Carlsmed (NASDAQ: CARL) raises revenue guidance, sales jump 65% but losses widen

Posted by Jessica Moore on Nov 11th, 2026

What happened

Carlsmed, Inc. (NASDAQ: CARL) raised its full-year 2026 revenue guidance to $78 million to $80 million. Third-quarter revenue grew 65%. The earlier range started at $74 million.

Third-quarter revenue was $21.6 million, up from $13.1 million a year earlier. The net loss widened to $12.2 million from $8.5 million, so faster sales came with a larger loss.

Chairman and CEO Mike Cordonnier said the surgeon user base grew by more than 60% over the prior year. Carlsmed describes itself as a medical technology company pioneering AI-enabled personalized spine surgery solutions.

Key numbers

Metric	Latest	Change	Source
Third-quarter revenue	$21.6 million	from $13.1 million, +65%	SEC 8-K Exhibit 99.1
Full-year 2026 revenue guidance (midpoint change versus prior $74 million to $78 million)	$78 million to $80 million	+3.9%	Calculated from SEC 8-K
Third-quarter gross margin	77.3%	from 75.9%, +1.4 percentage points	SEC 8-K Exhibit 99.1
Third-quarter operating expenses	$29.4 million	from $19.0 million, +54.9%	Calculated from SEC 8-K
Third-quarter net loss	$12.2 million	from $8.5 million, +43.6%	SEC 8-K Exhibit 99.1
Cash, restricted cash, short-term investments and marketable securities at Sept. 30, 2026	$80.3 million		SEC 8-K Exhibit 99.1

Read more: Carlsmed (CARL) company research

What the new range implies for the fourth quarter

The raise is larger at the bottom of the range than at the top. The low end rose $4 million and the high end $2 million. That lifts the midpoint to $79 million from $76 million, a 3.9% increase by OptimistFi's calculation. Carlsmed puts growth at over 56% at the midpoint versus full-year 2025.

Nine-month revenue was $56.61 million. Subtract that from the new range and OptimistFi calculates implied fourth-quarter revenue of $21.4 million to $23.4 million. The low end would be a small dip from the third quarter. The high end would be further growth.

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Margins and spending

Gross margin edged up to 77.3% from 75.9% a year earlier. Gross profit rose to $16.7 million from $9.9 million.

Operating expenses climbed to $29.4 million from $19.0 million. That is 54.9% growth by OptimistFi's calculation, slower than the quarter's revenue growth. The total included $2.8 million tied to executive transition costs and the expected resolution of certain legal matters.

General and administrative expense roughly doubled to $10.0 million from $4.9 million. Sales and marketing rose to $13.0 million from $9.6 million. Research and development rose to $6.4 million from $4.4 million.

Adjusted EBITDA loss narrowed to $7.3 million from $8.2 million. That measure leaves out stock-based compensation, which the reconciliation shows at $2.47 million versus $0.70 million a year earlier. It also leaves out executive transition costs and legal settlements.

Why it matters

OptimistFi has argued that CARL works if aprevo becomes a repeat-use, patient-specific spine platform and if adoption scales before cash burn or competitors erase the premium. Revenue growth and a surgeon base up more than 60% support the adoption side. The surgeon count shows breadth of use, not how often each surgeon returns to aprevo.

Reimbursement bears on the premium. The CMS inpatient payment rule for fiscal 2027 took effect Oct. 1 with increased reimbursement for inpatient aprevo lumbar procedures. Carlsmed also launched the aprevo Lumbar Bi-lateral Posterior System in October. It estimates the system addresses approximately 30,000 U.S. lumbar fusion procedures annually.

Cash is the caveat. Cash, restricted cash, short-term investments and marketable securities totaled $80.3 million on Sept. 30. The nine-month net loss was $31.45 million, against $21.02 million a year earlier. Higher revenue guidance does not yet show that the model scales profitably.

The company also promoted Jeff Bertolini to chief operating officer, appointed Rich Heppenstall as chief financial officer and added Tony Jarc, Ph.D., as chief product and AI officer. OptimistFi reads the quarter as mixed for the case.

What's next

Carlsmed said it would host a conference call and webcast on Nov. 10 at 4:30 p.m. Eastern to review the quarter. The next scheduled test is its fourth-quarter 2026 report.

Revenue inside the implied range would back the raised guidance. A result below the low end would weaken it. General and administrative spending, once this quarter's transition and legal items drop out, is the second line to check.