Carlsmed’s IPO: Personalizing the Future of Spine Surgery with AI

Carlsmed, Inc. is preparing for its debut on the Nasdaq Global Select Market under the ticker symbol CARL, offering 6.7 million shares of common stock in a traditional IPO. The company expects its shares to be priced between $14.00 and $16.00, with an additional approximately 1 million shares available to underwriters through a greenshoe option. This offering intends to raise $100.5 million and is poised to give Carlsmed a post-IPO valuation nearing $400 million, based on the mid-point of the price range and post-offering shares outstanding.

The underwriters for the offering include BofA Securities, Goldman Sachs, Piper Sandler, Truist Securities, and BTIG. Carlsmed is pioneering a highly differentiated solution in the surgical device space. Through its aprevo® Technology Platform, the company delivers an end-to-end personalized spine surgery experience powered by AI. The platform spans 3D surgical planning, custom 3D-printed titanium implants, and postoperative analytics, aiming to replace one-size-fits-all fusion devices with precision patient-specific solutions.

Unlike traditional spine fusion—which often suffers from imprecise planning, generic implants, and higher revision rates—Carlsmed’s platform addresses these pain points with AI-driven digital twins and anatomically matched implants. The company’s focus is currently on lumbar spine fusion, though it received FDA clearance for cervical spine procedures in late 2024 and is preparing for commercial launch in 2026.

From a structural perspective, this is a primary offering—no existing shareholders are selling. Post-IPO, company insiders will still hold a controlling 57.1% stake, underscoring long-term alignment with public investors. The company plans to deploy proceeds from the offering strategically: approximately $24.7 million to expand sales and marketing efforts, around $45.9 million into research and development (especially for cervical and next-gen solutions), and the remainder for general working capital.

Carlsmed was founded in 2018 and is headquartered in Carlsbad, California. As of mid-2025, it had grown its U.S. surgeon user base to 199, up from 116 just a year prior. The company’s go-to-market strategy is a blend of direct sales teams and independent agents focused on hospital and surgeon outreach. International expansion is planned, but Carlsmed’s current revenues are entirely domestic.

The company’s financials reveal a high-growth, early-stage medtech profile. Full-year revenue for 2023 was $13.8 million, which grew 97.2% year-over-year to $27.2 million in 2024. In the first quarter of 2025, revenue doubled again, reaching $10.2 million compared to $5.1 million in Q1 2024. Gross margins have steadily improved from 71.9% in 2023 to 73.8% in 2024, and hit 74.9% in Q1 2025. Despite these gains, Carlsmed remains unprofitable, posting a net loss of $24.1 million in 2024 and $5.7 million in Q1 2025. Operating expenses are expectedly high as the company scales its platform and headcount.

Here's a look at the financial summary over the last two full years and recent quarters:

Carlsmed is targeting multiple vectors of growth. In the short term, it aims to drive deeper penetration among U.S. spine surgeons, especially those treating degenerative disc disease (DDD) and adult spinal deformity (ASD). Longer-term, Carlsmed expects cervical fusion to be a key revenue driver and sees potential applications beyond the spine in broader musculoskeletal care. The company’s ability to monetize its massive database of radiographic images (over 4 million used in training) and clinical outcomes data gives it a defensible moat and first-mover advantage in AI surgical planning.

Recent IPOs from peers like SI-BONE, Procept BioRobotics, and Alphatec indicate strong investor appetite for next-gen medtech platforms, particularly those enhancing surgical outcomes with personalized solutions. Carlsmed’s implied ~14.6x EV/revenue multiple is aggressive but not out of line with growth-oriented, high-gross-margin medtech peers.

Post-IPO, Carlsmed will be focused on achieving additional FDA clearances for its cervical and plating platforms, optimizing manufacturing to reduce expedite fees, and potentially exploring M&A or technology partnerships. With its combination of clinical efficacy, strong gross margins, and AI-driven personalization, Carlsmed is positioning itself as a category-defining company in surgical spine care.

Carlsmed will debut the week of July 21^st, 2025