CARL

Carlsmed is a classic early-stage medtech growth story built around the aprevo Technology Platform — AI-designed, patient-specific interbody spine implants. The top line is compelling: FY2025 revenue of $50.5M grew +85.9% YoY (off $27.2M in FY2024), and gross profit grew even faster (+89.7%) to lift gross margin to 75.3%. Margins at that level are software-like and rare for a physical-implant business, signaling real pricing power and product differentiation. The balance sheet is pristine for a company this early: $85.8M cash, only $15.3M long-term debt, liabilities/equity of just 0.32x, and equity of $98.9M (up 240% as fresh capital — almost certainly IPO proceeds — landed on the books). Against a $303M market cap, the resulting P/S of 6.0x is a reasonable, not stretched, multiple for a business compounding revenue near 90%.

The other side of the ledger keeps this from being a buy. The company is deeply unprofitable and losing more in absolute dollars, not less: net loss widened to -$29.6M (-22.2% YoY) and operating loss to -$30.6M (-60.5% operating margin), with -$29.0M of operating cash burn. The accumulated deficit is -$101M. At the current ~$29M annual burn the $85.8M cash cushion implies roughly three years of runway — comfortable, but the burn is growing alongside the losses, so a future capital raise and dilution of the small 26.7M share base is a live risk. Diluted EPS improved to -$2.12 only because the share count reset around the IPO, not because economics inflected.