Welcome to everybody here in person and welcome to those online. My name is Todd Koning. I'm our Chief Financial Officer here at ATEC Spine. Welcome to our Investor Day. Today you'll hear from Pat Miles, our Chairman and CEO. He's going to walk through the road ahead. I will share the numbers around the road ahead, so the financial reflection of that road. And then we'll take some Q&A. As you might expect, today's presentation will contain some forward-looking statements subject to risks and uncertainties that could cause actual results to differ materially. Such risks and uncertainties are described in the materials presented along with this presentation and can be found in the company's most recent SEC filings. And with that, I'd like to welcome Pat Miles, our Chairman and CEO. Thank you for the warm welcome. Rarely do people clap. I always hope for clap after, not before. But I genuinely appreciate everybody's interest in the company. We have a ton of stuff going on and it's been a fantastic run to date. And so I cannot be more excited about what we're calling the road to a billion and beyond. And so this has been nothing less than a predictable walk. And I love to look back at some of the things we've previously presented. And back in 2018, we made a commitment when we were a $92 million, 1% share spine market shareholder. And we said we'd do $200 million in 2022. And I would tell you, we got a pretty hard time in terms of putting such a huge number out there as $200 million in 2022. I think the thing that was really best about that prognostication really was the substance behind what would drive the number. And so we'll talk a lot about clinical distinction. And so what we committed to as a company is really to expand new product revenue above 80%, launch eight-ten products a year, shift the sales team to really exclusive distribution, if you will, and then increase revenue per surgery and the number of product categories per surgery. And so the way that we think about that is really a surgical thesis. And so if you assemble products and you propose that to be a solution for a problem, that would be our surgical thesis. And they should use the reflection of that surgical thesis. But I'll go into more of that. So the great part is we showed up a year early. So we did $213 million of organic sales in 2021, so a year before the commitment in 2022. And then in 2022, we're about $100 million north of what the original commitment was. So I would say that we arrived and we delivered the 36% CAGR in revenue from 2018 to 2021. So love just the initiation of a predictable walk. And then we made a commitment back in 2021 when we were $243 million. We said in 2025, we'll do $555 million in sales. We'll have an Adjusted EBITDA of $80 million. We'll have a profit margin expansion of 2,500 basis points and a free cash flow of $10 million, which would have reflected a 23% CAGR. Ended up doing a 41% CAGR, so almost twice the commitment in 2023, had an Adjusted EBITDA of right around break even, 1,400 basis points. So we were halfway home with regard to the margin expansion. And we're tracking toward break even in 2025. So 2023 was a great year for us. And again, I think it was reflective of the type of momentum that the surgical thesis has reflected. And so as we look forward and we commit to another kind of plot in the walk forward, the commitment now is in 2027, so finish 2023 at $482 million. Commitment on 2027 is $1 billion, which is a 20% revenue CAGR, an Adjusted EBITDA reflection of $180 million or 18%. So it's a 2,000 basis point expansion, margin expansion, and $65 million of cash flow. And so that means we better break even in 2025. And so this was a company of humble origins, I would say. But the beauty is there's real line of sight to grandeur and to relevance in a space. I will tell you, it is a space that absolutely needs us. Really, when you think about what brought us to the dance thus far, there's so much opportunity to truly revolutionize the approach to spine surgery. There's an opportunity to make the rules, so become the standard bearer. From a core value perspective, really create a culture of performance. I love describing things like this to you guys because I think so often it's the reflection that you guys judge with regard to the numeric value. But what precedes the numeric value is often these types of things. It's fun to be able to describe it. I love the characterization of what a company is. A company is an assembly of people that is committed to a specific goal. I would tell you, we have a great company. One thing that you'll see, you'll see a lot of historical NuVasive types. I think there's a historical culture from the original NuVasive whereby there was a lot of innovation. Something that I think is interesting is we have a great senior team. I would tell you, the team under the senior team is as good or better. The beauty of the thing is it's from a configuration perspective reflective of where we're going. We have 230 product development engineers. I would tell you that I would expect that to be as big as any group in all of spine. The beauty of that becomes is we have a characterization of a NuVasive type of an innovation machine. We call it the organic innovation machine. From a sales perspective, we have more of a Stryker type of a sales discipline. I think purely from a cultural perspective, it's reflective of a scaling machine. When we got to Alphatec in late 2017, we turned over 100% of the executive management team, literally 96% of the employees, and 92% of the board. It's happened over time. When people think about Alphatec as a company, it's been around a little while. I would tell you that this is a brand new group. Something else that's fascinating, I think that we're living in a time where there's so much virtual commuting and there's heads of companies that are living outside of the geographic area of the company. I think it's tremendously hard to manage a company from afar. We love the fact that everybody is in a location in San Diego, in Carlsbad, right up north of San Diego. It's a flourishing place. And I would tell you, if there's the opportunity for you to visit the place, there's an energy that's reflective of a company on the move. I always said that spine surgery needs Alphatec. And I got to tell you, when we were $92 million and 1%, nobody believed us. But when you start to think about spine surgery and you say, "Gosh," people say, "Oh, it's commoditized. It's not an exciting market space." When you have revision rates in short segment surgery of 10%-15% in one to three years and 25%-30% in two to five years, I would tell you it's a troubled environment. And so to suggest that it's been settled, I think, is just such a profound misnomer. And so the proxies in orthopedic surgery is total knee and total hip. And it's 3% and 5% respectively. Just the opportunity to ultimately effectuate spine care, we think, is totally evident. We think that is a great opportunity. Our approach to doing so is different. We think being spine-only is profoundly opportune. We don't have to make decisions about different divisions. We're not a division of a division of a division. We're not allocating resources across divisions. Our existence is completely reflective of the spine surgeons with whom we work. There's a real alignment to the customer. When you start to think about why a company would do well, well, we're most aligned with the customer. I talked a little bit about the know-how. There's significant know-how in the company. I've been at this for 30 years. My commitment to the company is not to repeat the same mistakes I'd previously made. And so the question becomes is how do you translate forward? And I think it's important. But the whole, if you have such a whopping high percentage rate of revision, I would suggest that there's room for clinical distinction. And so the way that we think about the architecture of clinical distinction is through proceduralization. So we think, "Gosh, if you assemble products to mitigate variables, we think that that's profoundly important. And then if you use informatics to ultimately inform the route forward, we think that's important." So when you start to think about how we approach this, I would tell you that it's different than the way many people approach it, which is more, I would suggest, in individual products or widgets. And so we think that there's a great opportunity. And that's why we think it's hugely important. We love to say that innovation comes from the operating room and not the boardroom. I got to tell you, I would prefer to be in the operating room right now. My level of comfort in terms of the investment community is far less than it is in the operating room. That's where you want me, honestly. You want someone to operate a company that ultimately is fascinated by the requirements of the field. That's what we love is the space. When you think about surgery, what you want to do is if a patient comes into a surgeon's office, the surgeon is, in essence, trying to diagnose them. When they diagnose them, what they're trying to do is say, "How do I intervene upon this person to help them?" When they think about intervening on somebody, what they think about is the goals. And so when you think about the goals of surgery, the goals of surgery are, "How do I decompress a nerve root? How do I stabilize the spine? And how do I align them?" And so I don't expect you guys to become spine experts. But I think that those goals are reasonably straightforward goals. And so the opportunity to ultimately assemble products and create a workflow that reflects an elegance with regard to an experience, we think, is the reflection of sophistication in the space. And so what we've done has been very deliberate with regard to how we've assembled procedures. So I would tell you that we're a spine procedure company. Excuse me. And so back in 2018, we made the commitments. We said, "Gosh, if we create clinical distinction, what we're going to do is we're going to compel surgeon adoption. If we compel surgeon adoption, then the likelihood for us to build a sales force is very, very evident." And so one of the ways that you have to think about the sales force in this environment is that they are very, very important. And I think that people misunderstand why they are important. And what makes them important is that spine lacks predictability. And so in this day and age when there's so many traveling nurses and there's so much turnover in the operating room, oftentimes the one constant that a surgeon has is the salesperson. And so what I would tell you is that a great salesperson magnifies the predictability of the experience because ultimately these guys become clinical experts. And so when you start to think, "Oh my gosh, the salesperson becomes very, very important," they're important because they're the one constant. And so I think when you start to think about them, you have to start to think about why are they important? And ultimately, how do you inspire them to engage with your company? And you do so based upon what type of distinction you create from the inside. So when we just jumped into Alphatec and kind of did a lay of the land and tried to figure out what was going on, it was a company back in 2017 that was really kind of a widget company. And there was really no distinction. And when there's no distinction, the ability to ultimately attract salespeople is very difficult. And I used to always tease and say that the distribution was like a guy and his dog with two surgeon friends. There was no way you were going to ultimately leverage those relationships. There's no distinction. So you were in an arms race as it relates to commission. It was a very, very difficult place to operate. And so the field nickname was AlphaRec. And so it was a very challenging place to be. But what we did is we said, "You know what? There's new leadership and spine experience count. So what we do forward is going to be different." And that's where we started to say, "How do we create this whole organic innovation machine? And how do we further the sophistication of what we're doing?" And back to the whole in-house thing, my experience over the years has been that companies either they rot or they prosper based upon what happens internally. And I've been at both. And I will tell you, there's prosperity in this one. The opportunity for us to create a predictable experience from a product development perspective was highly valuable. The way that we did that under a single roof, we brought in expertise. The way that we develop products is marketing writes requirements. They do it with surgeons. Product development designs against the requirements. We have internally at ATEC, we have a machine shop that we call the Technology Advancement Group. So we make it in-house. We'll make the first generation in-house. We'll test it in-house. There's great experience for the engineers to ultimately understand how to make it and then how to test it or break it and then how to evaluate it. All of that know-how stays in-house. And so when you covet know-how and you become an expert in the field of what you're engaged in, it's of significant value. And so when you start to talk about innovation, it's the know-how that ultimately reflects in the perpetuation of innovation. So in 2018, we developed that process. We developed the group. And we started to fill out the team. And then what we did is we acquired SafeOp. And for those of you who don't appreciate, the group at ATEC is the same group that ultimately created XLIF. And if you understand anything about lateral surgery, you realize from the skin to the spine is not bones but nerves. So if you look at what is in between the skin and the spine, it's nerves. And so for you to say, "Gosh, I would love a robot in that space," a robot's probably less important than, say, a neurophysiology tool because what you're trying to do is avoid nerves and understand the health of nerves. And so our contemplation was to buy that such that what we could do is ultimately have the tool necessary to build the foundation for where we were going. And I think that you'll see that as you look through this. And there's a reason why we're sharing this with you because I think what you'll see is you'll see a very deliberate walk. And so again, kind of back to, I didn't want to make the same mistakes as last time. In my previous experience, what we did is we developed a procedure. And then some of the surgeons didn't like the products. And so what happened is the currency of the business is the implants. And we developed this very elegant procedure. But then we would miss out on the currency elements of the products. And so what we did in 2019 is made sure that, "Gosh, we have the products that are reflective of the requirements of the field." And so now we have the foundational products. We don't yet have the procedure in 2019. But we start to transform the sales force because what they see is what's forthcoming. These guys are making very good products. They're starting to understand the whole clinical distinction thing. And we're starting to gain leverage on the sales force. They understand where we're going. And so it's not financial leverage yet. But it's leverage in them knowing where we're heading, which becomes very valuable. The guy in the blue suit and masked up is a guy, Luiz Pimenta. He's a super genius. He is the pioneer of lateral surgery. He created XLIF. He is our Chief Medical Officer. If we were going to engage in a procedure, the likelihood of our understanding what requirements there are in lateral surgery was very, very high. That's why we bought the whole SafeOp thing. So what we did from the ground up is we built the PTP procedure. It is a lateral procedure. One of the things that's very important in lateral surgery is, if you remember, decompression, stabilization, and alignment. There were always compromises with XLIF in some of those goals. In PTP, those goals were mitigated because you could directly decompress. You could align the patient. The patient was positioned in a way that surgeons were familiar with. So you could decompress, stabilize, and align all in the same position. So a single position surgery. And it's done very, very well. And so we designed it from the ground up. We ultimately integrated the SafeOp element. And we were able to demonstrate predictability associated with that technique. And that's really kind of been such a driver of the growth of the company. And so exceedingly excited about PTP and what's transpired with that. When you start to understand momentum, what you do is you spend forward. And what we wanted to do is build a foundation from which we could grow. And so in 2021, we built the new headquarters. We built a distribution facility in Memphis. And then back to the whole, "Are you interested in serving the requirements of the space?" And that's why we bought EOS. If alignment is the greatest correlative to a durable outcome and you see the revision rates that we'd previously talked about, to me, it makes perfect sense why someone would ultimately acquire the most coveted tool as it relates to understanding alignment. And so what we did is we acquired EOS in 2021 and then set out to ultimately evolve it. 2022, what we understood is we said, "Hey, listen. We understand that there's a lot of business momentum based upon people garnering confidence of how good their lateral experience has been." So we expanded the lateral business. And not only did PTP, which the patient is on their stomach, but also did LTP with the patient on their side. So we expanded the lateral portfolio. What that reflected in is higher confidence by the surgeon and more products outside the scope of lateral. We call that the halo effect. That was a big part of what we did in 2022 as well as start a design and development process around expandable devices. It's been a very methodical walk. 2023, great year. We continued to develop EOS. We acquired a navigation robotic system in Valence and started to lay the groundwork for the long run in deformity. So much as SafeOp has been the foundation for our long run in lateral, EOS will be the foundation for our long run in deformity and ultimately will be reflected in degenerative. I think it's an easy way to think about it. Ultimately, what that's reflected since we started from 2018 to 2023 is a 40% revenue CAGR. The great part is there's a multifaceted reflection of the revenue number: 17% CAGR in new surgeon adoption, 24% procedural CAGR, and a 12% revenue CAGR. What that ultimately reflects is buy-in to the surgical thesis. Oftentimes on the quarterly calls, we'll talk about products per procedure. Again, that just functions as a proxy for where we are with regard to, "Hey, has somebody bought what we're selling with regard to the clinical thesis?" Hopefully, that makes sense. I think oftentimes we say, "We're just getting started." But we really mean it. It's not one of those just taglines. From our perspective, the opportunity to create a foundational company in lateral surgery is very, very evident. If I look at the stackup of the company from which I've come at a billion dollars, the stackup of technology that we have at half a billion dollars is better. And so again, I think to myself, what should my confidence interval be with regard to the run forward? And it's reasonably high. And it's reasonably high based upon the fact that the whole lateral dominance is just reflective of the asset set that we had previously. But there's so much of a tailwind with regard to all of the other pieces. And I just want to touch on the other pieces real quick so that there's an appreciation. From a market perspective, when you start to think about what PTP provides the company, what it does is it expands the market. And so historically, lateral surgery was adopted, as I said, by about 30% of surgeons. There were some application shortcomings to it such that it wouldn't expand outside of that. So at a billion-dollar market and 12% market share, when you start to look at the application opportunities with PTP, literally, you can obviate some of the PLIF and TLIF market, which ultimately expands the addressable market. And so I think the takeaway here is that with regard to PTP, it's not only the historical lateral market, but it also expands within a more conventional open surgery market. And then the opportunity to continue to create sophistication and continue to create a buffer between what everybody else is doing and what we're doing is very, very evident. And I think that the foundational pieces are in place. It's nice to have the ability to provide an understanding of where the nerves are and what the health of the nerves are in lateral approach surgery. It's also nice to have navigation for precision's sake. The ability to ultimately have a navigation robotic system where ultimately we can elevate the precision is very, very valuable. We are also adding modalities to our neurophysiologic tool such that we can also expand the utility of that as well. You'll see that expand. Speaking of expansion, you're seeing a more sophisticated type of application for things like PTP and the lateral transpsoas. The picture above shows a corpectomy. That means removing the entire vertebral body. Maybe it's a cancer patient. Or maybe it's a trauma patient. So the ability to not only continue to serve the general indications for surgery of lateral but also continue to expand them. So you'll continue to see growth not only in the momentum of the company but the expanded indications for surgery. And so the great part is, again, there's multiple runs with regard to that. Another place of significant interest that you'll start to see this year is our 3D-printed implants. And so as we start to discern what the future holds, our opportunity to ultimately print implants is very attractive, not only from a profitability perspective because they're less expensive to build but also there becomes properties that you could manage through the 3D printing that makes the opportunity for a bone quality measure within EOS of value as it informs different bone types in surgery. So the opportunity to continue to assemble these elements we think is very, very valuable. So the ability to continue to be sophisticated in lateral will continue to drive a halo effect that we think is important. We launched about 15 new products and line extensions in 2023. And I think that I could go over each one of these things. And they won't mean anything to you. But what you'll understand is the fact that our commitment to continued innovation is very, very apparent. And so we will continue to look within the requirements of these different approaches and realize what we need to do to continue to create sophistication. So through 2027, there is an abundance of opportunity to make spine surgery better. And we will continue the design and development effort to continue to expand the product portfolio and the relevance of it. And so a little bit about EOS and Valence. When people talk about enabling technology, I think so often they talk about one thing. And it's like, "I'm going to do this one thing." The reality is what you want is you want an ecosystem that's committed to the goals of spine surgery. Whoop. Maybe that was me. There we are. So you want an ecosystem that's ultimately reflective of the goals of surgery. And so when you start to think about, "Gosh, how do these things line up? And how do I assemble them within the workflow of the experience?" You say, "Gosh, if I have to do decompression and stabilization, it keeps jumping forward." So it wasn't me. I'm just kidding. It probably was. And I'll get off this slide clearly. But the ability to do decompression and stabilization is a reflection of height restoration of a disc space. So the value of an enabling technology like SafeOp is very core to that experience. Understanding the precision required in terms of the navigation, very, very important. And then so you say decompression and stabilization. And then alignment. The alignment is defined by EOS. And so the ability to ultimately have a goal foundationally, a goal-centered ecosystem is candidly what we built. And so the opportunity to further that is great. And so when we acquired EOS, what we acquired is really a technology that was coveted. If you were to go channel check the mavens of spine surgery, what they would tell you is EOS is a profoundly coveted imaging. I think one of the challenges initially with regard to the acquisition was that I think EOS thought of themselves as an imaging company. And we thought of them as an informatics company because we think the information that that provides as it relates to alignment is profoundly important. So our big focus was translation of the image. EOS is a full-body standard image. It's a standing. You're going to find this hard to believe. But your spine has something to do with your pelvis. It's amazing. Most spine surgery imaging is very focal. And so what happens is if someone compensates, they bend their knees or they retrovert their hips, it changes their alignment because they're compensating because they're hurting. The beauty of an EOS is it provides you a full-body scan where you get a 3D reconstruction of your entire skeletal system so you understand exactly what's going on. The surgeons covet that information. When we bought that, we thought, "Gosh, this is profoundly valuable." The literature is profoundly clear. The greatest correlative to a durable long-term outcome is alignment. When you saw, again, these elements where there's such a high revision rate, we felt like that this was very valuable. What we've done is we've tried to evolve the company. This was a little bit of a struggling company when we bought it. What we did is we updated the leadership in Paris. We improved the service operation. We exited from certain geographies that were not congruent to what we were intending. A lot of work that's gone on in that space. 2024 is a very big year for us for EOS. One of the reasons is what you're starting to see is the reflection of the informatics. The ability to start to really create a data ecosystem. In 2023 and 2022, we started to build this cloud infrastructure so as to collect the data. In 2024, what we're doing is we're creating automation. A lot of the reasons why surgeons don't plan is because it takes a lot of time. The ability to automate these efforts for them is very, very important. Kind of back to the disparity of an informatics system versus an imaging system, our view was how do we ultimately manipulate the information system such that we can reflect in value. We're automating the alignment measures. We're automating the surgical planning. There is the ability to create rods that are patient-specific out of the system. We will integrate the plan into the operative experience. There will be a reconciliation tool so that you can reconcile what the plan is in the operating room. Before you leave the operating room, you understand exactly what the alignment that you got. The problem with spine surgery is there's so many variables. It's done by so much gestalt, historical experience, that it's all art. If you're going to make something better, you have to create an objective measure. This is what we're doing with regard to the objective measure here. One of the great things is spine has been remiss with regard to the data, the volume of data. So much of the volume of data has been patient-reported outcomes. The objectivity around imaging provides such great value. We've already collected north of 50,000 images just based upon the Alphatec experience that we've had with a very few sites with EOS. The opportunity to ultimately have a more objective, data-driven environment we believe to be completely consistent with what we're doing here. The other opportunities is there's also a bone quality measure. If you think about the demographic of someone who has spine surgery, oftentimes it's an older patient and an older patient that has differing types of bone. When you start to think about the relevance of EOS, it's not only alignment but it's also bone quality. When you think about how to fix something, you fix things based upon creating an objective measure. I would just suggest that the current issues in spine surgery is focal imaging without the opportunity to understand the alignment measures and the objectivity around what a surgeon's doing. And so when we acquired EOS, the placements were really at kind of a who's who in spine surgery. If you think about us as a broken company and then the ability to have access to these places where there is a who's who we felt like was very, very large, it was nine out of the top 10 best ortho hospitals and 80% of the top 25 hospitals. And so when you start to think of an opportunity when you acquire something and your ability to ultimately create a cross-selling opportunity, it was apparent that this was the case with regard to EOS. And so one of the places that you'll continue to see us flourish is in the deformity realm. And so, as I said, much like you saw SafeOp supporting lateral, EOS will support a deformity run. And so we've yet to even see the reflection of that. There are so many specific elements within EOS that ultimately inform deformity surgery. And the opportunity to proceduralize it is very, very apparent to us. And so we've already started down that road. And we've already launched several products that you'll start to see reflect the top line of our business. But it's begun. I think a lot of the question is how will we monetize EOS? I think you've already seen from a capital perspective and a service revenue perspective, those are clear elements. A couple of examples of having monetized EOS, EOSedge had seven EOSs. They bought another five. I think that's a reflection of enthusiasm with regard to a highly coveted place. And so it's a place that Alphatec didn't have access before having acquired those. Now that we have access to HSS, we're doing surgery at HSS. So it provides an access that we didn't have previously. Another place is the Texas Back Institute or TBI. We did zero business with TBI. TBI wanted an EOS machine. Our ability to rebate back based upon revenue growth of our implants back to TBI to pay for the EOS was very apparent. And so the opportunity to monetize this thing is not only capital, not only service, we hope in the future software but clearly implant pull-through. And so the monetization of the tool is apparent to us. We're in a very good place as it relates to Valence. We've onboarded the team. We have an unbelievable team. It's the original team that did Sofamor Danek or Medtronic's Stealth system. It was Sofamor Danek back then. We've secured the clearance of our Invictus screw system. We will obtain freehand navigation in 2024 and integrate into the workflow in 2025. So super excited to integrate, especially in a PTP. The ability to do simultaneous surgery with this tool we think is very, very evident. One of the things that I think is interesting is when you look at the camera that's in the field and you look at the footprint of our system, our ability to ultimately integrate these things into different sites of service is huge. People start to talk about, "Gosh, there's going to be more surgery moving to the outpatient center." If you look at the pictures on the left, I think the understanding of an outpatient center is much higher likelihood than the picture on the right. There's very few surgeons that want to spend millions of dollars on capital equipment to ultimately do surgery in their surgery centers. Our ability to ultimately integrate this inside of service is huge. From a functionality perspective, it will be part of the core workflow. Pedicle screw placement, dilator and retractor placement, we'll be able to understand the migration and monitor the retractor if it moves, inner body placement. As we said, a smaller footprint, it'll be less than $500,000 and won't require 3D imaging. Lastly, kind of get into a little bit of the market. We've always said that we were going to go narrow and deep within the international marketplace. One of the things that's fascinating to me is when you go wide in the international marketplace, you start serving markets that ultimately don't align with the interest of the company. I will tell you, one of the great things about Australia, New Zealand, and Japan is there's a shared surgical thesis. And so when you start to think about lateral surgery, when you start to think about deformity surgery, there's a real shared approach to surgery in those countries with the U.S. And so there becomes an aligned interest. And so these are decent market sizes. The revenue that we just started in Australia, New Zealand, so we did $5 million in Australia, New Zealand, again, not a lot. But it's a great start. We have an unbelievable team in Australia, New Zealand. So it creates a level of predictability associated with where we're going. Have regulatory clearance in Australia, waiting for it in Japan. We're beginning on the surgeon training side. The sales presence is awesome in Australia, New Zealand. We've started to build the framework in Japan. Have office and warehouse in both countries. But both of them will be meaningful contributors to our business rolling forward, especially at $1 billion. So one of the things that I've been at this for 30 years. And I don't know if I've ever been in a more favorable time to be in the spine business than today. And I like to say that 35% of the market is disrupted. And other than the 5% that we have, the rest is apathetic. And what a better place to be is when you have revision rates that I showed earlier and you have an apathetic group. And so to me, it's such a great time to be in this space. And so the disruption started off in 2023 with the Orthofix, SeaSpine and the GMED NuVa. And what we've done since then is taken on about 50 salespeople from disrupted companies. And one of the things that you'll find about us is our desire to be a methodical walker in this space. And so what we're doing is we continue to bring people on. But it's going to be a methodical walk. And it's going to be gradual as it relates to our respective geographic needs. If you look at our sales force, we have three AVPs. We have seven regions. What we've done is we've aligned the EOS and the surgical. It's a franchise model. So we have rules that ultimately create an algorithm for success within the respective regions. It's kind of fun to look at the top 10 geographies. We were a 2% market share holder in these geographies in 2021. We're still a pittance at 6% in 2023. But there's great growth in terms of the profile. If you look at the share in places where we've had people for long periods of time, I think of San Francisco. We have 25% market share. The likelihood of you getting an ATEC intervention in San Francisco is exceedingly high. The problem is we're just focal. And that's what we're doing with regard to the expansion of the sales of the sales group. And so in closing, really, it's been kind of an investment to reposition the company, really lay the foundation from 2018 to 2020, an investment of growth in 2021 with the whole EOS and the Valence element, create the headquarters in San Diego and the distribution facility in Memphis. And then 2024 to 2027 really is profitable growth. So it's the laying of a foundation. It's creating a demand profile. The demand profile has clearly been reflected with regard to the 40% CAGR. And now it's time that what we do is clearly leverage. And so we believe ourselves to be building a foundation from which we can continue to build. And we're a procedural company, not a product company. And we think that that's the answer to what surgeons are looking for. There's truly alignment. Our existence is dependent upon spine. Their existence is dependent upon spine. I think we're well aligned. We're well suited for shifts inside of service. So as things go to the outpatient center, taking a procedure to an outpatient center versus a huge piece of capital we think is very apparent in terms of an opportunity. We're trying to create objective measure. The whole EOS thing was around how do you create objective measure in the most correlative element, which is alignment, and so obviating gestalt and just trying to settle the science as it relates to revolutionizing the approach to spine surgery. And so with that, I will turn it to Todd to provide the numeric reflection. Thanks, sir. Yes, sir. All right. Well, so clearly, I think the path ahead is one of profitable sales growth. So when you look at the extended commitments that Pat laid out, $1 billion in 2027, $180 million of Adjusted EBITDA, $65 million of free cash flow, clearly, the profit margin expansion that we have seen over the last year and a half, that clearly continues into the future as we grow on a very profitable base and leverage the investments we've made in the past. The confidence that we have in this business is the fact that we ultimately built the company in a very purposeful way. We laid the foundation. So early on, we created a demand profile. From that demand profile, we continued to grow. We invested along the way with that. So we've now kind of answered the question, is there a sustainable demand profile? The answer to that is yes. Have we invested in the infrastructure, kind of the chassis of the business that we can ultimately hang $1 billion+ of revenue on? The answer to that is yes. And so the investments we've made, we've talked about the headquarters that we made in Carlsbad in 2021. We've opened up a facility in Memphis for distribution. We've got direct distribution in Australia, New Zealand, beginning here in Japan as well. We've got a facility in Paris with EOS. We've invested in the enabling technology. So you think SafeOp, EOS, Valence, not just acquiring the assets but ultimately investing in those assets so that they reflect the clinical benefit of the company. And so all of that is investment in the future growth of the business. As we grow, we'll be able to see, I think, the profitability of the underlying business play out in a greater and greater way over time as we scale and grow the business. And I think the point lastly as well, and Pat made it, is the environment is very ripe for growing and for attracting the sales talent to support the significant growth that's in front of us. Clearly, a large market. We talk about, one, I think the health of that market today. We're probably growing mid-single digits last year. Feels like the same way this year, which is definitely a pickup from history. So I think the overall market's healthier. The $1 billion of lateral is really where our initial focus was. And we continue to penetrate that in a major way. We're making inroads in that $2 billion of traditional posterior approach surgery of PLIF and TLIF, ultimately attracting that to a lateral approach, being able to address that surgery with lateral approach so that lateral can be the largest and the fastest growing segment within spine surgery. You guys would recognize this from two years ago. This was our projection. You recognize this. This is what we've done and what we're projecting to do this year. And then this is the path here to $2 billion and going from 2023 to 2027 at a CAGR of 20% to get to $1 billion. That billion is made up of $100 million of EOS revenue growing about 14% a year. It's $30 million of international revenue and $870 million of U.S. surgical revenue. When you combine the international surgical revenue and the U.S. surgical revenue, you get $900 million of surgical revenue across the globe growing at a 21% CAGR over the time frame. So let's dig into the surgical revenue. Again, I think this construct for understanding the guidance and how we view the growth of the business is well established. Procedural volume times revenue per procedure should give you revenue. The way we look at this is our procedural volume is really a reflection of the surgeon adoption and the clinical distinction that we've created that drives that surgeon adoption. So high teens growth into the future, revenue per surgery getting to low single-digit growth from 2023 to 2027. And we'll unpack that a little bit more here. Surgical volume growth, really kind of two components to that. So, think new surgeon additions year-over-year and as well as the utilization of your existing surgeons. Now, the new surgeon additions here, we're projecting a 10% growth in net surgeon additions. That's compared to a history of probably mid-teens growth on that footprint. What drives surgeon addition? The new surgeon additions, they are a function of the clinical distinction that we've created supported by the surgeon training we've done. We probably do about 500 surgeon trainings a year that both helps new surgeon adoption as well as broader surgeon utilization. And so that's a great leading indicator for surgeon adoption. The footprint expansion, of course, also helps. So when you compel a surgeon, you've got to find the right sales organization or the right salespeople to support that surgeon oftentimes. Given this environment of disruption, it's also another tailwind or great opportunity to support really the clinical distinction that's driving the surgeon adoption, the new surgeons coming and adopting our procedural approach. The other point I want to make on new surgeons is the new surgeon additions, those are the additions that drive the growth in the future. It is the surgeon utilization that drives the growth currently and in the near term. And I think that might be an underappreciated component of the procedural volume revenue growth machine that exists today. You look at the surgeon utilization, it gives us great confidence because when you look at the historical utilization curves, I point out that going all the way back to 2018, surgeons will use more of our procedures every year. And that continues through 2018. The shape of those curves look very, very similar year after year after year. So this procedural volume utilization engine that is based on our existing surgeon set gives us great confidence in the numbers that ultimately we're committing to and presenting here. So that surgeon utilization growth ends up being mid-single-digit. That's earned confidence. That's halo effect. And it's a function of the continuous innovation that we provide our surgeons as well, which ultimately allows them to use our procedures across a broader set of pathologies. All that leads to high-teens procedural volume growth over the time horizon. Now, revenue per surgery, we're showing low single-digit. Historically, that was probably high single-digit to low double-digit growth. Now, there's probably a logical absolute maximum to this number. You'll ask me what it is. I'll tell you, I don't know what the number is. But I would tell you, prudence suggests that we should be cautious here and essentially are putting a low single-digit growth number on there. We've had significant growth historically. But we also know that we've got some tailwinds. We've got some headwinds to this revenue per procedure metric. The tailwinds would be lateral surgery. Lateral is our driver of growth. It continues to be twice the overall ASP of our average. I said that two years ago. So what that means is that our revenue per surgery in lateral has also grown since 2021. The reason is because ultimately, when we focus on a procedure, we're trying to get all of the revenue capture associated with that procedure. You think you hear us talk about the biologics attach rate. You hear us talk about the increased sophistication and the new products on the inner body front that ultimately allow for a broader set of applications, the disposables that go along with a procedure. So because we're procedural focused, we focus on the revenue capture for the full procedure. The headwinds in this case would be cervical cases. So I would tell you that the halo effect is working. We're gaining the trust and confidence of our surgeons. And they're using a broader set of our portfolio. It just so happens that cervical surgery has a lower overall ASP than our average. It's still revenue. It's still growth. And we're happy to take it. But at the end of the day, it's a little bit of headwind to the overall average here. And then, of course, our international mix has a little bit lower of an ASP as well. As we dig into the international business, I would tell you, we're going narrow and deep. Australia, New Zealand, and Japan, as Pat laid out, one of the things we're doing is we're building direct sales organizations. We do that for a couple of reasons. One, we believe that ultimately, we can get to a higher penetration rate in that market when you own the distribution channel. Two, you ensure that you reflect the procedural thesis and the clinical thesis of the company to the marketplace. And because you do that, you get to a higher penetration rate. And when you do that, you ultimately get to a profitability profile sooner and higher than you would otherwise. And so that's why we've entered these markets the way we have. So in 2023, you can see we were at $5 million of revenue in international. We're projecting $30 million of revenue in 2027. Now, that's about 4% of the overall international market that we're entering between Australia, New Zealand, and Japan. What that really means is you're probably high single digits in Australia and New Zealand and probably low single digits in Japan, which also tells you that you're likely to have a significant growth opportunity in this area well past the time horizon we're talking about here. And then the point I made earlier on how we've entered these markets and the profitability profile, in the fourth quarter, we were Adjusted EBITDA positive across our international business, meaning that revenue in Australia and New Zealand ultimately allowed us to pay for those resources as well as the investment that we're beginning to make in Japan. And so who knows if that will continue as we scale in Japan and get into launch. But I think for now, it certainly does prove the thesis that it's a profitable way of entering those markets. From an EOS perspective, much of what we've done on EOS has been behind the scenes. And so from the clinical influence of Insight, all of the engineering work that's gone and the development work that's gone on there, that's all been kind of behind the scenes. We've built the cloud infrastructure, the data infrastructure to support that Insight launch. We have improved the hardware itself, so the machine itself, from a reliability standpoint. We've really kind of rebuilt our sales organization, our service organization, our installation organization, and the processes around that so that we can ensure that we've got high customer satisfaction with today's installed base as well as be able to scale those processes as we grow and continue to increase the size of our installed base. The other thing that you're seeing here is you're seeing an increased discipline in the pricing of EOS. And so you've seen that here as our ASP has gone up significantly over the last couple of years. We've exited some non-strategic geographies. And all of that means is that we'll end up investing and focusing on the U.S. market in a major way. And so that's not a surprise given that's where the majority of our surgical revenue is. And so that's the whole point of EOS, which is to ultimately influence the surgical volume of the company. From a revenue standpoint, $100 million in 2027 growing 14%. As Pat laid out, the monetization of EOS comes in the form of a capital placement as well as a recurring service element. And as we launch Insight, we also expect a recurring software element to that as well. I think notably, and what I show on the right here is our EOS installed base in North America. In 2023, that's north of 200. It's only 65 EOSedges. And when you look in 2027, our EOSedge installed base quadruples. And so when you think of what we're trying to do, which is ultimately have a clinical effect of EOS on the implant business, and that's the real financial reflection of the EOS technology, we have just barely scratched the surface because the installed base is so small today relative to EOSedge. And so as we grow, that installed base grows. And our opportunity then to influence the surgical business grows significantly. The other thing I'd point out is there is a, as we, I guess, sunset the EOS 3.5 in favor of the EOSedge, there will be a meaningful tailwind of replacement and upgrade cycle that'll work in our benefit as well over this time horizon. From a profitability standpoint, we're well on our way to meeting the commitments we laid out two years ago. So you think about the fact that over two years ago, we had a four-year plan. So we're two years into it. We've delivered over half of the 2,500 basis points of margin expansion that we committed to. We have delivered six consecutive quarters of profit margin expansion. We achieved our break-even commitment in 2023. I think almost most importantly is all of that profit margin expansion is coming in the way that we expected it because of the foundation and the way we designed the business. The confidence I have that we can continue to grow profitably in the future and leverage the investments we've made in the past is because the profit is coming in the areas and in the way that we expect it to, which is a confirming data point for me that it's going to come in the way I expect it to in the future. Our extended commitments get us to $180 million in 2027, 18% Adjusted EBITDA margin. Our drop-through, so the dollar drop-through to profitability over that time frame is 36%. In the second half of 2022, the dollar drop-through is 16%. In the first half of 2023, it was 18%. In the second half of last year, 2023, it was 26%. And so in the first half of this year, we're kind of in the mid-20s. In the second half of this year, we're in the mid-30s. So you can see a continual growth in the amount of profitability that we're dropping through on the incremental revenue growth over time as we grow and scale the business. And the fact that historical profitability has come in the shape and size that we planned is also a confidence builder that we will be able to accomplish this. When you look at the gross margins, we are seeing stable gross margins over this time frame, about 70%. And the reason we believe that is because surgical revenue, which has a higher standard margin than the EOS revenue, is planned to grow faster. So you get some mixed benefit on that. Additionally, we're seeing a little bit of price benefit on the EOS side of things. And then finally, we think we'll get some cost benefits out of the volume efficiencies in production. The headwind here is the consistent low single-digit pricing pressure that this industry sees on the same-store, same-product basis. So then you look to the rest of the P&L. And you say, well, where is that profitability coming from? So there should be no surprises here. These are the same culprits that we've done and seen deliver the profitability expansion so far. About half of the 2,000 comes from variable selling expense. So that kind of year-over-year contractual time-bound step-down in our variable selling expense. The other half comes from R&D and our SG&A infrastructure. What I think is a benefit there is we know we've made the investments in the past to support a company of $1 billion plus. This assumes that essentially, in the non-variable selling expense portion of our expense profile, so R&D and SG&A infrastructure, we can grow those expenses in that part of the organization at about half the rate of sales. If we're growing at 20%, we can grow that part at about 10%. Those areas of the business are growing in absolute dollars, which I think is a very fair assumption and gives us a level of confidence of the achievability of these targets. Now, as I've gone through and I've talked to a lot of you, and one of the areas that is important for people to understand is really the shared growth incentives do drive variable selling expense leverage and how that plays out in our selling organization. So when you look at the sales agent principal, that sales agent principal kind of runs like a franchise in the sense that there's an expectation for operational rigor. They ultimately have sales reps that work for them, these sales agent principals. That sales rep will be paid 10%, 12% commission rates. And as they start and as they grow their business, those sales reps are going to make more money over time. And that's how that works. And then those sales reps are going to be employed by the sales agent. That sales agent is going to have a contract with us. Our commission structure is two-tiered. So whatever you sold last year is going to get paid at an industry competitive base rate called 20%-25%. And then for the growth that you generate this year, we're going to pay you another 10 percentage points on top of the base rate. And then as you grow, so your year-one sales are going to be smaller than whatever you walked away from. And then you're going to grow your business as an agent principle. So the absolute dollars you generate for yourself and your own business, they grow over time. While the average rate that we see on that revenue growth will lever down over time because contractually, you step down those rates. And the amount that is relative to the overall growth component is a smaller part of the total revenue than it was in the previous year. So you kind of get this double levering effect on the variable expense. The second point I would make here is the fact that today, when we are able to recruit sales agents, this is a much different company, a much better company than it was three, four, five years ago, as Pat laid out. That means that we're able to negotiate a much more favorable starting point today than we were, say, three or four years ago. So the variable expense walkdown is real, and it's contractual, and it is time-bound. So how does that play out from an EBITDA and cash flow perspective? So this graph here on the left, it shows the absolute dollars of Adjusted EBITDA over the time frame of the long-range plan. The light green line on the bottom that's going up and to the right is cash flow. We get to break even in 2025, generating $65 million of cash in 2027. Then the top line, the dark green line, is cash balance. Over the time horizon, we have a minimum cash balance of $100 million. Now, what you're seeing here is going from 2023 to 2024, you're seeing a dip from where we exited December to about $100 million, consistent with what I shared on our conference call at the end of the fourth quarter. We're investing what we raised in October in sets and inventory, bringing them into the warehouse so that we can continue to go and recruit the sales reps in these disrupted companies to come and join the company. They want to know that they have the assets required to support their business when they come. So we're in the process of deploying that capital, putting that capital to work, bringing that onto our balance sheet so that ultimately we can support revenue in the future and give confidence for the sales reps that come. Now, what that means is the second half of 2024, you'll be cash flow break-even or maybe even inflect a profitability. You kind of do that over the course of 2025. And then into 2026, you can see we start generating real cash flow. The relationship between absolute dollar growth, especially on the surgical business, the amount of inventory and instrumentation that is required to support that dollar growth, and how much Adjusted EBITDA we generate in a given period, those three things are very correlated. And they're important to understand our confidence behind why we believe that the cash flow presentation that we just showed is achievable and doable. So if you look on the left-hand side, 2022, about $90 million of surgical revenue growth in that year. We spent about $0.75 on the dollar to support that surgical revenue growth in the middle light green bar. The bar on the right-hand side is Adjusted EBITDA. And you can see that's negative. So you have to have cash to support the Adjusted EBITDA that's negative as well as the investment in the sets and inventory to drive that $90 million of revenue growth in 2022. Now, in 2023, you can see over those two years, we're projecting north of $200 million of surgical revenue growth year-over-year. We're investing more than that. So north, it's probably close to $250 million in instruments and inventory, which is well north of the 75% ratio relative to the revenue growth. And then you can see we start generating a little bit of Adjusted EBITDA over those two years. And so you need to have cash, which is what we did the raise for, ultimately to support that investment. That investment supports growth in 2025 and beyond. Now, on the right-hand side, you can see 2025, 2026, and 2027. That shows almost $400 million of revenue growth in that time period, $0.75 on the dollar for the investment to support that revenue growth. And then you can see the Adjusted EBITDA is well north of both the revenue and the requirement of sets and inventory. And so that's where you're in kind of this self-sustaining investment profile where you're generating enough profit to invest in the sets and inventory or the assets of the business to drive future growth, a self-sustaining enterprise if you want to think about it that way. And so that's how you ultimately get to cash flow break-even and can support cash flow positivity in 2026 and 2027. Now, the other point that is really important here is that when you look at the asset base we've created over this 2022 through 2027 time horizon, we've created an asset base that supports a revenue that's higher than the long-range plan would suggest. So it stands to reason that if we overachieve on the top line, you don't have to go back to capital markets to support that incremental revenue. You've bought forward and have already deployed that capital to support the incremental revenue. So we're in a position to do that. So clearly, we have an opportunity to create great, I think, great shareholder value over the time horizon of this long-range plan as we execute towards it. Significant revenue generation from existing surgeon utilization, the upside opportunities that we've laid out here creates a significant demand profile that we know. We've invested in the infrastructure of this business to support a billion dollar company, which gives us confidence that we can continue to see profitable sales growth ahead. We've invested in the revenue-generating assets to support this plan, plus upside as well. And that, along with the expanding profitability profile, enables us to self-fund future growth. So thank you for your time and attention today. And with that, Pat can join me up here for some Q&A. Thank you. Good job, guys. Brooks O'Neil from Lake Street. I guess I'm curious. I noticed a lack of numerical detail in 2025 and 2026. Does that reflect any less confidence in your ability to kind of predict what's going to happen in those years? Or how are you feeling about those years as we get to the billion dollar profile? Thank you. Well, thanks, Brooks. I think maybe two slides before this, we showed absolute Adjusted EBITDA growth on the graph, which I think is a reasonable amount of detail. It's similar to what we shared last time. I think the components of how we get there ultimately are going to be on the profitability expansion. And our ability to do that, I think, is predicated on how we've built the plan and we've laid the plan and the results we've driven. So while we haven't necessarily given P&L targets for each and every year, I think we've given a reasonable amount of absolute Adjusted EBITDA, order of magnitude, on the graph that should help you understand that we do have a level of confidence to deliver on the commitment. Thank you. Good afternoon. Matt Blackman with Stifel. Question for Todd. You're going to love this question. I apologize in advance. Let me just caveat it with that. You have a track record of being conservative in your guidance. But if I look at that $1 billion in 2027, that would imply a pretty steep step down in growth in those out years, approaching something like 10%. And as I just think about the stacked opportunities, you've got PTP rolling, LTP in early innings, almost entirely incremental opportunities from EOS, Complex, International, and Valence, that billion feels conservative. So first of all, should we be thinking about this through the lens of sort of your typical base case and just, again, sort of reflecting on your outperformance in the past? And then a follow-up question on it. Yes. So two questions and a follow-up, just to be clear. Or four. OK. So I guess I'd say that, one, this is a 20% CAGR. I think our growth this year is in the guidance about 23%. And so I don't necessarily know that it implies a 10% growth rate in the out years. But it does probably imply a mild step down. But still, I think reasonably significant growth in the out periods, which I think represents our confidence. Our guidance philosophy hasn't changed. And so we believe that we're putting numbers out there that we believe we can achieve and have a reasonable opportunity to exceed. And I do think that's one of the reasons why we tried to emphasize the strength of the underlying utilization that's gone on with the existing surgeon set that we've attracted. I guess the follow-up would be the low single-digit revenue per case growth seems like the big sort of toggle as we think about the different levers in there, especially when we think about EOS, the ability to pull through incremental revenue per procedure, but also to push you into higher, more complex procedures. Is that right? Should we be thinking about that as sort of the—I mean, there are other levers to get there. But that one stood out as I sort of sorted through it. Yeah. I do think it stands out relative to certainly our guidance last year. As even I stated in my comments, it stands out relative to kind of what we saw last year and the year before. I think there is a natural limit to that. Part of this is a mix, how fast cervical grows versus others. Those really aren't necessarily reflective of the surgical thesis. Those are just kind of how things play out over time. So I'm probably a little cautious there for those reasons. But if you looked at the amount of tailwinds versus headwinds, it probably reinforces your point there. Now, I would say on the volume component, again, when we run the math, we feel very good about the volume component here. Our surgeon additions are 10% growth versus a history of mid-teens. In absolute numbers, it's a smaller number implied. I think at the end of the day, I feel like we've got a good setup. Hey, Phillip Dantoin with Piper Sandler. Thanks. I really appreciate the detail given today. Just as it relates to EOS, the pull-through, it sounds like it remains a great tool as a land and expand within some of the more marquee hospitals. But can you talk about your ability to move down the spectrum, maybe of hospital size, with this product, especially in outpatient centers that will become increasingly more important than spine? Yeah. We have such a runway in terms of academic institutions. If I look at kind of the demographics, we work at UCSF. We work at Duke. We work at Northwestern. There's a ton of great academic institutions that we currently work in. There is a plethora of opportunity before we ever get to the outpatient setting from an EOS standpoint. And so although there are several offices, like OrthoIndy in Indianapolis has two. And so the ability to integrate them into the respective practices, independent of where they do the surgery, I think, is probably the opportunity. And to Todd's point, it's like this is such a tip of the iceberg, independent of just for us to take the current 3.5 models and take it to an EOSedge and then just the growth profile that we have with regard to just new opportunities is significant. Not sure that answers your question. But I think the ultimate reflection of the software element that provides the informatics will drive the interest in installs. Then as a follow-up, just on the replacement cycle, what does that installed base, that expectation for 2027, assume on that front? What does it assume in terms of how much replacements? Exactly. Yeah. If you kind of eyeball it, it looks like we replace about half the existing three-five installed base in the U.S. Thanks, Josh Jennings from TD Cowen. I wanted to just ask about PTP. I mean, it's been a big driver of growth over the last couple of years. But we expect it to continue to be a big driver of growth. I think you posted on one of your slides, Todd and both you, 12% share in that $1 billion lateral segment in the U.S. You've had the $2 billion PLIF, TLIF kind of tack on. So that would suggest overall maybe 4% share there. But just wanted to better understand just the contribution of growth from PTP and LTP as you guys are moving forward in this LRP. And maybe just share where your business stands, where your sales team stands in terms of penetrating and converting those PLIF, TLIF, PLIF, and TLIF surgeons over to minimally invasive in the PTP action. Let me give it qualitative if you give the quantitative. And too many acronyms in spine. I think where we are with regard to PTP is I would tell you that it's a verified, predictable experience. And so we are at the absolute inception. I so remember back we launched XLIF in 2003. And it took us forever to get to this verification state. I would tell you that based upon the volume of surgeries, it is a predictable experience. And so now that it's a predictable experience in a relatively common surgical utility, what happens is these guys start to expand the application. And so where they would have done it for what's called a spondylolisthesis, which is a small slip, now they'll do it for more complex surgery. And so that's why you're seeing more expensive parts. And so I feel great about where we are. Candidly, and again, the way I see it is this is the next generation of what's going on in the space. If we were to compare our procedure versus what's commonly done today in the marketplace, the suggestion that we can't do better than taping a patient to a bed is absurd. And so the opportunity to proceduralize something with regard to a patient positioner and then elevate the exposure and then elevate the neurophysiologic element and make for a more sophisticated solution is very, very apparent. And we feel like the run forward of it is phenomenal. And that's where it's like people have talked about site of service change forever. Our ability to start to do fixed pricing in an outpatient setting whereby you have a very predictable clinical experience, I think, is upon us. So to me, it's one of these things where it's like we are at the inception of PTP. It hasn't yet been reflected in the more complex utility. So, Josh, our expectation is that lateral PTP and LTP will continue to be a driver of the growth of the business. I think this is especially important as you think about the disruption and the fact that a lot of that disruption is happening in a former NuVasive space, if you will. Clearly, those sales folks and the surgeons are very much familiar with the lateral space that they've bought into the thesis. As Pat has said, it's the next generation lateral offering. Our ability to see continued growth in that just remains very, very strong. One of the things just this Friday and Saturday, we have Duke and Emory. There's 45 surgeons coming on pure anterior column stuff. So they'll do PTP and LTP. And when you have a footprint, I think, as prestigious as Emory and Duke, I think it's a phenomenal group. It's steeped in experience in lateral surgery. Those guys will be at the office for a couple of days. Those are great proxies for an expectation of momentum. Thanks. And just one follow-up. I mean, Valence, navigation, enabled robotics, you're going to kind of incorporate that into the PTP procedure here in the coming quarter, I guess, next year. But it also represents upside, I guess, that proceduralization and just adoption and utilization of Valence. Anything to share just on the business model as we think about our projections and building out our model and trying to incorporate the impact of Valence in 2025 and beyond? Thanks. Yeah. Again, qualitatively, I would tell you that we've been very conservative with regard to its influence. And again, at least in my world of trying to architect surgery, I see it as a tool to ultimately elevate predictability. And so what I see is our continuing the ramp of what one would expect from us in terms of increased sophistication. So as it relates to saying, gosh, this is the dollar value associated with another element that creates, I see it as part of the momentum that's reflected in the number. I think as you think about modeling that, you could take our base revenue growth and kind of the procedural numbers that we've laid out there, understand where we are in the existing lateral market today. I think you can project forward that lateral is going to be a growth driver, so probably a little bit higher than the overall average over that time frame. Then you can probably assume that Valence could be an uptick to that. That would be one way to think about it. Hey, good afternoon. Vik Chopra, Wells Fargo. Two questions from me. So I think the first one's for Todd. Todd, look, I don't think anyone's questioning your top-line growth momentum. But just talk about what gives you confidence in achieving your 18% EBITDA margin in 2027, as I think that was quite a bit better than we were expecting. And I had a follow-up. Yeah, Vik. I think when you look at it, well, one, I think the way we've built the company, the way we've set things up, the heavy investment in the organization to date, the fact that over the last year and a half, we're starting to see increased profitability drop through, that coming in the way that we expected it to, all of that gives me confidence that as we continue to grow, that that increased profitability and that profitable sales growth in the future will manifest itself in the way we've expected it to. So I think that's kind of on the one side. The other way to think about that, and this is why I shared essentially the fact that to get to these OpEx numbers, more or less, we can grow our R&D and our non-variable selling expenses at half the rate of sales. That's 10% growth on a 20% CAGR. That is a very reasonable growth number. I've been in organizations where it was lower than that. And so this is a very, very doable number, shall I say. And so I think my confidence is in the analysis of what it's expected. It's confidence in the fact that in absolute dollars, you're growing. So you have optionality in the future. And my confidence is in the fact that as you grow and we know what we've done in the past, we know what we've built, we know what's needed in the future. And the result of that is much more of what we're growing in the future is going to drop to the bottom line. That's helpful. The second question I had was on the hiring trends. I think I saw a chart that you've got about 50 reps from disruptive spine companies. So just maybe talk about your hiring trend expectations for 2024 and perhaps what's embedded in your LRP from a rep recruitment perspective. Thank you. Yeah. Just from, again, a qualitative perspective, it's a pressure burst pipes, right? So where areas that we have great strength, there's adjacencies where there is significant interest in momentum. So I would tell you that kind of the priorities become some of the adjacencies. But it's not like we did, was it 15 or 18 in New Jersey and New York at the end of the year. Doing those size integrations is somewhat taxing. Our desire is to continue to add guys, make sure that we have the reflective access to the institution, make sure that there's not a non-compete, make sure that we have the inventory available to serve the demographics of their business. It's all of those things. So clearly, not a numeric answer to your question. But I will tell you, there are plenty of people out there that have experience in the field of our demographic that want to come over. And so it makes for an opportune environment. And Vik, I'd say that from a sales build standpoint, we were looking at it as procedural volume and procedural ASP. And ultimately, the clinical distinction and the adoption curves should help you understand or give you some guidance on how to build your model out. What we shared here was 50 reps from disruptive companies. Clearly, we're adding reps from other companies as well. So that's not a whole number. But what we wanted to do is we wanted to reinforce the fact that the disruption that we know is out there that we talk about, we talk about this funnel of interest, it's real, and it's happening, which ultimately supports new surgeon adoption. And as I shared, new surgeon adoption is less about this year. And it's more about the engine that they drive in the years forward. I think the great thing, though, is if you just the simple math of it all is we're going to walk from 300 to 500. And we're going to expect in the $2 million range per rep. And so it's that walk. And it's a relatively linear walk. Can you hear me? Yep. Great. Thanks so much, David Saxon from Needham. Just maybe I'll ask one on EOS. So the $100 million, I guess, what's assumed in terms of catalysts driving some sort of inflection that's coming out later this year? And then you talked some about the cross-selling opportunity. Maybe can you quantify that? And how much of a benefit do you think that'll be over this LRP? Yeah. I would say that I wish things happened faster than they did. It's always one of those things where it's like we're going to demonstrate I think we're going to blow people away with regard to the feature set around EOS and the automation around EOS. There's going to be great enthusiasm. Then it's going to take us time to sell the units, get the capital allocated, get the thing placed, get the thing up and running. So I wish it happened faster. So I won't quantify the experience. But one of the beauties is knowing a bit where this thing ultimately goes and its relevance in idiopathic scoliosis. So you start to say, what's an opportunity within the context of EOS? If we're going to place more EOSes, is there an opportunity to understand idiopathic deformity in a way that ultimately enables us to treat it better? What you see us doing is you start to see us building things like Motor Evoked Potentials in our SafeOp platform. Motor Evoked Potential is valuable because when you rotate a spine, you want to make sure that there's an intact motor function in the cord. You start to think to yourself, what are the elements that we have to place in front of that experience so when it gets reflected, there will be great momentum? We have patient positioners for idiopathic scoliosis. We showed a little bit about the vertebral rotation, the direct vertebral rotation system within Invictus. And so we're laying down the foundation to ultimately reflect in the experience once we see the populace being laid, if that makes sense. Totally. I don't know if you want to quantify anything. What was the quantification question, David? Your class own opportunity to talk about. Yeah. We don't do anything in pediatric institutions. And so the great part is if we can be a 5% market shareholder, it's found money. And that's kind of why I said today, we've got, what, 65 EOSedge machines in the installed base. We talked about access to HSS. We've talked about TBI and its impact in Pat's section. That's on today's base and without EOS Insight in its launch. And so EOS Insight really becomes the clinical influence that can ultimately drive more surgical volume because of the value that that's creating. And so I think as the surgical or as the installed base grows, then I think the opportunity to see more adoption because of the availability of EOS Insight and then to take that into institutions where we really haven't had access before, I think, is certainly there. We're kind of coming at this from a degenerative company, elevating ourselves into adult deformity. Then you have idiopathic deformity over here, which we could be relevant in. So, candidly, we believe it to be a great place to be. That's why we so coveted that technology is we thought it was the opportunity to ultimately move the field forward, which is what we see as our responsibility. Thanks. Sean Lee from H.C. Wainwright. I just want to get a better understanding of how you think about the geographic expansions. So in the prepared remarks, we see that in the different territories, Alphatec has penetrations from low single digit all the way up to over 20%. So when we think about the future growth, do you believe that there's more opportunity in the markets where you already have good name recognition or more opportunity in where you're not well represented yet? What are your focuses going to be for the next couple of years? Yeah. I would say when you have a reputation in a market space, oftentimes, it's easier to ultimately expand into an adjacency. I always use the example of we do reasonably well in Atlanta, Georgia. We do very little in Augusta, Columbus, and Macon, Georgia. Those are $30 million spine markets per town. And so when you start to think about what opportunities you have, you think about the adjacencies, at least I do. And so we have a very good team. We have a very good reputation within those different spaces. And if there's close adjacencies, ultimately, we could fill. We see those as the immediate opportunity. And oftentimes, they're onesies and twosies from a salesperson perspective. It just is a more immediate, more predictable add, as well as people can swap territories and things of that nature such that you try to minimize the potential for issues with regard to non-competes. There's always the dynamic that the surgeons have independent interest to adopt the technology. So sometimes, that happens in an existing territory. They kind of get competed into it. Maybe they're at a facility that a surgeon. Great point. Is doing PTP. It's quite likely that they will begin doing PTP at some point in the future. And so that's very much just kind of a land and expand kind of experience versus if you got somebody in a geography where you haven't historically been, clearly, then you have to solve the problem of sales coverage. And so that's a little bit more complicated to solve versus the land and expand. To your point, though, go to Houston, Texas. And if you get intervened upon, the likelihood of you getting a PTP is high. Go to San Francisco, it's the same. And so often, to Todd's point, surgeons get competed into having to elevate their portfolio of things that they provide patients. And so you love the fact that you get a momentum in a market space. And what you see is you see it expand, which is a great demographic for us as one that we believe to be scalable. Drew Ranieri, Morgan Stanley. Just Todd, maybe for you and for Pat, just on international a little bit more. But I think in your last LRP, you were talking about several other countries that weren't listed. So should we think about those as upside areas? Or are they no longer of interest? And just talk a little bit more about approaching international growth profitably. You've said before you do share a lot of DNA kind of with NuVasive. And their international margins were kind of all over the place. So just what gives you kind of confidence that you can really do this profitably? I'm going to pull rank on that. When we were talking about him coming over and being the CFO, the first thing that we talked about since he was kind of the CFO of international in NuVasive is that there's no way that we are going to go wide. And it was one of the first places we were like, absolutely see the world in a similar vein. And so when we talked about how we scale the company, the view was, how do you create an environment to where it doesn't suck the energy out of the organization from a work perspective? How do you stay focal? How do you stay reflective of the market demographics that are in the U.S. too in the international? So the whole procedural element, you're not participating in, what are the German? Oh, like tenders and all that. Like tenders and things of that nature. What you're doing is you're selling procedures into a surgeon in a hospital. And so the first thing that we agreed upon was, we're going to be super narrow. Australia, New Zealand, there's tons of crossover in terms of the surgeons and the way that they approach things. Japan, the same way. At this point, if you look at just the opportunity within those marketplaces, it more than augments the need from a revenue growth perspective. And we can be profitable in those places. Yeah. The only thing I'd add to that, I think, is ultimately, what we shared last time, I think we've just narrowed our focus. And over the course of this time horizon, we've got a ton of opportunity to build out what we've started in Australia and New Zealand and are just starting in Japan. And so those are big markets. We exit here, as I said, on average at 4%, low single digits in Japan at this exit rate. There's a ton of opportunity for us to continue to grow in these spaces. You know, one of the things, too, that's kind of funny is our DNA. We've learned a lot. One of the things that we will do is not make some of the same mistakes. We won't have a service company. We won't go crazy in the international marketplace. It will be two lessons of the experience of my previous employer that I won't repeat. Yeah. Ultimately, when you looked at the overall profitability profile of that international business, it was a headwind to their ability to get to their goals and objectives. I think that's why we are trying to be disciplined and really stay the course on the path that we laid out. Just as a second question, just on robotics. Apologies if this sounds a little bit mean-spirited, but it's not. Sure, it's not. But for EOS, for example, it was a little bit behind kind of our expectations, our model. And robotics and spine is getting to be more table stakes. So what really is giving you confidence that as more competitors are coming into this space in 2025, that you have the right machine, you have the right implant portfolio to really drive this opportunity, not just for a couple of years, but for decades to come? Thanks for taking it. Yeah. That was totally mean-spirited. You know, the thing that I love about this business is that people think that there's a single fix to a revision profile that is unacceptable. The beauty is if spine surgery is decompression, stabilization, alignment, robotics gives you, at this point, stabilization help. The reality is to ultimately integrate it into the workflow of an issue. So as we talked about, if we think that lateral surgery is meaningful and we said from the skin to the spine is a bunch of nerves and not a bunch of bones, if I were to prioritize the technology, I'd say neurophysiology. The beauty is most innovation is about the assembly of goods. The assembly of robotics and navigation with neurophysiology is ultimately the solution that creates for greater predictability. So our view with regard to it being part of the solution, we think, is very, very, very valuable. If you don't have neurophysiology and you don't have advanced neurophysiology and you can't keep up with us on that front, it's highly problematic. And that's where our great confidence comes in terms of our ability to continue to be profoundly disruptive in lateral. And so we see it as part of the integrated element that reflects the requirements of a procedure and not a surgery. Robotics is not a surgery. Robotics is a piece of a surgery. And you need more than robotics. And that's the virtue that ultimately our solution provides is it'll be integrated in a very elegant way with regard to the workflow. Hi, Caitlin Cronin from Canaccord Genuity. Thanks for taking the question. Just a quick one on ASCs. You've pointed out the lower price point of Valence, which will be important for ASC uptake. Can you talk about your long-term strategy for this site of care with Valence and also the rest of your portfolio? Yeah. One of the virtues is things that are happening that we don't control. And one of them is pain management. And so from an analgesic perspective, your ability to control the pain of a patient is higher. And so when you start to think about limited morbidity surgery so if we can ultimately fulfill the requirements of a surgical intervention with regard to decompression, stabilization, alignment, and control the pain, then the site of service becomes less important. And so when you start to think about the demographics of capital equipment and guys saying, hey, I want to be a big capital equipment company in the OR, I hate capital equipment in the OR. What I want is I want as small of a profile as we could possibly assemble because ultimately, what somebody's going to want is they're going to want a predictable price. They're going to want a clinical experience and a predictable price. Imagine that. In health care, it doesn't exist. And so when a surgeon owns an ASC, I can tell you, you're going to deal with an informed buyer. And so what we'll do is we will say, here is a price. It's going to be a flat price. It's going to be a percentage of what your reimbursement is. And you're going to be more than satisfied with regard to the clinical experience that you get. And our cost is going to be such that it won't be an impediment for us to be in those institutions because the ultimate capital piece is so small. And so our desire is to continue to see site of service become less and less important such that we can move these things. And again, the long view and the thought of the EOS part was, how do we start to configure things? How do we custom configure trays? How do we custom configure implants? How do we start to understand with surgical planning what we exactly need? And so we could limit the costs we have into these elements. Sorry for the drone. It's coming. Yeah. One question in 12 parts. I'm just kidding. Matt Blackman again, Stifel. Todd, the framework of thinking about upside on the top line dropping through the bottom line is still sort of like 10% drop through the right framework to think about? That's the first question. Yeah. As we've thought about it, that is the right framework to think about it. I think that's predicated on our ability to deploy that into future growth. So I think so long as the growth profile is there, I think the benefit is to continue to drive a top line number that is distinguished versus others in the space at our scale and size. Given we've been talking about the long term here, I apologize. This is a very long-term question. But just trying to think about the profitability profile at scale, whatever you want to define, scale app. But if I look at some of your previous standalone peers, when they crossed the billion dollar threshold, there's a pretty wide dispersion. But something like mid-20s%-mid-30s% EBITDA, just think about structurally how we should think about what you're doing here, what you've built, and where you should ultimately land whenever you get to a point where maybe you're closer to steady state rather than investing for growth. Is it something in between? Is it 25% plus? Just any sort of framework to think about sort of the profitability of this model. Yeah. So I think the way we've approached this is to ultimately learn from our experiences in the past. And so you've really seen us be focused on building the business in markets that I think have certainly the U.S. market, obviously, but internationally for the reasons that we've stated. And so staying away from service organizations that have been kind of net headwinds to our previous experience, being diligent and narrow and deep in our international experience, I think being spine only focused is also another important part of this walk to a meaningfully better profitability profile than we are today. I think if you were to kind of pit and you didn't, but I will, you could put Globus on one hand and NuVasive on the other. I think for those reasons, we think that our DNA and our structure looks more like a Globus structure than it does a NuVasive structure. And so I think the question kind of becomes, what scale? How fast are you growing at that rate? And all of those things. But I think the fundamental components of how we're building the company reflect an ability to continue to see scale past the $1 billion. With a different culture. With a different culture. All right. Well. Oop. One more. One more. One more. Hi, Andrew Haber. Nice to meet you guys. Thanks for the time. Just on this pass-through point, is there any other key drivers of the improving leverage besides the sales efficiencies? Well, the sales efficiencies are half of it. The other half is the leverage on the infrastructure around SG&A and R&D. That was my point to Matt's question earlier no, I think it was Vik's question earlier about our confidence in getting to an 18% is, one, predicated on the fact that we've got contractual step-downs in our variable selling expense, which gets us about half of the margin expansion. The other half of the margin expansion comes from R&D and the SG&A and infrastructure. The fact is we've built the infrastructure of the company to date to support a much larger organization than we are today. We invested earlier. We're seeing leverage in the go-forward. To give a little bit of analytical horsepower to that, we said, well, what growth rate does your R&D and your SG&A infrastructure in absolute dollars look like? That growth rate, those numbers actually grow in absolute dollars over the time frame at half the rate of sales. If the sales are growing at 20%, those are growing at 10% on average. That's reasonably good living over this time period. It'll stay a major part of our cost profile. Completely. Anyway, thanks very much for your interest in ATEC. Appreciate everybody's time very much. Thanks. Thank you. Pick my grandkids up. Finally, I just have to tell them, no, Mommo can't pick you up anymore. I'm sorry. But come over here and sit on my lap. I was so sad to think about having a sixth spine surgery. But in my heart, I knew I'm 67. I have a lot of life to live. And I didn't want to live like that anymore. In pursuing which surgeon to go to, I had seen an EOS scan, which is a full body from your toes to the top of your head. And it had all these diagnostic numbers and told you about pelvic tilt and coronal imbalance and kyphosis and sagittal imbalance. And I just was fascinated by the science. But even more so, I was fascinated by the before and after pictures. And I knew at that point that's where I wanted to have the surgery done. I wanted to have that scan of my body. And boy, when I got the scan, it's just an aha moment beyond proportion. So when I see Susan in my practice, first thing we do is obtain EOS images. We recognize that she had multiple surgeries because of her degenerative scoliosis. Because of the multiple surgeries, she developed a significant sagittal imbalance. She developed significant thoracolumbar kyphosis. She wasn't able to stand up straight. And then they fixed my spine in kind of incremental piece by piece over five surgeries. When I first met Dr. Deviren at UCSF, it was such a different approach to have him say that, here, I'm going to have you take this full body scan. And we want to identify all the areas where you have problems so that we can fix you once and for all. I do not want you to have to have any more surgeries. Five years ago, when Susan started having pathologies or problems, if you obtained the EOS images, she could have avoided multiple surgeries. So that's why my surgery was successful because we obtained the EOS images. We did all the measurements. We understand what the alignment goals are going to be. And we achieved those goals. But when you properly align the patients, even though it was the biggest surgeries, she did much better than all the other five small surgeries. On the very first day I stood up, my husband was standing behind me. Right away, he said, oh, my gosh, you're so tall again. Then when I saw the EOS scan post-surgery, it made me want to cry, really. I feel like I had a miracle surgery. I have a pretty miraculous recovery. Immediately, I felt better. It's not painful at all. I can get down on the floor with the kids and play. I can run with the dog. You know what? I'm not just fixed right here. I'm fixed everywhere. I always wanted to go to Italy to hike the Dolomites. I never thought I'd actually be able to do it. I went. It was just amazing to think of where I came from and to where I am now, being pain-free. Here at ATEC, our mission is to revolutionize the approach to spine surgery. What we are in pursuit of is the perfect procedure. We do that through relentless innovation. This is a hard path. We're willing to take the hard path. It's who you are when you're committed to the long game. What makes innovation important is providing for the patient better results. At ATEC and with EOS, we're taking a much more holistic approach to spine care. We're able to develop very powerful predictive algorithms that better inform surgeons' clinical decisions because of the extraordinary levels of data that we unearth and harness through EOS. Everything from preclinical to clinical studies to sponsored and site-initiated research activities, systematizing routine data collection in a way that allows us to translate that back into predictive analytics.