Hello and welcome. My name is Fawzi Kawash, and I'm an Associate in the Healthcare Investment Banking team at J.P. Morgan. It's my pleasure to introduce Pat Miles, Chairman and CEO of Alphatec.
Thank you very much, Fawzi. Appreciate it. I appreciate everybody's interest in ATEC spine, and look forward to kinda giving you a reasonably deep look at what we're doing as an organization. Spine needs revolutionizing, and that's our intent to do. Clearly, there will be some forward-looking statements, so I will save you the walk through this. If you get anything out of the discussion, we are in a great time in a great place. I would tell you, and I'll kinda walk through some of the issues, but we have been growing consistently over the last five years at about a 40% rate. It's a big market that needs revolutionizing.
We've made a ton of investments, so our opportunity to profitably grow forward is very apparent, and there are a ton of catalysts in terms of what's going on. So, I'll walk through a lot of them, but lateral expansion, there's a lot of market disruption that I'll speak to. We have invested in some enabling technology launches that are important. We're entering the international marketplace in a more meaningful way, as well as we have some, I think, real opportunity to improve deformity spine surgery. And so, this is really kind of a market share expansion story. We've gone from 1%-6% over the last five years. The demographics of that growth is really reflected in our focus.
I love to talk about being a spine-focused company, because if you think about the customers in this space, a lot of the surgeons commit their entire vocation or calling to spine, and they like an aligned partner, and I would tell you that we're an aligned partner. So you look over the years in terms of how we reflected the growth, and it's been 17% adoption, new surgeon adoption, 24% volume, which continues to accelerate, which I'll go into, and 12% case expansion, and I'll talk a little bit about that as well. And really, 2023 was no exception to the strong performance.
And as I said, you know, the fun part about this is that what we're seeing is we're growing at a significant rate, and we're seeing acceleration through 2022, but then more so in 2023. So we accelerated 25% in 2022 and 31% in 2023. So it really positions us well for 2024. It's like we talk about these things as well, as a lot of these things reflect decisions made, you know, 12 to 18 months ago at the very least. And so, again, we're very enthusiastic with regard to what's going on in the business. Our surgical business grew 39%. Our EOS business grew 24%. We finished the year at $482 million, which is a 37% year-over-year growth.
To us, that just speaks to there, there's demand out there for what we're doing. There's a yearning for better solutions in spine. I think that people... I've been in the spine business for about 30 years, and I think it's one of those things where I don't think people appreciate kind of the game within the game. So our guidance for 2024 is $595 million, which is about 24% growth, and so we feel great about that. So whenever I think about a large opportunity, I think, is there a way to improve it?
Clearly, I think what a virtue is when you have a value creation opportunity that is foundationally one where you have a revision rate in spine surgery that's 10%-15% in what would be called short segment surgery, and it's 25%-30% in long surgery. So to infer that spine surgery is good today, I would suggest that these demographics would suggest otherwise, especially in the hands of the masses. And so you see a very large market and one where there's a great opportunity to control variables. And the reason why spine surgery is so challenging is because of the multitude of variables that ultimately you have to address as a spine surgeon.
And so, as many people think that this is a commoditized space, I would suggest that it's not, and I think that information like this would drive people to realize that there is a real innovation opportunity. We also think that the dynamics of the marketplace are very interesting as well. It's like when a third of the market is somewhat disrupted and 2/3 are somewhat apathetic, I think it creates a great environment for a company that's completely focused in a field to grow in a very significant way.
And so as we said, we've gone from 1% to probably closer to 6%, and a big part of the disruption is in the Globus NuVasive interaction, Orthofix and SeaSpine and ZimVie peeled their Spine business out to private equity. And so when you see that level of disruption, it does nothing but create opportunity. And then the other really kinda 2/3 of the business would be like a Stryker and a Medtronic and a J&J, which are gonna be less expedient than a focused company like ATEC. And so we clearly love the dynamics of the market space. So we believe that we have a winning strategy.
We have a team in San Diego that candidly was foundational, really, to the origin and the evolution of a previous company. So we're not new at this, and we're not guessing at what the requirements of the environment are. So in 2018, we acquired a company called SafeOp Surgical, which is a neurophysiology tool. That's a fancy word for saying, "Hey, I know where a nerve is, and I know what the health of the nerve is." I'll go into that in a little bit, but it was important to lay the foundation for what we were doing in lateral surgery. Lateral surgery is really kind of a great growth market within lateral. We took that technology, and we designed a lateral franchise.
What you're seeing today is a reflection of what we did back in 2019, 2020, 2021, and you're seeing that now reflected. And, and so when you see the opportunity to build a procedure like we've done before, and then you start to see the, the expansion of how it's utilized in terms of indications for surgery, you like to think that it has a long run, and I'd tell you that we're early in the phase of that. When you do something new, and you get to make the rules, oftentimes you get to dictate what's included in there, and that would be considered a procedure. And so our goal to create procedures, create confidence with the surgeons because the surgery goes well, it ultimately reflects in a halo, and that halo ultimately gives us access to more business.
And so if you think about the company over the last five years, what we have done is foundationally built a procedural company that ultimately has grown at least twice that of any other company in the space. The great part, though, is not only is their great run continuing with regard to the procedures, but there's a foundation in the acquisition of a company called EOS. We did the acquisition about two years ago, and what it is is an imaging system. We believe it really gives us a nice foray into what we would call informatics and just the ability to start to again mitigate some of the variables that undermine some of the challenging dynamics within the spine business. So again great momentum in the business. We feel like we've built the pieces.
We clearly built a lot of the pieces up front, from a building, from a team, you know, from an infrastructure perspective, we are loaded. And so I think that the run forward with regard to profitable growth is very apparent. And so really what makes us different is that, as I said, we are spine evangelicals. We are 100% spine-focused. Spine is a monster market. It's a very technical market. And when you don't know how to do something, you call it commoditized. When you have bad outcomes, it's kinda silly to call something commoditized. It's that candidly doesn't have the outcomes that you intend. So there's great know-how in the company.
When we started the build, we probably had 200 come up from a previous company, so there's a lot of experience in the building. I would tell you from a mechanical engineering perspective, from a neurophysiology engineering perspective, from an imaging perspective, from a navigation perspective, I would tell you it's an unbelievable team. We have north of 200 engineers and really an absolute machine. We have compelled through creating clinical distinction. You don't grow like we're growing unless there is some improvement in terms of what you're delivering to the customer. We believe that spine can be improved through the assembly of technology.
When a spine surgeon sees a patient and diagnoses the patient with a specific pathology, they don't think about individual components. They think of the assembly of a procedure that they could intervene in a way that provides a predictable outcome. And so we think that that's hugely important. That's how we've built the business. We think the next foray into that becomes improved informatics, and I'll go into a little bit about that. But the beauty is that we are great students of the environment, and being focused in spine really provides the opportunity to innovate. We realize that innovation comes from the operating room and not the boardroom, and we're not a division of a division. Our existence is dependent upon spine, and candidly, we love that.
We're not trying to be the leaders in musculoskeletal. What we're trying to be is great spine guys. So I can't voice enough what the importance is of being focused in a very large market. I think the team is outstanding. I can't be more proud of what we've assembled as a group of people. Companies are assemblies of people. We have an unbelievable assembly of people. The beauty is there's a real culture, and what you'll find is across the board, clearly there's a historical NuVasive influence with regard to a number of the people on the page. So everybody from the Chief Operating Officer, candidly, our Chief Medical Officer, is the guy who pioneered lateral surgery at NuVasive.
He is our Chief Medical Officer and clearly, highly influential with, with regard to what we do procedurally. There's also kind of a neat spin in terms of there's a... I think a lot of Stryker's discipline, especially from a selling perspective, and I think from a sales management perspective, there's a historical Stryker culture that has been, that has been very, very strong and very, very predictable, and so I'm very proud of that. But I would tell you, since 2017, we've turned over 100% of the executive management team, 96% of the employees, and 92% of the board. And so I think a lot of times people are like, Alphatec's been around a long time.
Well, not the Alphatec as it is today, based upon the demographics that I just shared. And so I think there's times we talk about things, and we use words that may not be as reflective of what people understand. And so when we talk about proceduralization, really it means the assembly of technology to ultimately address a specific pathologic state. And so the opportunity that we have to design and develop these things to work together, we believe to be very, very valuable. And so, when you think of spine surgery, here's your spine surgery lesson for today. The goals of spine surgery are decompression, stabilization, and alignment. Alignment is the greatest correlative. And this is not the world according to Pat Miles. This is the found in the literature, but the greatest correlative to a long-term outcome is alignment.
So our opportunity to create these procedures in a way that ultimately reflects the requirements of the intended pathology is apparent to us. Where you'll see some of the larger companies commit to big capital positions in hospitals where they'll sell in robots or they'll sell in, you know, intraoperative CT scans. We feel like the opportunity for us to improve the process or the predictability associated with the experience is to control the variables within the context of a procedure. So we love technology, but we love technology within the context of what it means to a procedure. We believe that ultimately is clinical distinction. What we have found is when... This sounds so stupid.
When you create a distinction or you do something better, imagine this, you compel surgeon adoption. It'll never work. And then, the sales guys will want to come because what they ultimately wanna do is sell something better. And so, our opportunity to improve surgery is very apparent to us, and we think that foundationally, good surgery is good business, and our opportunity to continue to further the clinical experience is a route to a financial performance that's big. So there is a ton of experience in this. In a past life, we created what was called XLIF, which was a lateral approach to the spine. It didn't exist before we created it at the previous place. The literature that supports its utility is significant.
So whenever you can minimize the morbidity of a surgery, meaning you're gonna minimize the exposure related to the surgery, you're able to reconstruct the spine, you're able to decompress, stabilize, and align, but do it through a less morbid approach, less blood loss. What happens is you start to open a market space up to older patients, sicker patients, and so it just ultimately expands the space. But I think it's been very clear in terms of what lateral has meant. The guy down in the lower right corner is Luiz Pimenta, and again, he's a maven as it relates to lateral surgeries from São Paulo, Brazil. Back in early 2000, I had the great pleasure of working with him to develop the procedure.
The problem with the original lateral procedure, that we laid the patient on their side, and it was not a very familiar position to surgeons. Ultimately, where the outcomes were very strong and the literature was very supportive, the uptake of the procedure really never surpassed 30% of the number of the surgeons out there. Surgeons get trained with a patient on their belly or the patient on their back. So when you change the position of the patient, it creates a lack of familiarity that ultimately impedes the comfort or the confidence that a surgeon has in terms of doing the procedure. So through the process, we also had some neural complication. As I said, lack of familiarity with the position.
You were also like, if we said that spine surgery is decompression, stabilization, alignment, to directly decompress a nerve, meaning create an opening in the back and directly go after the nerves from the posterior or the back, was very, very difficult. And so oftentimes, what you'd do is you'd put the patient in one position, you would do the lateral part, you would, you know, in essence, take all of the drapes off and tear the whole room down and reposition the patient, put them on their stomach, and then put screws in. And so, that was an arduous task, and it took a long time, and the hospital turnover was very, arduous. So it wasn't, it wasn't perfect.
And also, if you're laying on your side, what you want is you want a curvature called lordosis in your spine, and it's very hard to create lordosis with the patient laying on their side. And so anyway, there were relative impediments, and so we always felt like there was a compromise. And forever in spine surgery, people would say minimally invasive, minimally effective, and there is always compromises associated with a first-generation lateral procedure. And so as we looked at it, we said, "Gosh, you know, wouldn't it be great if you could do something where you didn't have to compromise from a decompression standpoint?
You didn't have to, to try to do a place pedicle screws in a, in a very odd position, and you can do a better job from an alignment perspective." And that was really the impetus for what we call PTP, which is prone transpsoas surgery. So what we realized that is if you control the patient's position, what you can do is lay them on their belly. Laying them on their belly is a much more familiar position to surgeons. So a surgeon that hasn't adopted lateral surgery before now may be compelled, based upon the optionality associated with doing a decompressive type of a maneuver. Being able to place screws in a position that you're familiar with, being able to align based upon the belly hanging and making sure it's a more anatomic position.
And so the opportunity to no longer compromise really kinda was the impetus for PTP. So when you hear us talk about growth rates and everything else, what you're hearing us talk about is lateral. And when we're talking about lateral, what we're talking about is PTP is really the flagship. We launched LTP last year, so we also have a lateral element that I'll show you, but it's one of those things where it's like our view is the way that we get at clinical sophistication or distinction is the assembly of technology. And so we feel like that a patient positioner is an absolute requirement. And the crazy part is, it's not as though we knew that beforehand. We found out based upon, you know, the intended perfecting of a procedure in the hands of the masses.
This is not a business unless the masses can do it, so the key is to simplify it. So we created a patient position. We designed and developed a specific retractor. We recently acquired a navigation and robotic tool, which, again, will be integrated into the workflow of exactly what we're doing. I think the key to the kingdom is back in 2018, when we acquired an automated neuromonitoring tool. And then what we did is we got all of the talent from the previous company that had a unique understanding of neuromonitoring and candidly made it better. If you look at lateral surgery, lateral surgery is your side.
If you think about the anatomy from your side to the spine, there's a muscle called the psoas, and what's in the psoas is a bunch of nerves. So if you're gonna need a technology, it's gonna be neural-related. And so the great part about SafeOp is not only does it tell you where the nerve plexus is, which is vitally important and it's what we had previously done, but the virtue of this technology is that in a very noisy room. So the operating room, from an electrical noise perspective, is unbelievably noisy. And so a somatosensory evoked potential, an SSEP, is a very, very small signal. And so for us to garner an understanding of signal to noise in a very, very challenging environment is hugely important.
So just the ability to have a canary in the coal mine to say, "Hey, there's a degradation in the signal of the neural plexus." If I'm trying to operate as a surgeon and try to decompress nerves, the last thing I wanna do is have a nerve palsy. And so the challenge with a lateral approach is if you didn't know that you were retracting a nerve too long, that is a complication that could happen. And so we feel like this becomes a great moat around a procedure that has clearly captured a lot of enthusiasm and a lot of momentum. And so one of the things that I would tell you that our company does extraordinarily well is we apply our learnings. And I was down in Brazil in 2001, taping patients to beds.
You know, it's one of those things where it's like, could you imagine being in an environment and saying, "Gosh, we just can't make this stuff better, but we're still taping people to beds?" Like, it's kinda nonsensical. And so when we started to understand the value of a patient positioner in the PTP procedure, we redesigned a patient positioner for lateral. And the option added about controlling a patient, in essence, avails a more supine type of what's called an ALIF or a front procedure at L5-S1. So what we do is we expand the utility of what we call LTP, lateral transpsoas surgery in a lateral position. And so again, when we start talking about lateral, we talk about PTP and LTP, and it just speaks to the level of sophistication.
If sophistication is defined by the number of distinctions you draw to a subject, I would tell you that we're what I would call lateral mavens. And this is just an example of kind of the orthogonal approach from the lateral, your ability to garner midline when you're at L5-S1 doing an ALIF, and then your ability to place pedicle screws as well. And so when we think of the procedure, if you wanted to make it super simple, if somebody has pathology that doesn't need significant realignment from L3 to S1, we think LTP is a great solution. If you need reconstructive, decompressive work where there's an alignment requirement, we think PTP is a great solution. And so the beauty of this becomes in what's the marketplace available to us?
And if you were to say that the lateral TAM was about $1 billion, we probably had 12% share. To us, it would be a little bit of a bore if that was all there was. And so when you start to look at what the opportunity is, really, the opportunity is anything at four, five, and above, from a lateral perspective. So PTP at four, five, and above, to obviate some of the what's currently done as a PLIF or a TLIF, and so the TAM goes to at least $3 billion. And so the opportunity for us to continue to create distinction in this field and move it forward is very, very apparent.
And so, what happens is, I think it's always interesting, like, you know, is it the chicken or the egg with regard to the sales force and who brings the business? And the surgeon always has to serve the interest of the patient, so oftentimes the surgeon will find a distinction with regard to the technological element, and they will move, and oftentimes the salesperson will follow, and it may appear that the salesperson is driving the surgeon, but it's really the surgeon driving the salesperson. But when you create confidence based upon doing something well, what happens is you garner more of their business.
And so we think that the lateral franchise has created enough confidence where to what we coin it as, you know, really a little bit of a halo effect as it relates to the more conventional procedures. And so there are places to distinguish yourself in spine, and we delved into that, but there's also an opportunity from a halo effect perspective. And so we feel like, if we just did the lateral thing and we were a procedural company, we have moved the ball forward, and we would continue our growth rate.
But, you know, with having been at this for a long time and really, with the challenge of minimizing the potential for the great revision rates, we think that there is a heck of a big opportunity to provide better informatics. And so, a good company would have been what we're doing procedurally and doing all the mechanical and some of the neurophysiology stuff. That would have been a great company. To revolutionize the space, we feel like that informatics is key. And so, two years ago, we bought a company called EOS, and EOS is a French company. And really what you want is you want predictability in spine.
If the nemesis of spine has been variable control, what you ultimately want is informatics that drive better decision-making. And so what EOS is a tool for ultimately us to have a standard, and there's very few standards in spine. Spine is driven by gestalt. It's driven by experience. What we wanna do is provide an objective reflection of these things, such that what we're doing is driving behavior. And so when we start to think about enabling technology, we think about the spine procedural things like SafeOp and the navigation robotic element. But we also think about much greater control over the overall informatics on the imaging front. And so if you were to describe EOS today, it would be a full body scan.
Like, it is so crazy in this business. Many of the X-rays taken for spine are very focal, and if they're long, oftentimes they're stitched together, and it's very, very underwhelming. Imagine this, you know, your hips and your knees have something to do with your spine. Imagine that. But it you start to think about how unsophisticated we could be at times, and so the ability to have a full body, two biplanar image that you can 3-D reconstruct becomes very, very valuable. If you're to speak to anybody within the field of deformity, they would tell you that the most coveted asset in all of deformity is EOS. There's a ton of study groups that don't let you join unless you have an EOS.
So I think as it relates to the questions about, is the technology valuable? It clearly is. The question for us is, can we do the same thing? Remember how we bought SafeOp, we evolved it, and we used that information to drive better surgery. We're doing the same thing with regard to EOS, and so there's no stitching errors, there's no magnification errors. These things are very important when you start to think about predictive analytics or you start to think about image recognition. When you don't have any magnification or any stitching errors, what it does is it enables automation. One of the things that's highly difficult with regard to this environment is spine surgery. Remember, is decompression, stabilization, alignment.
If you wanna realign the spine and understanding the required alignment, what you don't wanna do is have magnification errors or stitching errors. Also, there's a 5x less radiation, the throughput is highly expedient, and your ability to 3-D reconstruct the anatomy is very apparent. So really what it does is it creates objectivity around the environment. And so it'll tell you how out of align a patient is. It'll ultimately drive you at what intervention that you should apply, where and did the intervention achieve its goals? And so, again, I think that so much of surgery and so much of the revision dynamic is around this whole, hey, it's an art.
What we'd like to do is drive a greater science toward it. And so, you know, the ability to start to rely on a full body image that provides automation in the pelvic parameters that ultimately gives the surgeon the direction in terms of understanding what and how to operate, and how long of a construct to do, we believe to be very important. It also enables you to understand what the compensation. When some patient comes in and they start bending their knees, there becomes a compensation. And so, you know, today, without EOS, surgery relies on segmental imaging, and there's a limited view of the problem, there's a lack of global understanding, and it leads to misleading findings.
And the great part is that your ability to create an automated view of a patient and then create an automated plan becomes very, very valuable, and do it expediently. So the surgeons are not gonna change their behavior very easily. And so our ability to ultimately change it through the automation of a preoperative film, a preoperative plan, and then integrating that into the operative experience. And so we are releasing in Q2 of 2024. On Monday, we got the 510(k) clearance for automation. And so what you'll see in Q2 of 2024 out of EOS is you will see an automated alignment report. So when a patient gets scanned, it'll automatically show all of the angles of every meaningful measure in the spine. That will drive an automated surgical plan.
It's gonna be ironic that it's gonna have our implants. It'll be great. It'll also inform a pre-bent patient-specific rod, so our ability to go ahead and click a box and send a rod. We will have a intraoperative reconciliation tool to say, "Hey, listen, here is what the plan is. Here's what you're doing intraoperative." And then the ability to assess postoperatively. And so to be able to have that level of objectivity on every patient, we're already in the 40,000 data points in terms of all of these things feed a cloud computing foundation. So our ability to collect this data and ultimately utilize this data is very, very apparent.
And so, what our desire is to make sure that what we're doing is we're assembling the EOS and Informatics to ultimately the surgical experience. And so just the ability to utilize automation and artificial intelligence to identify exactly where everything is in space, what the angle is, and then ultimately integrate that into the surgical experience is very apparent. If you're not reconciling it from an operative perspective, it doesn't, you know, it becomes quite harder. So our ability to ultimately have a tool where what you can say is, "Here's my intended realignment, here's the respective angles that I need in the operative experience," is very, very important.
So that will be part of the Q2 2024 launch, as well as a customized pre-bent rod, which ultimately assembles the technology to the surgical experience. So this year will be Q2 2024 will be all of the alignment measures. Another thing that we find to be vitally important is the underlying tissue. And so if you don't understand what the density of the bone is, it becomes somewhat problematic from a stabilization perspective. And in the same scan that you're getting all the alignment measures, in the future, you will be able to get an understanding of the bone quality.
So right now, again, back to the gestalting and unanswered questions, surgeons go to the operating room without understanding exactly what the quality of the bone of each patient is. We will be able to tell from a segmental perspective exactly what the bone quality is. So we're very bullish in terms of ultimately demand matching the stabilization elements, the screws and whatnot, to what the bone quality is, and we feel like that's an opportunity. So the ability to facilitate an end-to-end measure, and you start to think, gosh, why is spine surgery challenging? It has a ton of variables. Mitigating variables is a big part of what we believe will ultimately continue to evolve it. And then what we wanna do is continue to fuel the predictive analytic part.
So there's a continued encirclement, if you will, of information that continues to serve the surgeon in terms of decision making. And so everything from controlling a surgeon's clinic. Like, we think it'd be unbelievable to say, "Hey, based upon this criteria, the likelihood of this being a surgical intervention patient is very high." And so if you're gonna ultimately sort your patients on a 30-patient clinic day, and the top 10 are a very high likelihood for surgical intervention, and your PA does the bottom 20, we believe that to be value creation. And so I think a lot of people talk about esoteric ways to use AI. I gotta tell you, we have very pragmatic ways to ultimately integrate these things. We recently acquired a navigation robotic system.
We think that robotics is somewhat underwhelming at this point in terms of what the utility is, clinically. If you wanna move a field forward, and you wanna do more, if you wanna place screws currently done today more precisely, it's not gonna minimize the volume of revision rates that I talked about earlier. We have a wholesale opportunity to make spine surgery better, and it requires more than just a greater precision of screw placement. That is not the overriding problem in spine surgery. However, we think that there's an opportunity to create precision, and we think the opportunity to design and develop that into the workflow becomes very, very valuable.
And so our interest is from a lateral perspective or PTP perspective, is to integrate neurophysiology technology so you understand exactly what and where the nerves are, and then what the health of the nerve is, as well as a precision tool to get you at the place in the anatomy that you want immediately. The beauty of that is we can also be able to tell in space if the retractor moves. If you wanna minimize complications, you wanna provide surgeons information, these things are nice opportunities. And so I would tell you that I think that we're very, very early on in these things, even though they've been out for a long period of time. We think that there's an opportunity.
We love things that don't take up a ton of space, and we feel like the opportunity to sell these in different sites of services is very, very important. And so our ability to ultimately, as I said, integrate these things in, where what you'll do is be able to navigate orthogonality. When you think about the reason lateral surgery is reproducible, it's because it is orthogonal. To understand that you absolutely delivered something orthogonally and have an adjunctive piece of technology affirm that you did, we believe to be very, very important. And so what we wanna do is ultimately continue to leverage the ecosystem. As I said, as SafeOp was to lateral, we think that EOS is to at least deformity. It'll also be used in degenerative.
There's a ton of different technologies that we can apply to make these things better, and we think that we can proceduralize different types of deformity surgery. We've already started with regard to some of the patient positioning and some of the other opportunities within the deformity realm. If you think about being relevant in spinal deformity, spinal deformity is early onset, it's adolescent idiopathic, and it's adult. There's a number of ways that through the technology suite that we've developed, you can improve this care. And so, we think that the ecosystem is huge. We think mitigating variables associated with the utility of information provides better outcomes, and we have great confidence. If you think about ATEC as a company, we are still, from a footprint perspective, very underpenetrated.
As I said, we're about 5% market share. In those areas that we have meaningfully tenured salespeople, we have significant market share. There's a number of areas where we have 25% market share, and so the opportunity for us to replicate those is significant. One of the things we're most proud of is if you start to think, gosh, this guy's talking about clinical distinction, what makes it real? And what makes it real is same-store sales. And when you start to think about our growth profile, 36% of our long-tenured distribution is growing at a significant rate. And so, we're driving expansion, which clearly fuels growth at the 40% range.
That's a volume growth, as I said, of 24% from 2018 to 2023 in revenue per surgery growth. From a surgeon adoption perspective, that continues to grow. We also see more utilization. So if somebody started using a few products in 2018, what we're seeing is the continued expansion of the product utility year after year after year. And so there's also a mix shift. What we're seeing is greater confidence in terms of the volume of lateral cases. You love when you create a thesis and it gets utilized. The things that we covet is if we create a surgical thesis and we say these products should be part of the surgical thesis, it's valuable to have a quantified reflection in the number of products per procedure.
And so we continue to see that rise as well. And so that, in essence, suggests to us acceptance. And, and so when you start to think about here's a, here's a company that in the surgical space grew 39%, you say, geez, that's, that's reasonably good. It's at least twice that of anybody else. And, and, and it's not on a, on a, on a tremendously small number. You say, gosh, you know, do you, do you continue to have a lot of catalysts to grow more? And I think in the, in the dynamics of this space, we still have a ton of running room in lateral. We literally just started in Australia. We'll be in Japan later this year. We're going to go narrow and deep in the international space. We continue to get more and more hospital access.
Providence was a hospital system that we got on just recently. From a market dynamic, as I said, a third of the market is profoundly disrupted, and there's an apathy, I would tell you, in the other 2/3. We feel like that we can improve the workflow with regard to some of the technologies that we recently acquired in Valence, and we think that EOS really provides a monster. And so it's great to see the momentum of the company continue, and ultimately still have a good way to go. We feel like we laid a great foundation of work. Our route forward is one of profitability, and so we're totally excited about that. We're well capitalized, and we're all about self-funding, and so we expect that to be a 2025 phenomenon.
So long-range financial plan update is March 19th at the New York Palace. So we're excited to update that. We'll add another couple of years, two years to the long-range plan, and so we would invite you to that. But really, I think the thesis is 40% CAGR in a big market that is candidly the stuff is not very good yet. And now we're in the process of profitable sales growth with a bunch of catalysts. So with that, I will leave the next 53 seconds for questions.
Well, thanks very much, Pat. I think we can end on that note, given timing, but really appreciate you, and, thanks for coming.
Absolutely. Thanks very much. Appreciate your interest in ATEC. Thanks.
Thanks.