Carlsmed stock barely flinched after earnings, closing up just 1% to US$13.70. That muted move sits against a report that put one issue front and center for investors. Revenue reached US$18.94m in Q2 while the company still reported a net loss of US$10.51m. The real story is the widening loss per share. Basic earnings per share declined to US$0.39 in Q2 from US$0.32 in Q1.

Is Carlsmed’s 5.9x P/S multiple a genuine discount to high growth peers, or a warning sign given ongoing losses? Compare how NasdaqGS:CARL screens on our valuation analysis for Carlsmed

Q2 2026 Earnings Summary

• Revenue (Q2 2026 vs. Q2 2025): US$18.94m vs. US$12.08m (up about 57% year on year)
• Net Loss (Q2 2026 vs. Q2 2025): US$10.51m loss vs. US$6.77m loss (loss widened)
• Basic EPS (Q2 2026 vs. Q2 2025): US$0.39 loss per share vs. US$1.47 loss per share (loss per share narrowed)
• Gross Margin (Q2 2026 vs. Q2 2025): 76.8% vs. 73.4% (improved by 340 basis points)

Prefer clean charts over another wall of earnings tables and ratios? See Carlsmed’s full visual breakdown with an easy to scan view of its valuation picture in the company report for Carlsmed.

Carlsmed bull case leans on execution milestones

Bulls argue Carlsmed can turn a differentiated personalized spine platform, strong clinical signals and reimbursement support into rapid scale and better margins. Q2 goes some distance toward that story. Revenue of US$18.94m grew 57% year on year, which lines up with management lifting 2026 revenue guidance to US$74m to US$78m and talking to midpoint growth of more than 50%. Surgeon users increased more than 60% and cervical already contributes about 10% of revenue, which backs the idea that new indications can add meaningful volume. Gross margin reached 76.8%, up 340 basis points, which supports the claim that the digital, capital light model can support high unit economics. The expanded education programs and upcoming ACE registry of more than 300 cervical patients also show concrete steps toward the deeper clinical and training footprint that the optimistic narrative requires.

Bear case tests losses, evidence and reimbursement risk

The bear case centers on widening losses, heavy cash use and dependence on favorable evidence and reimbursement. Q2 gives that camp some support. The company reported a GAAP net loss of US$10.51m and adjusted EBITDA loss of US$8.6m. Losses are still material, even with a 76.8% gross margin, which means operating expenses are absorbing most of the contribution. Management itself highlights that GAAP and adjusted EBITDA remain negative and that profitability relies on future operating leverage. The thesis around fewer reoperations currently leans on a Global Spine Journal retrospective cohort and upcoming ACE registry data, which are still in the build out phase. On reimbursement, the new lumbar MS DRG codes effective 1 October 2026 are a clear positive. However, management flags that hospitals may adopt slowly and that impact in 2027 is expected rather than near term, so funding and timing risks remain in focus.

After a quarter where Carlsmed grew revenue but continued to post material losses, it is fair to ask whether this is a temporary growing pain or a sign of deeper structural pressure. Review the full risk analysis for Carlsmed which shows 1 important warning sign

Stay Ahead With Simply Wall St

If Carlsmed’s widening losses and evolving reimbursement picture have your attention, register for free with Simply Wall St and add it to a Watchlist to track the share price against fair value and watch how the thesis develops. Once you decide to take a position, use the Portfolio Command Center to cut through noise and focus on the most important updates to your holdings. For a longer term view, tap into the collective insight of thousands of investors through the Community and see how others are thinking about risks and potential catalysts. This way you spot key shifts early, understand what really matters, and stay a step ahead of the market.

Seeking Alternatives Beyond Carlsmed?

Fresh ideas do not stay under the radar for long. Spot breakout potential and real momentum before the crowd catches up while the data still matters. Act now.

• Capture potential early movers with resilient balance sheets and steady fundamentals by scanning a curated list of solid balance sheet and fundamentals stocks (49 results) before they get fully priced in.
• Ride the next wave of compounding income by focusing on hand picked companies in the 9 dividend fortresses while yields and payout strength still look compelling.
• Target potential step change growth by zeroing in on curated 69 profitable AI stocks that aren't just burning cash while their cash generation and momentum are still under the radar for now.

This article by Simply Wall St is general in nature. We provide commentary based on historical data and analyst forecasts only using an unbiased methodology and our articles are not intended to be financial advice. It does not constitute a recommendation to buy or sell any stock, and does not take account of your objectives, or your financial situation. We aim to bring you long-term focused analysis driven by fundamental data. Note that our analysis may not factor in the latest price-sensitive company announcements or qualitative material. Simply Wall St has no position in any stocks mentioned.