水平時，最終會受到我們今天擁有的庫存的支持。因此，我的觀點是，我們在第二季度的庫存和當前的庫存尚不足以滿足需要，這最終將支持明年的收入增長，這意味著你不必購買一定數量的設備和庫存來支持明年的部分增長。

And so I think you look at what our expected growth rate is internally for next year. You understand what asset base you have, what asset base or what revenue base that that asset base will support. And you ultimately do the math and you come to the conclusion that about $50 million of investment in sets and inventory is what you need.

所以我認為你應該看看我們內部對明年的預期成長率是多少。您了解您擁有什麼資產基礎、什麼資產基礎或該資產基礎將支援什麼收入基礎。最後你算了一下，得出結論，你需要在佈景和庫存上投資大約 5000 萬美元。

And so I think our level of resolution and confidence in that is reasonably high given where we are in the planning cycle, knowing what investments we've made and subsequently what assets we have today and where we expect the revenue to come over the next 18 months. And so that's I think the level of confidence that we go into next year with on the asset front.

因此，我認為，考慮到我們處於規劃週期的哪個階段，知道我們做了哪些投資，隨後我們今天擁有哪些資產，以及我們預計未來 18 個月的收入來源，我們對此的決心和信心水平是相當高的。所以我認為，這就是我們明年在資產方面的信心程度。

And more specifically to Q4 and maybe the question is, you came in at $21 million of cash use, which was favorable to what you expected in the third quarter. Your cash flow expectation is 125 to 135. Ultimately, we saw some improvement in DSOs in the Q3, which helped us. And as we think about landing the plane in Q4 as it relates to cash flow, ultimately, we're giving ourselves a little bit of room for DSOs to creep back up to maybe in that 50 range, which is still pretty good.

更具體地說是第四季度，也許問題是，您的現金使用量為 2,100 萬美元，這與您對第三季度的預期相比是有利的。您的現金流量預期是 125 到 135。最終，我們看到第三季的 DSO 有所改善，這對我們有幫助。當我們考慮在第四季度實現與現金流相關的目標時，最終，我們給自己留出了一點空間，讓 DSO 回升到 50 左右，這仍然相當不錯。

And also, we have some incremental cash expense associated with some of the actions we've taken from an operating expense standpoint here in the third quarter or in the fourth quarter. And so that will also play itself out in the fourth quarter. So when you take all of those things into context, our view was, let's stick with the $125 million to $135 million cash used on the full year and all the things that we're doing should give us confidence that we can hit that in a good way.

此外，從第三季或第四季的營運費用角度來看，我們採取的一些行動產生了一些增量現金支出。這也會體現在第四季。因此，當你將所有這些因素考慮在內時，我們的觀點是，讓我們堅持全年使用 1.25 億至 1.35 億美元的現金，我們正在做的所有事情都應該讓我們有信心能夠以良好的方式實現這一目標。

That's great. Thanks so much.

那太棒了。非常感謝。

Matt O'Brien, Piper Sandler.

馬特奧布萊恩、派珀桑德勒。

Great. Thanks for taking the question. It's a long one, but it is one question, I think we're supposed to be sticking with. So maybe this question is for Todd. Todd, as I look at your CapEx spending the last couple of years and again, it's a long question, so bear with me. But you spent about $80 million in '23 on CapEx. You're going to grow the top line this year about [$100 million and $20 million-ish]. So call it a 1.6 like productivity of that capital, and I know it takes time to get up the curve and all that stuff.

偉大的。感謝您回答這個問題。這個問題很長，但我認為我們應該堅持這個問題。所以也許這個問題是問托德的。托德，當我查看你過去幾年的資本支出時，這是一個很長的問題，所以請耐心聽我說。但你在 23 年的資本支出約為 8000 萬美元。今年你的營收成長幅度約為[1 億美元和 2000 萬美元左右]。因此，我們可以將資本的生產力定為 1.6，我知道要達到這個水準需要時間。

But you're adding $130 million this year and you're able to get some level of productivity that's similar to what you see here in '24. Why wouldn't your top line in '25 be something that's greater than $130 million of incremental revenue just based on all the investments that you've made this year? Because as I look at The Street, only modeling things up about $120 million year-over-year it seems like just based on all these investments, it should be much higher than that. Thanks.

但今年你增加了 1.3 億美元，就能獲得與 24 年類似的生產力水準。為什麼僅基於您今年所做的所有投資，您 25 年的營業收入不會超過 1.3 億美元的增量收入？因為當我看華爾街時，只模擬同比 1.2 億美元的情況，似乎僅基於所有這些投資，實際數字應該比這高得多。謝謝。

So Matt, if you look at where we've invested over the course of '22 and '23, and I think we shared this in our long range plan. Historically, that rate has been $0.75 on the dollar of growth. And so if you look at the investment in inventory and sets and inventory -- inventory and sets combined, it takes about $0.75 to drive a dollar of growth.

所以馬特，如果你看看我們在 22 年和 23 年期間投資的地方，我想我們在我們的長期計劃中分享了這一點。從歷史上看，這一增長率為每增長 1 美元 0.75 美元。因此，如果您看一下庫存、套裝和庫存的投資——庫存和套裝的總和，大約需要 0.75 美元才能推動 1 美元的成長。

Clearly, here in 2024, our investment level is about $140 million. And so we ultimately bought ahead to support the potential for a higher revenue ramp. And so we wanted to be prepared for that. Clearly, we're growing at significant rates today. And so when you look at the investment over the course of 2024 and what we expect to invest in 2025 that 140 plus 50, that actually is ultimately, if you assume a 7.25, I think that's where The Street's at. If you look at that, that's about $0.80 on the gross dollar.

顯然，到 2024 年，我們的投資水準約為 1.4 億美元。因此，我們最終提前購買以支持更高收入成長的潛力。因此我們希望為此做好準備。顯然，我們今天正以顯著的速度成長。因此，當您查看 2024 年的投資情況以及我們預計在 2025 年進行的投資時，這 140 加上 50，實際上最終是，如果您假設為 7.25，我認為這就是華爾街的立場。如果你看一下，你會發現這大約佔總收入的 0.80 美元。

So I think to your point, our asset base does support a level of revenue growth that is higher than what's implied. Ultimately, we'll look at where we are and we'll talk about guidance in 2025. But I think your observation that we have invested and we have the asset base to continue to grow at meaningful rates and we've grown about, call it, over $100 million a year for the last three years or so. Clearly, we've got the assets that will allow us to continue to grow at that significant rate.

所以我認為，正如您所說，我們的資產基礎確實支持了高於隱含水準的收入成長。最終，我們將審視目前的狀況並討論 2025 年的指導。但我認為，正如你所說，我們已經進行了投資，並且我們擁有繼續以有意義的速度增長的資產基礎，並且在過去三年左右的時間裡，我們每年的增長速度大約在 1 億美元以上。顯然，我們擁有可以讓我們繼續保持如此顯著成長的資產。

Great. Thank you.

偉大的。謝謝。

Joshua Jennings, TD Cowens.

約書亞·詹寧斯（Joshua Jennings），TD Cowens。

Hi, this is Eric on for Josh, thanks for taking the question. Congrats on a strong quarter. Really strong momentum in the surgeon training front with [200-plus]. Just curious about what the conversion rate is on those surgeon trainings. Should we be assuming that the vast majority of those surgeons are going to be added to the Atec base once they're at your training center and have exposure to your technology? And then secondly, is there anything that you think can be done to possibly improve that conversion rate? Thank you.

大家好，我是 Eric，代表 Josh 回答這個問題。恭喜您本季業績強勁。外科醫生培訓方面勢頭強勁，[200多]只是好奇這些外科醫生訓練的轉換率是多少。我們是否可以假設，一旦這些外科醫生進入您的訓練中心並接觸到您的技術，他們中的絕大多數都將加入 Atec 基地？其次，您認為有什麼方法可以提高轉換率？謝謝。

Every one of them is going to be a customer, I'm kidding. It's a great question and I got to tell you, it's one that we ask every day. And I think that when you look at the greater than 200, it's reflective of the perpetuation of the interest in what we're doing. And I think people are at different places in their kind of evolution of surgery and evolution, I think, especially the lateral. Lateral really is kind of the place that people clearly find that that, hey, how do I learn lateral and can I learn it from the guy who created it, Luiz Pimenta.

他們每個人都會成為顧客，我在開玩笑。這是一個很好的問題，我得告訴你，這也是我們每天都會問的問題。我認為，當你看到這個超過 200 的數字時，它反映了人們對我們所做的事情的持續興趣。我認為人們在手術和進化的進化過程中處於不同的階段，特別是橫向進化。Lateral 確實是人們可以清楚地發現的地方，嘿，我如何學習 lateral，我可以向它的創建者 Luiz Pimenta 學習嗎？

And so what they want to do is they want to come in here, and we have such a unbelievable group of surgeons. So the peerto-peer experience here is unbelievable. And so we see a high level of engagement as surgeons come.

他們想做的就是來這裡，我們有一群令人難以置信的外科醫生。因此，這裡的點對點體驗是令人難以置信。因此，我們看到外科醫生的參與度很高。

Everybody has a different algorithm in terms of what makes them comfortable to engage in the technique. And so some guys will come in here, they won't do anything. Then we'll do a peer-to-peer at a facility. They'll go to that facility,t hey'll either watch a surgeon or they'll watch it online. We have some online tools. But every surgeon has a different algorithm of things that they require to ultimately be comfortable on applying the technique to a patient.

每個人對於如何舒適地運用這項技術都有不同的演算法。所以有些人會來這裡，但他們什麼也不會做。然後我們將在設施內進行點對點的交流。他們會去那個機構，要么觀看外科醫生的手術，要么在線觀看。我們有一些線上工具。但每位外科醫生對於最終能夠舒適地將技術應用於患者都需要有不同的演算法。

And so oftentimes it's different for each surgeon. So not to evade the question, but I'm not going to disclose the specific rate. But on the other side, it's one of those things where everyone is different and what we're doing is tailoring each of the different experiences. Part of the effort there is aligning interest. And I think it's making sure that are the right people being invited to come in and are they people that are serious about engaging in the technique.

因此，通常每個外科醫生的做法都是不同的。所以為了不迴避問題，我不會透露具體的利率。但另一方面，每個人都是不同的，我們要做的就是根據每個人不同的體驗來量身訂做。其中部分努力是協調利益。我認為要確保邀請合適的人來加入，並且他們是否認真對待這項技術。

Do we have the sales structure in place in that geography, do we have access to the hospital, do we have the things aligned such that we can ultimately count on someone applying the technique if the comfort level is there. And so those are the ways that you ultimately continue to elevate the yield associated with people coming in. But it's something that I've dealt with over the last 20 some odd years in this business or 25 years in the business. And I wish that there is a predictable algorithm associated with exactly who's going to use and who's not. There just isn't.

我們是否在該地區建立了銷售結構，我們是否可以進入醫院，我們是否已將一切安排妥當，以便如果情況允許的話，我們最終可以依靠某人應用該技術。所以，這些都是你最終繼續提高與入境人員相關的利益的方法。但這是我從業 20 多年甚至 25 年來一直在處理的事情。我希望有一個可預測的演算法，可以準確地確定誰會使用，誰不會使用。根本就沒有。

Understood. Yeah, appreciate that color. Thank you.

明白了。是的，欣賞那個顏色。謝謝。

Caitlin Cronin, Canaccord.

凱特琳‧克羅寧 (Caitlin Cronin)，Canaccord。

Hey guys, congrats on a great quarter. I just want to turn to EOS, you noted some record orders. Are these new EOS users or are they upgrades to the newer EOS system in order for those legacy users to use the Insight software specifically? And also just why keep EOS guys the same given the strength in order volumes? Is there a lead time for these volumes that isn't really translating to the Q4? Thanks.

嘿夥計們，恭喜你們度過了一個美好的季度。我只想談談 EOS，您注意到了一些記錄訂單。這些是新的 EOS 用戶嗎？而且，考慮到訂單量如此之大，為什麼 EOS 的訂單量保持不變？這些卷的準備時間是否與第四季沒有實際關係？謝謝。

Okay. Yeah. Todd, just told me he'll take two and I'll take one. I mean, take both. I'm just kidding. Can I tell you, there's great enthusiasm with regard to EOS Insight. And I think that people understand the translation of the technology. And if you saw the order book for Q3, it's outstanding and it's a who's who. And the thing that makes me most excited is that here's this little Atec five years ago that that couldn't buy themselves into a meeting, and now it's like who's who in spine surgery is buying EOS.

好的。是的。托德剛剛告訴我，他要拿兩個，我要拿一個。我的意思是，兩者都拿。我只是在開玩笑。我可以告訴你，人們對 EOS Insight 非常熱情。我認為人們了解該技術的轉化。如果你看過第三季的訂單簿，你會發現它非常出色，而且名單很齊全。而最讓我興奮的是，五年前這家小小的 Atec 公司連參加會議的費用都買不起，而現在，脊椎外科領域的知名企業都在購買 EOS。

And so it's all that speaks to is our getting access to those institutions and now proliferating those institutions with our implants. And I can't wait for the day that we are a ubiquitous player in this field, as well as what we're doing is we're taking the data from these tools and ultimately improving care. And so the vision is just that. And so to me, it's highly comforting to see the volume of enthusiasm of engagement associated with a tool.

所以，這一切都說明，我們可以進入這些機構，現在利用我們的植入物來擴張這些機構。我迫不及待地希望有一天我們能成為這個領域的無處不在的參與者，而我們正在做的就是從這些工具中獲取數據並最終改善護理。所以願景就是這樣的。因此對我來說，看到人們對某個工具的參與熱情如此之高，是件非常欣慰的事。

And a little bit like in (inaudible) EOS is a much more significant influence to spine care than, say, SafeOp is. And I love SafeOp. I think SafeOp is the gateway to lateral surgery. Because without automated neurophysiology, especially automated SSCPs and now automated MEPs, that is a gateway to lateral surgery and beyond. But when you start to think about the influence that SafeOp has had on lateral surgery, I will tell you the influence that EOS can have on deformity is profoundly bigger.

有點像（聽不清楚）EOS 對脊椎護理的影響比 SafeOp 大得多。我喜歡 SafeOp。我認為 SafeOp 是側向手術的門戶。因為如果沒有自動化神經生理學，尤其是自動化 SSCP 以及現在的自動化 MEP，這將無法進行側向手術及其他手術。但是當您開始思考 SafeOp 對側向手術的影響時，我會告訴您 EOS 對畸形的影響要大得多。

And so that I think is what creates all of the enthusiasm. But this is a step by step by step exercise. And so we're gonna be perpetually conservative with regard to placing the units, and these are new places that we're placing units they're not upgrades. And we continue to upgrade units, which is inspiring. But if you look at the recognition of revenue, I think, Todd could go into exactly why it's such a step by step phenomenon.

所以我認為這就是激發人們熱情的原因。但這是一個循序漸進的練習。因此，我們在放置單位方面將永遠保持保守，這些是我們放置單位的新地方，它們不是升級。我們還在繼續升級單位，這是令人鼓舞的。但如果你看一下收入確認，我認為，托德可以準確地解釋為什麼這是一個循序漸進的現象。

Yeah, it is. And I think, Caitlin, the point is that we've been about $15 million of revenue in EOS for the last probably six or seven quarters or so. And so this Q4 actually, the implied Q4 EOS revenue in our guidance is an $18 million number. And so it is a step up going from Q3 to Q4. And so I think our comfort with that number is backed up by the level of interest we're seeing in the order book.

是的。凱特琳，我認為關鍵在於，過去六、七個季度左右，我們在 EOS 的收入約為 1500 萬美元。因此實際上，我們預計第四季度 EOS 收入為 1800 萬美元。因此，從 Q3 到 Q4 是一個進步。因此，我認為，我們對該數字的滿意程度得到了訂單簿中看到的興趣程度的支持。

Great. Thanks so much.

偉大的。非常感謝。

David Saxon, Needham.

大衛薩克森，尼德漢姆。

Great. Good afternoon, Pat and Todd. Thanks for taking my question. I'll just ask one quick one on Valence. I know that's in kind of a friends and family stage launch at this point. So maybe just talk about kind of early feedback you've been getting and how we should think about the cadence from going from a friends and family into a broader launch in 2025? Thanks so much.

偉大的。下午好，帕特和托德。感謝您回答我的問題。我只想快速問一個關於 Valence 的問題。我知道這目前正處於朋友和家人階段的發表會。所以也許只是談談您收到的早期回饋，以及我們應該如何考慮從朋友和家人推廣到 2025 年更廣泛推廣的節奏？非常感謝。

Yeah, thanks. This is one of my favorite ones. It's like, I love when you don't have to back a bus up to a OR to bring in a tool that ultimately guides your screws. And we don't have to do that with Valence. It's a meaningfully small footprint in the operating room. And as I said, we're doing cases today. We want to continue to refine the thing in a way that there is real elegance to its integration into the operative work flow, and I would tell you that that's where we're spending most of our time.

是的，謝謝。這是我最喜歡的之一。就像，我喜歡你不必倒車到手術室去帶一個最終引導你擰螺絲的工具。而我們不必對 Valence 這麼做。它在手術室中佔用的空間非常小。正如我所說，我們今天正在處理案件。我們希望繼續完善它，使它能夠真正優雅地融入操作工作流程中，我可以告訴你，這就是我們花費大部分時間的地方。

So if I look over the kind of the time frame, our excitement is let's continue to refine the thing through middle of next year and then let's discern if we're ready to launch it then, that's our expectation and that's our excitement. And so -- but I would tell you, from a footprint perspective, from a technological perspective, from a software and capability perspective, having guys that have the type of experience who are putting this together, Brad Clayton, Kevin Fred, these guys are years into this business. There's a whole slew of software people in house here and in house in Colorado that have meaningful experience in this field.

因此，如果我看一下時間框架，我們興奮的是，讓我們在明年年中之前繼續完善這件事，然後讓我們判斷我們是否準備好推出它，這是我們的期望，也是我們的興奮。所以 — — 但我想告訴你，從足蹟的角度來看，從技術的角度來看，從軟體和能力的角度來看，有經驗的人在整合這些，布拉德·克萊頓、凱文·弗雷德，這些人在這個行業已經工作多年了。這裡和科羅拉多州的公司內部都有大量軟體人員，他們在這個領域擁有豐富的經驗。

And so what gives me confidence is I see the improvement that we're making every day on the thing and I see the opportunity that it presents, because it is a not a huge cost of goods, comparatively speaking, not a big footprint -- comparatively speaking. And so it just provides us flexibility in terms of how we get these things into the hospitals. And so I know not a specific response to your question, but kind of where we are today.

所以，讓我有信心的是，我看到了我們每天都在做的事情的進步，我看到了它所帶來的機遇，因為相對而言，它的商品成本並不是很高，足跡也不是很大——相對而言。因此，它為我們將這些物品運送到醫院提供了靈活性。所以我不知道你的問題的具體答案，但知道我們目前的狀況。

Great. That's helpful. Thanks.

偉大的。這很有幫助。謝謝。

Sean Lee, H.C. Wainwright.

李，H.C.溫賴特。

Good afternoon guys. Thanks for taking my questions and congrats on a strong quarter. My question is kind of a top level one. Looking back from beginning of last year, we can see that you have been able to consistently outperform your previous guidance. And now the latest revenues are more than 10% higher than what you expected you were able to achieve at the beginning of the year. So I was wondering whether this has been driven by a specific tailwind and whether this -- the upward surprises is coming from the trend that we can expect to continue going to next year? Thanks.

大家下午好。感謝您回答我的問題，並祝賀您本季業績表現強勁。我的問題有點像頂級問題。回顧去年年初，我們可以看到你們一直能夠持續超越之前的預期。現在最新的收入比你年初預期的收入高出 10% 以上。所以我想知道這是否是由特定的順風推動的，以及這——上升的驚喜是否來自於我們預計明年將繼續發展的趨勢？謝謝。

Well, Sean, I think when you look at the guidance we put out, at the beginning of the year and that was $595 million. Ultimately, that was where we're looking at today in terms of our guidance and the improvement and the increase in it, it's really all come from surgical revenue. So our EOS guidance has been consistent throughout the year. So you ask yourself why has the surgical revenue done better than what we anticipated early on? And it's really come through our volume assumptions.

嗯，肖恩，我想當你看到我們年初發布的指導方針時，這個數字是 5.95 億美元。最終，這就是我們今天所關注的指導以及其中的改進和增加，這些實際上都來自手術收入。因此我們的 EOS 指導全年都保持一致。那你會問自己，為什麼手術收入比我們早期預期的還要好？這確實是透過我們的數量假設得出的。

And so ultimately, I think this is a reflection of the interest, the adoption of our technology and our procedures by surgeons and aided and advanced through the addition of sales coverage and sales reps. And so it's not just one thing and I hate to be super simple about it. But ultimately, this has been a greater volume experience than we guided to at the outset of the year. And so I think that gives you confidence that we're on to something.

因此，最終，我認為這反映了外科醫生對我們的技術和程序的興趣和採用，並透過增加銷售覆蓋範圍和銷售代表來輔助和推動。所以這不只是一件事，我也不想把它想得太簡單。但最終，這項銷售體驗比我們年初預期的還要大。所以我認為這會讓你相信我們正在做一些事情。

Thanks for the additional color. That's all I have.

謝謝你添加的顏色。這就是我的所有了。

Drew Ranieri, Morgan Stanley.

摩根士丹利的德魯‧拉涅利 (Drew Ranieri)。

Hey, Pat and thanks for taking the questions. Just I'll sneak in two, this should be pretty quick. But Pat, maybe on EOS, I think in your part of the slide deck, you're talking about it laying the foundation for future implant growth. And maybe just put a little bit more context there, especially against what that means for the record EOS orders that you're seeing with Insights. Are you embedding volume based commitments with kind of like every new order from EOS, whether it's an upgrade or replacement?

嘿，帕特，謝謝你回答這些問題。我只需要偷偷溜進去兩個，這應該很快。但是帕特，也許關於 EOS，我認為在幻燈片的您部分，您正在談論它為未來的植入物增長奠定基礎。也許只是在這裡提供一點背景信息，尤其是針對您透過 Insights 看到的記錄 EOS 訂單的含義。您是否將基於數量的承諾嵌入到來自 EOS 的每筆新訂單中，無論是升級還是更換？

So maybe just talk to us a little bit about that. And then, Todd, just on the gross margin for the quarter. It came in a little bit weaker than we were expecting. And I know you highlighted product mix but we saw lateral kind of continue to take more share. So just talk to us a little bit more about why it was a little bit softer versus maybe our expectations and what you're kind of thinking about for the fourth quarter? Thanks for taking the questions.

因此也許您可以和我們稍微談談這個問題。然後，托德，我們來談談本季的毛利率。它比我們預期的要弱一些。我知道您強調了產品組合，但我們看到橫向產品繼續佔據更多的份額。那麼，請與我們進一步談談為什麼與我們的預期相比，銷售額略有下降，以及您對第四季度有何看法？感謝您回答這些問題。

I'll start, Drew, and thanks for the question. And I'm just worried about not doing a great job in terms of describing the integration of our implants into that experience. And so the beauty of automating these measures is that we get a ton of radiographs and a ton of opportunities to create plans, and those plans are informed by our implants. And the beauty of that is we see it all the way through the surgical intervention, all the way through the post op assessment.

我先開始，德魯，謝謝你的提問。我只是擔心在描述我們的植入物與這種體驗的結合方面做得不好。因此，這些措施自動化的好處在於，我們可以獲得大量的射線照片和大量製定計劃的機會，而這些計劃都是由我們的植入物告知的。它的美妙之處在於，我們可以在整個手術介入過程中以及術後評估過程中看到它。

Our ability to start to see the reflection of that spine care on the adjacent level and start to understand what the change has been in the spine alignment is profoundly valuable, because ultimately, it's the indicator of a future issue. And so the great part is the surgical planning element ultimately is informed with our implant. Our implant's to the tune of, hey, here's the type of rod, patient specific rod you need, we will bend that rod, that rod will go with our implant.

我們能夠開始看到脊椎護理在相鄰層面上的反映，並開始了解脊椎排列的變化，這是非常有價值的，因為最終，它是未來問題的指標。因此，最重要的是手術規劃元素最終是透過我們的植入物來告知的。我們的植入物是這樣的，嘿，這是您需要的桿的類型，特定於患者的桿，我們將彎曲該桿，該桿將與我們的植入物配合使用。

And so when you have the early engagement with the surgeon on what his findings are radiographically as he sees the patient and identifies the intervention that he's going to apply, our ability to plan it and integrate our implants and understand how our implants fulfill the requisite obligation is really outstanding.

因此，當您與外科醫生進行早期接觸，了解他在看病人時的放射學發現並確定他將要應用的干預措施時，我們規劃和整合植入物並了解我們的植入物如何履行必要義務的能力確實非常出色。

And so it really ties the implants to the plan and then we have an integrated tool interoperatively to reconcile against that plan, all that is proprietary. And so when we start to think about selling these units and garnering access to hospitals, our opportunity to garner access based upon the utility of this preoperative plan that's fundamentally driven by the AI that drives the alignment measures is outstanding.

因此，它實際上將植入物與計劃聯繫在一起，然後我們有一個整合的工具可以與該計劃進行協調，所有這些都是專有的。因此，當我們開始考慮出售這些設備並獲得進入醫院的權限時，我們根據這項術前計劃的實用性獲得訪問權的機會是卓越的，該計劃從根本上是由推動調整措施的人工智能驅動的。

And so tying our implants is a very presumptive exercise in this effort. And so I think just to give you a perspective of the type of volume, the automation is so important to ultimately garnering information and creating predictive -- like a predictive measure. I think we're over a 100,000 images in the 10 sites that we had in our alpha evaluation. And so when you start to think about the volume of information that we get through the integration of these tools that ultimately inform predictable spine surgery, it's awesome. And so anyway, that's what creates all the enthusiasm. I'm sure I'm droning. But it's like that's why you really can get a tool that is unlike anybody else has.

因此，在這項工作中，綁定我們的植入物是一個非常假設的練習。因此，我認為只是為了讓您了解資料量的類型，自動化對於最終收集資訊和創建預測（如預測指標）非常重要。我認為我們在 alpha 評估中的 10 個站點中已經有超過 100,000 張圖像。因此，當您開始思考我們透過整合這些工具所獲得的資訊量，而這些資訊最終可以為可預測的脊椎手術提供資訊時，您會覺得這真是太棒了。無論如何，這就是激發所有熱情的原因。我確信我在嗡嗡叫。但這就是為什麼你真的能得到一個與眾不同的工具。

And Drew, just on the product mix. Our EOS margins were a bit lower, driving a little bit of headwind there, that's just really kind of geographic mix more than anything with the international markets being at a lower margin because many of those are distributor sales. So that just provides a little bit of a margin drag in the quarter.

德魯，只談產品組合。我們的 EOS 利潤率略低，在那裡遇到了一些阻力，這實際上只是一種地理分佈組合，國際市場的利潤率較低，因為其中許多是分銷商銷售。所以這只會對本季的利潤率造成一點拖累。

And also as we kind of got healthy in our biologic portfolio, we saw a good strong biologic revenue performance in the quarter that had a lower margin profile as well. So both of those things contributed to the little bit of a headwind that we saw in the quarter. And think about the second -- think about the fourth quarter non-GAAP gross margin in that 69.5% range and we expect to end the year at about 70% gross margin. (multiple speakers)

而且隨著我們的生物製劑產品組合逐漸健全，我們在本季看到生物製劑收入表現強勁，但利潤率也較低。所以這兩件事都導致了我們在本季看到一些阻力。再想想第二點——第四季非 GAAP 毛利率在 69.5% 左右，我們預計今年年底的毛利率將達到 70% 左右。（多位發言者）

For taking the questions.

用於回答問題。

That includes our Q&A session. I will now turn the conference back over to Pat Miles for closing remarks.

其中包括我們的問答環節。現在我將會議交還給帕特·邁爾斯 (Pat Miles) 做結束語。

Yeah, I just want to thank everybody for their attention. And I hope you share your enthusiasm about what we're building. So thanks very much.

是的，我只是想感謝大家的關注。我希望你們也對我們正在建立的事業充滿熱情。非常感謝。

Thank you everyone for joining. You may now disconnect.

感謝大家的加入。您現在可以斷開連線。