Carlsmed Q2 2026 Earnings: 57% Revenue Growth Comes With Wider Losses

Carlsmed (Nasdaq: CARL) reported Q2 2026 revenue of $18.9 million, up 57% from $12.1 million a year earlier, while diluted EPS was a loss of $0.39 compared with a loss of $1.47. Gross margin expanded 340 basis points to 76.8%, but operating expenses rose to $25.6 million and drove the net loss to $10.5 million. The company also raised its full-year revenue guidance.

Core financial results

Procedure volume growth across the aprevo lumbar and cervical platforms drove the revenue increase. Gross profit grew faster than revenue, but the additional gross profit was insufficient to offset higher research, sales, and administrative spending.

Adjusted EBITDA is a non-GAAP measure. The apparent improvement in EPS did not reflect a smaller net loss: weighted-average diluted shares rose to 27.2 million from 4.6 million, reducing the loss allocated to each share.

Procedure adoption and reimbursement support the growth outlook

Carlsmed said trained surgeon users increased by more than 60% year over year, with notable engagement among early-career and post-fellowship surgeons. Management reported continued volume growth across both lumbar and cervical aprevo procedures.

The cervical platform completed its second full quarter of commercialization and contributed approximately 10% of quarterly revenue. Surgeon training on the platform also expanded from the prior quarter, although lumbar procedures remained the larger source of revenue.

The finalized CMS fiscal 2027 Inpatient Prospective Payment System rule introduces three new MS-DRG codes and enhanced hospital reimbursement for inpatient aprevo lumbar procedures. The change takes effect on October 1, 2026, so it did not contribute to the reported quarter but could affect access for Medicare patients in subsequent periods.

Gross-margin gains were outweighed by operating spending

Revenue increased by about $6.9 million and gross profit by about $5.7 million, but operating expenses grew by approximately $10.2 million. As a result, the operating loss widened by roughly $4.5 million despite the improvement in gross margin.

Sales and marketing was the largest expense category, rising to $11.9 million from $7.9 million. Research and development increased to $6.0 million from $4.2 million, while general and administrative expense more than doubled to $7.6 million from $3.3 million.

Net other income of $526,000, compared with a net expense of $264,000 a year earlier, partly offset the larger operating loss. Stock-based compensation also increased to $2.3 million from $258,000 and was a notable adjustment between the GAAP net loss and adjusted EBITDA.

Liquidity and balance sheet

Carlsmed ended June with $89.3 million across cash and cash equivalents, restricted cash, short-term investments, and marketable securities. That pool consisted of $46.2 million in cash and cash equivalents, $100,000 in restricted cash, $24.0 million in short-term investments, and $19.0 million in marketable securities.

The comparable combined balance was approximately $109.9 million at December 31, 2025, implying a decline of about $20.6 million over six months. At quarter-end, Carlsmed reported $109.6 million of current assets, $12.4 million of current liabilities, and a $15.4 million long-term term loan.

2026 revenue guidance

Carlsmed raised both ends of its full-year revenue outlook, citing procedure volume trends and its pipeline. The new midpoint is $76.0 million, up from the previous midpoint of $74.5 million, and represents growth of more than 50% over 2025.

Recent insider transactions

The source’s six-month summary classified 446,478 shares across five transactions as purchases and 197,855 shares in one transaction as sales, producing net purchases of 248,623 shares. It reported total insider holdings of 11.89 million shares and net purchases equal to 2.10% of that amount.

The detailed records are dominated by zero-price stock awards, alongside one derivative-security conversion and one sale. All ten transactions below were reported as direct holdings; the summary does not establish that the transactions classified as purchases were discretionary open-market buys.

Risks investors should monitor

• Operating expenses are growing faster than gross profit. Continued expansion in sales, research, and administrative costs could delay operating leverage even if revenue continues to rise.
• Ongoing losses are reducing liquidity. The company’s combined cash and investment balance declined by approximately $20.6 million during the first half of 2026.
• The outlook depends on procedure and surgeon growth. Full-year guidance reflects volume trends and the pipeline, while cervical remains an early-stage contributor at about 10% of quarterly revenue.
• The benefit from the CMS rule has not yet been demonstrated in reported results. The enhanced reimbursement begins October 1, 2026 and applies to inpatient aprevo lumbar procedures.
• Share-count growth affects per-share comparisons. The substantially higher weighted-average share count caused EPS losses to narrow even as the total net loss widened.

Summary

Carlsmed’s Q2 2026 results combined 57% revenue growth and higher gross margin with a substantially wider operating and net loss as spending expanded. Increased surgeon adoption, cervical commercialization, and the upcoming CMS reimbursement change supported a higher full-year revenue outlook. The main follow-up issues are whether revenue growth can produce operating leverage and how quickly the company’s liquidity declines while it remains unprofitable.