SI-BONE, Inc.

Good afternoon and welcome to SI Bones first quarter 2026 earnings conference call. At this time, all participants are in listen only mode. We will be facilitating a question and answer session towards the end of today's call. 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 for a few introductory comments.

Earlier today, SI Bone released financial results for the quarter ended March 31, 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 made 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 years. With that, I'll return the call over to Laura.

Thanks, Akib. 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're 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. IntraTI, which was launched in the quarter, is not just an expansion of our SI joint portfolio. It's a deliberate focus to further build the interventional segment with a solution that aligns with the physician 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're 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 and 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 of $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. This will positively impact our spinal pelvic market opportunity with Granite, if finalized as proposed. As you may recall, last year we had requested CMS to 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 acknowledgement 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 $50,000 per procedure, depending upon specifics of the patient's diagnosis and severity. This reimbursement change would be effective October 1st of this calendar year. 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 favorable reimbursement backdrop. This gives us confidence that we're positioned to accelerate our revenue growth going forward. Now, I'll highlight the progress we've made on our four key priorities, innovation and market development, physician engagement, commercial execution, and operational excellence. Starting with innovation and market development, we're 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 150,000 procedures and has established our deep competencies around enabling fixation and fusion of low-density bone. We're now leveraging this biomechanical leadership and our proprietary technology to expand beyond the sacroiliac joint into high-value clinical adjacencies and musculoskeletal care with a focus on patients with compromised, often osteoporotic bone. With nearly 300,000 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 IntraTI, 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 accelerating 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 lifestands 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're leveraging our expertise to develop targeted and competitively differentiated solutions that will complement Granite, 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 Policy 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 and NASC settings. The new DRGs proposed by CMS also reinforce Granta'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 130,000 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 60,000 target procedures are to treat low-intensity sacral insufficiency fractures. Our iFuse Torque TNT system is well aligned with existing surgeon workflows benefits from favorable reimbursement, including NTAP of over $4,000, and is supported by our strategic partnership with Smith and 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 also 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're targeting a 510K submission in the early third quarter. We have clear line of sight to a commercial launch, which we expect to meaningful 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's 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 generated three times the case volume of new users. reinforcing the value of long-term, deep engagement. We're 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 Granite and our upcoming technologies, we're well positioned to accelerate that expansion. Now let's turn to commercial execution. We ended the quarter 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 the territory managers, territory representatives, and over 300 third-party agents, continues to be a competitive advantage. Our hybrid sales model 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 and 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's still early, the initial physician and field reception has been encouraging, and we'll 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 the market in the coming years. Before I turn the call over to Anshul, I want to thank our employees for their continued focus and execution. We built one of the fastest growing differentiated technology platforms with deep expertise in addressing the needs of patients with compromised bones. That focus continues to guide our innovation and expansion into new indications that'll 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 conviction 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.