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.
Profitability Improves as Expenses Grow More Slowly Than Revenue
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.
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.
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.
New Device Filing and Reimbursement Developments
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.
Physician Base and Commercial Capacity Expand
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.
Company Raises Low End of 2026 Revenue Outlook
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.
About SiBone (NASDAQ:SIBN)
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.
