GMED

Welcome to Globus Medical's first quarter 2026 earnings call. At this time, all lines will be on mute, and a Q&A session will be held after the prepared remarks. Please be advised that today's conference is being recorded. I will now turn the call over to Brian Kearns, Senior Vice President, Business Development and Investor Relations. Mr. Kearns, please go ahead.

Thank you, Kathy, and thank you everyone for being with us today. Joining today's call from Globus Medical will be Keith Pfeil, President and CEO, and Kyle Kline, Chief Financial Officer. This review is being made available via webcast, accessible through the investor relations section of the Globus Medical website at www.globusmedical.com. Before we begin, let me remind you that some of the statements made during this review are or may be considered forward-looking statements. Our Form 10-K for the 2025 fiscal year and our subsequent filings with the Securities and Exchange Commission identify certain factors that could cause our actual results to differ materially from those projected in any forward-looking statements made today. Our SEC filings, including the 10-K, are available on our website. We do not undertake to update any forward-looking statements as a result of new information or future events or developments.

Our discussion today will also include certain financial measures that are not calculated in accordance with generally accepted accounting principles or GAAP. We believe these non-GAAP financial measures provide additional information pertinent to our business performance. These non-GAAP financial measures should not be considered replacements for and should be read together with the most directly comparable GAAP financial measures. Reconciliations to the most directly comparable GAAP measures are available in the schedules accompanying the press release and on the investor relations section of the Globus Medical website. With that, I'll now turn the call over to Keith Pfeil, our President and Chief Executive Officer.

Thanks, Brian. Good afternoon, everyone, thank you for joining us on today's call. Our first quarter results demonstrate our ongoing focus as we continue to scale and capture share while maintaining operational discipline, driving margin expansion, favorably impacting Q1 and our full-year results looking ahead. Overall, we are moving with purpose and in the right direction. As we progress through 2026, look for market share taking top-line growth coupled with exciting product launches while increasing gross margins and driving meaningful earnings expansion. Stepping back for a minute, I want to give a little perspective and highlight what we've accomplished by looking at our trailing 12-month performance and the activity that's occurred since the close of fiscal 2022. Since then, revenue has more than tripled.

We've generated 6 times the amount of free cash flow, all while closing two significant deals, extinguishing almost $1 billion in debt while deploying over $600 million to repurchase over 10 million shares at an average price of under $60 a share. That represented greater than 25% of the dilution that was created from the NuVasive merger. We sit here today debt-free, generating significant free cash, and have launched over 30 new products during this timeframe. Simply stated, we've leaned in and meaningfully scaled our business while maintaining the DNA of Globus of innovation, execution, and financial prudence. I'm thrilled with our results in Q1 and look forward to what 2026 and beyond has in store for our business.

Turning attention to our top-level performance, Q1 revenue totaled $759.9 million, growing 27% as reported and 25.5% on a constant currency basis. Fully diluted non-GAAP earnings per share was $1.12, growing 64.7% over the prior year quarter. Our Q1 base business revenue totaled $677.2 million, growing 13.2% as reported versus the prior year quarter, led by continued strength in US Spine while also seeing improved performance across Enabling Technologies and international spine. Digging further into US Spine, this business continues to show strength and resilience as it grew 10% in Q1 versus the prior year quarter, marking the third consecutive quarter of 10% growth. Our US Spine sales team remains resolute and focused, operating against a backdrop of driving achievement against key objectives.

We've seen this momentum continue and are now sitting at 58 weeks of consecutive growth. Cross-selling, competitive recruiting, and robotics pull-through are key to this strategy as we continue to capture volume and drive meaningful share growth across the category. Consistent with prior quarters, our growth remains broad as we continue to see double-digit growth across many categories, including standard fixation and MIS pedicle screws, expandable TLIF, ALIF, posterior cervical, as well as cervical plating. Categories such as power tools and products such as DuraPro continue to capture new share and drive incremental cross-selling opportunities as we seek to gain a greater share of each spine procedure. Competitive recruiting remains a strategic priority, and the spine leadership team is aligned from the top down to aggressively perform against this objective.

The process of doing so remains a competitive moat for Globus, and our execution around rep onboarding with sets and inventories continues to differentiate us as our supply chain meets the needs of the field by providing high-return capital investments, which is a testament to our philosophy of having the right products at the right price and being on time. Robotics pull-through remains a key driver, and as we demonstrate greater flexibility in how customers acquire capital, we seek to more aggressively drive the recurring revenue, whether through implants, disposables, service, or case coverage. Strategically, we are slightly altering our approach to capturing more accounts and expand upon surgeon and rep training, thus driving success at accounts with Enabling Technologies. Our first quarter saw Enabling Technologies post revenue of $26.9 million, growing 21% over the prior year quarter.

We saw a sequential step down in Q1 consistent with history. However, we maintained momentum in closing deals while also seeing greater penetration of international markets. Our pipeline of deals remains robust. However, the mix of pipeline deals is shifting with a greater focus on leases and rentals compared to the historical mix of outright sales, which historically resulted in higher upfront revenue recognition. This aligns with my earlier comments and the strategy of refocusing our capital approach to drive implant and other recurrent revenue product pull-through, all of which has been implied in our revenue guidance for 2026. Despite new and enhanced robotic competitors in our space, ExcelsiusGPS remains the standard for ease and simplicity with our floor-mounted, navigation-based robotic approach. The ground-up design with its native platform gives surgeons the access and control they need to facilitate a spine procedure while seamlessly navigating through our workflow.

To date, we've seen almost 130,000 robotic procedures and will continue to penetrate the market to launch new successful programs that foster utilization. No other competitive systems, including recently introduced products, have been able to replicate the reliability, ease, or accurate workflow attributes of our robot. Our international spine business grew 16.4% as reported and 9.8% on a constant currency basis, as we did not repeat the supply chain disruptions which occurred in the first quarter of the prior year. Strength was seen mainly in the EMEA and LATAM regions, and our growth was broad-based, including both direct and distributor businesses across our international markets.

On the product front, I'm pleased to announce that early in our second quarter, we received 2 FDA 510(k) clearances for both our patient-specific SCRIPT spacer system, comprising of 7 patient-specific lumbar interbody systems, as well as patient-specific SCRIPT rods. Both the SCRIPT spacers and SCRIPT rods are designed by surgeons using the ScriptStudio design and surgical planning software application. SCRIPT lumbar spacers are static-integrated, and expandable thoracolumbar interbody fusion devices additively manufactured with patient-matched end plate topography for maximum stability. The patient-specific SCRIPT spacers may be placed using ExcelsiusGPS instruments for navigation with ExcelsiusGPS, ExcelsiusHub, and ExcelsiusXR. SCRIPT patient-specific rods are precision-bent to the surgeon's pedicle screw placement plan and designed to reduce time spent on intraoperative rod bending. Rods are compatible with our CREO, Reline, and REVERE pedicle screw systems for both open and MIS procedures.

ScriptStudio screw plans can be uploaded to our ExcelsiusGPS and ExcelsiusHub systems for robotically navigated screw placement intraoperatively. Our platform keeps the physician at the center of the planning process with an intuitive interface, allowing the surgeon to efficiently fine-tune disc height restoration, spinal alignment, and pedicle screw placement, translating their precise clinical intent directly into the implant design. Our software is treated as an advanced tool rather than a replacement for clinical judgment, ensuring the implant perfectly executes to the surgeon's operative strategy. Our expandable offering incorporates our proven technology, allowing surgeons to insert the implant at a lower height designed to minimize nerve retraction and reduce the impaction forces required to implant the spacers. Once in the disc space, the spacer can be expanded to restore optimal disc height.

Our patient-matched spacers and rods are bundled with our high-quality implants and best-in-class disc prep and retractor systems while integrating with our Excelsius suite, thus ensuring final placement matches the digital pre-op plan to ensure proper navigated placement. With our SCRIPT approvals, we will be the only company positioned to offer a complete portfolio of patient-specific lumbar interbody spacers and rods integrated with our enabling technology, truly establishing us as the one-stop shop for lumbar patient-specific implants. The team is working tirelessly to finalize the launch plan to bring these new exciting products to market shortly. We remain excited for the future as the team embarks on an enhanced focus of development and investment to bring new products to market in 2026 and beyond. I sit here today truly excited for what we have in store for 2026.

Our trauma business posted a 30.4% increase over the prior year quarter, with growth coming from both our core trauma line through share taking as well as our Precice limb lengthening portfolio. Our ANTHEM elbow plating system continues to be a standout product, exceeding our expectations as surgeons have responded to this product based on the anatomic fit of this plating system. Consistent with comments last quarter, demand on this product has continued to surpass initial expectations such that we will be delivering additional sets to the field in the second quarter. Growth in Precice was driven by our ability to now fully satisfy the market after we transitioned manufacturing from the former NuVasive facilities to Globus in early 2025. Manufacturing output has now surpassed the historical output at the former facility, such that we are now able to fully supply the market.

Our commercial focus will remain on level 1 and level 2 trauma centers as we seek to drive share growth with a smart approach to investment that balances inventory and set availability in a manner that drives high ROI. We will remain diligent in sticking to this plan as we move ahead. First quarter Nevro revenue finished at $82.7 million as we've adopted the Globus approach to driving profitable sales growth. Although the strategy rollout led to sales declines, we had expected lumpiness to occur with this business as we worked through bringing it under the Globus umbrella in its first 24 months.

The team is actively recruiting new sales personnel and mapping new product introduction plans while transitioning to our revised selling model. We are and will remain active on the recruiting front as we move through 2026 and expect to return to a more historical run rate revenue late in the second half of the year as new associates are fully trained to enter the market. We are focused on enhanced training protocols moving forward, and we'll stress this for all new and existing Nevro sales associates, given the substantial clinical data pointing to our high-frequency technology offering a clinically superior solution for patients suffering from chronic pain.

We are committed to this business and bringing technologies to market while ensuring the business is positioned in a manner that will drive profitable sales growth over the long term as we seek to grow the existing business through improved go-to-market strategies and new product development, while devising products to expand the use of Nevro's patent portfolio outside of the direct markets in which they operate today. Longer term, this continuum of care is complementary to our overall product portfolio and will help drive our strategy moving forward. Operationally, we continue to execute on manufacturing and supply chain initiatives across our business to drive gradual and meaningful improvements to core product profitability. We reiterate our commitment to achieving a mid-seventies adjusted gross margin profile over the long term, leading to expanded levels of profitability, helping drive overall returns above our cost of capital.

As we move further into 2026, our key areas of focus will remain on driving organic sales growth while continuing to internally invest and launch new products. Our modes of innovation, vertical integration, a high-touch sales force, a scalable platform, and financial discipline allow us to move fast to address our long-term goals of improving outcomes and solving unmet clinical needs. Our approach to product development will remain focused on a ground-up mindset that is procedure-enabling, integrating imaging, navigation, robotics, surgical intelligence, and implants in a more thoughtful way to improve 10-year surgical outcomes to 95% or better. Surgical intelligence will focus on bringing together patient selection, surgical techniques, and complementary implants with technology to drive the proceduralization while creating a closed-loop intelligent ecosystem to help surgeons continuously drive outcomes higher. Thank you to all of our Globus team members from all around the world.

Your teamwork, dedication, and focus are how we continually work to solve unmet clinical needs. I will now turn the call over to Kyle.

Thanks, Keith, and good afternoon, everyone. Our first quarter delivered exceptional results on both the top and bottom line and is an impressive beginning to 2026 for the entire Globus team. Sales grew 27% as reported compared to the first quarter of the prior year, with over 13% of growth coming from the base business, including strong growth from substantially all of our underlying businesses. Our top-line results were once again highlighted by the US Spine business, which had its third straight quarter of 10% growth. We continued to see margin expansion in the quarter, with adjusted gross profit margin over 69% as we remain focused on disciplined execution of manufacturing and supply chain initiatives. We also achieved record Q1 fully dilutive non-GAAP earnings per share of $1.12.

In today's prepared remarks, I will provide insights into our quarterly business performance, including the impacts of Nevro and an update on guidance for 2026. First quarter 2026 results were highlighted by revenue of $759.9 million, growing 27% on an as-reported basis and 25.5% on a constant currency basis. GAAP net income was $124.3 million, resulting in $0.90 of fully diluted GAAP earnings per share. Non-GAAP net income was $154.9 million, delivering $1.12 of fully diluted non-GAAP earnings per share, or 64.7% of non-GAAP EPS growth over the prior year quarter. Adjusted EBITDA margin was 32.3% in the first quarter of 2026.

Our Q1 2026 base business Globus adjusted EBITDA margin was 34.8%, and standalone Nevro adjusted EBITDA margin was on 11.8% for the quarter. Our first quarter net sales of $759.9 million reflect base business Globus sales totaling $677.2 million, growing 13.2% as reported and 13.1% on a day-adjusted basis, with the same number of selling days in the U.S. and international and one more selling day in Japan compared to the prior year. Base business Globus sales grew 11.9% on a constant currency basis.

As mentioned in my opening remarks, we saw growth across substantially all of our underlying businesses, led by US Spine, which achieved 9.6% as-reported growth, and International Spine, which grew 16.4% on an as-reported basis and 9.8% on a constant currency basis. Trauma and our neuromonitoring businesses each grew over 30%, and Enabling Technologies started the year off with over 20% growth compared to Q1 2025. Nevro contributed $82.7 million of revenue during the quarter. On a sequential basis, Nevro's revenue contribution declined by $17.1 million, or 17.1% compared to the fourth quarter of 2025.

As mentioned over the prior few quarters, since announcing the Nevro acquisition, our goal with Nevro was to rightsize the business to drive profitable sales growth while reducing excess spending to quickly adopt the Globus approach. In 2025, we saw positive progress in profitability through enacting significant organizational and procedural changes, culminating in an achievement of non-GAAP EPS accretion occurring in the first three quarters. In Q1 2026, we continued to see the lasting and sustainable impact of these cost control actions. However, in the first quarter, we also saw a decline in revenue driven by the structural changes made within sales and marketing of the Nevro business at the tail end of 2025.

Although we weren't sure on exact timing, we had expected this decline to occur at some point in the early innings of owning the business, and it has been anticipated in our top and bottom line guidance for 2026. Pivoting back to overall results, musculoskeletal revenue achieved $733 million, growing 27.3% over Q1 2025. Base business Globus musculoskeletal revenue was $650.3 million, growing 12.9% as reported. Enabling Technologies revenue was $26.9 million, growing 21.1% as reported. The Enabling Technologies business saw a bounce back in both sales dollars and units when compared to a softer Q1 2025.

While we remain flexible in our offerings for our customers to acquire capital, as shared in Keith's comments about the pipeline earlier, we note that Q1 2026 results were primarily from cash sales, which we've seen historically in this business. U.S. revenue during the first quarter of 2026 was $604.9 million, growing 25% as reported. Base business Globus U.S. revenue during the first quarter of 2026 was $537.7 million, growing 11.1% versus the prior year quarter. Our base business Globus U.S. growth was primarily driven by our U.S. Spine, neural monitoring, and trauma businesses, all of which have achieved double-digit growth for three straight quarters when comparing to the comparable quarter of the prior year.

Q1 2026 international revenue was $155 million, growing 35.6% as reported and 27.8% on a constant currency basis. Globus-based business international revenue was $139.5 million, growing 22.1% as reported and 15.1% on a constant currency basis compared to the prior year quarter. International growth was seen across the board, with our EMEA and LATAM regions achieving double-digit as reported and constant currency growth, and APAC achieving high single digit as reported and constant currency growth. We note that the growth achieved this quarter was against a prior year comp that was negatively impacted by the timing of distributor orders and temporary supply chain disruptions.

We feel positive on our international spine business prospects this year as we work to finalize international integrations in the back half of 2026. Turning to the P&L, GAAP gross profit margin in the quarter was 66.4% compared to 63.6% in the prior year quarter. Adjusted gross profit margin was 69.2% compared to 67.3% in the prior year quarter, primarily driven by increased sales resulting in fixed cost leverage, favorable sales mix, and the impacts of synergy execution through our manufacturing and supply chain initiatives. Our base business, Globus adjusted gross profit margin was 69.3%. As I mentioned in our fourth quarter prepared remarks, we've leaned into manufacturing and supply chain initiatives, driving to build back to a mid-70s adjusted gross profit target.

From Q3 2024 forward, we've seen improvement in adjusted gross profit metrics in each sequential quarter. Q1 2026 continued that trend, maintaining a 69.2% adjusted gross profit margin from Q4 2025 despite the normal sequential step down seen in revenue from Q4 to Q1. We reiterate our expectation of adjusted gross profit margin falling in the range of 69%-70% in 2026 and our long-term goal for mid-seventies adjusted gross profit percentage. Research and development expenses in Q1 2026 were $36.5 million or 4.8% of sales, compared to $33.1 million or 5.5% of sales in the prior year quarter. Base business Globus R&D expenses totaled $32.7 million, or 4.8% of sales.

The resulting decline in legacy Globus R&D, both in dollars and as a % of sales, is attributable to synergy capture, resulting in lower headcount and leverage from higher sales volume. Nevro R&D was $3.9 million or 4.7% of Nevro sales. As we've worked through the integration of both NuVasive and Nevro, we reset the legacy business product development processes to align with the Globus approach. We expect that this will pay dividends in 2026 and beyond as we look to minimize the timeline from concept to launch for our innovative technologies. In 2026, we expect R&D expense to be in the range of 5%-6% of net sales, with a ramp in spend moving methodically throughout the remainder of the year.

SG&A expenses in the first quarter of 2026 were $297.8 million, or 39.2% of sales, compared to $242.8 million or 40.6% of sales in the prior year quarter. Base business Globus SG&A expenses were $251.7 million or 37.2% of sales. For base business Globus SG&A, the increase in spend is attributable to increased sales compensation costs from higher volume and increased employee benefit costs, partially offset by decreased employee-related costs from synergy actions. Nevro contributed $46.1 million of SG&A expenses in the quarter, or 55.7% of Nevro sales. Q1 2026 net interest income was $5.4 million compared to $1.7 million in the prior year quarter.

The $3.8 million favorable change is being driven by a decline in interest expense from the pay down of the remaining $450 million outstanding convertible debt in Q1 2025 that was assumed from the NuVasive merger. The GAAP tax rate for Q1 2026 was 20.9% compared to 27.2% in the prior year quarter. Our non-GAAP tax rate for the quarter was 21.6% compared to 26.6% in the prior year quarter. Our GAAP and non-GAAP tax rate in the current period were favorably impacted by stock option windfall benefits. Cash, cash equivalents and marketable securities were $799.3 million as of March 31, 2026, compared to $629.1 million at December 31, 2025.

The increase in cash is driven by operating cash flow of $202.4 million, primarily from higher net income and partially offset by cash spend on capital expenditures of $39.6 million or 5.2% of sales. In Q2 2025, we announced a new share repurchase program of $500 million, under which we purchased $110 million of shares in 2025. We have $390 million of authorization remaining under this program as of March 31st, 2026. Our capital allocation strategy remains unchanged. First, we will prioritize internal investment in innovative product development efforts. Second, we focus capital spending on building sets for our worldwide sales force and investing in facilities, machinery and equipment to continue to increase our manufacturing footprint.

Third, we will continue to buy back shares through our share repurchase program, minimizing dilution and increasing shareholder value. Finally, we will continue to evaluate complementary M&A while focusing the use of our capital on driving investment for long-term profitable growth. Pivoting to financial guidance, Globus Medical reaffirms its full year 2026 revenue guidance of $3.18 billion-$3.22 billion, and we are increasing our guidance for non-GAAP fully diluted earnings per share to be in the range of $4.70-$4.80 from the previous range of $4.40-$4.50. The revenue guidance implies growth over 2025 ranging from 8.2%-9.6%.

The revised fully diluted non-GAAP earnings per share guidance implies growth over 2025 ranging from 18.1%-20.6%. The upward revision of fully diluted non-GAAP earnings per share guidance reflects a favorable increase in expectations from the margin expansion seen in Q1, which we expect to have a favorable impact on our full year results. We are extremely pleased with the start to 2026 and remain upbeat on the performance of our core businesses. Our efforts to drive lasting and profitable growth have taken shape over the past few quarters, and we remain excited regarding our prospects going forward. The Globus team's can-do attitude, resilience, and desire to win is reflected in the results that we achieve. Your everyday efforts are appreciated, and together we drive Globus to be the leading musculoskeletal technology company in the industry.

Operator, we will now open the call for questions.

Thank you. To ask a question, you'll need to press star one one on your telephone and wait for your name to be announced. To withdraw your question, please press star one one again. Please stand by while we compile our Q&A roster. Your first question comes on line of Lawrence Biegelsen with Wells Fargo. Your line is now open.

Hi, thanks for taking our questions. This is Ross Osborne on for Larry. Maybe starting off your guidance and the reiteration of the top line, are there any incremental headwinds to revenue we should be thinking about versus when you established guidance at the beginning of the year? Or is this conservatism at this point?

No. Thanks for the question. When we think about guidance, I guess our main point in reiterating guidance is that we feel confident in our numbers. We feel confident with what we've done and been able to achieve in Q1 and feel confident in terms of the rest of the year from a guidance perspective. You know, as you think about our prepared remarks, we noted that the U.S. Spine business was up 10%. The international spine business was up 10% on a constant currency basis, and we saw strength across many of our underlying businesses. We also commented on a decline that we saw in Nevro coming from Q4 into Q1. Something that was expected from the ARP's perspective on the lumpiness, right?

The fact that it would, you know, at some point, we would see some lumpiness in that revenue. I think our overall expectation for the full year is still a strong conviction in what our guidance is. Ultimately, these numbers and our results were built into our expectation this year.

Thank you.

Thank you. Your next question comes on line of Shagun Singh with RBC Capital Markets. Your line is now open.

Great. Thank you so much, and congratulations on a strong print here. You know, I just wanted to kinda ask a high-level question on the performance here. You know, I heard you say a couple of things around scale, capturing share, recurring revenue and, you know, using an alternative approach here around Enabling tech. You know, it seems like the base strategy is still in place, which is, you know, rep recruitment, robotic pull-through, and then cross-selling here. It seems like you're doing something else differently. You know, can you just talk about your strategy, and how you're able to deliver such strong results here in Q1?

Shagun, this is Keith. Thank you for the question. Thank you for the comment on the strong quarter. You know, as you think about what we're doing, our strategy as it relates to implants really hasn't changed with rep recruiting, new product innovation, robotic pull-through. The thing that we're really slightly altering sits on the enabling tech side. You know, we historically have been more focused on just selling the robot. As time passed, you know, one of the things we saw is we need to get a little bit more flexible in how robots are placed in the hospitals. You know, there's always changing CapEx environments. There's more competition in the field. Really, at the end of the day, we're looking to drive the implant and the implant procedure to make sure that we're getting more of that case.

As we look at a robot, what's important to us is that the robot gets placed or the robot or the navigation system gets placed in the hospital, and our teams are trained, the hospital is trained, or the personnel in the OR are trained, and that we're really driving, making sure that all the programs that we launch are successful, back-end support, and really working to ensure that we're driving what I would call the replenishment sale in the OR, which is the implants, the instruments, service, all the things that go along with the case. That would really be the biggest thing that I would say that we're really altering. As I think about the strong numbers and the business performance, really I go back to some of the things I touched on in my prepared remarks.

You know, our US Spine business is performing really well. We've had several quarters here of 10% growth. More importantly, you know, last year, we talked about having some challenges early in the year with supply chain. Those challenges are really behind us. You know, we're getting sets out into the field. We're getting inventory out into the field, and that's helping the team really just be able to make sure that we can cover all the cases that they're being faced with. As I look across the rest of the portfolio, international, last year we spoke about the first quarter being a little bit soft for some supply chain reasons also. We're not seeing that same thing this year.

As I look across our business, specifically spine, our spine business is performing well both in the U.S. and internationally. We're continuing to see more contributions from our trauma business. Enabling tech didn't have the rough quarter in Q1 that it did last year. We had a nice 21% growth. Again, as we think about that business moving forward, and I go back to my prepared remarks, I had mentioned, you know, as we move forward, we wanna be more flexible. That mindset of being more flexible is contemplated in our guidance, our revenue guidance for this year, because in situations where there is more of a lease or a rental approach, you're not gonna see all that upfront rev rec that you would historically. We're making sure we're taking that into consideration.

Thank you. That's really helpful. Just very quickly on the mid-70s gross margin target long term, you know, any directional guidance of like, you know, how long it might take you to get there? Thank you.

I would say I'll start this off, Kyle. You can add comments as you see fit. As I look at the last several quarters, we've had consistent step forwards in our adjusted gross profit margin. I expect to see that happening at about the same cadence. I think that there's a lot of supply chain initiatives going on to help us achieve that.

Yeah. The only thing I would add is, yeah, as you think back of the 6 sequential quarters in terms of improvement, we expect to continue to see improvement. Something that we felt really strong about and positive as we saw results for this quarter is that we did have a 69.2% gross profit in Q4. With sales coming down, you typically see that gross profit come on down a little bit as well historically from Q4 to Q1. The fact that we're able to maintain that, I think sets us up positively to continue to expand our margin as we look forward through the rest of the year.

Thank you.

Thank you. Your next question of Matt Taylor with Jefferies, your line is now open.

All right. Thank you for taking the question and nice result here. Yeah, so maybe I just wanted to double-click on understanding the confidence to raise earnings by so much, but even though you beat revenue in Q1, maintaining that. So really two questions in there. One is just unpacking the sources of EPS upside to make that more clear. Then, you know, why not raise the top line a little bit too, given all the momentum?

Thanks, Matt, for the question. You know, as I think about the top line, Kyle mentioned earlier, you know, we remain confident in the parts and pieces of our business. Our base, the legacy base Globus business is performing at a high level. As I think about revenue and why I wouldn't raise the top line, you know, it's still early in the year, number 1. Number 2, the couple of things we commented on, I commented on the change in approach slightly with Enabling Tech. That change may impact revenue as you look out the rest of the year, which again, could impact overall top-line performance. Secondly, we commented on, you know, some lumpiness that we saw in Nevro.

You know, as we work to further bring that business in, we're mindful of that as we move ahead. That's a good reason why we didn't take top line up. When you think about the bottom line, really touches back on the things that Kyle said in his prepared remarks. When we've seen a nice step forward to gross margins, he just answered in the previous question, you haven't seen that sequential step down in gross margin from Q4 to Q1. That's pointing to the manufacturing and supply chain initiatives that are happening. That, to us, is durable savings that should continue to happen. When we think about our, you know, how we performed, last year we generated, what, $0.68 in Q1. This year it's $1.12. You know, it's a nice increase.

As you think about where we're at through the rest of the year, those incremental changes should continue to occur, I would say, in the gross margin line. Stepping down to OpEx, there's still synergy actions that are occurring. As the business continues to scale, you're going to see greater leverage on the bottom line, which will drive enhanced profitability. All of those things together point to us feeling confident about taking the number up.

Great. Thanks for the additional color. Thank you.

Thank you. Your next question comes to the line of Matt Miksic with Barclays. Your line is now open. Matt, if your phone is on mute, could you please unmute your line?

Hi. Thanks. Yeah. Thanks so much for taking the question. I was wondering about just robot demand, you know, hospital investments and robot platforms.

Thanks, Matt. This is Keith. Hospital investment robot platforms, if you're thinking about, you know, the pipeline and how our and what we're seeing, I see a healthy environment. You know, last year we talked about having a soft Q1. This year, I would say coming into the year, we came in with a fairly strong pipeline. We converted a lot of that in Q1. As I look into the 2nd quarter and beyond, I would say we have a large pipeline. The thing that I see in the pipeline this year is that the mix of how we're offering these robots is slightly different, where you see a higher mix of leases and rentals being quoted.

From my perspective, I see a durable market here, and we're going to continue to, you know, aggressively go after it the remainder of the year.

That's great. Thanks so much. Sorry about the confusion there. The other was just on, you know, on, you know, what you're seeing competitively, if there's been any change. We all know some of the big moves that other companies have made in the space or maybe are contemplating making. You know, any shift in competitive dynamics that you're seeing either from the smaller players in the space or from the some of the traditionally larger players in spine in the U.S. in particular. Thanks.

As I think about the competitive landscape, you know, what I see is, you know, we are competing mainly against Medtronic. That's what I see routinely. Obviously, as more competitors have entered the space, I would say that the speed to closing deals has elongated a bit because what I see happening is, you know, hospitals are still or they're now requiring everyone to go back and look at all the competitive offerings that are out there. When I sit and look at Excelsius versus the competition, I still think we're very well positioned. When you think about the Excelsius technology, it was designed from the ground up. You know, it's FDA cleared for cranial, cervical, sacrum, pelvic orthopedic applications, the end effector tracking.

There's just a lot of things that are still very unique to Excelsius. Even with some of the things that our competitors have come out with, they're really now just catching up to where Excelsius has been. As we think about where the robot is positioned and even the rest of our tools, we still think we're really well positioned to compete in this market.

Great. Thanks, Keith.

Thank you.

Thank you. Your next question comes to the line of Richard Newitter with Truist Securities. Your line is now open.

Hi, guys. Thanks for taking the questions. Congrats on the quarter. I wanted to ask on Enabling Technologies. You know, I think this is something you had mentioned, the strategy shift, actually over the last 2 quarters. It makes a ton of sense and, you know, to try to get the Trojan horse, if you will, into more institutions faster. I guess just with the guidance reiterated, is there a kind of switching of components that you would kind of advise analysts to kind of move around? You know, I see a consensus Enabling Technologies at around $150 million for 2026. We're at $134.

I'm just curious if there's any comment you could give on either of those 2 numbers just as we refine our models and get the components right to get to your guidance. Thanks.

Yeah. Thanks for the question, Rich. We're not going to break out our guidance into the different parts and pieces. What I point you to is in Keith's prepared remarks and my prepared remarks, A, talking about in Q1, we were still having primarily upfront cash rev rec type deals. Keith commenting on the pipeline being a larger percentage than in the past in terms of these rentals and leases and other types of models. I think you could use that to help guide your thoughts in the rest of the year.

Okay. Okay, thanks for that. I guess just on Nevro, one question we've gotten. I believe spinal cord stimulation might be captured under the pilot WISER program that CMS has in place. I was just curious, A, is that right? B, is that something that you've seen in any of the pilot states so far impacting the results at all and something you think will have an impact at any point going forward? Thank you.

Rich, this is Keith. I have not seen that impacting us or impacting how we go to market. I have really no comment and because I haven't seen it, I can't say that I've seen it in any specific state at this point.

Thank you.

Thank you.

Thank you. Questioner next comes to the line of Ryan Zimmerman with BTIG. Your line is now open.

Good afternoon, congrats on a nice quarter. Wanted to ask 2 questions, if I could. You know, 2 things on Nevro that we didn't have last year. They actually never reported a Q1 2025. I'm wondering, this is kind of a 2-part question, but wondering if you have those numbers and can give them out just so we have some basis for comparison year-over-year. 2, you know, given the guidance and in the context of the guidance, does Nevro get worse before it gets better? You know, kind of implied in your comments, Kyle. I have a follow-up.

Yeah, Ryan, thanks for the question. This is Kyle. No, we're not gonna give out that Q1 or last year number. The only comment I would make is if you looked at Nevro's business historically, consistent with our business, you typically see a step down from Q4 to Q1. That would be expected last year as well. Separately, in terms of the expectation in the rest of the year, it's hard to predict because we're starting to see, you know, what happened in Q1, finally, that lumpiness that we'd been talking about throughout 2025. My expectation is likely that it will probably get a little bit worse before it gets better.

I point you to Keith's remarks of expecting to get back to in the direction of historical norms late in the back half of the year.

Okay. Appreciate that. That's helpful. You know, on gross margins, I, you know, appreciate the comments, the long-term guidance. It's, it's all, you know, very helpful. I'm wondering, I mean, is the gross margin opportunity, you know, purely a cost exercise from your seat? Or do you need price to, you know, to drive, you know, your gross margins higher and can you do that with, you know, in spine in such a competitive market and so forth? Just kind of lay out kind of, you know, some of that insourcing opportunities in Ohio or things where you see, you know, kind of the best, you know, low-hanging fruit, I guess, on gross margins.

Yeah. Thanks, Ryan. This is Kyle again. I guess I would answer that and say that, it's some of each. We're obviously focusing on cost, and that being something that Globus has always focused on, right? From those manufacturing and supply chain initiatives going back to what Nevro or NuVasive had done historically from a manufacturing perspective versus what Globus had done, trying to align those sites, the approach within those sites. That gets you to the point of having some efficiency on the COGS line.

From the top line perspective, I think it points to our strategy of launching new and differentiated products and trying to identify places where we can get pricing premiums there as well to try to fight off any type of price erosion that's out there in the field, and also find opportunities to sell those new and exciting products at a higher premium.

Yeah. The only thing I would add is, you know, as I think about that, we've always modeled, you know, you're going to launch new products, but you're always going to see price erosion, you might be down net 1%. As you think about getting that mid-70s gross margin profile, majority of that really comes from our ability to drive costs. You know, it's really getting more efficient supply chain, thinking about your contracts, thinking about how you manufacture. You're going to get leverage on your manufacturing footprint as you're continuing to drive growth. A lot of that comes from that ability to really focus on the cost side of things.

Thank you.

Thank you. Your next question comes from the line of David Saxon with Needham & Company. Your line is now open.

Great. Good afternoon, Keith and Kyle. Thanks for taking my questions, congrats on the strong quarter here. Wanted to ask on the EPS guidance. You raised it, you know, I guess this is your third time this year. You're starting to bump up against where the street is for 2027. Would love to just understand kind of how you think of Globus' go forward EPS growth profile, like with the path to mid-70s gross margin, maybe Nevro comes back and some other cost actions. Like, can you be a double-digit grower over the next few years? Then, Kyle, if you could just clarify what the tax assumption is for the guide as well.

Great. Thanks, David, for the question. Yeah, this is Kyle. In response to your question, you know, thinking about raising guidance here a couple of times, I think what we would point to is seeing the results that we have both for the end of the year in Q4 as well as here in Q1. We've taken away, you know, a positive momentum, primarily in gross profit margin expansion. I think that's really the catalyst to why we feel good about the business. Obviously, we feel good about sales and where we're at with sales, and as you have sales and sales growth, you're gonna get leverage on your bottom line as well. Those two things kind of driving that guidance push a little bit higher.

I won't comment on 2027 and specifically what we're looking out in terms of the out years, but if you think about what we've always said with Globus, we strive to be that high single-digit top-line grower, and we look to go above and beyond that on the bottom line and then outpace that growth on the top line.

We, you know, we feel really good about, you know, our business, and we see a lot of organic growth opportunity across our business. You know, as we look ahead, you know, we're gonna be spending more on R&D. We're gonna, you know, be doubling down in spine R&D, Enabling tech R&D. That's stuff that we see happening as we move forward. That'll, you know, a little be a bit of an offset to some of that.

Hello?

Yes, please remain on the line. Your conference will resume shortly. Please stand by. Thank you. Thank you again for standing by while we troubleshoot.

[Break]

Speaker line is muted.

Hey, hey, are you guys back?

Yes. We're back.

Yeah, we're back. Perfect.

Perfect. All right. Technical difficulties, David. Sorry about that.

Yeah, no problem. Yeah, I mean, I think you answered my question well. I'll just throw my second one in, which is just around the competitive rep hiring. I mean, that's been a driver for a long time. Wanted to get an update from around, like, where are you from a geographic coverage perspective in the U.S.? Is it more about, you know, filling any gaps you might have, or is it more about density at this point? Thanks so much.

Thanks. Our competitive rep program continues like it has with history. I mean, you know, as we look to add, I'm always looking to add density. You know, there always could be gaps to fill here and there, but at the end of the day, we're always looking to add quality reps to our team. That hasn't changed.

Great. Thank you.

Okay. Thank you. Your next question comes from the line of Caitlin Roberts with Canaccord. Your line is now open.

Hi. Thanks for taking the question, congrats on a great quarter. Any commentary on geopolitical risks in the Middle East, either from a revenue exposure or cost supply perspective?

Thank you, Caitlin. It's a great question. From geopolitical risk, I don't see any material risk from a revenue perspective, based on sales in the Middle East or other places. From a cost perspective also, we see little to no risk there as it relates to geopolitical events.

Great. Just any commentary on the progress in the Ortho and then the ExcelsiusFlex rollout?

No comments at this point. You know, the business we're continuing to develop implants. You know, as that becomes more, I would say, prominent, we will update on that in the future.

Understood. Thank you.

Thank you.

Thank you. Your next call comes from the line of Thomas Stephan with Stifel. Your line is now open.

Great. Hey, guys. Thanks for taking the questions. First one just on the revenue guide. Wanted to ask about kind of phasing comps. A little wonky in 2Q versus 2H this year. Can you help us think about just kind of revenue cadence rest of year? I'll have a follow-up.

Thanks for the question. This is Kyle. I would say, you know, your typical, what you would see in the past, pre any of the acquisitions and the noise that came in from having an acquisition in enduring the year, is you typically see a step down from Q4 to Q1, like we saw here, and then a step up into Q2, roughly leveling off in Q3, and then an increase again for harvest season in Q4. I think I would point you to those kind of historical norms directionally about how revenue will kind of have a cadence throughout the year.

Got it. That's great. Appreciate that. Just my follow-up on OUS Spine already back to double-digit growth. No supply issues were a dynamic last year, but, you know, mentioned finalizing some integrations in the back half. You know, can you talk about expectations rest of year in OUS Spine? Is there a path to that business potentially accelerating as 2026 progresses? You know, is around this kind of 10% range more reasonable for constant currency growth? Thanks.

This is Kyle. Good question with that. What I would point you to is we saw double-digit growth in the mid-teens on the international spine business from an as-reported basis. If you looked at it from a constant currency basis, it's just under 10%. We did see some favorability from currency in Q1. I'd also point you back to last year, first quarter of last year, where we had some supply chain disruption and some movement in terms of stocking orders as well, which made it a little bit of a softer comp. If you go back to what we talked about in Q4, and what I'll reiterate here, is that our expectation for that business is to pick back up as we move throughout the year.

Despite the fact that we had a strong Q1, I still think as you work your way throughout the year, there's not a massive revenue acceleration in terms of growth year-over-year. As we look to exit the year and get back to consistently in that low double-digit growth pattern.

Yeah, I think that we're gonna grow into this. You know, long term, we still think the international business grows, you know, low to mid double digit, 12% to 15%, we're gonna grow into that over time. Our approach is to go deeper in the markets that we're operating in. We're not looking to suddenly add more countries, because we wanna drive density where we're operating.

Got it. Thanks, guys.

Thank you. Your next question comes from the line of Matthew O'Brien with Piper Sandler.

Hi, this is Anna. I'm on for Matt this afternoon. Thanks for taking our questions. I'll just keep it to one in the interest of time here. I wanted to ask on US Spine. You commented to 10% US Spine growth, strong run rate for the past few quarters. Wondering if you could provide any more detail on, you know, how much of that growth comes from market share gains versus underlying market growth. Just any comments you could provide on the health of the market in general. Thanks.

Yeah. This is Keith. I'll take that question. I would say that the majority of our growth is really coming from share gains. You know, and we don't spend a lot of time talking or looking into research in terms of how the market is performing, but I would say that the market probably growing 3%, 3%, give or take. You know, from my perspective, the majority of growth you're seeing from us is obviously in excess of that, and that's because of us taking share.

Excellent. Thank you.

You're welcome.

Thank you. Your next question comes on line of Mathew Blackman with TD Cowen. Your line is now open.

Hi, Keith and Kyle. It's Drew Ronair on for Matt tonight. Keith, maybe just a question to go back on Enabling Technologies. I mean, we've seen, like, soft tissue robotic companies have a pretty regular cadence of launching their next generation systems. I was just thinking, as you're looking at ExcelsiusGPS development roadmap, how are you kind of thinking about the system evolving since you're stepping up on R&D spend? I mean, is the focus still to broaden applications or end effectors, or are you focused more on efficiencies? Maybe as the next generation comes, does that bring more surgeons into the fold about using robotics in spine surgery? Thanks for taking the question.

Thanks. It's a great question. I'm a little more limited into my comments, but as I think about, you know, the evolution of Excelsius, it's really coming down to more refined software and how the software performs in the OR. Interbody fusion. I think about DuraPro, integrating DuraPro and additional cranial procedures. That's what we're thinking about as we move forward in terms of enhancing the software. There's lots to unpack there, but those are my comments that I would leave for now.

Okay. Maybe if I can just squeeze one in too. Sorry for the time, but we've heard other ortho and spine companies talk about weather and the Kaiser strike, but was that any drag for you in the quarter, and would you get those procedures back in the second or throughout the year?

I would say there's maybe a small impact, but I, you know, given the performance of the business, I don't wanna say that, you know, we could have finished higher. I'm comfortable with our prepared comments. You know, as we think about the rest of the year, we're thinking about growing wherever we can and driving smart growth across our business.

Thanks.

Thank you.

Thank you. With no further questions, this concludes the Globus Medical earnings call. Thank you for participating. You may now disconnect.