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Image source: The Motley Fool. Monday, Aug. 3, 2026 at 9:00 a.m. ET Chief Executive Officer - Laura Francis Vice President, FP&A and Investor Relations - Saqib Iqbal Executive - Anshul Maheshwari Operator: Good afternoon, and welcome to SI-BONE's Second Quarter 2026 Earnings Conference Call. [Operator Instructions] As a reminder, this call is being recorded for replay purposes. I would now like to turn the call over to Saqib Iqbal, Vice President, FP&A and Investor Relations at SI-BONE. Please go ahead. Saqib Iqbal: Earlier today, SI-BONE released financial results for the quarter ended June 30, 2026. A copy of the press release is available on the company's website. Before we begin, I'd like to remind you that management's remarks today may include forward-looking statements within the meaning of federal securities laws, which are made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. These forward looking statements are subject to a number of risks and uncertainties, including those set forth in our SEC filings, such as our most recent Form 10-K, and actual results may differ materially from any forward-looking statements that we make today. Accordingly, you should not place undue reliance on these statements. These forward-looking statements speak only as of the date that they are made, and we do not assume any obligation to update any forward-looking statements, except as required by law. During the call, management may also discuss certain non-GAAP measures, including adjusted EBITDA and free cash flow. Unless otherwise noted, any reference to profitability is in terms of positive adjusted EBITDA. For a reconciliation of these non-GAAP measures to GAAP accounting, please see the company's full earnings release issued earlier today. Unless otherwise noted, all results are compared to the comparable period in the prior year. With that, I'll turn the call over to Laura. Laura Francis: Thanks, Saqib. Good afternoon and thank you for joining us. Our second quarter results demonstrate the strength of our core competencies and the momentum they've created in the business. We founded the company with a clear clinical objective to develop differentiated solutions that enable durable fixation and fusion in high-risk patients with compromised, often osteoporotic bone. Our target patients often live with debilitating pain and diminished quality of life. Our focus has allowed us to identify large addressable markets, establish compelling technical and clinical moats, and create a diversified business with multiple avenues for growth. During the quarter, we continued to translate that strategy into new products and markets. We extended the application of our biomechanical expertise and proprietary technology beyond the sacroiliac joint into high-value adjacencies across musculoskeletal care. In June, we submitted the 510(k) application for our third technology with breakthrough device designation. This is our first platform designed for use outside the pelvis and is intended to address a recognized failure point in complex spine procedures. Subject to the 510(k) clearance, we remain on track to begin a phased commercial launch in the fourth quarter, perhaps as early as October. Additionally, we advanced several development programs targeting new markets we expect to enter over the next 18 months and expanded U.S. field capacity in preparation for the upcoming launches. Second quarter performance was strong across markets. Worldwide and U.S. revenues were $56 million and $53.2 million respectively, both representing approximately 15% growth. Sequentially, U.S. procedure volume increased approximately 9%, marking our strongest second quarter sequential increase in years, dispelling industry concerns regarding the payer environment. International revenue grew approximately 26% to $2.8 million, led by continued demand for our expanded portfolio. The strong top-line growth yielded meaningful operating leverage. Revenue grew nearly twice as fast as operating expenses, contributing to a 178% improvement in adjusted EBITDA. Looking ahead, we believe the business is well positioned for continued revenue growth and further profitability improvement. Our expanding portfolio, improving reimbursement, and additional commercial capacity should deepen our relevance with physicians, reduce economic barriers, and extend our reach. Together, these factors reinforce our confidence in a strong finish to 2026. We believe the impact should be even more meaningful in 2027 as our new product moves through the adoption curve, the territories added this year become more productive, and reimbursement changes support broader utilization. I'll now discuss our three key growth drivers, innovation and market development, physician engagement, and commercial execution. Anshul will then cover our fourth priority, operational excellence, along with our financial performance and updated outlook. Starting with innovation and market development, innovation is the cornerstone of our long-term growth strategy and has helped us deliver compound annual revenue growth of more than 20% per year over the past 5 years. We believe we have one of the industry's broadest portfolios focused on patients with compromised bones. These high-risk patients often face difficult recoveries and elevated revision rates. By improving procedural outcomes, our technologies have the potential to enhance patient quality of life while reducing the economic burden on the healthcare system. We have a track record of developing differentiated technologies, gaining reimbursement coverage, driving physician adoption, and growing significantly faster than the underlying market. In SI joint dysfunction, currently our largest market, the relatively low density bone of the sacrum makes durable fixation challenging. iFuse-3D, TORQ, and INTRA product families provide a comprehensive portfolio of metal and allograft solutions for surgeons, as well as the fast-growing base of interventional spine physicians across all sites of service. In spinopelvic fusion, our fastest scaling market, there's an increasing number of patients with bone compromising conditions, such as osteoporosis and osteopenia. With Granite, we believe we have the best-in-class solution for pelvic fixation and spine fusion procedures. Within pelvic trauma, where the majority of our target patients are being treated for low-intensity sacral insufficiency fractures, iFuse TORQ TNT is gaining adoption among surgeons. Our next major catalyst for further accelerating growth is the launch of our first non-pelvic solution. As I highlighted earlier, we submitted the 510(k) application in June. We're working with suppliers to build surgical capacity and we're on track for the phased commercial launch. Because the solution targets accounts where our team already has established relationships, we expect to leverage our existing commercial infrastructure to support an efficient launch. We also have several programs at different stages of development targeting large, established markets where current treatment approaches leave meaningful room for improvement. We expect two additional solutions to progress toward design freeze later this year, with potential commercialization targeted over the next 18 months. As we look forward, our longer-term vision extends beyond titanium and allograft solutions. We pioneered 3D printed titanium implants and helped create a new product category. We're actively exploring and testing additional materials to address new disease states and developing AI-driven procedure enablement capabilities. Collectively, these initiatives are transforming SI-BONE from a leader in sacropelvic solutions into a broader spinopelvic company focused on procedural solutions for compromised bone. By organizing our innovation around the needs of these high-risk patients, we remain committed to improving procedural and long-term clinical outcomes. Before turning to physician engagement, I'd like to briefly update you on reimbursement. We're pleased by the recent proposed CMS changes affecting SI joint fusion procedures. Today, the majority of SI joint fusion procedures are performed in the hospital outpatient departments, ASCs and office-based labs or OBLs. CMS has proposed increasing hospital outpatient reimbursement by approximately $2,300 to more than $20,000. For ASCs, they proposed an increase of approximately $1,000 to nearly $16,000. CMS has also proposed establishing OBL reimbursement of over $20,000 for CPT code 27279. If finalized, these changes would improve the economics of treating SI joint dysfunction across all outpatient care settings, expand physician choice, and make these procedures accessible to more patients. Furthermore, the new family of DRGs for complex spinal fusion procedures, including procedures incorporating Granite, is encouraging. Depending on the patient's diagnosis and severity, these new DRGs could increase the average hospital payment by up to $50,000 per procedure. We believe this framework better reflects the complexity and resource requirements of treating these high-risk patients, reduces economic objections of our hospital customers, and supports the long-term adoption of Granite. The reimbursement framework is also relevant to the third breakthrough device, which is intended to address another important source of failure in complex spine procedures and may be used independently or with Granite. Now, let me discuss the progress on physician engagement. Physician adoption and utilization remain important leading indicators of future procedure growth. In the second quarter, 1,715 unique physicians performed at least one procedure using our technologies, an increase of approximately 19% versus the same quarter a year ago. For context, the quarterly physician count exceeded the number of unique physicians who used our technologies during full year 2023. We achieved double-digit percent growth across each of our call points. This broad-based engagement reflects the clinical relevance of our solutions, as well as the effectiveness of our physician engagement and customer engagement efforts. Our concerted efforts to grow physician awareness and adoption continue to deliver. In the quarter, the number of physicians performing more than one type of procedure increased approximately 15%. Physicians active in both the current and prior year quarters averaged approximately 3x the case volume of physicians performing their first procedure with us during the quarter. In aggregate, growth in our physician base, broader use of our portfolio, and increasing utilization create a strong foundation for sustained procedure and revenue growth. As we introduce additional products that address physician-identified procedural challenges, we expect case volume per physician to become an increasingly important contributor to revenue growth and overall execution efficiency. Now let's turn to commercial execution. We ended the quarter with 93 quota-carrying territory managers who were supported by over 400 agents and junior representatives. We designed the hybrid model so that our territory managers lead clinical education and cultivate high-value physician relationships, while third-party agents and junior representatives provide procedural support and extend our reach across accounts and geographies. Trailing 12 months revenue per territory was approximately $2.2 million, reflecting continued productivity gains and the scalability of our hybrid commercial model. We remain on track to exit 2026 with nearly 100 territories. This is a deliberate expansion ahead of multiple product launches planned for the next 18 months. Building capacity now gives our territory managers the bandwidth to strengthen physician relationships, prepare accounts for upcoming launches, and support rapid post-launch adoption. We also continue to progress in our commercial partnership with Smith+Nephew. Physician and field engagement is growing, and that's translating into steady improvement in adoption. We're coordinating joint field activity with Smith+Nephew's leadership team and expect momentum to build throughout the rest of 2026. Before I turn the call over to Anshul, I'd like to thank my colleagues for their continued dedication and exemplary execution. With our upcoming product launch and an active pipeline of new solutions, we're adding to our track record of meaningful and differentiated innovation. Together, we're entering an important new phase of growth. This is a direct result of your work, and I'm incredibly proud of what we're building together. Anshul will now discuss our fourth priority, operational excellence, along with additional financial details and our updated outlook. Anshul Maheshwari: Thanks, Laura. Good afternoon, everyone. I will focus on second quarter revenue growth, profitability, liquidity, and our updated 2026 revenue guidance. Unless otherwise noted, all comparisons are with the same period last year. Starting with revenue growth, worldwide revenue was $56 million, representing 15.2% growth. U.S. revenue increased 14.7% to $53.2 million. U.S. procedure volume increased nearly 15% with double-digit growth across all modalities. On a 2-year stack basis, procedure volume grew nearly 20% in the quarter. International revenue increased 25.9% to $2.8 million, driven by growing demand for TORQ and TNT. Given this momentum, we are evaluating opportunities to introduce more of our portfolio and future products in existing international markets and to qualify and enter select new target geographies. We believe these initiatives can make our international business an increasingly meaningful and durable contributor to worldwide growth. Turning to profitability. Gross profit increased 14.8% to $44.5 million. Gross margin remained strong at 79.5%, supported by the stable average selling price, product cost optimization initiatives, and improved utilization of surgical capacity. Operating expenses increased 7.7%, a rate substantially below revenue growth, resulting in meaningful operating leverage, which was well ahead of what we had indicated at the beginning of 2026. The operating expense increase reflected ongoing investment in R&D, higher commissions associated with revenue growth, and targeted marketing investments supporting recent and upcoming product launches. Net loss narrowed to $4.1 million or $0.09 per diluted share compared to a net loss of $6.2 million or $0.14 per diluted share. Adjusted EBITDA improved 178% to $2.8 million, representing an adjusted EBITDA margin of approximately 5.1%. For the trailing 12 months through the second quarter, adjusted EBITDA quadrupled to $12.8 million compared with the prior year period. This step-up in profitability reflects both our strong top line growth and the scalability of our infrastructure. As Laura highlighted, we are developing product material and software capabilities that will broaden our product portfolio and address additional clinical needs. Given our outperformance on profitability in the first half, we are intentionally increasing targeted research and development investment in the back half of the year to advance these longer-term programs. While remaining committed to our annual operating leverage and profitability expansion goals, we believe these programs can create differentiated capabilities in treating compromised bone, support faster revenue growth, and significantly increase long-term profit dollars. Turning to liquidity and cash flow. We ended the quarter with $145.9 million in cash and equivalents, an increase of approximately $1.3 million sequentially. We also delivered another quarter of positive cash flow from operations reflecting continued operating rigor and disciplined working capital management. We expect to see higher than normal cash flow variability in the next two quarters, mostly driven by the timing of payments for build-out of a new headquarters, the vast majority of which is now expected in the third quarter, and the timing of the resulting tenant improvement allowance reimbursement. We're also investing in surgical capacity to support the new product launch. These temporary yet disciplined investments will strengthen our operating infrastructure, improve our employee experience, and position the company to scale efficiently as we enter our next phase of growth. With approximately $146 million in cash and equivalents, and a clear line of sight to consistent free cash flow generation, we can fund our planned development programs while maintaining financial flexibility. Turning to guidance. Based on strong first-half performance, we are raising the low end of our 2026 worldwide revenue guidance while maintaining the high end. We now expect revenue of $231 million to $233 million, representing approximately 15% to 16% growth. Our prior guidance was $230 million to $233 million, representing approximately 14% to 16% growth. We entered the second half with strong momentum and multiple upcoming catalysts, including the anticipated 510(k) clearance of the new product, as well as the potential benefit of higher reimbursement from Granite in the fourth quarter. Given the timing of the 510(k) clearance, the phased nature of the launch, and the time required for reimbursement changes to translate into procedure growth, we're maintaining a measured approach on the impact of these catalysts. We are maintaining full-year gross margin guidance at 79%. At the midpoint of our revenue range, we now expect full-year operating expenses to increase in the 12% area. With that, I will turn the call over to Laura. Laura Francis: Thanks, Anshul. Our second quarter results extend our track record of outperformance across revenue and profitability. With an expanding portfolio in compromised bone, increasing commercial capacity, an improving reimbursement backdrop, and a multi-year innovation pipeline, we believe we are well-positioned for durable growth and expanding profitability in 2027 and beyond. With that, we're happy to answer your questions. Operator? Operator: [Operator Instructions] Our first question will come from the line of Matthew O'Brien of Piper Sandler. Matthew O'Brien: For starters, maybe Anshul, just on the guide for the year, good to see Q2 come in a little bit above expectations, but if you do the math on the back half, it's about a $500,000 increase to the midpoint, you know, versus $1 million that you just put up. It also kind of implies that the back half U.S. number decelerates a little bit versus the first half. So, you know, is there something specific? Are you having a little bit harder time getting into these -- this latest tranche of clinicians in terms of your full product portfolio or is it something else that you really want to call out as far as the guide goes for the back half. And then I do have a follow-up. Anshul Maheshwari: Sure, happy to take that, Matt. On the guidance side, let me just start. Well, look, we're feeling great about the setup we have going into the back half of the year. 19% growth in active physician base. That's a very solid physician base to enter the back half of the year with. The broad-based procedural demand growth that we saw -- as you saw in the second quarter, sequentially growth grew 9% on a 2-year CAGR 20%. The sequential growth was one of the strongest that we've seen in recent history at that 9% sequentially in the second quarter. And then the growing infrastructure on the commercial side positions us well. So that's on what's already in the business. Then you layer on additional catalyst around the anticipated launch of the third breakthrough device and also the impact of the new DRGs that just got finalized on Friday, those are additional tailwinds in the business as well. Now, when it comes to guidance, as I said in my prepared remarks as well, we're being consistent with our thoughtful guidance philosophy. We know third quarter seasonality can have a little bit of noise in the business. And also, we want to make sure we're growing into these catalysts that I just outlined around the third breakthrough device and the new DRG impact on the fourth quarter. So we actually feel pretty good about the setup and there could be room for upside as those catalysts play out better than anticipated. Matthew O'Brien: Got it. Appreciate that. And then congrats on filing for the third breakthrough device product. Would love to just hear, and I know we're not going to get much on the product itself, but just about the profitability profile of that device. Is it going to be a big drag on gross margins or operating margins for a while? Are there big working capital requirements? Or is it similar to what you have right now in the business? And do you think there could be a halo effect from that device for the rest of the portfolio as it starts to see more uptake in '27? Anshul Maheshwari: Yes, Matt, that's a great question. So really excited about the third breakthrough device that we filed a 510(k) for in June, so it was actually ahead of schedule for us. And that sets us up really well on being able to subject to FDA clearance, commercialize this product in the fourth quarter, and as Laura said in her prepared remarks, as early as October. So feeling really good about this. Now, this device actually has some inherent advantages. First, it's serving a call point where we already have established relationships. Granite, as you know, has been a great success with spine surgeons and it's going to go after that same market from a call point perspective. Second, this is targeting one of the largest known unmet needs in spine fusion procedures as well. So it's a known physician challenge that we're going after. And number three, it actually fits the physician workflow, so there is no need for extensive training. What that means is once we get through the alpha launch in the fourth quarter, this product actually has potential to rapidly scale. And as you asked about the gross margin implications, we're in the process of building out the surgical capacity to be prepared for a fourth quarter launch. Our gross margin assumptions right now are at 79% for the year. We were very deliberate in holding those gross margin numbers at 79% despite the outperformance in the first half. That is because we are anticipating depreciation on those assets to start out earlier on and revenue to follow subsequently. Overall, it should actually be an efficient ramp for us because our reps already are in relationship with those docs. They are in a lot of the procedures with Granite already. So we're pretty excited about the commercial ramp as well. Operator: Our next question will be coming from the line of Caitlin Roberts of Canaccord Genuity. Caitlin Cronin: Congrats on the quarter. I guess just maybe starting with the procedure volumes, just want to get maybe a little bit more color on what really drove the strength in the quarter and the sequential increase. Any one call point or product to call out there? Laura Francis: I can talk a little bit to what we're seeing on the procedure volume side. It's broad-based, actually. So, we have three different areas of procedures that we're talking about. We have our SI joint fusion procedures, our pelvic fixation procedures, and our pelvic trauma procedures. And as we said in our prepared remarks, all of those areas grew in the double digits. And then there's three different call points that we're selling to as well, spine surgeons, interventional spine, and then trauma surgeons, which are more being approached by distribution and Smith+Nephew. But strong growth there too. So I would say that the growth that we're actually seeing, Caitlin, is broad-based in the quarter. And then we're excited about where we're headed as well with the new product that Anshul just talked about quite a bit, our new product that is planned to come out in the fourth quarter that we filed with the FDA already. And then one thing that hasn't been discussed yet, we actually had a very big day on Friday and it was the confirmation of the new Granite DRGs. Those DRGs specifically reference our Granite technology. The increase is up to $50,000 for those new DRGs, so that has all been confirmed and will go into place on October 1st. And then in addition, there was also a lot of discussion in the CMS notes about breakthrough devices. There is a grandfather clause that's been put through that does recognize those breakthrough devices and the alternative pathway to receive an NTAP. So we believe we're going to fall into that category as well. So we have a lot of catalysts that we're talking here that are going to drive these procedure volumes, whether it's reimbursement or new product, in addition to some new platform launches that are going to be coming out as well. So what we're doing is we're expanding our commercial footprint in order to support all of that in the coming quarters. Anshul Maheshwari: The only thing I would say, Caitlin, is Laura mentioned the huge physician base and the double-digit growth across all call points. As we launch this third breakthrough device, that's a huge asset for us and a huge competitive advantage. Not just for this product, but for future products, but specifically for this product, we do feel great about the position and the ability to really accelerate the adoption for this product even better than, you know, what we've seen with Granite, for example, which was, as we've said in our prepared remarks, one of our fastest scaling products. Caitlin Cronin: Awesome. And then maybe just a question on the future products. You had 2, you noted potentially coming in the next 18 months. Any color on those, such as if they're beyond the sacropelvic anatomy as well, and if they're enabling tech-related, I know you called out software, capabilities as a potential, you know, R&D investment, and just thoughts on M&A, and your interest in that, or is the main focus really on the internal investment? Laura Francis: Yes, good questions. And so the way that we've been expanding is thinking about compromised bone as the focus for the company. And what it's allowed us to do is we already have a very strong organic growth engine within the company. Our product development capability that we have, whether it's engineering or product marketing or regulatory quality, is a very high performing organization. And then we have the support of the clinical work that we've done, very high-quality clinical work, the education that's focused on these new devices and then the support from a reimbursement perspective. So what we're doing is we're going after those broader categories and it's basically filled our product roadmap with these new products. And so as I said, we've really developed this core capability that's been a focus for us. And so what we're really going to do is just to leverage that. And we're going to continue to focus, though, on our existing call points. So we think that's really important so that we can remain focused and really leverage just the sheer number of surgeons that we're working with. We expect that we'll probably work with close to 3,000 surgeons just this year alone. And by launching additional products that can be used with those existing surgeons and oftentimes in the same cases it gives us the opportunity to significantly increase our surgeon density as well as our average selling price for those different procedures. So you should think along those lines. We are also expanding some of our capabilities. We talked a little bit about AI and software capabilities. We think that's a natural extension of what we've been doing with our anatomy-specific implants. Our TNT implant is an example of that. We're also working with new technologies and new materials as well, which we think are important in some of these markets for these patients with compromised bones. So a lot of different organic activities that we're engaged in. As it relates to M&A, that's really not our focus area. Our focus area is really more around what are we going to do organically to drive growth and accelerate growth. Operator: Our next question will come from the line of Xuyang Li of Jefferies. Young Li: I guess to start, I'm just kind of curious, you know, as you expand and increase your profitability, can you maybe talk a little bit about some of the internal focuses that might get more attention versus others? I'm thinking things like you talk about more R&D, so the potential to launch more products and extensions, the potential for commercial expansions. I'm thinking adding more territories as well as partnerships as well as OUS expansion. So where do those rank internally? Laura Francis: I think if you listen to what I just described, what we're really doing is we have developed these core competencies over the last few years in product development, clinical, education, and reimbursement, and so the focus is going to continue to be on driving those core competencies and using them in order to accelerate the growth of the business and get operating leverage as well. So you should expect to continue to see us spend a significant percentage on R&D and that includes our clinical by the way. But you should also expect to see us continue to drive the sales force productivity upward from the $2.2 million that we talked about. And you should expect to just see us leverage a lot of those other capabilities that we've built over time. So I would say that from a profitability perspective, we're going to continue to do what we've been doing. And that's continue to drive the growth on the top line, but drive that down to the bottom line from a profitability perspective. And then, as we said, also have a nice line of sight to free cash flow as well. Anshul Maheshwari: Yes, Xuyang, just to provide a little bit more context as well, even though we added more territories in the quarter, you saw productivity improve at the territory level. So as we think about a commercial expansion, that's going to be very deliberate and targeted, and you should still continue to see productivity improve. Now, you know, the initial pace of improvement may be a little bit more moderate, but the benefit of our innovation strategy is by focusing on the same call point, going after known unmet needs, the productivity ramp should be much faster once those territories have been established. So you've seen us use this playbook before, before we launched TORQ and Granite. We did expand our sales footprint, but you saw us really quickly accelerate our productivity from what was sub-$1 million to $2-plus million in a span of three years. This time around with more product launches at a more regular cadence, we feel really good about the ability to continue to drive productivity over time. So that's one aspect. The other aspect, when we think about the spend on the R&D side, that spend, if you look at what we did in the current year as well, you know, we're ahead on the profitability side in the first half of the year. We actually adjusted our OPEX guidance to actually be at 12% growth versus the 12.5% growth while still having the flexibility to invest in some of these growth-driven initiatives, that could have a meaningful impact on the business as early as late '27 into 2028. So we're striking the right balance. Like Laura said, we expect profitability to continue to grow. Our midterm guidance has always been for this year around 1.2, 1.25 operating leverage. Even at the midpoint of our revenue guide, we're ahead of that. And what we've said over time, that revenue leverage would oscillate anywhere between 1.25 to 1.75x, and we feel very comfortable about that. Young Li: Okay, great. That's really helpful. And then I guess just on the third breakthrough device and then, you know, you also kind of commented on other new products launching in the next several years. How should we think about these new products expanding your TAM for surgeons as well as number of procedures? Laura Francis: Yes, these new procedure types that we're talking about, they will actually expand our TAM. They are not sacroiliac joint procedures. They're not pelvic fixation procedures. So they are additive to the business. And as I said, this next breakthrough device that we're talking about that's launching later this year is one that we can lean into our existing call point, our existing procedures, and our existing distribution capability as well. So that's a good example of what we're planning to do in our product roadmap. So it's continuing to focus on those existing call points and identify the opportunity. We really have a laser focus on increasing surgeon density. We have such a big asset between our sales force, our hybrid focus, including third-party agents, but then also just the sheer number of physicians that we're working with right now, spine surgeons and interventionalists in particular. It gives us the ability to deliver additional products. And we're not talking about me-too products, these are breakthrough devices addressing unmet clinical needs and developing new markets basically and becoming the market leader in those different spaces. So we're very excited about where we're going and, as I said, everything is falling into place for us from a product perspective and a reimbursement perspective as well. Operator: Our next question will be coming from the line of David Saxon of Needham & Company. David Saxon: Congrats on the quarter. So, looks like territories ticked up and I think in the past you've talked about getting to 100 over time. So I wanted to ask about how you're approaching hiring and actually getting to 100 in the context of this upcoming product launch and kind of the broader pipeline over the next 18 months. Like, are these independent workflows or are you thinking about kind of accelerating the hiring to capitalize on what you have with this breakthrough device and then these other products you're talking about. Laura Francis: Yes, hiring is definitely a key focus for us right now. As you know, over the last three years, we've kept our number of territory managers relatively constant. And the reason why we did that was the operating leverage that we were able to get on, Anshul mentioned going from $1 million to over $2 million in sales rep productivity over these last few years, and that really was an area of focus for us. And also just leveraging that hybrid organization that we have with our more junior territory representatives covering cases, and then our third party agents as well. But we are going into a different period in the history of the company. And the new device that we're coming out with, this third breakthrough device, has been a very important area for us to build our internal capabilities and to hire additional quota-carrying territory managers. We're doing that in a couple of ways. One way is to promote some of those high-quality territory representatives that have been with the company for some period of time, split the territory, and provide them with their own book of business. And then it's also hiring people from outside of the company as well. So things have changed. We ended the quarter with 93 territory managers. As we said, our plan is to grow that to close to 100 by the end of the year, and you're going to see some more hiring into 2027 too. And the goal is it usually takes around six months for a territory manager in order to get productive and so we are hiring in anticipation of these upcoming launches. David Saxon: Okay, that's helpful. Thanks for that, Laura. And then on the Smith+Nephew partnership, I'd love to hear kind of the early feedback you're getting. And then in terms of, you know, procedure volumes, how are you seeing those ramp in the new centers they're getting you in? And then just in general, like how long do you expect it to take to fully ramp that partnership and then, your thoughts on how meaningful that partnership could be in terms of revenue contribution longer term, but also in 2027. Laura Francis: Yes, I think this is a very important partnership that we've developed because what we really want to do is focus our existing territory managers on ortho and neuro spine surgeons as well as interventional spine physicians as well. So Smith+Nephew, they really have the depth of relationship with orthopedic trauma surgeons. And it is a different call point. Our TNT product, our TORQ product, the ability to address sacral insufficiency fractures with those surgeons we think is absolutely critical. In terms of the relationship with Smith+Nephew, the partnership is progressing well. The cases are underway. There's a lot of physician engagement that's including both the territory manager from Smith+Nephew as well as our own territory manager and we really like the collaboration that we're seeing between our two organizations. So, operationally we're continuing to train their field organization and expand surgical capacity, additional trays that are getting out into the field, inventory implants that are getting out into the field. But if you think about a normal onboarding cycle with new physicians, I had mentioned that it takes around six months for a territory manager to get up to speed. We're seeing something similar to this with the Smith+Nephew relationship. So really preparing for that seasonally strong fourth quarter is how we're thinking about it. Operator: Our next question will come from the line of Richard Newitter of Truist Securities. Richard Newitter: Maybe, Anshul, just while you have all of us here at once, I guess, appreciate the small bump to the midpoint of the guidance range for the year. But for third quarter, within the context of your seasonality comments, it looks like the Street is modeling about $55.5 million. Is that a good place to be in the right level of seasonality and all the push-pulls that we have kind of thinking quarter to quarter? And I guess I'll have to follow up after that. But anything else you'd call out from a quarterly cadence standpoint, too, down the P&L as well? Anshul Maheshwari: No, Richard, so obviously, as you know, we don't guide to quarters. But historically, you've seen seasonality in the third quarter. A lot of times it's vacations. It's also conferences that may show up, although this time NASS is in the fourth quarter, not in the third quarter, that used to be the big conference. The way we've assumed it in our guidance is sort of the between 1% and 2% sequential decline just from a seasonality standpoint. Now what we have going on in the business is the strong physician base, the expanded sales force, the opportunity with interventional with the INTRA family of products. And like Laura said, continuing to do the work we're doing with TNT. So I think our focus is how do we work through that seasonality, but right now what's embedded is that 1% to 2% sequential decline. Richard Newitter: Okay. And then maybe just for follow-up, I guess as I look at the drivers that you have, it sounds like you're embedding some conservatism in answering Matt's question to the back half deceleration. It sounds like all else equal, If business trends hold, you should do better and you're not factoring in a ton of contribution from some meaningful tailwinds like the reimbursement and new product launch contribution. So I guess the question here is, all else equal, is there any reason why 4Q shouldn't hold if not accelerate from -- shouldn't accelerate from 2Q levels? And then also just if you can answer, do we get concern over utilization trends out there in the recent months, especially for spine and ortho. And if you've seen anything, your quarter-over-quarter unit growth wouldn't suggest that, but I'm just curious if you can just give us a sense of what you're hearing out there from your customers and if there's anything that you would flag. Anshul Maheshwari: Yes. No, again, Richard, not getting into quarterly guidance expectation setting, but you're spot on when you think about all the things that we have going on for our business, especially as we approach that October 1, there are quite a few things that could drive upside in the fourth quarter, and that gives us excitement. But some of that is, as we said, we want to moderate our own expectations from a guidance perspective, just given the timing of when some of those come into play. So, the faster-than-anticipated impact of the DRGs, our assumption is it takes some time for the reimbursement to flow through and get reflected in the procedure volume. But in this case, it's a new DRG. It automatically maps all Granite procedures to the new DRG. There is no special coding requirement as such, which was the case in NTAP. That's number one. Number two is, you know, we're prepping for bigger than an alpha launch when we go out with this new breakthrough device product, but our assumption is the fourth quarter will be an alpha launch. But as you've heard from our prepared remarks, it's not going after the same call point. It's a known disease state. It's training light. So based on how we see the alpha launch expand, we could accelerate that in the fourth quarter. That could be potential upside. And then the last thing that our guidance does assume is sort of low-single digit ASP degradation. Part of that is just as we think about some of the things that could ramp in interventional, which uses fewer implants, or in trauma, which uses fewer implants. That's the underlying assumption. Now, you know, this new product that we want to launch is complementary to Granite. It could be used in the same case as Granite. So you could actually have ASP upside. So there's a lot of potential for outperformance, but we want to be really measured because we want to see how some of these play out in the fourth quarter. Operator: And our next question will be coming from the line of Patrick Wood of UBS. Daniella Paretti: This is Daniella on for Patrick. I wanted to ask you about INTRA Ti. As you touched on in the prepared remarks, one of the biggest benefits of the product is the favorable reimbursement that it has versus its predecessor and peers and that it receives nationwide CMS reimbursement and unlocks 22-some-odd states that were previously uncovered. So I was curious, what has been the interventionalist feedback on INTRA Ti so far since launch? And are you seeing outsized demand in those 22 incremental states? Or is it more broad-based? I have one more. Laura Francis: Yes, thanks for the question. We are excited about INTRA Ti. I was actually at the ASPN meeting a couple of weeks ago and what we have now is the broadest portfolio in SI joint fusion. We're obviously the market leader in this space. We have historically worked with spine surgeons but seeing very rapid growth in interventional and the INTRA product line is driving that. And so the goal that we have is to provide a variety of solutions that meet the needs of the patients, the surgeons, the physicians, the site of service. And so, INTRA Ti has a unique role to play. It is a 27279 product. It is a device, that is posterior. It's single use. So in theory it can be used at all sites of service and by surgeons or physicians alike. And so we're actually pretty excited about what we're seeing with INTRA Ti and the initial reception of it. We do think that some of these reimbursement tailwinds going into 2027 are going to continue to drive adoption of INTRA Ti as a solution for 27279 and it can be inpatient, outpatient, ASC, or in office as well. So all of these things bode well for our business and where we're really seeing all of this is just the rapid adoption by interventionalists of our technologies. Daniella Paretti: And then just to expand upon the Smith+Nephew partnership, I totally appreciate that it may take up to 6 months to be fully up and running with the territory managers. But can you just provide some context relative to, let's say, a year ago, how many incremental Level 1 and Level 2 trauma centers do you now have access to where you can plug TORQ and TNT, among other products. Laura Francis: Yes, I mean, we don't usually give that specific sort of information, but there's a couple hundred Level 1, Level 2 trauma centers that we're going after, specifically working with Smith+Nephew. It is an area where our sales are small, so there's a lot of opportunity for growth in that particular space. And we do think that there's a really nice symbiotic relationship between us and Smith+Nephew, given the breakthrough device that we have addressing this unmet clinical need with sacral insufficiency fractures, but then their depth of relationship on the trauma side specifically. And ultimately, our goal is to keep our sales force focused on spine and interventional, and then leverage that capability with Smith+Nephew on the trauma side. Operator: Our next question will come from the line of Matt Blackman of TD Cowen. Andrew Ranieri: It's Drew on for Matt tonight. Just first on utilization, Laura, you kind of touched on this through your prepared remarks and some of the answers to the questions, but one of the things you said was we expect case volumes per physician to become an increasing contributor to revenue growth. And you know, just when I look over the last couple years, we've seen 20% active surgeon growth, while utilization is really not much moved much. So maybe what can the business look like heading into 2027? I mean, how much of utilization can be driven from taking the economic arguments off the table, what's the limiting factors for utilization? Just maybe just talk a little bit more about what you're seeing and why investors should have confidence that utilization growth can really kind of finally start. Laura Francis: Yes, I think it's a great question. And Drew, quite frankly, I think it's what I'm most excited about for the business going forward. We have done an extraordinary job of first of all building a first-class sales organization. We've invested a lot in it and developing this hybrid organization where we're working with third party agents and junior reps. It's given us this very broad reach in the United States. And -- but what you've seen, as you said, is you've seen a lot of one-for-one in terms of growth of our surgeon numbers and growth in terms of volume. And this quarter is no exception, an increase of 19% in the number of physicians that did at least one case in the second quarter. It's 1,715 physicians that did at least one procedure with us. That number rivals most of the largest players in this market. And so, you know, where we can really grab operating leverage is by increasing this utilization number. And I do think that the product launches that we're talking about here are particularly important. And I'm not talking about 18 months from now, I'm talking about the next product launch that we are going to as early as October start to see sales of that particular product. Those are procedures that the same surgeon base that we've been growing for all of these years, those surgeons are very excited about using this particular product. And as I said, in some cases they're going to be using it in independent procedures. In other cases they're going to be using it with our existing Granite products as well. So it really represents a very specific opportunity for us to truly leverage utilization and increase our surgeon density. Andrew Ranieri: And just, Anshul, a question to you, and I'm sure you're going to love this one. But just kind of given some of Laura's comments right there. You were just talking too about really your R&D spending. You're going to have more reps into 2027. As we do think about 2027's leverage capabilities, should we be thinking about the lower end of the range that you gave at 1.2? Or is there enough positives, tailwinds that you could actually see maybe something better than that in leverage for next year. Anshul Maheshwari: Yes, Drew, you're right. I won't be responding to that question yet because I'm not providing guidance. But, you know, the way the business is set up, a lot of that leverage and the spend that you're seeing happen this year will be reflected in what we can see in the long-term growth rate of the business. A lot of the things that you've heard us talk about today, those are not one-time catalysts, those are multi-year catalysts, whether it's the new products like TNT and INTRA Ti continuing to gain traction, whether it's a better reimbursement for Granite with the new DRGs, the potential for higher SI joint reimbursements at ASCs and outpatient as well as the potential for OBL for 27279. Then you've got the potential for NTAP that we plan to apply for the third breakthrough device that if approved, and we have a pretty good track record of that going effective October 1, 2027. So you've actually got a lot of revenue tailwinds in the business. And that gives us confidence that the operating leverage will continue to improve in the outer years. Now, timing of whether it's 1.3x next year or is it 1.5x next year, will be dependent on where we are in the investment cycle for a product, but we're feeling very good about the leverage continuing to grow, more dollars coming to the bottom line. And we just talked about the cash flow inflection as well, Laura did earlier in the Q&A. That's huge for us. If you look at the last 5 quarters, 4 of the last 5 quarters, we were positive cash flow from operations. And if you look at our cash balance has actually grown year-over-year since Q2 of last year, and that's after making investment in the surgical capacity. So we're not just thinking about the stronger top line. We're thinking about the stronger top line, the continued operating leverage, maintaining the asset-light business so we can get more profit dollars to the bottom line, start moving from adjusted EBITDA to more GAAP profitability, but also then start inflecting on a sustained basis on free cash flow. Operator: I'm showing no further questions. I would now like to turn the conference back to Laura for closing remarks. Laura Francis: I'd just like to say thank you to everybody. I appreciate you participating in our call, as well as your interest in SI-BONE. And we look forward to seeing you all at upcoming conferences and non-deal roadshows. Goodbye. Operator: This concludes today's conference. Thank you for participating. You may now disconnect. Before you buy stock in SI-Bone, consider this: The Motley Fool Stock Advisor analyst team just identified what they believe are the 10 best stocks for investors to buy now… and SI-Bone wasn’t one of them. The 10 stocks that made the cut could produce monster returns in the coming years. 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As with all our articles, The Motley Fool does not assume any responsibility for your use of this content, and we strongly encourage you to do your own research, including listening to the call yourself and reading the company's SEC filings. Please see our Terms and Conditions for additional details, including our Obligatory Capitalized Disclaimers of Liability. The Motley Fool has no position in any of the stocks mentioned. The Motley Fool has a disclosure policy. SI-BONE (SIBN) Q2 2026 Earnings Call Transcript was originally published by The Motley Fool

This article first appeared on GuruFocus. Revenue: Worldwide revenue was $56 million, up 15.2% year-over-year. U.S. Revenue: Increased 14.7% to $53.2 million. International Revenue: Grew 25.9% to $2.8 million. Gross Profit: Increased 14.8% to $44.5 million. Gross Margin: Remained strong at 79.5%. Net Loss: Narrowed to $4.1 million, or $0.09 per diluted share, compared to a net loss of $6.2 million, or $0.14 per diluted share, in the prior year. Adjusted EBITDA: Improved 178% to $2.8 million, representing an adjusted EBITDA margin of approximately 5.1%. Cash and Equivalents: Ended the quarter at $145.9 million, an increase of approximately $1.3 million sequentially. Cash Flow: Delivered another quarter of positive cash flow from operations. Operating Expenses: Increased 7.7%, a rate substantially below revenue growth. Physician Engagement: 1,715 unique physicians performed at least one procedure, an increase of approximately 19% versus the same quarter a year ago. Commercial Capacity: Ended the quarter with 93 quota-carrying territory managers, supported by over 400 agents and junior representatives. Revenue Guidance: Raised the low end of 2026 worldwide revenue guidance to $231 million to $233 million, representing approximately 15% to 16% growth. Warning! GuruFocus has detected 3 Warning Signs with SIBN. Is SIBN fairly valued? Test your thesis with our free DCF calculator. Release Date: August 03, 2026 For the complete transcript of the earnings call, please refer to the full earnings call transcript. SI-BONE Inc (NASDAQ:SIBN) delivered strong second-quarter results with worldwide and U.S. revenues of $56 million and $53.2 million, respectively, both representing approximately 15% growth, and U.S. procedure volume grew nearly 15% with double-digit growth across all modalities. The company achieved significant operating leverage, with revenue growing nearly twice as fast as operating expenses, leading to a 178% improvement in adjusted EBITDA to $2.8 million. SI-BONE Inc (NASDAQ:SIBN) submitted a 510(k) application for its third breakthrough device, a non-pelvic solution targeting a recognized failure point in complex spine procedures, with a phased commercial launch on track for Q4 2026. The company saw broad-based physician adoption, with 1,715 unique physicians performing procedures in Q2, a 19% increase year-over-year, and double-digit growth across all call points. Reimbursement tailwinds are strong, including a proposed ~$1,000 increase for SI joint fusion CPT code 27279, new OBL reimbursement of over $20,000, and new DRGs for complex spinal fusion that could increase hospital payments by up to $50,000 per procedure. SI-BONE Inc (NASDAQ:SIBN) raised the low end of its 2026 revenue guidance to $231 million-$233 million, reflecting 15%-16% growth, and maintained its gross margin guidance at 79%. The company's updated 2026 revenue guidance implies a slight deceleration in U.S. revenue growth in the back half of the year, with management citing typical Q3 seasonality and a measured approach to new product and reimbursement catalysts. SI-BONE Inc (NASDAQ:SIBN) expects higher-than-normal cash flow variability in the next two quarters due to timing of payments for its new headquarters build-out and investments in surgical capacity for the upcoming product launch. The company is intentionally increasing R&D investment in the back half of the year to advance longer-term programs, which could temper near-term profitability expansion despite first-half outperformance. Gross margin is expected to remain flat at 79% for the full year, as the company anticipates depreciation on new surgical capacity assets to begin before associated revenue ramps up. The commercial partnership with Smith & Nephew is still in early stages, with a typical onboarding cycle of around six months for new physicians, meaning meaningful contribution from this channel may not materialize until late 2026 or 2027. The company's guidance assumes low single-digit ASP degradation, partly due to growth in interventional and trauma procedures that use fewer implants per case. Q: Can you provide more color on what drove the strength in procedure volumes and the sequential increase in Q2? Was there a specific call point or product to highlight? A: Laura Francis (CEO) noted that the growth was broad-based across all three procedure areas (SI joint fusion, pelvic fixation, and trauma) and all three call points (spine surgeons, interventional spine, and trauma surgeons). She highlighted the confirmation of new DRGs for Granite, which could increase hospital payments by up to $50,000 per procedure, and the proposed reimbursement increases for SI joint procedures, including a new OBL payment of over $20,000. These catalysts, along with the upcoming launch of the third breakthrough device, are expected to drive continued procedure volume growth. Q: Regarding the third breakthrough device, what is its profitability profile? Will it be a drag on gross or operating margins, and what are the capital requirements? A: Anshul Maheshwari (CFO & COO) explained that the device targets a call point where SI-BONE already has established relationships (spine surgeons) and addresses a known unmet need in spine fusion. It fits the physician workflow, requiring no extensive training, which allows for rapid scaling post-launch. The company is building surgical capacity, and the 79% gross margin guidance for the year already anticipates depreciation on these assets. The commercial ramp is expected to be efficient due to existing physician relationships. Q: Can you elaborate on the future products expected in the next 18 months? Are they beyond sacral pelvic anatomy, and are you focusing on internal investment versus M&A? A: Laura Francis (CEO) stated that the company is expanding its focus on compromised bone, with a strong organic growth engine. The new products will expand the total addressable market (TAM) and are not SI joint or pelvic fixation procedures. The company is also exploring AI and software capabilities, as well as new materials. M&A is not a focus; the priority is organic growth and leveraging the existing surgeon base to increase density and average selling price. Q: How should we think about the new products expanding your TAM for surgeons and the number of procedures? A: Laura Francis (CEO) confirmed that the new procedure types will expand the TAM and are additive to the business. The upcoming breakthrough device leverages existing call points, procedures, and distribution capabilities. The strategy focuses on increasing surgeon density by delivering additional breakthrough devices that address unmet clinical needs, creating new markets and establishing market leadership. Q: Can you provide an update on the Smith & Nephew partnership, including early feedback and how procedure volumes are ramping in new centers? A: Laura Francis (CEO) described the partnership as progressing well, with cases underway and strong collaboration between the two field organizations. The focus is on orthopedic trauma surgeons, a different call point for SI-BONE. The company is training Smith & Nephew's field organization and expanding surgical capacity. Similar to onboarding new territory managers, the partnership is expected to take about six months to ramp, with preparations targeting a strong fourth quarter. Q: What is the expected quarterly cadence for Q3, and are there any concerns about utilization trends in Spine and Ortho? A: Anshul Maheshwari (CFO & COO) acknowledged historical Q3 seasonality, with a 1% to 2% sequential decline embedded in the guidance. He noted that the new DRGs automatically map all Granite procedures, requiring no special coding, which could drive upside in Q4. The guidance assumes a low single-digit ASP degradation, but the company is prepared for a larger-than-alpha launch of the new device, which could accelerate adoption. He expressed confidence in the business's momentum and the potential for upside from these catalysts. Q: What has been the interventionalist feedback on IntraTI since launch, and are you seeing outsized demand in the 22 incremental states? A: Laura Francis (CEO) expressed excitement about IntraTI, noting it provides the broadest portfolio in SI joint fusion. The product is a 27279 device, posterior, and single-use, making it suitable for all sites of service. The company is seeing rapid adoption by interventionalists, and the reimbursement tailwinds are expected to drive further adoption into 2027. The feedback has been positive, and the product is positioned to benefit from the proposed reimbursement changes. Q: How much of utilization growth can be driven by removing economic barriers, and what are the limiting factors? A: Laura Francis (CEO) stated that increasing utilization is a key focus. The company has built a first-class sales organization and a large physician base (1,715 physicians in Q2). The upcoming product launches, particularly the third breakthrough device, are expected to drive utilization by offering procedures that the existing surgeon base is excited to use, sometimes in conjunction with Granite. This represents a specific opportunity to leverage utilization and increase surgeon density. Q: As you expand profitability, where do internal focuses rank, such as R&D, commercial expansion, partnerships, and OUS expansion? A: Laura Francis (CEO) emphasized continued focus on core competencies in product development, clinical education, and reimbursement. The company will continue to drive salesforce productivity upward from $2.2 million and leverage built capabilities. Anshul Maheshwari (CFO & COO) added that commercial expansion will be deliberate and targeted, with productivity expected to improve. R&D spending is being increased to support growth initiatives that could impact the business as early as late 2027 into 2028, while maintaining operating leverage and profitability goals. Q: Can you provide context on the number of incremental Level 1 and Level 2 trauma centers you now have access to through the Smith & Nephew partnership? A: Laura Francis (CEO) did not provide specific numbers but noted that there are a couple of hundred Level 1 and Level 2 trauma centers being targeted with Smith & Nephew. The company's sales in this area are currently small, presenting significant growth opportunity. The partnership is symbiotic, leveraging Smith & Nephew's depth in trauma relationships while allowing SI-BONE to focus its sales force on spine and interventional call points. For the complete transcript of the earnings call, please refer to the full earnings call transcript.

Our analysts just identified a stock with the potential to be the next Nvidia. Tell us how you invest and we'll show you why it's our #1 pick. Tap here. Performance was driven by broad-based demand across all three core procedure areas: SI joint fusion, pelvic fixation, and pelvic trauma. Management attributed the 9% sequential U.S. volume growth to the effectiveness of their hybrid commercial model, which dispelled broader industry concerns regarding the payer environment. The company is strategically pivoting from a sacroiliac-focused leader to a broader spinopelvic company targeting high-risk patients with compromised bone. Operating leverage improved significantly as revenue grew nearly twice as fast as operating expenses, reflecting the scalability of the existing infrastructure. The active physician base grew 19% year-over-year, with established physicians averaging approximately 3x the case volume of those performing their first procedure. International growth of 26% was led by the expanded portfolio, prompting management to evaluate entering new target geographies to sustain global momentum. Management expects a phased commercial launch of the third breakthrough device in Q4 2026, targeting accounts where the team already has established relationships. Revenue guidance assumes a measured impact from new catalysts, including potential seasonality in Q3 and the time required for reimbursement changes to translate into volume. The company plans to exit 2026 with nearly 100 territories, a deliberate capacity expansion to support multiple product launches planned over the next 18 months. Strategic R&D investment will increase in the second half of 2026 to advance longer-term programs in AI-driven capabilities and new materials. Management anticipates that new CMS-proposed reimbursement increases for SI joint fusion across all outpatient settings will reduce economic barriers and expand physician choice. New DRGs for complex spinal fusion procedures incorporating Granite could increase average hospital payments by up to $50,000 per procedure starting October 1st. A 510(k) application for the third breakthrough device was submitted in June, ahead of the original schedule. Cash flow variability is expected in the next two quarters due to the timing of new headquarters build-out payments and subsequent tenant improvement reimbursements. Guidance assumes a low-single digit ASP degradation due to a shift in product mix toward interventional and trauma procedures which utilize fewer implants. One stock. Nvidia-level potential. 30M+ investors trust Moby to find it first. Get the pick. Tap here. Management characterized the guidance as thoughtful and measured, accounting for Q3 seasonality and the ramp-up time for new reimbursement frameworks. Upside potential exists if the new DRGs for Granite and the alpha launch of the third breakthrough device accelerate faster than the current baseline assumptions. The device is expected to have an efficient commercial ramp because it targets the same physician call point as Granite and requires minimal additional training. Gross margin guidance was held at 79% to account for early depreciation of surgical capacity assets before full revenue contribution begins. The company is focusing on organic growth through its high-performing product development engine rather than pursuing M&A. Upcoming solutions will expand the TAM beyond the sacroiliac joint while remaining focused on existing surgeon call points to increase surgeon density. The partnership is progressing through an onboarding cycle, with momentum expected to build into the seasonally strong fourth quarter. The collaboration allows SI-BONE to leverage Smith+Nephew's deep relationships with orthopedic trauma surgeons while keeping the internal sales force focused on spine and interventionalists.

Delivered ~15% WW revenue growth and ~178% increase in adjusted EBITDA ~19% increase in U.S. physician base Second Quarter 2026 Financial Highlights (all comparisons are to the prior year period) Worldwide revenue of $56.0 million, representing growth of 15.2% U.S. revenue of $53.2 million, representing growth of 14.7% Gross margin of 79.5% Net loss of $4.1 million, representing an improvement of 33.6% Positive adjusted EBITDA of $2.8 million, an improvement of 178.0% Positive cash from operations of $0.8 million $145.9 million in cash and equivalents, representing a sequential increase of $1.3 million Recent Operational Highlights (any comparisons are to the prior year period) 1,715 active U.S. physicians, representing growth of 19% $2.2 million in trailing 12-month average revenue per territory, representing an increase of 5% In June, submitted 510(k) application for the third-breakthrough device targeting one of the largest unmet needs in spine surgery CMS finalized new MS-DRG family providing higher payments for complex spinal fusion procedures that incorporate iFuse Bedrock Granite in an in-patient setting, effective October 1 SANTA CLARA, Calif., Aug. 03, 2026 (GLOBE NEWSWIRE) -- SI-BONE, Inc. (Nasdaq: SIBN), the global leader in developing procedural solutions to address clinical challenges associated with compromised bone, today reported financial results for the quarter ended June 30, 2026. “Our accelerating growth and expanding profitability reinforces our conviction in the demand for our superior platform technologies and the significant runway ahead,” said Laura Francis, Chief Executive Officer. “This quarter’s record physician engagement reflects our strategy to develop unique procedural solutions for patients with compromised bone and underscores the meaningful market need we are addressing. We are excited about the upcoming third breakthrough device launch in the fourth quarter, a substantially improved reimbursement backdrop, and an expanding commercial reach. Together, these tailwinds position us to expand adoption, broaden patient access, and enter our next phase of strong, sustainable multi-year revenue growth.” Second Quarter 2026 Financial ResultsWorldwide revenue was $56.0 million in the second quarter 2026, a 15.2% increase from $48.6 million in the corresponding period in 2025. U.S. revenue for the second quarter 2026 was $53.2 million, a 14.7% increase from $46.4 million in the corresponding period in 2025. U.S. revenue growth benefited from 14.9% growth in procedure volume. International revenue for the second quarter 2026 was $2.8 million, a 25.9% increase from $2.2 million in the corresponding period in 2025. International revenue growth reflects the strong initial reception for iFuse TORQ and iFuse TORQ TNT. Gross profit was $44.5 million in the second quarter 2026, an increase of 14.8% from $38.8 million in the corresponding period in 2025. Gross margin was 79.5% for the second quarter 2026, compared to 79.8% in the corresponding period in 2025. Operating expenses increased 7.7% to $49.4 million in the second quarter 2026, as compared to $45.8 million in the corresponding period in 2025. The change in operating expenses was primarily driven by general commercial activity related to higher revenue and new product rollout as well as increase in research and development spend. Operating loss improved by 31.4% to $4.8 million in the second quarter 2026, as compared to an operating loss of $7.0 million in the corresponding period in 2025. Net loss improved by 33.6% to $4.1 million, or $0.09 per diluted share, in the second quarter 2026, as compared to a net loss of $6.2 million, or $0.14 per diluted share, in the corresponding period in 2025. Adjusted EBITDA was $2.8 million in the second quarter 2026, improving from an adjusted EBITDA of $1.0 million in the corresponding period in 2025. Cash and equivalents as of June 30, 2026 were $145.9 million, compared to $144.7 million as of March 31, 2026. Net cash generated was $1.3 million in the second quarter 2026, compared to $1.1 million in net cash generated during the corresponding period in 2025. Updated Fiscal 2026 Financial Guidance SI-BONE increases 2026 worldwide revenue to be in the range of $231 million to $233 million, implying year-over-year growth of ~15% to 16%. The Company is maintaining gross margin guidance at ~79%, and updating operating expenses guidance to now be ~12% compared to the prior guidance of ~12.5%. Webcast InformationSI-BONE will host a conference call to discuss the second quarter 2026 financial results after market close on Monday, August 3, 2026 at 4:30 P.M. Eastern Time. The conference call can be accessed live over webcast at https://edge.media-server.com/mmc/p/4chyjb8g/. Live audio of the webcast will be available on the “Investors” section of the company’s website at: www.si-bone.com. The webcast will be archived and available for replay for at least 90 days after the event. About SI-BONE, Inc.SI-BONE (NASDAQ: SIBN) is a global leader in developing procedural solutions to address clinical challenges associated with compromised bone. With expertise in biomechanical design and anatomy specific innovation, SI-BONE has built a technology platform with market-leading applications centered on the spinopelvic anatomy. SI-BONE continues to leverage the deep experience in addressing the challenges of low-density bone in the sacrum to develop unique technologies that are targeting new clinical adjacencies to help improve outcomes for patients with compromised bone. Since 2009, SI-BONE has supported physicians in performing over 150,000 procedures. A unique body of clinical evidence supports the use of SI-BONE's technologies, including four randomized controlled trials and over 190 peer reviewed publications. For additional information on the company or the products, including risks and benefits, please visit www.si-bone.com. SI-BONE®, iFuse Bedrock Granite®, iFuse TORQ® and iFuse TORQ TNT® are registered trademarks of SI-BONE, Inc. All other marks referenced herein are property of their respective owners. ©2026 SI-BONE, Inc. All Rights Reserved. Forward-Looking StatementsThe statements in this press release regarding expectations of future events or results, including SI-BONE’s expectations of continued revenue and procedure growth and financial outlook, are “forward-looking” statements. These forward-looking statements are based on SI-BONE’s current expectations and inherently involve significant risks and uncertainties. These risks include SI-BONE’s ability to introduce and commercialize new products and indications, SI-BONE’s ability to maintain favorable reimbursement for procedures using its products, the impact of any future economic weakness or deterioration in economic conditions as a result of tariffs and retaliation by U.S. trading partners on the ability and desire of patients to undergo elective procedures including those using SI-BONE’s products, SI-BONE’s ability to manage risks to its supply chain, future capital requirements driven by new surgical systems requiring instrument tray and implant inventory investment, and the pace of the re-normalization of the healthcare operating environment including the ability and desire of patients and physicians to undergo and perform procedures using SI-BONE’s products. Actual results and the timing of events could differ materially from those anticipated in such forward-looking statements as a result of these and other risks and uncertainties, many of which are described in SI-BONE’s most recent filings on Form 10-K and Form 10-Q, and SI-BONE’s other filings with the Securities and Exchange Commission (SEC) available at the SEC’s Internet site (www.sec.gov), especially under the caption “Risk Factors.” SI-BONE does not undertake any obligation to update forward-looking statements and expressly disclaims any obligations or undertaking to release publicly any updates or revisions to any forward-looking statements contained herein, except as required by law. Use of Non-GAAP Financial MeasuresTo supplement our condensed consolidated financial statements, which are prepared and presented in accordance with generally accepted accounting principles in the United States ("GAAP"), SI-BONE uses two non-GAAP financial measures: Adjusted EBITDA and free cash flow. Non-GAAP measures should be considered supplemental to, and not a substitute for, financial information prepared in accordance with GAAP. Adjusted EBITDA excludes the effect of items that increase or decrease SI-BONE’s reported results of operations. Free cash flow is not intended to represent our residual cash flow available for discretionary expenditures. Management strongly encourages investors to review, when they become available, the company's consolidated financial statements and publicly filed reports in their entirety. The company's definition of adjusted EBITDA and free cash flow may differ from similarly titled measures used by others. Adjusted EBITDA excludes from net loss the effects of interest income, interest expense, depreciation and amortization, and stock-based compensation. Free cash flow is defined as net cash provided by operating activities less purchases of property and equipment. SI-BONE believes the presentation of these financial measures is useful to management because it allows management to more consistently analyze period-to-period financial performance and provides meaningful supplemental information with respect to core operational activities used to evaluate management's performance. SI-BONE also believes the presentation of non-GAAP financial measures is useful to investors and other interested persons as it enables these persons to use this additional information to assess the company’s performance in using this additional metric that management uses to assess the company’s performance. Investor Contact Saqib IqbalVP, FP&A, and Investor [email protected]

Interested in SiBone? Here are five stocks we like better. Strong second-quarter performance: SiBone’s revenue rose 15.2% year over year to $56 million, driven by nearly 15% U.S. procedure-volume growth and a 25.9% increase in international revenue. The net loss narrowed to $4.1 million, while adjusted EBITDA surged 178% to $2.8 million. Product and reimbursement catalysts: The company submitted a 510(k) application for its third breakthrough-designated technology and expects a phased launch as early as October, pending FDA clearance. Proposed CMS reimbursement increases and new complex-spine DRGs could materially improve procedure economics. 2026 outlook raised: SiBone increased the low end of its full-year revenue forecast to $231 million-$233 million, representing 15%-16% growth, while maintaining its 79% gross-margin outlook. The company is also expanding its physician base and sales capacity ahead of several product launches. 4 Recent Earnings Winners Riding Fresh Momentum in May SiBone (NASDAQ:SIBN) reported second-quarter 2026 revenue growth of 15.2% and narrowed its net loss as procedure volumes increased across its U.S. business and international demand rose for its expanded product portfolio. Worldwide revenue reached $56 million for the quarter ended June 30, while U.S. revenue increased 14.7% to $53.2 million. International revenue grew 25.9% to $2.8 million, driven by demand for the company’s TORQ and TNT products. → Lost in Space: Why Aerospace Valuations Are Plummeting Right Now Management said U.S. procedure volume increased nearly 15% year over year and about 9% sequentially, which it described as its strongest second-quarter sequential increase in years. The company said growth was broad-based across SI joint fusion, spinal pelvic fixation and pelvic trauma procedures. Gross profit rose 14.8% to $44.5 million, while gross margin was 79.5%. SiBone said margin performance reflected stable average selling prices, product-cost optimization efforts and improved utilization of surgical capacity. → MarketBeat Week in Review – 07/27- 07/31 Operating expenses increased 7.7%, below the company’s revenue growth rate. The expense increase included research and development investments, higher commissions tied to sales growth, and marketing investments supporting recent and planned product launches. Net loss narrowed to $4.1 million, or $0.09 per diluted share, from a loss of $6.2 million, or $0.14 per diluted share, in the prior-year period. Adjusted EBITDA improved 178% to $2.8 million, representing a 5.1% margin. For the trailing 12 months through the second quarter, adjusted EBITDA was $12.8 million, four times the amount reported in the comparable prior-year period. → GE HealthCare Stock Climbs on Vital Diagnostics Demand The company ended the quarter with $145.9 million in cash and equivalents, up about $1.3 million sequentially, and reported another quarter of positive cash flow from operations. Management said cash flow could be more variable over the next two quarters because of payments related to its new headquarters build-out, tenant-improvement reimbursement timing and investment in surgical capacity for an upcoming product launch. Laura said SiBone submitted a 510(k) application in June for its third technology to receive breakthrough device designation. The product is the company’s first platform intended for use outside the pelvis and is designed to address a failure point in complex spine procedures. Subject to Food and Drug Administration clearance, SiBone expects a phased commercial launch in the fourth quarter, potentially as early as October. Management said the product will target physicians and accounts where the company already has established relationships through its Granite spinal pelvic fixation business. During the question-and-answer session, management said the device is designed to fit into physician workflows without extensive training. The company is building surgical capacity ahead of the anticipated launch and said depreciation associated with those assets was a factor in maintaining its full-year gross-margin guidance despite first-half performance. The company also highlighted reimbursement developments. The Centers for Medicare & Medicaid Services has proposed raising hospital outpatient reimbursement for SI joint fusion procedures by about $2,300 to more than $20,000, while ambulatory surgery center reimbursement would rise about $1,000 to nearly $16,000. CMS also proposed office-based lab reimbursement of more than $20,000 for CPT code 27279. Separately, management said newly finalized diagnosis-related groups for complex spinal fusion procedures, including procedures using Granite, could increase average hospital payments by up to $50,000 per procedure depending on diagnosis and severity. The new DRGs are scheduled to take effect Oct. 1, according to management. SiBone said 1,715 unique physicians performed at least one procedure using its technologies during the second quarter, an increase of about 19% from a year earlier. The company said the quarterly physician count exceeded the number of physicians using its products during all of 2023. The number of physicians performing more than one procedure type increased about 15%. Management said physicians active in both the current and prior-year quarters averaged about three times the case volume of doctors completing their first SiBone procedure during the quarter. SiBone ended the quarter with 93 quota-carrying territory managers, supported by more than 400 agents and junior representatives. Trailing 12-month revenue per territory was approximately $2.2 million. The company expects to exit 2026 with nearly 100 territories as it adds capacity ahead of multiple anticipated product launches over the next 18 months. Management also said its commercial partnership with Smith+Nephew is progressing, with joint physician and field engagement increasing. The partnership is focused on orthopedic trauma surgeons and expanding access for the company’s trauma-focused products, including iFuse TORQ TNT. Based on first-half performance, SiBone raised the low end of its full-year worldwide revenue outlook. The company now expects 2026 revenue of $231 million to $233 million, representing growth of approximately 15% to 16%, compared with prior guidance of $230 million to $233 million. The company maintained its full-year gross-margin outlook of 79%. At the midpoint of its revised revenue range, it expects operating expenses to increase by about 12% for the year. Management said it is increasing targeted R&D spending in the second half to advance longer-term development programs while maintaining its goals for operating leverage and profitability expansion. The company said two additional solutions are expected to move toward design freeze later this year, with potential commercialization targeted within the next 18 months. Si-BONE, Inc is a commercial‐stage medical device company focused on the design, development and commercialization of implant systems to treat degenerative conditions of the sacroiliac (SI) joint. Its flagship product, the iFuse Implant System, consists of triangular titanium implants that are inserted via a minimally invasive surgical procedure to stabilize the SI joint and alleviate chronic lower back and buttock pain. FDA‐cleared in 2012, the iFuse portfolio has expanded to include the iFuse-3D and iFuse-3Di devices, which feature a porous, 3D-printed surface to promote bone ongrowth and biological fixation. This instant news alert was generated by narrative science technology and financial data from MarketBeat in order to provide readers with the fastest reporting and unbiased coverage. Please send any questions or comments about this story to [email protected]. The article "SiBone Q2 Earnings Call Highlights" was originally published by MarketBeat. View MarketBeat's top stocks for August 2026.

Delivered ~11% worldwide revenue growth, record physician engagement and ~440% improvement in adjusted EBITDA First Quarter 2026 Financial Highlights (all comparisons are to the prior year period) Worldwide revenue of $52.6 million, representing growth of 11.2% U.S. revenue of $49.3 million, representing growth of 10.0% Gross margin of 79.8% Net loss of $4.3 million, representing an improvement of 33.8% Adjusted EBITDA of $2.5 million, representing an improvement of over 440% $144.7 million in cash and equivalents Recent Operational Highlights (any comparisons are to the prior year period) Over 1,650 active U.S. physicians, representing growth of 17% $2.2 million in trailing 12-month average revenue per territory, representing an increase of 11% Expanded international presence with the launch of iFuse TORQ TNT in Europe and iFuse TORQ in Australia CMS proposes, in their FY2027 IPPS Proposed Rule, the creation of a new MS-DRG family with higher payment for hospitals supporting complex spinal fusion procedures that incorporate iFuse Bedrock Granite SANTA CLARA, Calif., May 11, 2026 (GLOBE NEWSWIRE) -- SI-BONE, Inc. (Nasdaq: SIBN), the global leader in developing procedural solutions to address clinical challenges associated with compromised bone, today reported financial results for the quarter ended March 31, 2026. "The first quarter demonstrated the strength and durability of our platform, with record physician engagement and double-digit growth across all key metrics," said Laura Francis, Chief Executive Officer. "We advanced several high-impact initiatives during the quarter, including the U.S. launch of INTRA Ti, our trauma partnership with Smith + Nephew, and the introduction of iFuse TORQ TNT and iFuse TORQ across various international markets, each of which expands our addressable market and deepens our competitive position. With growing commercial scale and our third breakthrough device on track for launch later this year, we are well positioned to accelerate revenue growth through 2026 and into 2027." First Quarter 2026 Financial Results Worldwide revenue was $52.6 million in the first quarter 2026, a 11.2% increase from $47.3 million in the corresponding period in 2025. U.S. revenue for the first quarter 2026 was $49.3 million, a 10.0% increase from $44.8 million in the corresponding period in 2025. U.S revenue growth benefited from expanded adoption of the product portfolio across all sites of care and increased sales channel coverage. International revenue for the first quarter 2026 was $3.3 million, a 33.9% increase from $2.5 million in the corresponding period in 2025. International revenue growth reflects the growing demand for iFuse TORQ. Gross profit was $41.9 million in the first quarter 2026, an increase of 11.3% from $37.7 million in the corresponding period in 2025. Gross margin in the first quarter 2026 was stable compared to the prior year period at 79.8%. Operating expenses increased 4.1% to $47.0 million in the first quarter 2026, as compared to $45.2 million in the corresponding period in 2025. The change in operating expenses was primarily driven by general commercial activity related to higher revenue and new product rollout. Operating loss improved by 31.9% to $5.1 million in the first quarter 2026, as compared to an operating loss of $7.5 million in the corresponding period in 2025. Net loss improved by 33.8% to $4.3 million, or $0.10 per diluted share, in the first quarter 2026, as compared to a net loss of $6.5 million, or $0.15 per diluted share, in the corresponding period in 2025. Adjusted EBITDA was $2.5 million in the first quarter 2026, improving from an adjusted EBITDA of $0.5 million in the corresponding period in 2025. Cash and equivalents as of March 31, 2026 were $144.7 million, compared to $147.8 million as of December 31, 2025. Updated Fiscal 2026 Financial Guidance SI-BONE increased 2026 worldwide revenue expectation to be in the range of $230 million to $233 million, implying year-over-year growth of ~14% to 16%. SI-BONE increased its estimate for full year 2026 gross margin to ~79%. Webcast Information SI-BONE will host a conference call to discuss the first quarter 2026 financial results after market close on Monday, May 11, 2026 at 4:30 P.M. Eastern Time. The conference call can be accessed live over webcast at https://edge.media-server.com/mmc/p/vde24u4q. Live audio of the webcast will be available on the “Investors” section of the company’s website at: www.si-bone.com. The webcast will be archived and available for replay for at least 90 days after the event. About SI-BONE, Inc. SI-BONE (NASDAQ: SIBN) is a global leader in developing procedural solutions to address clinical challenges associated with compromised bone. With expertise in biomechanical design and anatomy specific innovation, SI-BONE has built a technology platform with market-leading applications centered on the spinopelvic anatomy. SI-BONE continues to leverage the deep experience in addressing the challenges of low-density bone in the sacrum to develop unique technologies that are targeting new clinical adjacencies to help improve outcomes for patients with compromised bone. Since 2009, SI-BONE has supported physicians in performing nearly 150,000 procedures. A unique body of clinical evidence supports the use of SI-BONE's technologies, including four randomized controlled trials and over 185 peer reviewed publications. For additional information on the company or the products, including risks and benefits, please visit www.si-bone.com. SI-BONE®, iFuse Bedrock Granite®, iFuse TORQ® and iFuse TORQ TNT® are registered trademarks of SI-BONE, Inc. All other marks referenced herein are property of their respective owners. ©2026 SI-BONE, Inc. All Rights Reserved. Forward-Looking Statements The statements in this press release regarding expectations of future events or results, including SI-BONE’s expectations of continued revenue and procedure growth and financial outlook, are “forward-looking” statements. These forward-looking statements are based on SI-BONE’s current expectations and inherently involve significant risks and uncertainties. These risks include SI-BONE’s ability to introduce and commercialize new products and indications, SI-BONE’s ability to maintain favorable reimbursement for procedures using its products including CMS's finalization of the proposed FY 2027 Inpatient Rule referenced herein, the impact of any future economic weakness or deterioration in economic conditions as a result of tariffs and retaliation by U.S. trading partners on the ability and desire of patients to undergo elective procedures including those using SI-BONE’s products, SI-BONE’s ability to manage risks to its supply chain, future capital requirements driven by new surgical systems requiring instrument tray and implant inventory investment, and the pace of the re-normalization of the healthcare operating environment including the ability and desire of patients and physicians to undergo and perform procedures using SI-BONE’s products. Actual results and the timing of events could differ materially from those anticipated in such forward-looking statements as a result of these and other risks and uncertainties, many of which are described in SI-BONE’s most recent filings on Form 10-K and Form 10-Q, and SI-BONE’s other filings with the Securities and Exchange Commission (SEC) available at the SEC’s Internet site (www.sec.gov), especially under the caption “Risk Factors.” SI-BONE does not undertake any obligation to update forward-looking statements and expressly disclaims any obligations or undertaking to release publicly any updates or revisions to any forward-looking statements contained herein, except as required by law. Use of Non-GAAP Financial Measures To supplement our condensed consolidated financial statements, which are prepared and presented in accordance with generally accepted accounting principles in the United States ("GAAP"), SI-BONE uses two non-GAAP financial measures: Adjusted EBITDA and free cash flow. Non-GAAP measures should be considered supplemental to, and not a substitute for, financial information prepared in accordance with GAAP. Adjusted EBITDA excludes the effect of items that increase or decrease SI-BONE’s reported results of operations. Free cash flow is not intended to represent our residual cash flow available for discretionary expenditures. Management strongly encourages investors to review, when they become available, the company's consolidated financial statements and publicly filed reports in their entirety. The company's definition of adjusted EBITDA and free cash flow may differ from similarly titled measures used by others. Adjusted EBITDA excludes from net loss the effects of interest income, interest expense, depreciation and amortization, and stock-based compensation. Free cash flow is defined as net cash provided by operating activities less purchases of property and equipment. SI-BONE believes the presentation of these financial measures is useful to management because it allows management to more consistently analyze period-to-period financial performance and provides meaningful supplemental information with respect to core operational activities used to evaluate management's performance. SI-BONE also believes the presentation of non-GAAP financial measures is useful to investors and other interested persons as it enables these persons to use this additional information to assess the company’s performance in using this additional metric that management uses to assess the company’s performance. Investor Contact Saqib Iqbal VP, FP&A, and Investor Relations [email protected]

Interested in SiBone? Here are five stocks we like better. SiBone raised its full-year 2026 guidance after posting Q1 revenue of $52.6 million, up 11.2% year over year. The company also narrowed its net loss and improved adjusted EBITDA, citing stronger physician adoption, international growth, and better operating leverage. Product launches and partnerships are expected to drive growth through the rest of the year. Management highlighted the rollout of INTRA Ti, TNT TORQ, TORQ in Australia, and a planned fourth-quarter launch of a third Breakthrough Device Designation product, plus growing contribution from its Smith+Nephew trauma partnership. A proposed CMS reimbursement change could be a major tailwind for Granite adoption in complex spinal fusion cases. SiBone said the new DRG families could increase hospital payment by as much as $50,000 per procedure and help remove a key barrier to use. 4 Recent Earnings Winners Riding Fresh Momentum in May SiBone (NASDAQ:SIBN) raised its full-year 2026 outlook after reporting double-digit revenue growth in the first quarter, with management pointing to new product launches, expanding physician adoption, international momentum and a proposed Medicare reimbursement change as key drivers for the year ahead. The medical device company reported worldwide revenue of $52.6 million for the quarter ended March 31, 2026, up 11.2% from the prior-year period. U.S. revenue rose 10% to $49.3 million, while international revenue increased 33.9% to $3.3 million. → Beyond NVIDIA: Picks-and-Shovels AI Plays with Strong Momentum Chief Executive Officer Laura Francis said the quarter reflected progress across SiBone’s platform strategy, including its focus on technologies for patients with compromised bone. “We have never been better positioned as we accelerate growth through 2026 and into 2027,” Francis said. SiBone said gross profit increased 11.3% to $41.9 million, while gross margin was flat year over year at 79.8%. Management said the margin performance reflected better-than-anticipated average selling prices from favorable procedure mix and benefits from operational efficiency initiatives. → MercadoLibre Boldly Invests in Growth: Discount Deepens Operating expenses rose 4.1% to $47 million, a pace below revenue growth. Francis said the company’s operating expense growth represented “nearly 2.5x operating leverage.” The company’s net loss narrowed to $4.3 million, or $0.10 per diluted share, compared with a net loss of $6.5 million, or $0.15 per diluted share, in the prior-year quarter. Adjusted EBITDA was $2.5 million, compared with $0.5 million in the first quarter of 2025. Free cash flow was negative $3.4 million, improving 50.7% from the prior year. The company ended the quarter with $144.7 million in cash and marketable securities. → 3 Ways to Target the Resources Powering AI and Data Centers Management noted that first-quarter results were modestly affected by weather disruptions early in the period and by the company’s decision to pace trauma distributor onboarding while finalizing its partnership with Smith+Nephew. In response to an analyst question, management estimated the weather-related impact at about $500,000 and said much of that volume is typically recaptured within roughly 60 days. SiBone increased its full-year revenue guidance to a range of $230 million to $233 million, implying year-over-year growth of about 14% to 16%. The company also raised its full-year gross margin expectation to approximately 79%, up 100 basis points from prior guidance. Management said revenue growth is expected to accelerate as the year progresses, with a more pronounced impact in the second half from product launches, commercial expansion and geographic initiatives. Full-year operating expenses are expected to grow approximately 12.5% at the midpoint of revenue guidance. In the question-and-answer session, management said the guidance increase was consistent with the company’s “disciplined approach” early in the year, while noting potential upside from INTRA Ti, the Smith+Nephew partnership, proposed reimbursement changes and a planned fourth-quarter launch of a third Breakthrough Device Designation product. Francis highlighted several recent product and market developments, including the launch of INTRA Ti, a 3D titanium solution within SiBone’s sacroiliac joint portfolio. She said INTRA Ti is intended to align with interventional physician workflows and outpatient sites of care, while also serving surgeons. The company also introduced TNT TORQ in Europe and launched TORQ in Australia. Francis said TNT TORQ expands the company’s pelvic trauma portfolio in Europe, while TORQ gives SiBone a “beachhead” in pelvic fixation in Australia. SiBone said its third Breakthrough Device Designation product is progressing on schedule, with verification and validation nearing completion and a 510(k) submission targeted for the early third quarter. Francis said the company expects a commercial launch in the fourth quarter, depending on timing, and described the technology as addressing a significant unmet need in spine surgery. Francis said the new product could be used by spine surgeons in procedures they already perform and may be used in the same cases as Granite, the company’s spinopelvic fixation product. She said that could increase surgeon engagement and procedure density among existing customers. A major focus of the call was a proposed reimbursement change from the Centers for Medicare & Medicaid Services. Francis said CMS has proposed creating new diagnosis-related group families for extensive or complex spinal fusion procedures, including procedures that incorporate Granite. SiBone had previously requested that CMS assign pelvic fixation procedures using Granite to higher severity levels within existing DRGs. Francis said CMS instead proposed new DRG families after analyzing the complexity and cost profile of the procedures. “We appreciate the acknowledgment by CMS of the higher procedure complexity in cases where Granite is used,” Francis said. She added that the proposed change could increase average hospital payment by as much as $50,000 per procedure, depending on patient diagnosis and severity, and would take effect Oct. 1 if finalized. Francis said the proposed reimbursement would help remove cost as a potential objection for hospitals and support long-term access to Granite. In the Q&A session, she said the proposed new DRGs are “significantly better” than what the company requested and described the change as a “very significant and underappreciated tailwind.” SiBone reported more than 1,650 active physicians in the quarter, up more than 17% year over year. Francis said the company has now posted 20 consecutive quarters of double-digit physician growth. The company ended the quarter with 89 quota-carrying territory managers. Annual revenue per territory was $2.2 million, up 11% from the prior year, marking the 14th consecutive quarter of double-digit territory productivity growth. Francis said the company remains on track to expand to approximately 100 territories over the next 12 months. SiBone’s hybrid commercial model includes territory managers, territory representatives and more than 300 third-party agents. Francis said the model allows territory managers to focus on high-impact engagement while expanding reach, particularly in spinopelvic and pelvic trauma markets. The company also discussed its partnership with Smith+Nephew, which is focused on trauma. Francis said the first phase of field rollout was completed in April, with training and surgical capacity rollout expected to be substantially complete by the end of the second quarter. Revenue contribution is expected to build in the third quarter and accelerate in the fourth quarter. Francis said Smith+Nephew’s trauma team is focused on level 1 and level 2 trauma centers and that SiBone’s TNT product is synergistic with its partner’s portfolio. Management said it would provide more detail as the relationship matures. Francis closed the call by emphasizing the company’s physician growth, territory productivity gains, improving profitability and product pipeline. “We’ve built something durable and scalable here, and we’re excited about what comes next,” she said. Si-BONE, Inc is a commercial‐stage medical device company focused on the design, development and commercialization of implant systems to treat degenerative conditions of the sacroiliac (SI) joint. Its flagship product, the iFuse Implant System, consists of triangular titanium implants that are inserted via a minimally invasive surgical procedure to stabilize the SI joint and alleviate chronic lower back and buttock pain. FDA‐cleared in 2012, the iFuse portfolio has expanded to include the iFuse-3D and iFuse-3Di devices, which feature a porous, 3D-printed surface to promote bone ongrowth and biological fixation. This instant news alert was generated by narrative science technology and financial data from MarketBeat in order to provide readers with the fastest reporting and unbiased coverage. Please send any questions or comments about this story to [email protected]. The article "SiBone Q1 Earnings Call Highlights" was originally published by MarketBeat. View MarketBeat's top stocks for May 2026.

Image source: The Motley Fool. Monday, May 11, 2026 at 4:30 p.m. ET Chief Executive Officer — Laura Francis Chief Financial Officer — Anshul Maheshwari Need a quote from a Motley Fool analyst? Email [email protected] Laura Francis: Thanks, Saqib. Good afternoon, and thank you for joining us. In the first quarter, we advanced our platform strategy on multiple fronts. Underpinning these strategic priorities is our clear focus on developing disruptive technologies that address unmet clinical needs for our surgeons and interventionalists when treating patients with compromised bone. Our technologies are differentiated in how they uniquely adhere to low-density bone to enable more durable fusion and better outcomes relative to the current standards of care. We have never been better positioned as we accelerate growth through 2026 and into 2027. Our raised full-year outlook reflects that confidence. To better frame our progress in the quarter, let me connect our recent activities around product launches and commercial partnerships to our overarching strategy. We are focused on expanding into high-value clinical segments, extending our leadership position across global markets, and doing so efficiently through our hybrid commercial model, including strategic collaborations. Intra TI, which was launched in the quarter, is not just an expansion of our SI joint portfolio; it is a deliberate focus to further build the interventional segment with a solution that aligns with the physician's workflow and site of care, while also providing another compelling solution for surgeons. In Europe, the introduction of TNT TORQ expands our pelvic trauma portfolio and builds on the success we are seeing with TORQ. In Australia, the launch of TORQ extends our leadership in SI joint fusion and gives us a beachhead in pelvic fixation. The recently announced partnership with Smith & Nephew enables us to broaden our access to trauma while keeping our direct team focused on driving depth and density in spine and interventional. In the quarter, our worldwide revenue was $52.6 million, representing over 11% growth. In the U.S., revenue was $49.3 million, reflecting approximately 10% growth. International revenue for the quarter was $3.3 million, representing an impressive 34% growth. Our two-year stacked worldwide and U.S. revenue growth of 18% highlights the durability of demand for our solutions. Importantly, this growth was delivered with strong operating discipline. Our operating expenses grew just over 4%, significantly below revenue growth, reflecting nearly 2.5 times operating leverage. This demonstrates our ability to drive growth while progressing towards sustained profitability and cash flow generation. Before I provide an update on our strategic priorities, let me provide insight into the recently announced reimbursement proposal that will positively impact our spinal pelvic market opportunity with Granite, if finalized as proposed. As you may recall, last year we requested that CMS assign pelvic fixation procedures incorporating Granite to a higher severity level within existing DRGs. Based on analysis of the complexity and cost profile of these procedures, CMS has instead proposed creation of new DRG families for supporting extensive or complex spinal fusion procedures, including those that incorporate Granite. We appreciate the acknowledgment by CMS of the higher procedure complexity in cases where Granite is used. Overall, we believe the proposal more appropriately aligns reimbursement with the cost of these procedures. The increase in the average hospital payment under the proposed new DRGs could be as high as $50 thousand per procedure, depending upon specifics of the patient's diagnosis and severity. This reimbursement change would be effective October 1, 2026. We believe this incremental reimbursement would support continued adoption of our differentiated technology and ensure patients, surgeons, and hospitals maintain long-term access to Granite. It will remove cost as a potential objection and further substantiate Granite as the standard of care in spinal pelvic procedures. Taken together, we made significant progress toward building a durable growth engine with record physician engagement, a broadening procedural footprint, expanding commercial scale, and a favorable reimbursement backdrop. This gives us confidence that we are positioned to accelerate our revenue growth going forward. Now I will highlight the progress we have made on our four key priorities: innovation and market development, physician engagement, commercial execution, and operational excellence. Starting with innovation and market development, we are a category leader in developing and commercializing differentiated procedural solutions for patients with compromised bone. To date, our focus on the sacroiliac joint across three distinct disease states has resulted in nearly 150 thousand procedures and has established our deep competencies around enabling fixation and fusion of low-density bone. We are now leveraging this biomechanical leadership and our proprietary technology to expand beyond the sacroiliac joint into high-value clinical adjacencies in musculoskeletal care, with a focus on patients with compromised, often osteoporotic, bone. With nearly 300 thousand annual target procedures, fixation and fusion to treat SI joint dysfunction remains our largest opportunity. As we know, the sacrum has relatively low-density bone. We are the undisputed leader, with multiple RCTs that demonstrate the effectiveness of our technologies in treating this disease state. We have the most comprehensive platform that includes technologies and placement trajectories to address patient concerns and physician preferences across all sites of service. The recent launch of Intra TI, our 3D titanium solution, further extends our leadership by combining the clinical benefits of metal implants with the speed and simplicity of what we call our Intra, or posterior-approach-based, workflow. Our Intra platform is a crucial enabler of our strategy to drive strong adoption among our fast-growing base of interventionalists and accelerate our penetration in the ASC and OBL sites of care. With the ongoing migration of procedures to these settings of care, we see a significant untapped market opportunity and a long runway for sustained growth. Spinal pelvic fusion is our fastest-scaling market. As life spans increase, we expect a rise in spinal pelvic procedures for patients with bone-compromising conditions like osteoporosis or osteopenia. Building on the success of Granite, we are leveraging our expertise to develop targeted and competitively differentiated solutions that will complement Granite and address other areas of procedural failures, thereby improving outcomes for this growing patient population. Since the launch of Granite, our spinal pelvic revenue growth has meaningfully outpaced the broader deformity market growth rate, supported by strong physician adoption and compelling clinical outcomes. The superiority of Granite was reaffirmed in the 160-patient POLA study published in March. The study demonstrated zero Granite breakage or pullout while delivering clinically meaningful improvements in both pain and disability scores at 12 months. Granite benefits from favorable reimbursement dynamics, including the existing transitional pass-through with zero device offset in the outpatient ASC settings. The new DRGs proposed by CMS also reinforce Granite’s economic attractiveness in inpatient settings by providing enduring reimbursement for our hospital customers and providing a framework for our commercial payers to follow suit. With nearly 130 thousand target procedures, intuitive surgeon workflow, superior clinical outcomes, and highly supportive reimbursement, we believe that Granite, as well as our future platform technologies, can potentially make the spinal pelvic fusion market our largest revenue contributor in the coming years. In pelvic trauma, the majority of our approximately 60 thousand target procedures are to treat low-intensity sacral insufficiency fractures. Our iFuse TORQ/TNT system is well aligned with existing surgeon workflows, benefits from favorable reimbursement including NTAP of over $4 thousand, and is supported by our strategic partnership with Smith & Nephew. With the strong reception for TNT in Europe, we expect the pelvic trauma market to be an attractive contributor to global growth. Finally, our multi-year pipeline is advancing ahead of plan, reinforcing our position as an innovation leader. Our third Breakthrough Device is advancing on schedule; verification and validation are nearing completion, and we are targeting a 510(k) submission in early third quarter. We have clear line of sight to a commercial launch, which we expect to meaningfully expand our total addressable market, deepen engagement with our spine surgeons, and represent a significant new revenue driver over the next several years. This technology addresses a significant unmet need in spine surgery and is designed to deepen our platform's utility in procedures our surgeons are already performing. Now let us move on to physician engagement. We had over 1,650 active physicians in the quarter, representing more than 17% growth. This extends our track record of another quarter of double-digit growth across all call points, including spine, interventional, and trauma. Our expanding platform positions us to build cross-procedure relationships and increase the number of procedures performed per physician. In the first quarter, physicians active in the current quarter and prior year grew faster than the overall base, reinforcing our ability to retain physician engagement while expanding their use of our platform. These physicians generate three times the case volume of new users, reinforcing the value of long-term deep engagement. We are also seeing continued progress in cross-procedure adoption. The number of physicians performing more than one procedure type increased 10% in the quarter compared to the prior-year period. Today, only 25% of physicians performing SI joint fusion utilize our platform across additional indications, highlighting a significant opportunity to expand within our existing base. With 89 quota-carrying territory managers, annual revenue per territory was $2.2 million, reflecting 11% year-over-year growth. This marked the 14th consecutive quarter of double-digit territory productivity growth. Our hybrid sales model, which is comprised of territory managers, territory representatives, and over 300 third-party agents, continues to be a competitive advantage. It has been particularly effective in expanding the reach of our direct sales force, especially in the spinal pelvic and pelvic trauma markets. Our territory managers are considered clinical experts and thought leaders, and the hybrid approach allows them to prioritize engagement activities and maximize their impact in the field. With Smith & Nephew, we completed the first phase of field rollout in April and expect training and surgical capacity rollout to be substantially complete by the end of the second quarter. We anticipate revenue contribution to begin building in the third quarter and accelerate into the fourth quarter. This is consistent with how trauma volume seasonally concentrates in the back half of the year. While it is still early, the initial physician and field reception has been encouraging, and we will provide more specific updates as the partnership matures. Finally, we remain on track to expand to approximately 100 territories over the next 12 months, aligning our commercial capacity with our strategy to bring several unique platform technologies to market in the coming year. Before I turn the call over to Anshul, I want to thank our employees for their continued focus and execution. We have built one of the fastest-growing, differentiated technology platforms with deep expertise in addressing the needs of patients with compromised bone. That focus continues to guide our innovation and expansion into new indications that will improve the lives of hundreds of thousands of patients over the next several years. The fundamentals of this business across physician engagement, commercial productivity, and a broadening innovation pipeline give us real confidence in the trajectory ahead. Anshul will now take you through the fourth priority of operational excellence, as well as provide financial details and our updated guidance which reflects that confidence. Anshul Maheshwari: Thanks, Laura. Good afternoon, everyone. My comments today will focus on first-quarter revenue growth, profitability, and liquidity. All comparisons are versus the same period in the prior year unless noted otherwise. Starting with revenue, our worldwide revenue was $52.6 million, representing growth of 11.2%. U.S. revenue was $49.3 million, increasing 10% even with the stronger prior-year comparison that benefited from three product launches. The first-quarter performance was modestly impacted by weather-related disruptions early in the quarter and our decision to deliberately pace trauma distributor onboarding while finalizing the Smith & Nephew partnership. Revenue momentum accelerated as the quarter progressed, driven by expanding adoption of our portfolio by a record number of physicians across all sites of service. International revenue was $3.3 million, increasing 33.9%, reflecting accelerating demand for iFuse TORQ across Europe and Australia. This trend, combined with the early enthusiasm for TNT in Europe, reinforces our confidence in the significant long-term opportunity across our international markets. Moving to profitability, our gross profit was $41.9 million, an increase of $4.2 million, or 11.3%. Our gross margin for the quarter was flat year over year at 79.8% and remains among the best in the industry. Better-than-anticipated ASP from a favorable procedure mix, alongside the sustained impact of our operational efficiency initiatives, contributed to the strong gross margins in the quarter. Operating expenses were $47.0 million, representing 4.1% growth. The modest increase was driven by higher commissions tied to revenue growth, as well as targeted investments in training, marketing to support the Intra TI launch, and ongoing investment in the product pipeline. The combination of strong revenue growth and operating discipline continues to drive meaningful operating leverage in the business. Our net loss narrowed to $4.3 million, or $0.10 per diluted share, compared to a net loss of $6.5 million, or $0.15 per diluted share, representing strong year-over-year progress. Adjusted EBITDA was $2.5 million in the quarter, representing over 440% improvement compared to $0.5 million in 2025. We are pleased with the expanding profitability even as we prioritize investments in innovation and commercial expansion. Turning to liquidity, we exited the quarter with $144.7 million in cash and marketable securities, providing us with significant financial flexibility. Free cash flow in the first quarter was negative $3.4 million, representing a 50.7% improvement compared to the prior-year period. As a reminder, first-quarter cash usage reflects the seasonal impact of fourth-quarter commission true-ups and annual bonus payouts. We do expect higher-than-normal cash flow variability in the second and third quarters driven by the timing of payments from buildout of our new headquarters, which is expected in the second quarter, and the timing of tenant-improvement allowance reimbursements. Our balance sheet, combined with the progress towards free cash flow breakeven, positions us well to both invest and scale profitably. We have the liquidity to accelerate R&D investments and expand the commercial infrastructure to support multiple product launches over the next five years. Now turning to our updated outlook for 2026. We are increasing our full-year revenue guidance to a range of $230 million to $233 million. The updated guidance implies year-over-year growth of approximately 14% to 16%. We expect quarterly year-over-year revenue growth to accelerate as we progress through the year, driven by the impact of the strategic innovation, commercial expansion, and geographic initiatives we highlighted today. We are still in the early stages of realizing the full benefit of these efforts, which we believe could represent a meaningful source of potential outperformance in 2026 and going into 2027. As their impact increases, we will appropriately reflect that upside in our guidance. We are also raising our annual gross margin expectations to approximately 79%, up 100 basis points from our prior guidance. This reflects the favorable procedure mix and the sustained impact of our operational efficiency initiatives. Taken together, both raises reinforce our conviction that the business is performing at a high level and that our path to expanding profitability is on track. We expect full-year operating expenses to grow approximately 12.5% at the midpoint of our revenue guidance. We believe this disciplined investment will further strengthen our competitive position and facilitate sustained long-term growth. With that, I will turn the call back to Laura. Laura Francis: Thanks, Anshul. Before we go to Q&A, let me leave you with a few proof points that define our execution track record: 20 consecutive quarters of double-digit physician growth and a record 1,650 active physicians in the first quarter; 14 consecutive quarters of double-digit territory productivity growth; improving profitability and free cash flow trajectory; guidance raised after the first quarter with revenue growth accelerating as we progress through the year; and a third Breakthrough Device on track for launch in the fourth quarter. We have built something durable and scalable here, and we are excited about what comes next. With that, we will now open the call for questions. Operator: To ask a question, please press 1-1 on your telephone and wait for your name to be announced. In the interest of time, we ask that you please limit yourself to one question and one follow-up. Our first question comes from Matthew O'Brien with Piper Sandler. Your line is open. Matthew O'Brien: Afternoon. Thanks for taking the questions. Just Anshul, can you quantify the weather impact in the quarter? And then I guess the top end of the guide was only raised by $0.5 million. The bottom end came up by $1 million. Why not take it up a little bit more? Is there anything to read into that? And then I do have a follow-up. Anshul Maheshwari: Hey, Matt. Happy to take that. We are really pleased with how the business performed in the quarter. We saw, as I said in my prepared remarks, acceleration in revenue as we progressed through the quarter, and that trend continued into April, so very encouraged there. In terms of the weather-related impact in January, I would say it is circa the half-million-dollar range, but a lot of that gets recaptured. If you go back in time, even during the pandemic or other disruptions, it generally takes about 60 days or so for those procedures to get rescheduled. So I would say the impact for the quarter was pretty muted; it was just timing between month one and later. In terms of our guidance, we raised the lower end of the guide by $1.5 million and the upper end by $0.5 million, so the midpoint is going up about $1 million. That is consistent with our disciplined approach to guidance, especially this early in the year. Laura highlighted several initiatives we have been focused on in Q1, and we know there is potential upside, especially when you think about the opportunity for our Intra TI product as we expand into interventional, the potential for the Smith & Nephew partnership as it gets seasoned in the back half of the year, and then you have tailwinds around the potential higher DRG reimbursement that could go into effect on October 1. That could be a nice tailwind for our Granite business, which has been scaling really well. Then you have the third BDD product that we will launch in the fourth quarter. There are a lot of tailwinds, but given that we are early in the year and many are still preliminary, we want to grow into those and then reflect upside in updated guidance as we go through the year. Matthew O'Brien: Got it. Appreciate that. And then, Laura, thanks for the update on the new product that is coming out relatively soon that has Breakthrough Device designation. You said Q3 510(k) filing. Is it too aggressive to think that we may be able to see that at NASS this year or launch it, or should we really expect more of a launch in 2027? Laura Francis: Thanks, Matt. We said we will have a filing in early third quarter and expect the product to launch sometime in the fourth quarter based on that timing. As soon as we have a product, we will bring it to various conferences. NASS may be a little bit early in the year for us to talk about it, but we are very excited. It is our third Breakthrough Device, and we believe we are addressing a large unmet clinical need with our spine surgeons. We also think it will provide a strong opportunity to increase surgeon density. Last year, we had over 2,400 physicians who did at least one case with us, so we have a very significant customer base to utilize that product. We believe it may be used in the same cases as Granite as well, and given the new DRGs and that product being used in those cases, it provides an opportunity not just to open up new TAM for us, but also to increase surgeon density in a significant way. As soon as we have a clearance, you are going to know about it, and you are going to see the product. We are incredibly excited about what it can bring to us late this year and into 2027. Operator: Thank you. Our next question comes from Young Lee with Jefferies. Your line is open. Young Lee: Thanks for taking my questions. There is a lot of momentum in the business with a new product launching, reimbursement tailwinds, and adding new territories. Can 2027 growth be higher than 2026 growth, or your exit rate growth? Anshul Maheshwari: Young, thanks for that question. Even thinking about how we set expectations for the rest of 2026, we do believe there is potential for significant upside as those tailwinds start having a more meaningful impact as we progress through the year. That is embedded in our statement around year-over-year growth acceleration in each of the subsequent quarters. In terms of exit growth rates into 2027, as revenue growth accelerates, that should be a nice off-ramp. I will not provide a specific 2027 outlook, but let me add quantitative color on the secular tailwinds that extend beyond 2026. Within SI joint fusion, our interventional strategy is in the early innings. With the increase in reimbursement for OBL, our Intra product family is doing really well, and Intra TI just launched; adoption is ramping and should only accelerate going into 2027. On pelvic fixation, Granite has scaled up really well. With potential new DRGs going into effect on October 1, you will have an impact in Q4 and a more pronounced impact next year. Layer on the new product Laura just discussed; it provides an opportunity for higher procedure ASP because that product alongside Granite can go into the same case. In pelvic trauma with Smith & Nephew, as the relationship matures, we will continue to put surgical capacity out there in 2027 across Level 1 and Level 2 trauma sites. Internationally, TNT was commercialized in Europe roughly nine months ahead of schedule, and as it seasons, that will be a tailwind too. So, there are a lot of positive long-term secular tailwinds that extend into 2027. Consistent with our approach, we want to execute through 2026, grow into those tailwinds, and then articulate what the exit ramp translates into for 2027 growth. Young Lee: Very helpful. And on revenue per territory manager, still solid double-digit growth. Where can that grow to, and does it cap out, especially with the Smith & Nephew contributions and the new territories you are adding? Laura Francis: You are right. We have continued to see productivity gains; over three years we have roughly doubled sales rep productivity. Our hybrid model has been a big driver—89 quota-carrying territory managers supported by more junior territory reps and over 300 third-party agents. The $2.2 million per territory is not the cap. Our largest territories are more than double that, and we use those as best-practice examples. We do plan to get to nearly 100 territories over the next 12 months to capitalize on current demand and upcoming launches in 2026 and into 2027. Growth is not solely dependent on territory count. The ramp with Smith & Nephew should provide opportunity specifically in trauma while allowing our sales reps to focus on spine and interventional. Overall, we aim to continue driving growth and penetration with current and new customers while maintaining operating leverage. Operator: Thank you. Our next question comes from Matt Plagman with TD Cowen. Your line is open. Analyst: Hi, Laura and Anshul. It is Drew on for Matt tonight. Laura, you said the spinal pelvic fusion market could be your largest contributor over the next few years. Do you need the third BDD device to drive the bulk of that, or is there more in the pipeline? And can you help size Granite revenue today so we can better appreciate the opportunity? Laura Francis: Thanks, Drew. We are excited about spinal pelvic. We worked with over 2,400 physicians last year, most of those spine surgeons, and more are doing Granite procedures. Our comment that this could be our largest market considers continued Granite growth, especially supported by the proposed new DRGs effective in October that should remove cost as an objection and support Granite as standard of care. The third Breakthrough Device is also targeted to spine surgeons, falls into the spinal pelvic category, and may be used in the same cases as Granite. It provides an opportunity to engage new physicians and significantly increase density with existing physicians, either on its own or in combination with Granite, which would increase ASP for those cases. Anshul Maheshwari: I would add we have a very active R&D pipeline. We want a regular cadence of launches focused on large unmet markets that are synergistic at both the procedure and call point levels. That gives us confidence—not just these two products, but others in the hopper. We will talk more as we get closer to FDA submissions or clearances. Analyst: Got it. And Anshul, on capital spending: Q1 looked like the lowest CapEx in several quarters. How do we balance that with your commentary about putting more surgical capacity in the field for Smith & Nephew and product launches this year and next? Anshul Maheshwari: Good question. For run-rate CapEx related to instrument trays and surgical capacity, think roughly $9 million to $10 million per year when you are launching products; we have generally been in the $8 million to $10 million range. Offsets include driving higher utilization of existing capacity and leveraging our launch experience to lower cost per tray for new products. We are also building our new headquarters on an eight-year lease; there will be a bit of one-time spend between Q2 and Q3, though some of that will be reimbursed via tenant-improvement allowances. Even with these investments, we feel very good about our target to reach free cash flow breakeven. Operator: Thank you. Our next question comes from Travis Steed with Bank of America Securities. Your line is open. Travis Steed: Maybe ask a bit more about the Smith & Nephew partnership—how that is ramping—and any way to think about the quantitative contribution to growth in 2026 and assumptions in the guide raise? Laura Francis: Thanks for the question. We are really excited about the Smith & Nephew partnership. It covers Level 1 and Level 2 trauma centers and allows trauma surgeons access to our TNT product as well as TORQ to treat sacral insufficiency fractures. We had the Smith & Nephew trauma leadership team at our offices last week; the excitement and commitment are clear both in the field and with physicians. TNT is very synergistic with their portfolio. We are completing rep training, and the rollout should be complete by the end of the second quarter. Given a normal ramp timeline—typically a few months between training and first case—we should start to see revenue contribution in the second half, building into Q4. As to opportunity size, the TAM is around 60 thousand patients and approximately $300 million per year. We will provide more as the relationship develops and incorporate into guidance as we see momentum. Travis Steed: Great. Quick follow-up: what are you seeing in the second quarter already in terms of procedure volumes or trends in the spine market? Anshul Maheshwari: We are not providing specific intra-quarter commentary. We noted acceleration as we progressed through Q1 and the trend we saw in April. We think about our business on an annual and multi-year basis because many tailwinds are secular and play out over years. That confidence is reflected in our guidance. Operator: Thank you. Our next question comes from Caitlin Roberts with Canaccord Genuity. Your line is open. Caitlin Roberts: Hi, thanks for taking the questions, and congrats. On Europe and the U.S., TNT launched earlier than expected in Europe, and TORQ launched in Australia. Do these change OUS growth expectations for this year? Anshul Maheshwari: Happy to take that. International performed really well—both in Q4, the first full quarter of TORQ in Europe, and in Q1 with TORQ and the early commercialization of TORQ in Australia and TNT in broader Europe. It is still about 5% to 6% of our business, but it is tracking well. Given we are in early launch stages, we want to be thoughtful about scaling before incorporating significant upside. We are confident Europe, with these new products plus the strength of our SI joint business with Triangle, should be accretive to worldwide growth, which it has not been for the last few years. We also are evaluating other international markets showing physician interest to deploy TNT, TORQ, and potentially Granite. Caitlin Roberts: And on the Smith & Nephew partnership, Smith & Nephew has its own U.S. priorities this year. Any risk the ramp for you is slower given their focus, or are these areas separate? Laura Francis: For the most part, these are separate. We are working specifically with the trauma team at Smith & Nephew, and the products are very synergistic. They are focusing on the pelvis later this year, and TNT/TORQ support that. The product has Breakthrough Device designation, NTAP of over $4 thousand, and a typical ASP significantly higher than much of their portfolio—all favorable for uptake. We are working through training, deploying assets into the field, and hospital approvals. We feel Smith & Nephew will be a great partner and are seeing that commitment. Operator: Thank you. Our next question comes from David Saxon with Needham & Company. Your line is open. David Saxon: Good afternoon, Laura and Anshul, and congrats on the quarter. On the path to 100 territories over the next year—that would be the fastest pace of hiring since 2021. What is the confidence in getting there, and how important is it in the context of the upcoming BDD launch? Laura Francis: Since 2021, much of our sales force expansion has leveraged our hybrid model. We grew from a small number of third-party agents to over 300 today, driving significant operating leverage. The Smith & Nephew relationship is another element of that strategy. Expanding to nearly 100 territories over the next 12 months is important to prepare for the next Breakthrough Device launch that we believe will attract additional surgeons and increase surgeon density. We had a record 1,650 active physicians in Q1 with 17% growth, and unlike typical seasonality between Q4 and Q1, we did not see a fallback. We have a tremendous asset in our customer base, and this product will help meet their needs across SI joint fusion, pelvic fixation, and the new indication we are targeting. Anshul Maheshwari: To build on that, if you look back to 2021, once we built out the salesforce, it was quickly followed by four launches—TORQ, Granite, TNT, and the Intra family—and growth inflected to roughly 22% CAGR from 2021 to 2025. You are seeing a similar playbook now at a larger scale, anticipating an aggressive innovation cycle over the next five years, with continued operating scale and leverage. David Saxon: Great. And on margins—really strong performance in Q1. What is driving that: leverage on higher revenue, or anything operational? And what is the latest pricing assumption in guidance? Anshul Maheshwari: We are pleased with gross margins at 79.8%, nearly 80%, which are industry-leading and ahead of expectations. That is why we increased full-year guidance for gross margin by 100 basis points to approximately 79%. Drivers include better-than-expected procedure mix and ASP, plus incremental impact from supply chain efficiencies and cost optimization initiatives. As we launch new products and roll out additional surgical capacity to support Smith & Nephew, we do expect some non-cash depreciation on instrument trays in the back half, which is incorporated in the 79% full-year outlook. On ASP, we started the year assuming mid-single-digit ASP decline but have done better, with Granite a big contributor due to more four-implant cases than initially guided. We are now assuming low-single-digit ASP degradation. We think we could do better, but interventional (Intra family) generally uses fewer implants, and trauma might use one to two implants per procedure, which we embed as ASP pressure. We are not incorporating additional upside from Granite continuing to see more four-implant cases or from the continued strength in SI joint where you use three implants. Operator: Our next question comes from David Turkaly with Citizens. Your line is open. David Turkaly: Hey, good evening. Quickly, Anshul, you mentioned the headquarters—did you put a dollar amount on that? And from a capital allocation standpoint, you have a lot of cash; what are your priorities, and has a buyback ever been considered? Anshul Maheshwari: On CapEx, as noted, instrument tray and surgical capacity is around $9 million to $10 million for the year, and then you have another $4 million-plus on CapEx for the new headquarters. Some of that will be reimbursed as part of the TI allowance; timing is TBD based on the contract. On capital allocation, our focus remains on investing in R&D and new product innovation, clinical data to support the growing number of products we plan to commercialize, associated surgical capacity, and building commercial infrastructure to support growth. We like how the business is positioned with growth in gross margin dollars and continued operating leverage inflection, but our priority remains growth-accretive investments within the business. Operator: Thank you. Our next question comes from Richard Newitter with Tru Securities. Your line is open. Analyst: Hi, thanks for taking the questions. On the cadence of the revenue guide—you expect acceleration through the year. Consensus is around 15% to 16% for Q2 or about $55 million, implying roughly 2.5% acceleration through the year. Is that about right, and can you comment on that cadence or the Q2 number at all? And you maintained OpEx growth guidance; you are coming out of the gates at almost 3x your top-line growth versus your OpEx growth. What is behind that? Are expenses being pushed out, or is that conservatism? Anshul Maheshwari: As you know, we do not provide quarterly guidance and manage the business on a full-year, multi-year basis. We do expect year-over-year growth to accelerate, more pronounced in the second half. Part of that is the timing of scaling in interventional and the Smith & Nephew partnership, where we expect a meaningful contribution in Q3 and Q4. You might see some timing shift between Q2 and Q3 mostly because of Smith & Nephew. For the year, we feel good about growth and, importantly, the exit ramp from Q4 into 2027. On spend, we like the operating leverage we saw. At our scale, timing can have a big impact. In Q2 and Q3, we are in the midst of V&V testing and regulatory submissions, plus marketing activities for Intra TI and the new product for Q4 commercialization. You will see a bulk of that spend there. We are also embedding R&D spend that will impact 2027 launches. There could be upside on operating leverage, but we prefer to be conservative, incorporate the spend, and let growth speak for itself as we progress through the year. Analyst: That is helpful. And on the DRG proposal tailwind, this seems like a really big potential benefit. Is this the outcome you expected, and why would this not be an enormous tailwind next year? Laura Francis: Great question. We believe this is a very significant and underappreciated tailwind. Granite has been one of our fastest-scaling products, addressing fixation failure in multilevel constructs with compelling clinical data. It should become the standard of care in roughly 130 thousand cases per year in the U.S. The inpatient rule proposes a new DRG group for complex and extensive spine surgeries. Under the proposal, Granite is one of only two technologies for which those procedures automatically map to the new DRG. The proposal is significantly better than what we requested. We had been in discussions with CMS for two years, initially requesting reassignment of Granite cases to higher severity levels within existing DRGs. CMS concluded that would not fully address cost differentials and instead created a new DRG family. The improvement in hospital payment under the proposed new DRG could be as high as $50 thousand, depending on diagnosis and severity. These new DRGs are more durable than NTAP and not limited to Medicare; if finalized, we expect commercial payers to broadly adopt them alongside CMS. We strongly believe the new DRGs will positively impact the spinal pelvic market opportunity for Granite, assuming finalized as proposed, supporting adoption and removing cost as a potential objection. Operator: Thank you. I am showing no further questions at this time. I would now like to turn it back to Laura Francis for closing remarks. Laura Francis: Thank you to everyone for participating in today's call. We appreciate your interest in SI-BONE, Inc., and we look forward to seeing you at upcoming conferences as well as on non-deal roadshows. Goodbye. Operator: This concludes today's conference call. Thank you for participating. You may now disconnect. 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