Carlsmed (CARL)
Market Price (5/4/2026): $9.44 | Market Cap: $251.7 MilSector: Health Care | Industry: Health Care Technology
Carlsmed (CARL)
Market Price (5/4/2026): $9.44Market Cap: $251.7 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 -37% Strong revenue growthRev Chg LTMRevenue Change % Last Twelve Months (LTM) is 86% 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 -76%, 3Y Excs Rtn is -113% | Not profitable at operating income levelOp Inc LTMOperating Income, Last Twelve Months is -31 Mil, Op Mgn LTMOperating Margin = Operating Income / Revenue Reflects profitability before taxes and before impact of capital structure (interest payments). is -61% Not cash flow generativeCFO/Rev LTMCash Flow from Operations / Revenue (Sales), Last Twelve Months (LTM) is -57%, FCF/Rev LTMFree Cash Flow / Revenue (Sales), Last Twelve Months (LTM) is -60% 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 -16% 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 -37% |
| Strong revenue growthRev Chg LTMRevenue Change % Last Twelve Months (LTM) is 86% |
| 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 -76%, 3Y Excs Rtn is -113% |
| Not profitable at operating income levelOp Inc LTMOperating Income, Last Twelve Months is -31 Mil, Op Mgn LTMOperating Margin = Operating Income / Revenue Reflects profitability before taxes and before impact of capital structure (interest payments). is -61% |
| Not cash flow generativeCFO/Rev LTMCash Flow from Operations / Revenue (Sales), Last Twelve Months (LTM) is -57%, FCF/Rev LTMFree Cash Flow / Revenue (Sales), Last Twelve Months (LTM) is -60% |
| 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 -16% |
| Key risksCARL key risks include [1] its current lack of profitability and high operating losses, Show more. |
Qualitative Assessment
AI Analysis | Feedback
1. Persistent Unprofitability Despite Strong Revenue Growth. Carlsmed reported robust revenue growth, with Q4 2025 revenue increasing by 61.2% year-over-year to $15.2 million, surpassing analyst estimates. Full-year 2025 revenue also grew significantly by 86% to $50.5 million. However, the company remained unprofitable, reporting a net loss of ($29.6) million for the full year 2025. This continued unprofitability, despite strong top-line expansion and rising operating expenses, likely contributed to investor concerns regarding the company's path to sustainable earnings.
2. 2026 Revenue Guidance Aligned with Expectations, Lacking Upside Surprise. Carlsmed provided 2026 revenue guidance in the range of $70 million to $75 million, which at its midpoint represents a 44% growth over 2025. While this indicates continued growth, the guidance was largely in line with existing analyst consensus estimates of approximately $71.7 million. This lack of a significant upside surprise in the forward-looking guidance may have led to a "sell the news" reaction, as the stock experienced a 3.83% drop with 6.8 times higher volume on the day of the Q4 2025 earnings report despite beating revenue and EPS estimates.
Show more
Stock Movement Drivers
Fundamental Drivers
The -23.7% change in CARL stock from 1/31/2026 to 5/3/2026 was primarily driven by a -82.8% change in the company's Shares Outstanding (Mil).| (LTM values as of) | 1312026 | 5032026 | Change |
|---|---|---|---|
| Stock Price ($) | 12.42 | 9.48 | -23.7% |
| Change Contribution By: | |||
| Total Revenues ($ Mil) | � | 51 | 0.0% |
| P/S Multiple | � | 5.0 | 0.0% |
| Shares Outstanding (Mil) | 5 | 27 | -82.8% |
| Cumulative Contribution | 0.0% |
Market Drivers
1/31/2026 to 5/3/2026| Return | Correlation | |
|---|---|---|
| CARL | -23.7% | |
| Market (SPY) | 3.6% | 38.1% |
| Sector (XLV) | -5.8% | 28.7% |
Fundamental Drivers
The -26.5% change in CARL stock from 10/31/2025 to 5/3/2026 was primarily driven by a -82.8% change in the company's Shares Outstanding (Mil).| (LTM values as of) | 10312025 | 5032026 | Change |
|---|---|---|---|
| Stock Price ($) | 12.89 | 9.48 | -26.5% |
| Change Contribution By: | |||
| Total Revenues ($ Mil) | � | 51 | 0.0% |
| P/S Multiple | � | 5.0 | 0.0% |
| Shares Outstanding (Mil) | 5 | 27 | -82.8% |
| Cumulative Contribution | 0.0% |
Market Drivers
10/31/2025 to 5/3/2026| Return | Correlation | |
|---|---|---|
| CARL | -26.5% | |
| Market (SPY) | 5.5% | 29.9% |
| Sector (XLV) | 1.5% | 25.4% |
Fundamental Drivers
nullnull
Market Drivers
4/30/2025 to 5/3/2026| Return | Correlation | |
|---|---|---|
| CARL | ||
| Market (SPY) | 30.4% | 26.4% |
| Sector (XLV) | 5.2% | 18.8% |
Fundamental Drivers
nullnull
Market Drivers
4/30/2023 to 5/3/2026| Return | Correlation | |
|---|---|---|
| CARL | ||
| Market (SPY) | 78.7% | 26.4% |
| Sector (XLV) | 14.3% | 18.8% |
Price Returns Compared
| 2021 | 2022 | 2023 | 2024 | 2025 | 2026 | Total [1] | |
|---|---|---|---|---|---|---|---|
| Returns | |||||||
| CARL Return | - | - | - | - | -15% | -28% | -39% |
| Peers Return | -8% | -11% | -1% | 13% | 29% | -20% | -4% |
| S&P 500 Return | 27% | -19% | 24% | 23% | 16% | 5% | 92% |
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% | -29% | |
| Peers Max Drawdown | -18% | -36% | -26% | -18% | -17% | -22% | |
| S&P 500 Max Drawdown | -1% | -25% | -1% | -2% | -15% | -7% | |
[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 5/1/2026 (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 |
|---|---|---|
| 2025 US Tariff Shock | ||
| % Loss | -11.7% | -18.8% |
| % Gain to Breakeven | 13.3% | 23.1% |
| Time to Breakeven | 142 days | 79 days |
| 2022 Inflation Shock & Fed Tightening | ||
| % Loss | -13.8% | -24.5% |
| % Gain to Breakeven | 15.9% | 32.4% |
| Time to Breakeven | 166 days | 427 days |
| 2020 COVID-19 Crash | ||
| % Loss | -27.9% | -33.7% |
| % Gain to Breakeven | 38.8% | 50.9% |
| Time to Breakeven | 77 days | 140 days |
| Q4 2018 Fed Policy Error / Growth Scare | ||
| % Loss | -15.0% | -19.2% |
| % Gain to Breakeven | 17.6% | 23.7% |
| Time to Breakeven | 191 days | 105 days |
| 2015-2016 China Devaluation / Global Growth Scare | ||
| % Loss | -15.9% | -12.2% |
| % Gain to Breakeven | 18.9% | 13.9% |
| Time to Breakeven | 165 days | 62 days |
| 2011 US Debt Ceiling Crisis & European Contagion | ||
| % Loss | -15.8% | -17.9% |
| % Gain to Breakeven | 18.8% | 21.8% |
| Time to Breakeven | 153 days | 123 days |
In The Past
SPDR Select Sector Fund's stock fell -11.7% during the 2025 US Tariff Shock. Such a loss loss requires a 13.3% gain to breakeven.
Preserve Wealth
Limiting losses and compounding gains is essential to preserving wealth.
Asset Allocation
Actively managed asset allocation strategies protect wealth. Learn more.
CARL has limited trading history. Below is the Health Care sector ETF (XLV) in its place.
| Event | XLV | S&P 500 |
|---|---|---|
| 2020 COVID-19 Crash | ||
| % Loss | -27.9% | -33.7% |
| % Gain to Breakeven | 38.8% | 50.9% |
| Time to Breakeven | 77 days | 140 days |
| 2008-2009 Global Financial Crisis | ||
| % Loss | -37.9% | -53.4% |
| % Gain to Breakeven | 61.1% | 114.4% |
| Time to Breakeven | 767 days | 1085 days |
In The Past
SPDR Select Sector Fund's stock fell -11.7% during the 2025 US Tariff Shock. Such a loss loss requires a 13.3% gain to breakeven.
Preserve Wealth
Limiting losses and compounding gains is essential to preserving wealth.
Asset Allocation
Actively managed asset allocation strategies protect wealth. Learn more.
About Carlsmed (CARL)
AI Analysis | Feedback
Here are 1-3 brief analogies for Carlsmed:
- Invisalign for spine implants
- Warby Parker for spine implants
AI Analysis | Feedback
- aprevo AI-enabled Software Solutions: This software utilizes AI algorithms and diagnostic imaging to develop personalized digital surgical plans for spine fusion procedures.
- aprevo Interbody Implants: These are custom-designed interbody implants tailored to each patient's unique pathology and vertebral bone topography for optimal spine fusion.
- aprevo Single-Use Surgical Instruments: These specialized instruments are provided as part of the aprevo Technology Platform to facilitate precise spine fusion surgeries.
AI Analysis | Feedback
Carlsmed (CARL) primarily sells its aprevo Technology Platform to hospitals.
The provided company description does not list the names of specific hospital systems or individual hospitals that are its major customers.
AI Analysis | Feedback
null
AI Analysis | Feedback
Mike Cordonnier, Co-Founder, President, Chief Executive Officer, and Chairman of the Board
Mike Cordonnier co-founded Carlsmed in 2018. He has over two decades of leadership experience introducing groundbreaking medical technologies across both private and public organizations, including NuVasive, Ellipse Technologies, Zimmer Biomet, Orchid Orthopedics, and X-Spine Systems. He led the commercialization of the PRECICE deformity correction technology for Ellipse Technologies, which was subsequently acquired by NuVasive. Before Ellipse, he was responsible for the development and successful launch of the patient-specific digital dentistry business at Zimmer Biomet.
Leo Greenstein, Chief Financial Officer and Treasurer
Leo Greenstein brings over two decades of strategic financial leadership experience from the surgical device, biotechnology, and oncology diagnostics sectors. Prior to joining Carlsmed, he served as CFO of Tarsus Pharmaceuticals, Inc., where he was instrumental in guiding the company through significant growth and its IPO in October 2020. He is a Certified Public Accountant and a member of the California State Bar.
Niall Casey, Co-Founder, Chief Intellectual Property Officer, and Director
Niall Casey co-founded Carlsmed with Mike Cordonnier in 2018. He possesses extensive expertise in the spine industry, having held technology leadership roles at companies such as Alphatec Spine, Ellipse Technologies, NuVasive, and Johnson & Johnson DePuy Synthes Spine.
Scott Durall, Chief Commercial Officer
Scott Durall has more than 30 years of experience in the medical device industry, with a background that includes leadership positions in sales, marketing, and corporate strategy at companies such as U.S. Surgical.
Jennifer Kamocsay, Chief Legal Officer and Secretary
Jennifer Kamocsay serves as the Chief Legal Officer at Carlsmed and is also the Secretary of the Carlsmed Board of Directors.
AI Analysis | Feedback
```htmlThe key risks to Carlsmed's business include:
-
Failure to Obtain Timely FDA Clearances for Cervical Products: Carlsmed's planned commercialization of its aprevo Technology Platform for cervical fusion surgery in 2026 is contingent upon obtaining additional FDA clearances for its cervical software platform and personalized plating solutions. The company explicitly states there is "no guarantee that our cervical software platform and our personalized plating solutions will obtain FDA clearance on the expected timeline, or at all." Failure to secure these clearances could significantly delay or prevent entry into the cervical spine fusion market, a key growth area for the company.
-
Uncertainty of CMS X-code Approval for Cervical Procedures: Carlsmed's potential for enhanced reimbursement and market adoption for its cervical spine fusion technology is linked to the proposed CMS ICD-10-PCS ("X-codes") for custom-made anatomically designed fusion devices. These X-codes, if approved, could enable hospitals to receive additional New Technology Add-on Payments (NTAP) of up to $21,125 per procedure. However, the company notes, "there is no guarantee that this proposal will be approved in its current form." Without this premium reimbursement, the financial incentive for hospitals to adopt the aprevo Technology Platform for cervical fusions might be reduced, potentially hindering market penetration and revenue growth in this segment.
-
Challenges in Expanding Surgeon Adoption and Market Penetration: Despite the perceived benefits of the aprevo Technology Platform over traditional spine fusion surgery, Carlsmed faces the ongoing challenge of expanding its surgeon user base. As of June 30, 2025, the company had 199 surgeon users compared to an estimated 4,000 surgeons across the United States whose patients could benefit from the technology. Successfully growing this user base and overcoming the inertia associated with established traditional surgical methods is crucial for achieving its estimated $13.4 billion total addressable market in the United States and driving sustained revenue growth.
AI Analysis | Feedback
null
AI Analysis | Feedback
```htmlThe total addressable market for Carlsmed's aprevo Technology Platform in the United States is approximately $13.4 billion. This estimate is based on the projected 445,200 lumbar fusion surgeries in the United States in 2025 and the company's current average selling price.
```AI Analysis | Feedback
The following are expected drivers of future revenue growth for Carlsmed over the next 2-3 years:- Commercialization of the aprevo Technology Platform for cervical spine fusion surgeries: Carlsmed expects to commercialize its aprevo Technology Platform for cervical spine fusion surgeries in 2026, following successful completion of the first in-human personalized cervical procedure in July 2025 and FDA 510(k) clearance for its aprevo interbody implants for cervical interbody fusion surgeries in November 2024.
- Expansion of the surgeon user base and increased utilization in lumbar spine fusion: The company sees ample opportunity to grow its surgeon user base, noting an increase from 103 surgeon users as of March 31, 2024, to 177 as of March 31, 2025, and from 116 to 199 surgeon users as of June 30, 2025. This indicates continued market penetration and adoption of their aprevo Technology Platform for lumbar spine fusion.
- Potential favorable reimbursement for cervical spine fusion surgeries through CMS X-codes: In April 2025, CMS announced proposed ICD-10-PCS (X-codes) for custom-made anatomically designed fusion devices for cervical spine fusion surgeries. If approved, these X-codes could make hospitals eligible for NTAP of up to $21,125 per cervical spine fusion procedure, which is expected to drive surgeon adoption and patient access.
- Expansion into strategic international markets: While currently focused on the U.S. market, Carlsmed plans to engage in market access initiatives for strategic international regions, opening up new geographical markets for its aprevo Technology Platform.
AI Analysis | Feedback
Share Repurchases
- Carlsmed has no history of share buybacks.
Share Issuance
- Carlsmed completed its 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 gross proceeds from the IPO were approximately $100.5 million, before deducting underwriting discounts, commissions, and other offering expenses.
- Underwriters were granted a 30-day option to purchase up to an additional 1,005,000 shares of common stock at the initial public offering price.
Inbound Investments
- In March 2024, Carlsmed raised $52.5 million in venture capital funding through a Series C round co-led by B Capital and U.S. Venture Partners.
- The company's Initial Public Offering in July 2025 also served as a significant inbound investment, raising over $100 million and materially strengthening its financial position for growth investments.
Trade Ideas
Select ideas related to CARL.
| Date | Ticker | Company | Category | Trade Strategy | 6M Fwd Rtn | 12M Fwd Rtn | 12M Max DD |
|---|---|---|---|---|---|---|---|
| 04302026 | GEHC | GE HealthCare Technologies | Dip Buy | DB | FCFY OPMDip Buy with High FCF Yield and High MarginBuying dips for companies with high FCF yield and meaningfully high operating margin | 0.0% | 0.0% | 0.0% |
| 04302026 | IQV | IQVIA | Dip Buy | DB | FCFY OPMDip Buy with High FCF Yield and High MarginBuying dips for companies with high FCF yield and meaningfully high operating margin | 0.0% | 0.0% | 0.0% |
| 04302026 | UHS | Universal Health Services | Dip Buy | DB | FCFY OPMDip Buy with High FCF Yield and High MarginBuying dips for companies with high FCF yield and meaningfully high operating margin | 0.0% | 0.0% | 0.0% |
| 04302026 | ABT | Abbott Laboratories | Dip Buy | DB | P/E OPMDip Buy with Low PE and High MarginBuying dips for companies with tame PE and meaningfully high operating margin | 0.0% | 0.0% | 0.0% |
| 04302026 | ZBIO | Zenas BioPharma | Insider | Insider Buys 45DStrong Insider BuyingCompanies with multiple insider buys in the last 45 days | 0.0% | 0.0% | 0.0% |
Research & Analysis
Invest in Strategies
Wealth Management
Peer Comparisons
| Peers to compare with: |
Financials
| Median | |
|---|---|
| Name | |
| Mkt Price | 45.95 |
| Mkt Cap | 6.9 |
| Rev LTM | 1,881 |
| Op Inc LTM | 253 |
| FCF LTM | 289 |
| FCF 3Y Avg | 383 |
| CFO LTM | 399 |
| CFO 3Y Avg | 506 |
Growth & Margins
| Median | |
|---|---|
| Name | |
| Rev Chg LTM | 13.9% |
| Rev Chg 3Y Avg | 24.0% |
| Rev Chg Q | 15.9% |
| QoQ Delta Rev Chg LTM | 4.0% |
| Op Inc Chg LTM | 9.8% |
| Op Inc Chg 3Y Avg | 15.8% |
| Op Mgn LTM | 5.3% |
| Op Mgn 3Y Avg | 13.3% |
| QoQ Delta Op Mgn LTM | 1.0% |
| CFO/Rev LTM | 13.0% |
| CFO/Rev 3Y Avg | 19.0% |
| FCF/Rev LTM | 7.5% |
| FCF/Rev 3Y Avg | 15.4% |
Valuation
| Median | |
|---|---|
| Name | |
| Mkt Cap | 6.9 |
| P/S | 3.5 |
| P/Op Inc | 4.9 |
| P/EBIT | 4.9 |
| P/E | 8.5 |
| P/CFO | 15.3 |
| Total Yield | -2.5% |
| Dividend Yield | 0.0% |
| FCF Yield 3Y Avg | 2.8% |
| D/E | 0.2 |
| Net D/E | 0.1 |
Returns
| Median | |
|---|---|
| Name | |
| 1M Rtn | -3.1% |
| 3M Rtn | -20.8% |
| 6M Rtn | -19.8% |
| 12M Rtn | -13.4% |
| 3Y Rtn | -15.0% |
| 1M Excs Rtn | -14.3% |
| 3M Excs Rtn | -25.0% |
| 6M Excs Rtn | -26.0% |
| 12M Excs Rtn | -39.5% |
| 3Y Excs Rtn | -94.2% |
Segment Financials
Revenue by Segment| $ Mil | 2025 | 2024 |
|---|---|---|
| Designing, manufacturing, and marketing of aprevo, a comprehensive technology platform for spine | 27 | 14 |
| Total | 27 | 14 |
| $ Mil | 2025 | 2024 |
|---|---|---|
| Designing, manufacturing, and marketing of aprevo, a comprehensive technology platform for spine | -24 | -19 |
| Total | -24 | -19 |
Recent Forward Guidance [BETA]
Latest: Q4 2025 Earnings Reported 2/25/2026
| Forward Guidance | Guidance Change | ||||||
|---|---|---|---|---|---|---|---|
| Metric | Low | Mid | High | % Chg | % Delta | Change | Prior |
| 2026 Revenue | 70.00 Mil | 72.50 Mil | 75.00 Mil | 46.5% | Higher New | Actual: 49.50 Mil for 2025 | |
| 2026 Revenue Growth | 44.0% | -46.3% | -38.0% | Lowered | Guidance: 82.0% for 2025 | ||
Prior: Q3 2025 Earnings Reported 11/6/2025
| Forward Guidance | Guidance Change | ||||||
|---|---|---|---|---|---|---|---|
| Metric | Low | Mid | High | % Chg | % Delta | Change | Prior |
| 2025 Revenue | 49.00 Mil | 49.50 Mil | 50.00 Mil | 6.5% | Raised | Guidance: 46.50 Mil for 2025 | |
| 2025 Revenue Growth | 80.0% | 82.0% | 84.0% | 15.5% | 11.0% | Raised | Guidance: 71.0% for 2025 |
Insider Activity
Expand for More| # | Owner | Title | Holding | Action | Filing Date | Price | Shares | Transacted Value | Value of Held Shares | Form |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | Cordonnier, Michael | CEO, President | Direct | Sell | 3042026 | 13.29 | 197,855 | 2,629,889 | 18,032,539 | Form |
| 2 | 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 | |
| 3 | Sidow, Kevin | Direct | Buy | 7242025 | 15.00 | 13,333 | 199,995 | 893,490 | Form | |
| 4 | Mittendorff, Robert II | See footnotes | Buy | 7242025 | 15.00 | 1,333,333 | 19,999,995 | 75,207,585 | Form | |
| 5 | Root, Jonathan D | Direct | Buy | 7242025 | 15.00 | 466,666 | 6,999,990 | 7,259,985 | Form |
External Quote Links
| Y Finance | Barrons |
| TradingView | Morningstar |
| SeekingAlpha | ValueLine |
| Motley Fool | Robinhood |
| CNBC | Etrade |
| MarketWatch | Unusual Whales |
| YCharts | Perplexity Finance |
| FinViz |
Prefer one of these to Trefis? Tell us why.