Carlsmed (CARL)
Market Price (2/19/2026): $11.9 | Market Cap: $250.9 MilSector: Health Care | Industry: Health Care Technology
Carlsmed (CARL)
Market Price (2/19/2026): $11.9Market Cap: $250.9 MilSector: Health CareIndustry: Health Care Technology
Investment Highlights Why It Matters Detailed financial logic regarding cash flow yields vs trend-riding momentum.
| Cash is significant % of market capNet D/ENet Debt/Equity. Debt net of cash. Negative indicates net cash. Equity is taken as the Market Capitalization is -39% | Weak multi-year price returns2Y Excs Rtn is -57%, 3Y Excs Rtn is -87% | Not profitable at operating income levelOp Inc LTMOperating Income, Last Twelve Months is -26 Mil, Op Mgn LTMOperating Margin = Operating Income / Revenue Reflects profitability before taxes and before impact of capital structure (interest payments). is -58% |
| Megatrend and thematic driversMegatrends include Precision Medicine, and Digital Health & Telemedicine. Themes include Personalized Diagnostics, Targeted Therapies, Show more. | Not cash flow generativeCFO/Rev LTMCash Flow from Operations / Revenue (Sales), Last Twelve Months (LTM) is -62%, FCF/Rev LTMFree Cash Flow / Revenue (Sales), Last Twelve Months (LTM) is -65% | |
| Valuation getting more expensiveP/S 6M Chg %Price/Sales change over 6 months. Declining P/S indicates valuation has become less expensive. is 248% | ||
| Yield minus risk free rate is negativeERPEquity Risk Premium (ERP) = Total Yield - Risk Free Rate, Reflects the premium above risk free assets offered by the investment. is -15% | ||
| Key risksCARL key risks include [1] its current lack of profitability and high operating losses, Show more. |
| Cash is significant % of market capNet D/ENet Debt/Equity. Debt net of cash. Negative indicates net cash. Equity is taken as the Market Capitalization is -39% |
| Megatrend and thematic driversMegatrends include Precision Medicine, and Digital Health & Telemedicine. Themes include Personalized Diagnostics, Targeted Therapies, Show more. |
| Weak multi-year price returns2Y Excs Rtn is -57%, 3Y Excs Rtn is -87% |
| Not profitable at operating income levelOp Inc LTMOperating Income, Last Twelve Months is -26 Mil, Op Mgn LTMOperating Margin = Operating Income / Revenue Reflects profitability before taxes and before impact of capital structure (interest payments). is -58% |
| Not cash flow generativeCFO/Rev LTMCash Flow from Operations / Revenue (Sales), Last Twelve Months (LTM) is -62%, FCF/Rev LTMFree Cash Flow / Revenue (Sales), Last Twelve Months (LTM) is -65% |
| Valuation getting more expensiveP/S 6M Chg %Price/Sales change over 6 months. Declining P/S indicates valuation has become less expensive. is 248% |
| Yield minus risk free rate is negativeERPEquity Risk Premium (ERP) = Total Yield - Risk Free Rate, Reflects the premium above risk free assets offered by the investment. is -15% |
| Key risksCARL key risks include [1] its current lack of profitability and high operating losses, Show more. |
Qualitative Assessment
AI Analysis | Feedback
1. Investor apprehension regarding continued unprofitability despite revenue growth.
Carlsmed announced strong preliminary Q4 2025 revenue of approximately $15.2 million, a 61% increase year-over-year, and full-year 2025 revenue of approximately $50.5 million, an 86% increase over 2024. However, the company reported a Q3 2025 net loss of $8.5 million, which was wider than analyst projections. The consensus EPS forecast for Q4 2025 is a loss of $0.426, with a substantial EBITDA loss of $30.7 million reported. The announcement on February 11, 2026, of the upcoming Q4 and full-year 2025 financial results on February 25, 2026, led to a 5.78% stock decline, erasing approximately $18 million in market valuation, reflecting investor caution regarding sustained profitability.
2. Bearish technical signals indicating a downward trend.
Multiple technical indicators turned negative in late January 2026, contributing to the stock's decline, which decreased 9.47% since the beginning of 2026 and 11.06% in the past month leading up to February 14, 2026. The Momentum Indicator for CARL fell below the zero level on January 27, 2026, signaling a potential new downward trend. Furthermore, the Moving Average Convergence Divergence Histogram (MACD) for CARL also turned negative on January 29, 2026, suggesting a likely stock downturn. The stock moving below its 50-day moving average on January 28, 2026, further reinforced a bearish outlook.
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Stock Movement Drivers
Fundamental Drivers
The -8.1% change in CARL stock from 10/31/2025 to 2/18/2026 was primarily driven by a 0.0% change in the company's Shares Outstanding (Mil).| (LTM values as of) | 10312025 | 2182026 | Change |
|---|---|---|---|
| Stock Price ($) | 12.89 | 11.85 | -8.1% |
| Change Contribution By: | |||
| Total Revenues ($ Mil) | � | � | 0.0% |
| Net Income Margin (%) | � | � | 0.0% |
| P/E Multiple | � | � | 0.0% |
| Shares Outstanding (Mil) | 5 | 5 | 0.0% |
| Cumulative Contribution | 0.0% |
Market Drivers
10/31/2025 to 2/18/2026| Return | Correlation | |
|---|---|---|
| CARL | -8.1% | |
| Market (SPY) | 0.6% | 30.2% |
| Sector (XLV) | 9.3% | 21.5% |
Fundamental Drivers
The -15.7% change in CARL stock from 7/31/2025 to 2/18/2026 was primarily driven by a 0.0% change in the company's Shares Outstanding (Mil).| (LTM values as of) | 7312025 | 2182026 | Change |
|---|---|---|---|
| Stock Price ($) | 14.06 | 11.85 | -15.7% |
| Change Contribution By: | |||
| Total Revenues ($ Mil) | � | � | 0.0% |
| Net Income Margin (%) | � | � | 0.0% |
| P/E Multiple | � | � | 0.0% |
| Shares Outstanding (Mil) | 5 | 5 | 0.0% |
| Cumulative Contribution | 0.0% |
Market Drivers
7/31/2025 to 2/18/2026| Return | Correlation | |
|---|---|---|
| CARL | -15.7% | |
| Market (SPY) | 8.9% | 24.4% |
| Sector (XLV) | 21.4% | 12.6% |
Fundamental Drivers
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Market Drivers
1/31/2025 to 2/18/2026| Return | Correlation | |
|---|---|---|
| CARL | ||
| Market (SPY) | 15.0% | 24.6% |
| Sector (XLV) | 8.8% | 13.8% |
Fundamental Drivers
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Market Drivers
1/31/2023 to 2/18/2026| Return | Correlation | |
|---|---|---|
| CARL | ||
| Market (SPY) | 75.1% | 24.6% |
| Sector (XLV) | 23.7% | 13.8% |
Price Returns Compared
| 2021 | 2022 | 2023 | 2024 | 2025 | 2026 | Total [1] | |
|---|---|---|---|---|---|---|---|
| Returns | |||||||
| CARL Return | - | - | - | - | -15% | -9% | -23% |
| Peers Return | -8% | -11% | -1% | 13% | 29% | -8% | 10% |
| S&P 500 Return | 27% | -19% | 24% | 23% | 16% | -0% | 82% |
Monthly Win Rates [3] | |||||||
| CARL Win Rate | - | - | - | - | 33% | 50% | |
| Peers Win Rate | 48% | 53% | 52% | 53% | 45% | 40% | |
| S&P 500 Win Rate | 75% | 42% | 67% | 75% | 67% | 50% | |
Max Drawdowns [4] | |||||||
| CARL Max Drawdown | - | - | - | - | -18% | -13% | |
| Peers Max Drawdown | -18% | -36% | -26% | -18% | -17% | -11% | |
| S&P 500 Max Drawdown | -1% | -25% | -1% | -2% | -15% | -1% | |
[1] Cumulative total returns since the beginning of 2021
[2] Peers: GMED, ATEC, OFIX, MDT, SYK.
[3] Win Rate = % of calendar months in which monthly returns were positive
[4] Max drawdown represents maximum peak-to-trough decline within a year
[5] 2026 data is for the year up to 2/18/2026 (YTD)
How Low Can It Go
CARL has limited trading history. Below is the Health Care sector ETF (XLV) in its place.
| Event | XLV | S&P 500 |
|---|---|---|
| 2022 Inflation Shock | ||
| % Loss | -16.1% | -25.4% |
| % Gain to Breakeven | 19.1% | 34.1% |
| Time to Breakeven | 599 days | 464 days |
| 2020 Covid Pandemic | ||
| % Loss | -28.8% | -33.9% |
| % Gain to Breakeven | 40.4% | 51.3% |
| Time to Breakeven | 116 days | 148 days |
| 2018 Correction | ||
| % Loss | -15.8% | -19.8% |
| % Gain to Breakeven | 18.8% | 24.7% |
| Time to Breakeven | 326 days | 120 days |
| 2008 Global Financial Crisis | ||
| % Loss | -40.6% | -56.8% |
| % Gain to Breakeven | 68.3% | 131.3% |
| Time to Breakeven | 1,100 days | 1,480 days |
Compare to GMED, ATEC, OFIX, MDT, SYK
In The Past
SPDR Select Sector Fund's stock fell -16.1% during the 2022 Inflation Shock from a high on 4/8/2022. A -16.1% loss requires a 19.1% gain to breakeven.
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About Carlsmed (CARL)
AI Analysis | Feedback
Here are 1-2 brief analogies to describe Carlsmed:
- Align Technology (Invisalign) for spinal implants: Carlsmed uses AI-enabled technology and advanced manufacturing to create patient-specific spinal implants, much like Align Technology creates customized clear aligners for teeth using digital planning and 3D printing.
- A specialized, AI-driven Medtronic or Stryker for personalized spinal implants: Carlsmed operates in the medical device space for orthopedics, similar to giants like Medtronic or Stryker, but focuses specifically on hyper-personalized, AI-designed implants for spine surgery.
AI Analysis | Feedback
```html- Aide® Platform: This AI-enabled personalized surgery platform is designed to improve outcomes for patients undergoing spinal deformity surgery by creating individualized surgical plans and patient-specific implant devices.
AI Analysis | Feedback
Carlsmed (NASDAQ: CARL) is a medical technology company that designs and manufactures patient-specific spinal implants. As such, the company primarily sells to other companies (B2B).
Carlsmed's major customers are healthcare providers that perform spinal surgeries. These primarily include:
- Hospitals: Public, private, and university-affiliated hospitals where complex spinal deformity surgeries are performed.
- Ambulatory Surgical Centers (ASCs): Specialized outpatient facilities that conduct a range of surgical procedures, including some spinal interventions.
- Healthcare Systems: Large organizations that own and operate multiple hospitals and surgical centers, which serve as the ultimate purchasing entities for medical devices.
Carlsmed works directly with spine surgeons within these facilities to implement their personalized Aprevo® devices. Additionally, the company utilizes third-party distributors for sales in certain international markets.
It is important to note that Carlsmed's latest annual report (10-K) does not disclose any single customer accounting for 10% or more of its total revenue. This indicates a broad and diversified customer base across numerous healthcare facilities and systems rather than reliance on a few named "major customer companies" that contribute a disproportionately large share of revenue. Therefore, specific public customer companies, like large hospital chains (e.g., HCA Healthcare, symbol: HCA; Tenet Healthcare, symbol: THC), are not explicitly identified by Carlsmed in their public filings as major customers in a way that would allow for listing them with their symbols as individual entities responsible for a significant percentage of revenue.
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Mike Cordonnier, Chief Executive Officer
Mike Cordonnier is the Co-Founder, President, and Chief Executive Officer of Carlsmed, also serving as the Chair of the Board of Directors. He co-founded Carlsmed with Niall Casey in 2018. With over two decades of leadership experience, he has introduced groundbreaking medical technologies and guided teams across both private and public organizations, including NuVasive, Ellipse Technologies, Zimmer Biomet, Orchid Orthopedics, and X-Spine Systems. Ellipse Technologies, where he served as R&D Director, was acquired by NuVasive.
Leo Greenstein, Chief Financial Officer
Leo Greenstein is the Chief Financial Officer at Carlsmed. He possesses over two decades of experience in business and finance, with expertise in the surgical device, pharmaceutical, and oncology diagnostics sectors. His leadership journey includes significant roles at Spectrum Pharmaceuticals, Endologix, and Tarsus Pharmaceuticals.
Jennifer Kamocsay, Chief Legal Officer
Jennifer Kamocsay is the Chief Legal Officer and Secretary at Carlsmed. She brings over two decades of corporate legal experience from various in-house counsel roles in the life science and technology sectors. Prior to joining Carlsmed, she served as the Chief Legal Officer of Akoya Biosciences and held senior legal roles at Rubius Therapeutics and Progress Software Corporation. She began her legal career at Skadden, Arps, Slate, Meagher & Flom LLP, where she counseled biotechnology, pharmaceutical, and technology clients on M&A, securities law, and corporate governance matters.
Scott Durall, Chief Commercial Officer
Scott Durall is the Chief Commercial Officer at Carlsmed. He has more than 30 years of experience in the medical device industry, holding leadership roles across sales, marketing, and corporate strategy. His career includes successful tenures at U.S. Surgical Corporation, Boston Scientific Corporation, and NuVasive.
Sharon Schulzki, Chief Clinical & Market Access Officer
Sharon Schulzki is the Chief Clinical & Market Access Officer at Carlsmed. Her extensive professional journey includes senior leadership roles in marketing and surgical affairs at prominent companies such as Johnson & Johnson and Stryker. She has also played crucial C-suite roles at successful startup ventures, namely Micropore Biosurgery, N-Spine, and Tissue Regeneration Systems, all of which achieved successful exits.
AI Analysis | Feedback
The key risks to Carlsmed's business include:- Lack of Profitability and High Operating Losses: Carlsmed is not yet profitable, reporting significant net losses as it continues to invest heavily in research and development, sales expansion, and marketing. The company expects these losses to continue and there is no guarantee of achieving profitability in the future.
- Market Adoption, Competition, and Regulatory Hurdles: The success of Carlsmed's aprevo® platform is contingent on its adoption by surgeons and hospitals, and the company faces the challenge of convincing medical professionals to switch to personalized implants. Furthermore, Carlsmed operates in a competitive landscape with larger, well-established medical device companies like Medtronic and Johnson & Johnson. The company is also subject to stringent FDA regulations, and any delays or failures in obtaining additional clearances for its devices could impede growth.
- Reliance on a Single Product and Third-Party Manufacturers: Carlsmed's business model is heavily reliant on its single product category, the aprevo® platform for spinal fusion. Additionally, the company depends on third-party contract manufacturers for the production of its devices, which exposes it to risks such as supply chain disruptions and potential quality control issues.
AI Analysis | Feedback
nullAI Analysis | Feedback
Carlsmed (CARL) focuses on AI-enabled personalized spine surgery solutions, primarily with its aprevo® Technology Platform. The company's main products address two key market segments in spine fusion surgery:
-
Lumbar Spine Fusion: For lumbar spine fusion procedures, Carlsmed estimates an addressable market of approximately $13 billion to $13.4 billion in the U.S. This estimate is based on nearly 500,000 patients undergoing lumbar spine fusion procedures annually.
-
Cervical Spine Fusion: Carlsmed is expanding its aprevo platform to include cervical spine fusion, with commercialization anticipated in 2026. This segment represents an addressable market of $4.6 billion, specifically within the U.S.
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Carlsmed (NASDAQ: CARL) is poised for significant revenue growth over the next 2-3 years, driven by several key factors highlighted in recent earnings reports and company statements.
Here are the expected drivers of future revenue growth for Carlsmed:
- Expansion of Surgeon User Base and Increased Aprivo Utilization: Carlsmed's revenue growth has been consistently fueled by the increasing number of surgeons adopting their AI-enabled aprevo® technology platform and the higher utilization of the platform by both new and existing surgeons. For instance, the company reported a 70% year-over-year growth in its surgeon user base in Q3 2025. This trend is expected to continue as the company invests in sales and marketing and surgeon education programs to expand its commercial footprint.
- Launch and Commercialization of Cervical Spine Platform: A significant driver for future revenue is the anticipated commercial launch of Carlsmed's personalized cervical spine platform in early 2026. The company successfully completed its first personalized cervical spine surgery using the aprevo® technology platform in July 2025 and has already completed over 50 cervical aprevo procedures as part of its clinical evaluation program. This expansion into cervical fusion procedures represents a new market segment for Carlsmed's innovative technology.
- Positive Reimbursement Developments: The securing of CMS New Technology Add-On Payment (NTAP) reimbursement for aprevo® cervical procedures, which went into effect on October 1, 2025, is expected to positively impact revenue. This reimbursement provides favorable payment for the company's cervical procedures, making them more accessible and attractive to healthcare providers.
- Operational Efficiencies and Reduced Production Lead Times: While not a direct revenue driver, Carlsmed's focus on operational excellence, particularly the reduction of production lead times for its aprevo® interbody implants to within eight business days, from 20 business days in Q3 2024, supports its ability to scale and meet growing demand. This efficiency allows the company to process more procedures and onboard new surgeons effectively, indirectly contributing to revenue growth.
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Share Issuance
- Carlsmed completed an Initial Public Offering (IPO) in July 2025, offering 6,700,000 shares of common stock at an initial public offering price of $15.00 per share.
- The IPO generated approximately $100.5 million in gross proceeds and $93.5 million in net proceeds for the company.
- Underwriters were granted a 30-day option to purchase up to an additional 1,005,000 shares of common stock.
Inbound Investments
- In March 2024, Carlsmed raised $52.5 million in Series C funding, co-led by B Capital and U.S. Venture Partners.
- The company announced a $64.5 million funding round in an amended filing in February 2025.
- Carlsmed received $93.5 million in net proceeds from its Initial Public Offering in July 2025.
Capital Expenditures
- Research and development expenses were $4.2 million in Q2 2025 and $4.4 million in Q3 2025, primarily allocated to personnel costs for product development and AI initiatives, including the aprevo® Technology Platform for cervical spine fusion surgeries.
- Sales and marketing expenses, reflecting investments in commercial infrastructure, were $7.9 million in Q2 2025 and $9.6 million in Q3 2025, driven by personnel additions and growth-related sales and marketing efforts.
- The company launched its digital production system in November 2024 to enhance delivery of aprevo interbody implants, indicating investment in operational capabilities.
Trade Ideas
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Research & Analysis
Invest in Strategies
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Peer Comparisons
| Peers to compare with: |
Financials
| Median | |
|---|---|
| Name | |
| Mkt Price | 51.96 |
| Mkt Cap | 7.1 |
| Rev LTM | 1,794 |
| Op Inc LTM | 204 |
| FCF LTM | 284 |
| FCF 3Y Avg | 331 |
| CFO LTM | 375 |
| CFO 3Y Avg | 444 |
Growth & Margins
| Median | |
|---|---|
| Name | |
| Rev Chg LTM | 11.2% |
| Rev Chg 3Y Avg | 21.9% |
| Rev Chg Q | 17.2% |
| QoQ Delta Rev Chg LTM | 4.2% |
| Op Mgn LTM | 2.8% |
| Op Mgn 3Y Avg | 13.9% |
| QoQ Delta Op Mgn LTM | 1.5% |
| CFO/Rev LTM | 12.5% |
| CFO/Rev 3Y Avg | 19.0% |
| FCF/Rev LTM | 7.3% |
| FCF/Rev 3Y Avg | 14.3% |
Valuation
| Median | |
|---|---|
| Name | |
| Mkt Cap | 7.1 |
| P/S | 4.0 |
| P/EBIT | 6.8 |
| P/E | 11.0 |
| P/CFO | 18.2 |
| Total Yield | -2.2% |
| Dividend Yield | 0.0% |
| FCF Yield 3Y Avg | 2.8% |
| D/E | 0.2 |
| Net D/E | 0.1 |
Returns
| Median | |
|---|---|
| Name | |
| 1M Rtn | -2.8% |
| 3M Rtn | -0.5% |
| 6M Rtn | -2.5% |
| 12M Rtn | 2.5% |
| 3Y Rtn | 11.4% |
| 1M Excs Rtn | -2.0% |
| 3M Excs Rtn | -4.4% |
| 6M Excs Rtn | -9.6% |
| 12M Excs Rtn | -9.4% |
| 3Y Excs Rtn | -54.2% |
Earnings Returns History
Expand for More| Forward Returns | |||
|---|---|---|---|
| Earnings Date | 1D Returns | 5D Returns | 21D Returns |
| 11/6/2025 | 14.9% | 7.0% | 8.8% |
| 8/28/2025 | -2.8% | -6.9% | -1.8% |
| SUMMARY STATS | |||
| # Positive | 1 | 1 | 1 |
| # Negative | 1 | 1 | 1 |
| Median Positive | 14.9% | 7.0% | 8.8% |
| Median Negative | -2.8% | -6.9% | -1.8% |
| Max Positive | 14.9% | 7.0% | 8.8% |
| Max Negative | -2.8% | -6.9% | -1.8% |
Insider Activity
Expand for More| # | Owner | Title | Holding | Action | Filing Date | Price | Shares | Transacted Value | Value of Held Shares | Form |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | B, Capital Group Management, Lp | B Capital Global Growth III, L.P. | Buy | 7242025 | 15.00 | 1,333,333 | 19,999,995 | 75,207,585 | Form | |
| 2 | Sidow, Kevin | Direct | Buy | 7242025 | 15.00 | 13,333 | 199,995 | 893,490 | Form | |
| 3 | Mittendorff, Robert Ii | See footnotes | Buy | 7242025 | 15.00 | 1,333,333 | 19,999,995 | 75,207,585 | Form | |
| 4 | Root, Jonathan D | Direct | Buy | 7242025 | 15.00 | 466,666 | 6,999,990 | 7,259,985 | Form | |
| 5 | Young, Philip M | See Footnotes | Buy | 7242025 | 15.00 | 59,999 | 899,985 | 799,995 | Form |
External Quote Links
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