The rise of technological innovation in the surgical arena has led to life-saving techniques and dramatic increases in quality of life for patients. NuVasive (NASDAQ:NUVA) has played a key role in spinal surgery, with its minimally disruptive and procedurally integrated solutions helping to make patients healthier faster and with fewer complications.

Coming into Wednesday's fourth-quarter financial report, NuVasive investors were looking for solid growth in revenue and profit. Revenue numbers weren't quite as strong as most had hoped, but earnings growth is helping the San Diego-based company build momentum heading into 2019. Moreover, with takeover rumors still swirling around the company, many will want to know if there's any truth to the potential for a buyout.

Suite of surgical tables with sophisticated equipment surrounding them, including monitors, lighting, and instrumentation.

Image source: NuVasive.

NuVasive: Standing tall

NuVasive's fourth-quarter results showed the challenges and opportunities that the spinal surgical specialist has faced lately. Sales picked up 6% to $288.3 million, which was slightly below the 7% growth rate that most of those following the stock had hoped NuVasive would produce. Adjusted net income picked up 24% to $36.1 million, and that resulted in adjusted earnings of $0.69 per share. That was well above the $0.63 consensus forecast among investors.

NuVasive saw pockets of strength among its various segments. The surgical support division once again showed the best growth rate, with revenue rising almost 9% from year-ago levels. The international segment also produced good growth of 8% on the top line. Only the spinal hardware arena fell short of those growth rates, and even there, revenue gains of 4.5% showed the organic growth potential throughout NuVasive's business lines.

Once again, NuVasive suffered from some cost pressures. Gross margin was down more than 2 percentage points from the fourth quarter of 2017, falling to just over 70%. Operating profit was down by almost 2 percentage points to 9%. Large increases in sales, marketing and administrative expenses contributed to the margin deterioration, along with a significant rise in spending on research and development.

New CEO Christopher Barry seemed pleased with how things went. "NuVasive delivered strong year-over-year revenue growth of more than 7% in 2018," Barry said, "demonstrating the company's ability to take share in a stable but relatively flat U.S. spine market." He also noted that it continued to make progress on some key strategic initiatives intended to foster longer-term profitability.

What's next for NuVasive?

In particular, NuVasive has continued to work at bulking up its manufacturing facility in West Carrollton, Ohio, to produce more in-house products and components. By doing so, the company hopes to make it easier to meet customer needs while keeping costs under control.

NuVasive also has high hopes for 2019. As Barry described it, "We will demonstrate a disciplined approach toward funding key areas for long-term company growth -- furthering our product leadership in global implant systems, accelerating our surgical intelligence platform, and investing in surgeon training and education with an ongoing focus on globalization efforts."

Some investors probably won't like the guidance that NuVasive gave. The company believes that revenue for 2019 will come in between $1.14 billion and $1.16 billion, which is a bit below the $1.17 billion consensus forecast among those following the stock. Similarly, adjusted earnings guidance for $2.20 to $2.30 per share would be well below the $2.47 that investors project NuVasive will be able to earn.

Shareholders will want to pay close attention to how the company's innovations perform. For instance, the spinal surgery specialist just announced an all-internal bone transport system to treat bone defects in the tibia and femur. If NuVasive can take its spinal expertise and extend it to other applications, the long-term growth implications could be huge -- and encouraging for investors, as long as NuVasive remains independent.