SIBN — SI-BONE, Inc.

SI-BONE Q4 2025 Earnings Call Summary

1. Key Financial Results and Metrics

• Revenue: Q4 worldwide revenue reached $56.3 million, up 15% year-over-year. Full-year revenue was nearly $201 million, marking a 20.2% increase.
• U.S. Revenue: Q4 U.S. revenue was $53.5 million (13.9% growth), with a full-year total of $191.1 million (20.6% growth).
• International Revenue: Q4 international revenue grew 38.8% to $2.9 million.
• Adjusted EBITDA: Positive adjusted EBITDA of $5.1 million in Q4 (9.1% margin), and $8.9 million for the full year, a significant improvement from a loss in 2024.
• Net Loss: Q4 net loss narrowed to $1.6 million ($0.04 per share), and full-year net loss was $18.9 million ($0.44 per share).
• Cash Position: Ended 2025 with $147.8 million in cash, achieving positive free cash flow of nearly $0.5 million in Q4.

2. Strategic Updates and Business Highlights

• Product Innovation: Launched INTRA Ti, a new product for SI Joint Fusion, and received FDA clearance for it. The company plans to commercialize another breakthrough device in late 2026.
• Reimbursement Gains: Secured favorable reimbursement positions, including NTAP for iFuse TORQ TNT and TPT for iFuse Bedrock Granite, enhancing access and adoption.
• Physician Engagement: Over 2,400 U.S. physicians performed nearly 22,000 procedures in 2025, with a 22% increase in physician adoption.
• Commercial Expansion: Entered a strategic partnership with Smith & Nephew to enhance trauma market penetration. Plans to add 10 new territories in 2026 to capture growth opportunities.

3. Forward Guidance and Outlook

• 2026 Revenue Guidance: Expected worldwide revenue of $228.5 million to $232.5 million, reflecting 14% to 16% growth, with a focus on high teens growth in U.S. procedure volume.
• Gross Margin: Anticipated annual gross margin of approximately 78%.
• Operating Expenses: Expected to grow by 12.5% to support new product launches and sales force expansion.
• Adjusted EBITDA: Expected to increase compared to 2025, with a focus on maintaining profitability and free cash flow commitments.

4. Bad News, Challenges, or Points of Concern

• Growth Rate Deceleration: The guidance reflects a slowdown in growth compared to 2025, with high teens growth expected in U.S. procedure volume.
• Product Mix Impact: Potential pressure on average selling prices (ASP) due to a shift in procedure mix, particularly with lower ASP trauma procedures.
• Market Competition: The company faces competitive pressures in the orthopedic and neurospine markets, necessitating continuous innovation and market engagement.

5. Notable Q&A Insights

• Smith & Nephew Partnership: Management expressed optimism about the partnership, emphasizing its potential to expand access to trauma solutions while allowing SI-BONE’s sales force to focus on spine and interventional markets.
• Interventional Physician Engagement: The launch of INTRA Ti is expected to enhance engagement with interventional spine physicians, with positive clinical data supporting its adoption.
• Revenue Cadence: Management indicated that revenue growth is expected to be weighted towards the second half of 2026, driven by multiple tailwinds including new product launches and improved reimbursement.
• Long-term Growth Potential: The company highlighted an "innovation super cycle" over the next five years, suggesting that new product launches could accelerate growth beyond historical rates.

This summary encapsulates SI-BONE's financial performance, strategic initiatives, outlook, and key insights from the earnings call, providing a balanced view of the company's current position and future prospects.