SIBN — SI-BONE, Inc.

SI-BONE Q4 2025 Earnings Call Summary

1. Key Financial Results and Metrics

• Q4 Revenue: $56.3 million, a 15% increase year-over-year.
• U.S. Revenue: $53.5 million, up 13.9% year-over-year; 20.7% growth on a two-year stack basis.
• Full Year Revenue: $200.9 million, reflecting 20.2% growth.
• Gross Profit: Q4 gross profit increased 14.8% to $44.5 million, with a gross margin of 79%.
• Net Loss: Narrowed to $1.6 million ($0.04 per share) in Q4, compared to a loss of $4.5 million in the prior year.
• Adjusted EBITDA: Positive $5.1 million in Q4, with a 9.1% margin; full year adjusted EBITDA was $8.9 million, a significant improvement from a loss in 2024.
• Cash Position: Ended 2025 with $147.8 million in cash and equivalents, achieving positive free cash flow of nearly $0.5 million in Q4.

2. Strategic Updates and Business Highlights

• Product Innovation: Launched INTRA Ti, enhancing the SI Joint Fusion portfolio; two additional breakthrough devices expected to be commercialized by late 2026.
• Reimbursement Gains: Secured favorable reimbursement positions, including NTAP for iFuse TORQ TNT and TPT for iFuse Bedrock Granite, which are expected to enhance market access and adoption.
• Physician Engagement: Record 1,640 physicians performed procedures using SI-BONE solutions in Q4, marking an 18% increase year-over-year.
• Sales Strategy: Entered a strategic partnership with Smith & Nephew to expand trauma market reach, allowing trauma surgeons access to SI-BONE products.

3. Forward Guidance and Outlook

• 2026 Revenue Guidance: Expected to be between $228.5 million and $232.5 million, indicating a year-over-year growth of 14% to 16%.
• Adjusted EBITDA: Anticipated to increase compared to 2025, although specific figures were not disclosed.
• Market Dynamics: Growth expected to be weighted towards the second half of 2026, driven by new product launches and increased physician engagement.

4. Bad News, Challenges, or Points of Concern

• Growth Rate Deceleration: Guidance reflects a potential slowdown in procedure volume growth compared to 2025, attributed to tougher year-over-year comparisons and the gradual ramp-up of new products.
• Gross Margin Compression: Guidance for 2026 gross margin at approximately 78%, indicating a potential 160 basis point decline due to product mix and increased operational costs.
• Market Competition: The company faces ongoing competitive pressures in the orthopedic and neurospine markets, necessitating continuous innovation and market engagement.

5. Notable Q&A Insights

• Smith & Nephew Partnership: Expected to enhance market penetration but too early to quantify its financial impact. Initial activities anticipated as early as March 2026.
• INTRA Ti Product Impact: Positioned to drive growth in the ambulatory surgery center (ASC) market, with expectations for significant adoption over the next couple of years.
• Operating Leverage: Management indicated that investments in new products and commercial infrastructure are expected to yield operational efficiencies and profitability improvements in the long term.
• Market Expansion: The company is focused on expanding its footprint in trauma and interventional markets, leveraging partnerships and new product offerings to capture additional market share.

Overall, SI-BONE reported strong financial performance in Q4 2025, driven by innovation and strategic partnerships, while also navigating challenges related to growth rate expectations and margin pressures.