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spk02: Thank you for standing by and welcome to Globus Medical's fourth quarter and full year 2022 earnings conference call. At this time, all participants are in a listen-only mode. After the speaker presentation, there will be a question and answer session. To ask a question during the session, you will need to press star 1-1 on your telephone. I would now like to hand the call over to Senior Vice President of Business Development and Investor Relations, Brian Kearns. Please go ahead.
spk05: Thank you, Lateef, and thank you, everyone, for being with us today. Joining today's call from Globus Medical will be Dan Scavilla, President and CEO, and Keith Feil, Chief Financial Officer. This review is being made available via webcast, accessible through the Investor Relations section of the Globus Medical website at www.globusmedical.com. Before we begin, let me remind you that some of the statements made during this review are or may be considered forward-looking statements. Our Form 10-K for the 2022 fiscal year and our subsequent filings with the Securities and Exchange Commission identify certain factors that could cause our actual results to differ materially from those projected in any forward-looking statements made today. Our SEC filings, including the 10-K, are available on our website. We do not undertake to update any forward-looking statements as a result of new information or future events or developments. Our discussion today will also include certain financial measures that are not calculated in accordance with generally accepted accounting principles or GAAP. We believe these non-GAAP financial measures provide additional information pertinent to our business performance. These non-GAAP financial measures should not be considered replacements for and should be read together with the most directly comparable GAAP financial measures. Reconciliations to the most directly comparable GAAP measures are available in the schedules accompanying the press release and on the Investor Relations section of the Globus Medical website. With that, I will now turn the call over to Dan Scavilla, our President and CEO.
spk13: Thanks, Brian, and good afternoon, everyone. Globus finished 2022 with a strong fourth quarter. Revenue for the year was a record $1,023,000,000, crossing the billion-dollar threshold for the first time. We delivered $65 million, where 7% as reported and 8% constant currency growth for the full year. This is above last year's difficult post-COVID comp, where we grew 21% for 2021. We achieved record sales while maintaining industry-leading profitability, generating a record $2.06 in non-GAAP EPS, and an adjusted EBITDA of 33%, even as we continue to invest heavily in INR, trauma, competitive recruiting, and absorb significant currency headwinds. We also launched seven new products in 2022. Four of the launches occurred in the fourth quarter. Revenue for the quarter was $275 million, up 10% as reported, or 12% in constant currency. Non-gap EPS was 59 cents, up 20% versus prior year Q4, and adjusted EBITDA was 33%. US Spine grew 10% in Q4, with notable gains across our product portfolio in expandables, biologics, MIS screws, 3D printed implants, and cervical and lateral offerings. The gains were driven by competitive rep conversions and robotic pull-throughs. We have a strong competitive recruiting year, surpassing the hiring levels in 2020 and 2021. This is usually a leading indicator of growth in the coming years, and we're excited about the potential of the team we've onboarded in 2022. In Q4, we launched our prone lateral patient positioning system as part of our focus on the continuum of care. It is an interactive adjustable bed mount that enables a single position, single stage, lateral surgical approach for direct and indirect decompression, designed to maximize operational efficiencies, increase ease of implant placement, and minimize surgeon fatigue. It integrates seamlessly with our Excelsius GPS and E3D solutions and enables significant capabilities in non-robotic procedures. When combined with our Excelsius platform and our range of expandable interbody offerings, we have unique and customizable lateral solutions available to our surgeons. Enabling technology sales were $30 million, up 20% on a constant currency basis versus prior year, driven by robotic and imaging system sales. This was our highest quarter since launching enabling tech, surpassing last year's Q4 sales that delivered 40% post-COVID growth. We continue to see increased interest in placements with significant international gains of Excelsior's GPS and EMEA in the UK that we feel will lead to future implant pull-through and strong market share gains. Robotic procedures continue to accelerate, growing 25% for the full year and exceeding 43,000 robotic procedures performed to date. We launched the Excelsis 3D imaging system in Q2 of this year and continue to penetrate the market throughout the year. Surgeons have said this is a game changer. Excelsis 3D is a three-in-one imaging platform offering three image modalities in a single cart with high maneuverability, a large field of view, a seamless integration with our Excelsis GPS robotic system. It is a key component of the Excelsis ecosystem in the operating room, an ecosystem that is designed and built from the ground up to communicate together seamlessly. Market interest remains high for this state-of-the-art technology and customer orders continue to grow. Excelsis 3D is positioned to be a major growth driver as we enter 2023. Our international spinal implant business, excluding Japan, delivered record sales in Q4, growing 20% on a constant currency basis compared to prior year. We deliver double-digit growth in most markets and continue to see strong growth in key markets ranging between 25 and 50% for the quarter, with UK and Australia being major contributors. Our trauma business delivered its 12th consecutive quarter of sequential growth, delivering 70% growth for Q4 and 71% for full year. Trauma performance is driven by Salesforce expansion and strong uptake in all 14 product lines, delivering high double-digit growth in each product offering. In Q4, we launched the Audubon EVO femoral nail systems. The intergrade nail is designed to be a standalone, and the retrograde nail is designed for either standalone or plate nail combo procedures with our Anthem distal femur system. Initial surgeon feedback is strong, and we expect the next generation of nail to be a key growth driver in 2023. Our product development engine continues to make progress, focusing on procedural solutions, designing implants, instrumentation, and procedures that will function together within our Globus ecosystem for a seamless and comprehensive approach in spine, trauma, and joints. At the same time, we're expanding our solutions throughout the patient's entire continuum of care, supporting surgeons in preoperative planning, intraoperative execution, and postoperative patient care to capture outcome data for future surgical planning. While this complex approach has extended development timelines beyond our historical rapid pace, I believe the upcoming launches will have greater significance in shaping procedures of the future. Moving into 2023, Globus Medical and Nuvasiv are planning to combine in an all-stock transaction to create a global musculoskeletal company focused on rapid innovation, addressing unmet clinical needs, and improving offerings to our surgeons and patients. The all-stock structure preserves cash to deleverage the company and accelerate investment in assets to fuel growth. The combination capitalizes on our complementary commercial organization where we see little territory overlap and should allow us to accelerate our globalization strategies to increase customer reach and strengthen our surgeon relationships. We plan to bring together the best-in-class technologies from our portfolios to create a differentiated and comprehensive procedural solution offering as part of our approach to address unmet clinical needs and support our surgeons and patients. Our product development engines will combine and increase our focus on rapidly developing innovative solutions throughout the continuum of care from preoperative planning through to surgical monitoring. Our operational footprints are highly complementary, allowing us to better leverage each other's manufacturing and supply chain resources to increase internal production while reducing the amount of capital investment required as stand-alones so we can redirect investment and improve cash flow. Over the past several months, it has become clear to me that both organizations have more in common than they are different. The complementary strengths of Globus Engineering with an invasive surge in relations, education, and training will combine for a truly potent innovation company. We will continue to outpace the market growth where we compete and gain share while maintaining financial discipline to drive sales growth, continue mid-30s EBITDA, accelerate EPS growth, and increase cash flows for our investors. As an update on the merger status, we are currently preparing our HSR submission and the joint proxy statement. Cross-functional integration planning has ramped up so we can pivot to integration implementation once the merger is approved when we clear HSR, secure shareholder approvals, and meet closing requirements. We expect to close the deal in mid-2023. In closing, we remain focused on core elements for long-term growth, innovative new product introductions, robot and imaging system sales, competitive rep recruiting, and merger integration planning. 2023 is all about focus and execution to deliver value to our customers and drive growth. I know we are well positioned to achieve our mission of becoming the preeminent musculoskeletal company in the world. I will now turn the call over to Keith.
spk09: Thank you, Dan, and thank you to everyone for joining us on today's call. Globus achieved a milestone in 2022, growing to over $1 billion in sales, despite strong currency headwinds and lingering COVID impacts earlier in the year. Full year 2022 revenue was $1.023 billion, growing 6.8% as reported and 8.2% on a constant currency basis with the same number of selling days in 2022 and 2021. Currency impacts were unfavorable to revenue by $14 million in 2022. Net income was $190.2 million, resulting in fully diluted earnings per share of $1.85, Non-GAAP net income was $211.6 million, generating $2.06 of fully diluted non-GAAP earnings per share. 2022 adjusted EBITDA was 33.2%, and we generated $104.4 million of free cash flow for the full year. Q4 2022 revenue was $274.5 million, growing 9.8% as reported and 11.7% on a constant currency basis. Net income was $50.1 million, and non-GAAP net income was $60.1 million. Q4 2022 fully diluted earnings per share was 49 cents, while our fully diluted non-GAAP earnings per share was 59 cents. Adjusted EBITDA was 32.8%, and we generated $45.6 million of free cash flow for the quarter. U.S. revenue in the fourth quarter of 2022 was $233.2 million, growing 9.5% as reported compared to the prior year quarter led by growth in U.S. spine, biologics, and trauma. International revenue for the fourth quarter was $41.3 million, growing 11.4% as reported and 24.2% on a constant currency basis, driven by increased INR and implant sales. Gross profit in the fourth quarter was 74.3% versus 75.3% in the prior year quarter, and it's consistent with expectations. The 100 basis point decline was driven primarily by product mix, and higher freight costs, partially offset by lower inventory reserves and depreciation expenses. Full year 2022 gross profit was 74.2% compared to 75% in 2021. The 80 basis point decrease was driven by product mix, primarily higher capital sales and higher freight expenses. Research and development expenses in Q4 were $19.5 million or 7.1% of sales compared to $51 million or 20.4% of sales in the prior year quarter. The lower spending is driven by decreased IP R&D spending in Q4 22 versus Q4 21. On a normalized basis, Q4 21 R&D spending was $16.7 million or 6.7% of sales. The resulting quarter over quarter increase is driven primarily by higher continued investments in R&D, mainly driven by increased headcount across our spine, INR, and trauma portfolios. Our full year 2022 research and development expenses were $73 million, or 7.1% of sales, compared to $97.3 million, or 10.2% of sales in the prior year. Adjusting for acquisitions made in both periods, R&D expenses in 2022 were $72.9 million, or 7.1% of sales, compared to $63 million, or 6.6% of sales in the prior year. The increased spending is consistent with my comments on Q4 2022, namely headcount investments across our portfolio. SG&A expenses in the fourth quarter were $118.1 million or 43% of sales compared to $106.6 million or 42.6% of sales in the prior year quarter. The increase is primarily higher selling costs as a result of higher compensation costs from competitive recruiting as well as higher travel expenses. Full-year SG&A expenses were $432.1 million, or 42.2% of sales, compared to $408.1 million, or 42.6% of sales. The increased dollar spending is primarily driven by volume impacts from higher sales growth, as well as higher sales compensation expenses and higher travel. SG&A spending decreased 40 basis points versus 2021, driven by leverage on fixed spending, partially offset by higher sales costs and training expenses. The income tax rate for the quarter was 19.4% compared to 23.8% in Q4 of 2021, driven primarily by lower international tax expenses. Our full year 2022 income tax rate was 21.7% compared to 17.3% in the prior year, with the resulting increase driven by lower benefits associated with stock option exercises. Fourth quarter net income was $50.1 million, and non-GAAP net income was $60.1 million. Q4 diluted earnings per share was $0.49, and non-GAAP diluted earnings per share was $0.59 compared to $0.49 in the prior year quarter. The $0.10 increase in Q4 2022 non-GAAP EPS includes a net $0.04 of non-operating favorability driven by a lower tax rate and higher interest income, partially offset by currency translation impacts. On a normalized basis, non-GAAP EPS in the fourth quarter was $0.55 compared to $0.49 in the prior year quarter, growing 12.2%, driven primarily by sales volume growth, as mentioned earlier. Full year 2022 diluted earnings per share was $1.85, and non-GAAP diluted earnings per share was $2.06, compared to $2.04 of non-GAAP EPS in 2021. Our full year 2022 non-GAAP EPS is inclusive of 14 cents of non-operating items, which includes unfavorable currency impacts worth 11 cents, a higher tax rate worth 10 cents, partially offset by higher interest and other income worth $0.05 and a lower share count worth $0.02. Full year 2022 adjusted EBITDA of 33.2% includes 90 basis points of unfavorable currency impacts resulting in a normalized 34.1% adjusted EBITDA for the year. Net cash provided by operating activities were $64 million in the fourth quarter of 2022 and $178.5 million for the full year. Free cash flow was $45.6 million in the fourth quarter and $104.4 million for the full year 2022. Our 2022 free cash flow was impacted by higher capital expenditures, as well as investments in working capital, namely inventory and accounts receivable. The company remains debt free. At this time, the company is establishing its full year standalone 2023 guidance. We are projecting full year 2023 sales guidance of $1.1 billion representing 7.5% growth versus 2022. We are guiding to a full year, fully diluted, non-GAAP earnings per share of $2.30, representing 11.7% growth versus 2022. Our 2022 results are reflective of continued investment across our business. R&D spending increased as we seek to bring more new and exciting products to market. Our sales and marketing spending increased as we continue to grow our sales force, and our CapEx spending increased to meet increased demands for product output and set deployment. In closing, I'll briefly add a few comments in addition to Dan's earlier comments as it relates to our February 9th announcement that we've entered into a definitive agreement to combine an all-stock transaction with NuVasive. Once shareholder and regulatory approvals are obtained and the transaction closes, we expect to deliver 20 plus percent non-GAAP EPS accretion by the completion of the first full year. This assumes likely near-term sales dis- synergies from rep and account disruptions partially offset by revenue synergies around complementary implant sales and additional INR sales of Globus Capital and NuVasive accounts. In addition, this includes delivering on $170 million of cost synergies, of which we expect to achieve 50% by the end of year one, 75% by the end of year two, and 100% by the end of the third year.
spk08: Operator, we will now answer the call for questions.
spk02: As a reminder, to ask a question, you will need to press star 1-1 on your telephone. Again, that's star 1-1 on your telephone to ask a question. Please stand by. Again, that's star 1-1. Our first question comes from the line of Shagan Singh of RBC Capital Markets. Your line is open.
spk32: Great. Thank you so much, and congratulations on exceeding a billion dollars in sales. So I guess my first question is, I guess we've all had some time to digest the deal, but just given the stock reaction, I'm wondering if you could comment on where you see the disconnect in your thinking versus investors on deal rationale, financials, and or strategy. And one of the other things that's come up is if you may sweeten the deal, could you just talk about the flexibility and willingness to close the deal here? Any comments would be helpful. Thank you so much.
spk13: Thanks, Shigal. So just keep in mind as we did this and as we've talked about during our announcements, you're really looking at what we believe is a complementary global scale with the ability to expand customer reach with minimal overlap. We've talked about being able to develop a comprehensive and innovative portfolio in spine and orthopedics when we combine these out. And we remain committed to innovative product development and surgeon education. We're seeing that the operational capabilities fit nicely together in this and actually can benefit us as a combined And when you look at that and you combine this out, the compelling upside of revenue and what even Keith mentioned with the EPS and accretion that's all out there for value opportunity, that's what we see. The disconnect, I can't say. I can't speak for Wall Street. They'll point to several unrelated deals and look at that, but that's okay. It's certainly their prerogative to do it. As for what we would do in a market and change in stock, that's something we wouldn't be in a position to actually comment on. And it's something we'll have to evaluate and see when that time comes.
spk32: Got it. And just as a follow-up question, can you just talk about the relative contribution from rep recruitment versus NPIs versus pull-through from enabling tech to U.S. implant sales? And then are you parsing out final implant and imaging sales for Q4? And thank you for taking the questions.
spk13: Thanks. Again, to be honest with you, I wouldn't have the ability to pull all those things apart and really tell you what they were. Again, since we're running the business as a whole, I think the fact that we've significantly outpaced the market with continued growth is probably more important as to the sum of the parts.
spk01: Got it.
spk04: Thank you.
spk02: Our next question comes from the line of Matt Taylor of Jefferies. Your question, please, Matt.
spk07: Great. Hi, thanks for taking the question. So I wanted to see if you could address more specifically, I think the main concern a lot of investors have is about the disenergies, the turnover that you talked about. Can you talk a little bit about how you can mitigate that and then also how you may be able to offset that with some of the revenue synergies that you discussed here, maybe the timing of this?
spk13: Thanks, Matt. So we won't go into too much detail. We're going to put together filings and different things in our proxy where you would certainly have access to that in the near future. What we're signaling of course, is that like in any deal, we would expect to have some reasonable amount of dis synergies. And I think that anybody would want that in there as a prudent statement. So we've built that in that way, whether that be reps going to a competitor accounts, switching to just natural things that would occur. What Keith said and what I would stand by is however, When we're able to get our hands on a cervical disc that's multilevel that they have, their lateral procedures, we can hand to them our expandables. We can open up a market for our enabling technology. All of those things will have actually offsets that we believe would occur over a couple of years. And I think we all strongly believe in this. So by combining the portfolios, combining the markets, we'll come out stronger and we'll see some short-term pain. But both teams are doing this for the long term, not the current 12 months, but we're really looking to say for multi-year, we're building a strong company.
spk07: Maybe I could just ask one follow-up on the synergies. You seem very confident in that target that you laid out. Maybe just talk about how much of that stuff is you'd call well-identified or lower-hanging fruit, and how much of it is harder to kind of pull apart and synergize in your plan?
spk09: Thanks for the question. Yeah, we do feel good about achieving the $170 million in synergies. I would say that we're, you know, in the early stages of working with the teams to better understand the business. But as we look at our cost structure versus their cost structure, we feel confident that we're able to achieve these savings when you look at the combined spending of both companies together.
spk06: Great. Thank you, guys.
spk09: Thank you.
spk33: Thank you.
spk02: Our next question. comes from the line of Matt Mixick of Barclays. Your line is open, Matt.
spk22: Hi, it's Matt Mixick. I wasn't quite sure if you were referring to me. I'm sorry, I lost the last name. But if you can hear me, can you hear me okay? Yes, we got you, Matt. Got a lot of Matt on these calls. One, just follow up if I could on the synergies on Matt Taylor's comment, and then I have one on margins if I could. So on the synergies, can you talk about maybe what is not included in those? I mean, there's a fair amount of complementary products, robots and cervical disc replacement and the cervical portfolio at GMAD that are potentially you know, complimentary in the sense of driving additional sales. Are those included? You know, if they are, you know, I guess, you know, what things have you and have you not included in that number? And then I have one follow-up.
spk13: Yeah, Matt, so for clarity, I believe you're talking about sales synergies and dis-synergies. Is that right?
spk20: Yes, correct.
spk13: Okay, so separate from the overall cost savings with that. Again, we're not going to go into a lot of granular detail. I think what we're just saying is take a look at what Nuvasiv has as a strength where we can benefit, and we're saying look at the opposite way for us too. It's really that combination. We have some placeholders and some ideas that we're working through, but this is early stages, right? We really just announced this a few days ago, and we've gone from being blind into ability to look at this with a little bit more clarity. We'll focus through it. I think what we're signaling is confidence that we have enough tools in our offering to to offset sales to synergies. And then just kind of back to the question Matt had asked on actually cost synergies. Again, we have several areas to look at. We haven't fine-tuned those down by accounts, certainly, or anything like that, or even department. We just realized that the abilities are there, and we're in the early stages of working through those.
spk22: Got it. Okay. That's helpful. And then margins going forward. Obviously, you're looking for some EBITDA margin leverage this year. You know, can you talk about maybe some of the headwinds that you're facing, you know, to sort of keep you here in kind of the low end of the mid-30s range as far as we can tell that's kind of where your $2.30 EPS number kind of puts you for this coming year based on the top line and how those kind of play out throughout the year. That'd be helpful. Thanks.
spk09: Sure. Thanks for the question. So as you think about going into next year on a standalone basis, the EBITDA margin does come out on the lower end of the range. But when you think about some of the things we've done recently, we've really stepped up our investment in R&D spending. That's jumped out. We've invested a little bit more in Salesforce. That'll show, you know, that should show fruits as we move forward. But, uh, you know, I talked a little bit about product mix, uh, in the quarter and the full year, uh, capital sales have a little bit of a headwind on overall profitability, but stepping back to that, we still feel that we're a mid seventies business. I mean, if you, if you look at, uh, this year, specifically 2022, you know, the currency impact of $14 million was worth about 90 basis points to EBITDA. So, you know, when I look at that, I look at the business and I still see that, you know, we're healthy and we're driving the business forward. Places that we see inflation, obviously I've talked a lot about freight this year. I think in each quarter we've seen freight tick up, you know, just from fuel prices. Across the rest of the P&L, I think it's fair to assume that you're seeing some inflation in travel. You know, last year in 2021, the travel grew sequentially as COVID started to dissipate. But I think as you got really the Q4 and into this year, you saw inflation take hold as well while people continued to travel. So it's absolutely some of the driver that you're seeing in the increases there, which, you know, offset some of the leverage growth or the leverage benefit you might see in SG&A.
spk04: Thanks so much. Thank you. Thank you.
spk02: Our next question comes from the line of Vic Chopra. of Wells Fargo. Your question, please, Vic.
spk19: Hey, good afternoon, and thanks for taking the question. So two for me. First, related to the deal, I know you've said there's limited customer overlap, but can you talk about where some of the product overlap is and which assets or categories you think you may have to divest? My second question is one of the large orthopedic competitors has talked about coming out with a spine robot application in 2024. Can you perhaps talk about the market and competitive landscape and whether you expect any impact in 2023 to your ability to continue to sell Excelsior systems? Thank you.
spk13: Thanks, Vic. So, you know, I would just get through the second part of the question. We've always expected, we've always talked about how we're one of the first to move on this and the market will actually grow over time and become naturally competitive. So you kind of asked the question, what do you do to stay relevant? We've been talking continuously about our development of the ecosystem of multiple things that all fit together. We've talked about our procedural applications from pre-op planning through to post-op data and feedback loops. All of those items were well ahead of the curve. We're pushing out, we're driving. That will not only keep us relevant, but actually keep us as a leader here. And so, listen, competition will come. It's natural. They're coming because of our success. And we're going to go continue to innovate spend. We've talked continuously about our investment in R&D and how that's a pull down because we're investing properly to build the strength for long-term gains here. That was the first part. And I apologize. Can you bring up your first part of the question again on the deal itself?
spk19: Yeah, sure. Just on the divestiture, can you talk about where some of the product overlap is and which assets or categories you think you may have to potentially divest?
spk13: No, it's a great question. I would tell you that given our size, we're not anticipating any significant divestitures at this time. We're in the middle of all of this filing. So again, we've got to place this in the hands of the government and wait. But we're not going in with any thought or concern that we're seeing right now that would trigger anything of significance.
spk04: Thank you. Thank you.
spk02: Our next question comes from the line of David Saxon of Niedermann Company. Please go ahead, David.
spk15: Hi, guys. This is Joseph on for David.
spk16: Maybe just looking towards the upcoming knee robot launch, could you Maybe talk about some of the strategy behind that. What are the initial accounts you're going to be targeting? You can talk about the expansion of the sales force, but maybe could you also talk about maybe pricing and features that may be relative to currently available robots? And then if possible, could you quantify those commercial investments associated with the launch?
spk13: Thanks, Joseph. I wish I could, but we don't have all of that data just yet. So let me break your question into those chunks and go at them. I think it counts. Certainly we would have our eyes on ASCs and certainly hospitals. So I wouldn't say we're going to specialize in one or the other. We'll look to go at both with that type of approach. You are correct that our initial thought was capital reps and obviously implant reps will require us to take steps and investments, things that we've built into our projections. But again, if you know us, we don't go out and have a big bang. We use concentric circles. We'll hire a group, stabilize them, get it going, moving. We'll pay for them and go on and on, just as we've done in the past. So I wouldn't signal that there's a major drop or an anticipated investment that takes us off of our curve that way. And finally, with pricing, I would just tell you we'll price at the market appropriately. We recognize there's competition out there. We feel like we've got a viable solution that will add value to doctors. And like I said, depending on what the market bears, we're in a position to actually do that.
spk16: Okay, great. Yeah, that makes sense. And then maybe, could you maybe just give a quick update on the commercial team out in Japan, if things are maybe stabilized there, you know, there's still more wood to chop?
spk13: Yeah, I would tell you that it's in the stabilization phases. It's probably about a quarter behind where I would have wanted it to be. But what we're seeing right now is That is settling down into where I think it's actually at the point where we should expect to see some building up of it in the first half of this year.
spk14: Okay, great. Thank you for taking our questions, and congrats on the quarter.
spk04: Thank you.
spk02: Thank you. Our next question comes from the line of Steve Flickman of Oppenheimer. Please go ahead, Steve.
spk18: Thank you. Even guys. Looking at it to the 2023 sales guidance, I'm wondering if you can provide any color on components of growth. U.S. versus no U.S. fine, emerging tax, incremental trauma, any color there?
spk09: Great question. Thanks for it. You know, we typically don't break out the parts and pieces. But when I step back and look at, you know, the year that we're going into, I think we still feel very bullish about our U.S. spine business and its ability to grow. I think we came off a strong quarter between that, biologics, and trauma in the U.S. Enabling tech, I see that continuing to grow. Cognizant that we're entering into a recession. However, one of the things that we see happening is greater sales of those units internationally. So that's something that we feel good about going into next year. But that's about as much detail as I'll give in terms of breaking out the guidance.
spk13: Steve, one thing I'd add to that, which I'm pleased with, is we're not dependent upon one or two of these. It really seems like we're projecting forward as we've performed in the past. And while we'll never get each one of these exactly right, we have enough levers here that I feel strongly that we can get into this and achieve it.
spk18: Okay, thanks, Keith and Dan. And then just secondly, as you look ahead here near term, is there anything you feel you need to do to help retain reps and prevent any coaching ahead of the deal closing? Or just overall, what's the center of the group in the last couple, three weeks here? Thanks.
spk13: It's a great question. And look, it's human nature in the state of change to have some discomfort. So the best thing to do is communicate because we don't need to beg here with this. Keep in mind that we as Globus and what we intend to do as the bigger company is is pay strongly for our reps, and we've been doing that historically without change, unlike other companies, so we're going to maintain that. At the same time, we have discussed in person with the field team our portfolio to understand the strengths that we're about to give them on the Nuvasiv side, and they actually are in the process of doing the same for us on the Globus side with that. So we're talking about strong compensation, arguably the strongest offering for products in the spine market with that. And then, you know, our enabling technology along with the Pulse system can really become a powerful tool, and I think everybody can see that. And then, of course, we're always looking at what near-term yet future innovation can be to significantly tie these together through that ecosystem. When we offer that up with people, it's a tough thing to compete against, and a rep that is long-term focused and wise can recognize that within 12 months, they're going to have at their fingertips the most powerful offering in the industry.
spk03: Got it. Thanks, Dan.
spk02: Thank you. Our next question comes from the line of Matthew O'Brien of Piper Sandler. Please go ahead, Matthew.
spk17: Hey, I kind of broke up. Did you say Matthew O'Brien? He did. okay fantastic um thanks for taking my questions so i guess dan can you you or keith actually just talk about the timing of the nuva vote uh from the shareholders and then it is a take under at this point it's about five percent lower stock prices versus where it was traded before the announcement so how are you going to talk those investors into voting for this transaction between you and chris and um you know are you so committed to this deal that you would offer up a sweetener, be it more stock or even cash, if need be, to make sure this gets done. And I do have one more follow-up.
spk13: Thanks, Matt. So a lot of questions there. I would tell you that we're not going to be in a position yet to comment on what it is we're going to do. Certainly, we're going to talk to investors, show them why this deal makes sense, show them the math to get them lined up with this and understand that this is a long-term gain that will create a significant acceleration versus if we stayed alone as standalones. I think that's probably the biggest thing with it. But to talk about any other steps at this point, we've premature, so I'll refrain from that.
spk17: Okay, but Dan, when we hear middle of the year closing, you think, all right, June 30th, so the vote would be sometime before then. I mean, is it the next few months where we could see the vote?
spk13: I'm sorry, I did leave that off. I wasn't avoiding that with that. Really what we need to do right now is create the joint proxy first and then get the vote. We're in the process of compiling that, as I said in my statements. You know, look, I don't have an exact date where we'll say that's done, but it's obviously the priority right now is to get the HSR filing in, get that working, get the joint proxy going so we can get this in motion.
spk17: Okay. And then the follow-up, Dan, is, again, more of a strategic question, because I think part of the reaction in the stock was kind of the adjustment to the strategic direction of the business that I think most were anticipating, because you were kind of more diversifying away from SPI, and now you're doubling down more. Is this part of a bigger push for the company longer term, you know, double down on SPI and get big there, get a lot of cash flow, and then invest in other areas of Orto to become a much bigger entity in the space? Excellent.
spk13: Thanks, Matt. Again, really good question. So, you know, it's obviously interesting from this seat. For years, for eight years, investors have asked, what are you going to do? How are you going to make an acquisition? What are you going to do? We've made an acquisition, and folks are sort of stepping back by it. But the fact is we've been patient. We've looked. We've analyzed. We've decided this is the right time to do it. We've looked through multiple scenarios throughout our portfolio and really came back to this being the strongest opportunity now to go do this. And what you touched on is exactly right. The combined company will be stronger than the individuals, and our cash flow itself when we combine will be significant, which will allow us then to move on to other larger acquisitions over time. It doesn't mean that we've just shifted and won't create innovation and launch organically. We're just saying we want to use the financial strength to our benefit as well as our engineering prowess. Got it. Makes a lot of sense. Thanks so much.
spk02: Thank you. Our next question comes from the line of Craig Bijou, Bank of America. Please go ahead, Craig.
spk10: Thanks, guys. Thanks for taking the questions. I wanted to focus on enabling tech here. And, you know, it did come in a little bit lower than the street was expecting. I know you guys had a record quarter. And you guys have talked about the strength internationally. So maybe kind of wanted to parse out U.S. versus O.U.S. trends with enabling tech and then really see kind of what you see in your funnel and has anything changed over the last, you know, three months or so since the last quarter with the funnel, either U.S. or O.U.S.?
spk13: Yeah. Thanks, Greg. Thanks, Greg. Yeah, I guess my first thought is I'm not sure I would apologize for delivering 20% growth in a recession and a challenged market. I think that's very strong performance that was done by the team. And so I'll stay by that one. Certainly last year, 2021, you had a lot of sales robotically in the U.S. because of pent-up demand, a lot of activity along with COVID. And while I say we came close to that this year, the international has, I think, recovered economically a little bit better than the U.S. in some of these concerns. So what we're signaling is we've seen some great placements internationally that kind of put us back into a strong spot overall that way robotically. And as we've said, we've also put out the imaging system really U.S. right now with where that is and what we're doing with that and just continuing to take advantage of that market.
spk10: Got it. And just following up, I'll stick on enabling tech, but Keith made the comment about looking into a recession in response to one of the previous questions. But your view on 23, you still feel like there's a strong hospital appetite for capital and you don't see any concerns or any changes in either the thinking or the actions of hospitals?
spk13: I would say it's a little too soon for us to call. I mean, certainly, even getting all through COVID and into last year, we've seen behavioral changes and concerns and shorting of staff that they have to divert funds otherwise, all things like that that have been a ripple through this. So I don't know if we had a chance to look for really the last two to three years at a steady state and understand what's normal. And now we're in the face of a recession. So difficult to call. Again, what I would tell you is we've placed out standalone guidance, and in that we have fairly strong numbers that we feel we can achieve, recognizing that there may be some pressure on the enabling tech. But, again, there's enough levers throughout our overall portfolio. We feel confident we can achieve those numbers.
spk09: Yeah, and the only comment I would add to what Dan stated is if you step back and look at enabling tech going back to 2018, that business delivered $47 million in sales in 2018. It delivered $47 million in 2019. We went through COVID-19. and we delivered 41 million. And last year, we delivered 81 to finish this year at 96. So the business has really grown. Obviously, there's always issues that we're going to be faced with, but at the end of the day, we're going to really work to get through them and really get our capital in the hands of our customers.
spk11: Got it. Thanks for taking the questions, guys. Thank you.
spk02: Thank you. Our next question is, comes from the line of Kyle Rose of Canaccord Genuity. Please go ahead, Kyle.
spk04: Kyle Rose, your line is open.
spk26: Oh, sorry. I didn't hear my name there. Thank you for taking the question. I want to talk a little bit about top line guidance. You outlined some expectations for the usual sales dis-synergies once the deal closes. I'm just wondering how you're thinking about the first half of the year pre-deal close, any sort of people taking the eye off the ball, maybe guidance contemplates some of that on a standalone basis, and then there's a little upside there if that doesn't play out. Any insights you could provide there would be helpful. And then secondarily on new products, you're still talking about the total joint application from a robotics perspective, but in the past you've detailed maybe some product gaps or a need to improve the underlying implant systems and total joints. Is it fair to expect that we should see some of those new product launches come along ahead of the robotics launch? Thank you.
spk09: All right, thanks for the question. I'll take the first part and hand the second part over to Dan. So as it relates to guidance, standalone guidance, and looking at 2023, I don't see or we don't see anybody taking their eye off the ball. We're happy with what we've seen thus far in the quarter. Sales are meeting expectations. So I don't see anyone taking their eye off the ball. It is we are running a business and we're moving the business forward as we intended prior to the deal announcement.
spk13: What I would say on your second question is we will launch out our robot that will have a knee application. We're working on other applications now. I would not think that you're going to see them come out before the knee application would be my initial thoughts. I think we'll start out with knee. We're going to migrate in hip, as we said, and then we have the ability to move into other applications over time that way.
spk04: Thank you.
spk02: Thank you. Our next question comes from the line of Matthew Blackman of Stifel. Your question, please, Matthew.
spk29: Hi, it's Matt Blackman from Stifel. Thank you for taking my question. Just one, just thinking about the inputs you put into your deal model, revenue, the synergies, synergies. Where do you think there's the most flex, or maybe better said, where's the most opportunity and perhaps the most risk as you think about those different inputs? Thanks.
spk13: Yeah, that's a great question. A little bit of a teasing question we probably don't want to answer, but what I would tell you is I feel like we were aggressive in what we think the dis-synergies would be and light in what we think the synergies will be. We're a conservative group by nature, if you know us. And so I do think that we might be able to retain better than we've planned in the synergies. And I think that we could probably beat if we have the right focus on our synergies within those sales areas, but not product specific, just in general.
spk28: I appreciate it. Thank you.
spk02: Thank you. Our next question comes from the line of Richard Newitter of Truist. Please go ahead, Richard.
spk25: Hi, thanks for taking the question. Two for me. Just on the deal, you mentioned minimal customer overlap. I was hoping you could elaborate on what the threshold was for defining minimal overlap per surgeon between the two companies. I'm essentially just trying to gauge whether a surgeon that you consider you know, not to be overlapped, will that necessarily translate into minimal disruption in the region, especially in the way that territories are going to be grown? Because you still need to split those territories. So I was just hoping you could maybe elaborate a little bit on that.
spk13: Yeah, Rich, I'll do that in a certain way. There's not a lot I can reveal right now with where we're going on this, but I will give you what I think we can do along these lines. So during the diligence, of course, all of this data was blinded and it was done by bankers, not us. And we traced it down to a surgeon level as the most logical way to go. And what we found is we had the vast majority as complementary. And what that definition of complementary is, is that someone may either have 100%, 80%, 75% of a surgeon by themselves. And it was kind of after that, maybe if you're 50-50 or less, that would be the overlap. And so what we found is kind of, I can't really reveal this, but I would say, you know, extremely high in the 90s of the ability to match up. Now, as we unblind that, perhaps we see it differently, we adjust, we look and go. But even with a surgeon overlap, very well could be that the surgeon is using invasive pedicle screws in our inner body or vice versa. So It may not be a product conflict. The thought being that even along those lines where that is the case, we can decide between those reps what's best. Does one keep the surgeon? Do they both keep it that way? Our goal is to maintain all of the reps. We have enough space, enough growth, enough opportunity to do this, so it's not really about a rep rationalization. And what we're signaling out to the market is we believe that this is a very favorable thing for the deal that will minimize disruption.
spk25: Got it. And then just I think you would reference the new augmented reality headset product launch in 2023 on your last conference call. Just curious if that's still on track and what the timing might be there.
spk13: I'm speaking to you through it right now, Rich. No, I'm kidding. No, listen, it's on track. I think that, again, it can never say for sure what's going on with the FDA and the filings, but I would tell you that we signaled that with the thought that it would be out towards the latter part of this year, and by no means will we take our eye off that ball. That's going to be a great player for us to get out and continue to differentiate with this type of approach, so it's one of the top priorities.
spk25: Okay, and anything in there from a guidance standpoint baked in?
spk13: Well, you know how we always answer that, right? So, in total, we feel good. It's one of the levers that we'll look at, but it's something that would not take us off our ability to achieve our numbers, whether it came to market or did not.
spk24: Great. Thanks a lot.
spk02: Thank you. Again, to ask a question, please press star 1-1 on your telephone. Again, that's star 1-1 on your telephone to ask a question. The next question comes from the line of Drew Rangieri of Morgan Stanley. Your question, please, Drew.
spk31: Hi. Thanks for taking the question. Just one on international. I think in your prepared comments, you said international ex-Japan was up 20% year over year. Can you maybe give us a little bit more detail about the all-in number with Japan? And then just comment on any kind of key moving drivers there in the international market. It seemed like from the acquisition call, you were putting a lot of emphasis on the global reach of the two companies. So any more detail that you could share there would be great. Thank you.
spk09: Thanks for the question. So as we look at international, the Japan sales were down. There's obviously some currency impacts in there as well. But what we really saw as we got to the back end of the quarter touches on the stabilization that Dan commented on earlier. As we get into 2023, we expect to start to see this business to move forward and grow.
spk02: Thank you. With no further questions, this concludes the Globus Medical fourth quarter and full year 2022 analyst call. Thank you for your participation. You may now disconnect.
spk12: The conference will begin shortly. To raise and lower your hand during Q&A, you can dial star 1 1. The conference will begin shortly. To raise and lower your hand during Q&A, you can dial star 1 1. The conference will begin shortly. To raise and lower your hand during Q&A, you can dial star 1 1. The conference will begin shortly. To raise and lower your hand during Q&A, you can dial star 1 1. The conference will begin shortly. To raise and lower your hand during Q&A, you can dial star 1 1. you Bye. Thank you. Thank you.
spk02: Thank you for standing by and welcome to Globus Medical's fourth quarter and full year 2022 earnings conference call. At this time, all participants are in a listen-only mode. After the speaker presentation, there will be a question and answer session. To ask a question during the session, you will need to press star 1-1 on your telephone. I would now like to hand the call over to Senior Vice President of Business Development and Investor Relations, Brian Kearns. Please go ahead.
spk05: Thank you, Lateef, and thank you, everyone, for being with us today. Joining today's call from Globus Medical will be Dan Scavilla, President and CEO, and Keith Feil, Chief Financial Officer. This review is being made available via webcast accessible through the investor relations section of the Globus Medical website at www.globusmedical.com. Before we begin, let me remind you that some of the statements made during this review are or may be considered forward-looking statements. Our Form 10-K for the 2022 fiscal year and our subsequent filings with the Securities and Exchange Commission identify certain factors that could cause our actual results to differ materially from those projected in any forward-looking statements made today. Our SEC filings, including the 10-K, are available on our website. We do not undertake to update any forward-looking statements as a result of new information or future events or developments. Our discussion today will also include certain financial measures that are not calculated in accordance with generally accepted accounting principles or GAAP. We believe these non-GAAP financial measures provide additional information pertinent to our business performance. These non-GAAP financial measures should not be considered replacements for and should be read together with the most directly comparable GAAP financial measures. Reconciliations to the most directly comparable GAAP measures are available in the schedules accompanying the press release and on the Investor Relations section of the Globus Medical website. With that, I will now turn the call over to Dan Scavilla, our President and CEO.
spk13: Thanks, Brian, and good afternoon, everyone. Globus finished 2022 with a strong fourth quarter. Revenue for the year was a record $1,023,000,000, crossing the billion-dollar threshold for the first time. We delivered $65 million, where 7% as reported and 8% constant currency growth for the full year. This is above last year's difficult post-COVID comp, where we grew 21% for 2021. We achieved record sales while maintaining industry-leading profitability, generating a record $2.06 in non-GAAP EPS, and an adjusted EBITDA of 33%, even as we continue to invest heavily in INR, trauma, competitive recruiting, and absorb significant currency headwinds. We also launched seven new products in 2022. Four of the launches occurred in the fourth quarter. Revenue for the quarter was $275 million, up 10% as reported, or 12% in constant currency. Non-gap EPS was 59 cents, up 20% versus prior year Q4, and adjusted EBITDA was 33%. US Spine grew 10% in Q4, with notable gains across our product portfolio in expandables, biologics, MIS screws, 3D printed implants, and cervical and lateral offerings. The gains were driven by competitive rep conversions and robotic pull-throughs. We have a strong competitive recruiting year, surpassing the hiring levels in 2020 and 2021. This is usually a leading indicator of growth in the coming years, and we're excited about the potential of the team we've onboarded in 2022. In Q4, we launched our prone lateral patient positioning system as part of our focus on the continuum of care. It is an interactive adjustable bed mount that enables a single position, single stage, lateral surgical approach for direct and indirect decompression, designed to maximize operational efficiencies, increase ease of implant placement, and minimize surgeon fatigue. It integrates seamlessly with our Excelsius GPS and E3D solutions and enables significant capabilities in non-robotic procedures. When combined with our Excelsius platform and our range of expandable interbody offerings, we have unique and customizable lateral solutions available to our surgeons. Enabling technology sales were $30 million, up 20% on a constant currency basis versus prior year, driven by robotic and imaging system sales. This was our highest quarter since launching enabling tech, surpassing last year's Q4 sales that delivered 40% post-COVID growth. We continue to see increased interest in placements with significant international gains of Excel, CSGPS, and EMEA in the UK that we feel will lead to future implant pull-through and strong market share gains. Robotic procedures continue to accelerate, growing 25% for the full year and exceeding 43,000 robotic procedures performed to date. We launched the Excelsis 3D imaging system in Q2 of this year and continue to penetrate the market throughout the year. Sturgeons has said this is a game changer. Excelsis 3D is a three-in-one imaging platform offering three image modalities in a single cart with high maneuverability, a large field of view, a seamless integration with our Excelsis GPS robotic system. It is a key component of the Excelsis ecosystem in the operating room, an ecosystem that is designed and built from the ground up to communicate together seamlessly. Market interest remains high for this state-of-the-art technology, and customer orders continue to grow. Excelsis 3D is positioned to be a major growth driver as we enter 2023. Our international spinal implant business, excluding Japan, delivered record sales in Q4, growing 20% on a constant currency basis compared to prior year. We deliver double-digit growth in most markets and continue to see strong growth in key markets, ranging between 25% and 50% for the quarter, with UK and Australia being major contributors. Our trauma business delivered its 12th consecutive quarter of sequential growth, delivering 70% growth for Q4 and 71% for full year. Trauma performance is driven by Salesforce expansion and strong uptake in all 14 product lines, delivering high double-digit growth in each product offering. In Q4, we launched the Audubon Evo femoral nail systems. The intergrade nail is designed to be a standalone, and the retrograde nail is designed for either standalone or plate nail combo procedures with our Anthem distal femur system. Initial surgeon feedback is strong, and we expect the next generation of nail to be a key growth driver in 2023. Our product development engine continues to make progress, focusing on procedural solutions, designing implants, instrumentation, and procedures that will function together within our Globus ecosystem for a seamless and comprehensive approach in spine, trauma, and joints. At the same time, we're expanding our solutions throughout the patient's entire continuum of care, supporting surgeons in preoperative planning, intraoperative execution, and postoperative patient care to capture outcome data for future surgical planning. While this complex approach has extended development timelines beyond our historical rapid pace, I believe the upcoming launches will have greater significance in shaping procedures of the future. Moving into 2023, Globus Medical and Nuvasiv are planning to combine in an all-stock transaction to create a global musculoskeletal company focused on rapid innovation, addressing unmet clinical needs, and improving offerings to our surgeons and patients. The all-stock structure preserves cash to deleverage the company and accelerate investment in assets to fuel growth. The combination capitalizes on our complementary commercial organization where we see little territory overlap and should allow us to accelerate our globalization strategies to increase customer reach and strengthen our surgeon relationships. We plan to bring together the best-in-class technologies from our portfolios to create a differentiated and comprehensive procedural solution offering as part of our approach to address unmet clinical needs and support our surgeons and patients. Our product development engines will combine and increase our focus on rapidly developing innovative solutions throughout the continuum of care, from preoperative planning through to surgical monitoring. Our operational footprints are highly complementary, allowing us to better leverage each other's manufacturing and supply chain resources to increase internal production while reducing the amount of capital investment required as stand-alones so we can redirect investment and improve cash flow. Over the past several months, it has become clear to me that both organizations have more in common than they are different. The complementary strengths of Globus Engineering with an invasive surge in relations, education, and training will combine for a truly potent innovation company. We will continue to outpace the market growth where we compete and gain share while maintaining financial discipline to drive sales growth, continue mid-30s EBITDA, accelerate EPS growth, and increase cash flows for our investors. As an update on the merger status, we are currently preparing our HSR submission and the joint proxy statement. Cross-functional integration planning has ramped up so we can pivot to integration implementation once the merger is approved when we clear HSR, secure shareholder approvals, and meet closing requirements. We expect to close the deal in mid-2023. In closing, we remain focused on core elements for long-term growth, innovative new product introductions, robot and imaging system sales, competitive rep recruiting, and merger integration planning. 2023 is all about focus and execution to deliver value to our customers and drive growth. I know we are well positioned to achieve our mission of becoming the preeminent musculoskeletal company in the world. I will now turn the call over to Keith.
spk09: Thank you, Dan, and thank you to everyone for joining us on today's call. Globus achieved a milestone in 2022, growing to over $1 billion in sales, despite strong currency headwinds and lingering COVID impacts earlier in the year. Full year 2022 revenue was $1.023 billion, growing 6.8% as reported and 8.2% on a constant currency basis with the same number of selling days in 2022 and 2021. Currency impacts were unfavorable to revenue by $14 million in 2022. Net income was $190.2 million, resulting in fully diluted earnings per share of $1.85, Non-GAAP net income was $211.6 million, generating $2.06 of fully diluted non-GAAP earnings per share. 2022 adjusted EBITDA was 33.2%, and we generated $104.4 million of free cash flow for the full year. Q4 2022 revenue was $274.5 million, growing 9.8% as reported and 11.7% on a constant currency basis. Net income was $50.1 million, and non-GAAP net income was $60.1 million. Q4 2022 fully diluted earnings per share was 49 cents, while our fully diluted non-GAAP earnings per share was 59 cents. Adjusted EBITDA was 32.8%, and we generated $45.6 million of free cash flow for the quarter. U.S. revenue in the fourth quarter of 2022 was $233.2 million, growing 9.5% as reported compared to the prior year quarter led by growth in U.S. spine, biologics, and trauma. International revenue for the fourth quarter was $41.3 million, growing 11.4% as reported and 24.2% on a constant currency basis, driven by increased INR and implant sales. Gross profit in the fourth quarter was 74.3% versus 75.3% in the prior year quarter, consistent with expectations. The 100 basis point decline was driven primarily by product mix, and higher freight costs, partially offset by lower inventory reserves and depreciation expenses. Full year 2022 gross profit was 74.2% compared to 75% in 2021. The 80 basis point decrease was driven by product mix, primarily higher capital sales and higher freight expenses. Research and development expenses in Q4 were $19.5 million or 7.1% of sales compared to $51 million, or 20.4% of sales in the prior year quarter. The lower spending is driven by decreased IP R&D spending in Q4 22 versus Q4 21. On a normalized basis, Q4 21 R&D spending was $16.7 million, or 6.7% of sales. The resulting quarter over quarter increase is driven primarily by higher continued investments in R&D, mainly driven by increased headcount across our spine, INR, and trauma portfolios. Our full year 2022 research and development expenses were $73 million, or 7.1% of sales, compared to $97.3 million, or 10.2% of sales in the prior year. Adjusting for acquisitions made in both periods, R&D expenses in 2022 were $72.9 million, or 7.1% of sales, compared to $63 million, or 6.6% of sales in the prior year. The increased spending is consistent with my comments on Q4 2022, namely headcount investments across our portfolio. SG&A expenses in the fourth quarter were $118.1 million or 43% of sales compared to $106.6 million or 42.6% of sales in the prior year quarter. The increase is primarily higher selling costs as a result of higher compensation costs from competitive recruiting as well as higher travel expenses. Full-year SG&A expenses were $432.1 million, or 42.2% of sales, compared to $408.1 million, or 42.6% of sales. The increased dollar spending is primarily driven by volume impacts from higher sales growth, as well as higher sales compensation expenses and higher travel. SG&A spending decreased 40 basis points versus 2021, driven by leverage on fixed spending, partially offset by higher sales costs and training expenses. The income tax rate for the quarter was 19.4% compared to 23.8% in Q4 of 2021, driven primarily by lower international tax expenses. Our full year 2022 income tax rate was 21.7% compared to 17.3% in the prior year, with the resulting increase driven by lower benefits associated with stock option exercises. Fourth quarter net income was $50.1 million, and non-GAAP net income was $60.1 million. Q4 diluted earnings per share was $0.49, and non-GAAP diluted earnings per share was $0.59 compared to $0.49 in the prior year quarter. The $0.10 increase in Q4 2022 non-GAAP EPS includes a net $0.04 of non-operating favorability driven by a lower tax rate and higher interest income, partially offset by currency translation impacts. On a normalized basis, non-GAAP EPS in the fourth quarter was $0.55 compared to $0.49 in the prior year quarter, growing 12.2%, driven primarily by sales volume growth, as mentioned earlier. Full year 2022 diluted earnings per share was $1.85, and non-GAAP diluted earnings per share was $2.06, compared to $2.04 of non-GAAP EPS in 2021. Our full year 2022 non-GAAP EPS is inclusive of 14 cents of non-operating items, which includes unfavorable currency impacts worth 11 cents, a higher tax rate worth 10 cents, partially offset by higher interest and other income worth 5 cents and a lower share count worth 2 cents. Full year 2022 adjusted EBITDA of 33.2% includes 90 basis points of unfavorable currency impacts, resulting in a normalized 34.1% adjusted EBITDA for the year. Net cash provided by operating activities were $64 million in the fourth quarter of 2022 and $178.5 million for the full year. Free cash flow was $45.6 million in the fourth quarter and $104.4 million for the full year 2022. Our 2022 free cash flow was impacted by higher capital expenditures, as well as investments in working capital, namely inventory and accounts receivable. The company remains debt free. At this time, the company is establishing its full year standalone 2023 guidance. We are projecting full year 2023 sales guidance of $1.1 billion representing 7.5% growth versus 2022. We are guiding to a full year, fully diluted, non-GAAP earnings per share of $2.30, representing 11.7% growth versus 2022. Our 2022 results are reflective of continued investment across our business. R&D spending increased as we seek to bring more new and exciting products to market. Our sales and marketing spending increased as we continue to grow our sales force, and our CapEx spending increased to meet increased demands for product output and set deployment. In closing, I'll briefly add a few comments in addition to Dan's earlier comments as it relates to our February 9th announcement that we've entered into a definitive agreement to combine an all-stock transaction with NuVasive. Once shareholder and regulatory approvals are obtained and the transaction closes, we expect to deliver 20 plus percent non-GAAP EPS accretion by the completion of the first full year. This assumes likely near-term sales dis- synergies from rep and account disruptions partially offset by revenue synergies around complementary implant sales and additional INR sales of Globus Capital and NuVasive accounts. In addition, this includes delivering on $170 million of cost synergies, of which we expect to achieve 50% by the end of year one, 75% by the end of year two, and 100% by the end of the third year.
spk08: Operator, we will now answer the call for questions.
spk02: As a reminder, to ask a question, you will need to press star 1-1 on your telephone. Again, that's star 1-1 on your telephone to ask a question. Please stand by. Again, that's star 1-1. Our first question comes from the line of Shagan Singh of RBC Capital Markets. Your line is open.
spk32: Great. Thank you so much, and congratulations on exceeding a billion dollars in sales. So I guess my first question is, you know, I guess we've all had some time to digest the deal, but just given the stock reaction, I'm wondering if you could comment on where you see the disconnect in, you know, your thinking versus investors on deal rationale, financials and or strategy. And one of the other things that's come up is if you may sweeten the deal, you know, could you just talk about the flexibility and willingness to close the deal here? Any comments would be helpful. Thank you so much.
spk13: Thanks, Chagall. So just keep in mind as we did this and as we've talked about during our announcements, you're really looking at what we believe is a complementary global scale, the ability to expand customer reach with minimal overlap. We've talked about being able to develop a comprehensive and innovative portfolio in spine and orthopedics when we combine these out. And we remain committed to innovative product development and surgeon education. We're seeing that the operational capabilities fit nicely together in this and actually can benefit us as a combined And when you look at that and you combine this out, the compelling upside of revenue and what even Keith mentioned with the EPS and accretion that's all out there for value opportunity, that's what we see. The disconnect, I can't say. I can't speak for Wall Street. They'll point to several unrelated deals and look at that, but that's okay. It's certainly their prerogative to do it. As for what we would do in a market and change in stock, that's something we wouldn't be in a position to actually comment on. And it's something we'll have to evaluate and see when that time comes.
spk32: Got it. And just as a follow-up question, can you just talk about the relative contribution from rep recruitment versus NPIs versus pull-through from enabling tech to U.S. implant sales? And then are you parsing out final implant and imaging sales for Q4? And thank you for taking the questions.
spk13: Thanks. Again, to be honest with you, I wouldn't have the ability to pull all those things apart and really tell you what they were. Again, since we're running the business as a whole, I think the fact that we've significantly outpaced the market with continued growth is probably more important as to the sum of the parts.
spk01: Got it.
spk04: Thank you.
spk02: Our next question comes from the line of Matt Taylor of Jefferies. Your question, please, Matt.
spk07: Great. Hi. Thanks for taking the question. So I wanted to see if you could address more specifically, I think the main concern a lot of investors have is about the dis-energy, the turnover that you talked about. Could you talk a little bit about how you can mitigate that and then also how you may be able to offset that with some of the revenue synergies that you discussed here, maybe the timing of this?
spk13: Thanks, Matt. So we won't go into too much detail. We're going to put together filings and different things in our proxy where you would certainly have access to that in the near future. What we're signaling, of course, is that like in any deal, we would expect to have some reasonable amount of dis-energies. And I think that anybody would want that in there as a prudent statement. So we've built that in that way, whether that be reps going to a competitor, accounts switching, just natural things that would occur. What Keith said and what I would stand by is, however, When we're able to get our hands on a cervical disc that's multilevel that they have, their lateral procedures, we can hand to them our expandables, we can open up a market for our enabling technology. All of those things will have actually offsets that we believe would occur over a couple of years. And I think we all strongly believe in this. So by combining the portfolios, combining the markets, we'll come out stronger and we'll see some short-term pain. But both teams are doing this for the long term, not the current 12 months, but we're really looking to say for multi-year, we're building a strong company.
spk07: Maybe I could just ask one follow-up on the synergies. You seem very confident in that target that you laid out. Maybe just talk about how much of that stuff is you'd call well-identified or lower-hanging fruit, and how much of it is harder to kind of pull apart and synergize in your plan?
spk09: Thanks for the question. Yeah, we do feel good about achieving the $170 million in synergies. I would say that we're, you know, in the early stages of working with the teams that better understand the business. But as we look at our cost structure versus their cost structure, we feel confident that we're able to achieve these savings when you look at the combined spending of both companies together.
spk06: Great. Thank you, guys.
spk09: Thank you.
spk02: Thank you. Our next question. comes from the line of Matt Mixick of Barclays. Your line is open, Matt.
spk22: Hi, it's Matt Mixick. I wasn't quite sure if you were referring to me. I'm sorry, I lost the last name. But if you can hear me, can you hear me okay? Yes, we got you, Matt. Got a lot of masks on these calls. So one, just follow up, if I could, on the synergies on Matt's Taylor's comment, and then I have one on margins if I could. So on the synergies, can you talk about maybe what is not included in those? I mean, there's a fair amount of complementary products, you know, robots and cervical disc replacement and the cervical portfolio at GMAD that are potentially, you know, complementary in the sense of driving additional sales. Are those included? You know, if they are, you know, I guess, you know, what things have you and have you not included in that number? And then I have one follow-up.
spk13: Yeah, Matt, so for clarity, I believe you're talking about sales synergies and dis-synergies. Is that right?
spk20: Yes, correct.
spk13: Okay, so separate from the overall cost savings with that. Again, we're not going to go into a lot of granular detail. I think what we're just saying is take a look at what Nuvasiv has as a strength where we can benefit, and we're saying look at the opposite way for us too. It's really that combination. We have some placeholders and some ideas that we're working through, but this is early stages, right? We really just announced this a few days ago, and we've gone from being blind into ability to look at this with a little bit more clarity. We'll focus through it. I think what we're signaling is confidence that we have enough tools in our offering to to offset sales to synergies. And then just kind of back to the question Matt had asked on actually cost synergies. Again, we have several areas to look at. We haven't fine-tuned those down by account, certainly, or anything like that, or even department. We just realized that the abilities are there, and we're in the early stages of working through those.
spk22: Got it. Okay. That's helpful. And then margins going forward. Obviously, you're looking for some EBITDA margin leverage this year. You know, can you talk about maybe some of the headwinds that you're facing, you know, to sort of keep you here in kind of the low end of the mid-30s range as far as we can tell that's kind of where your $2.30 EPS number kind of puts you for this coming year based on the top line and how those kind of play out throughout the year. That'd be helpful. Thanks.
spk09: Sure. Thanks for the question. So as you think about going into next year on a standalone basis, the EBITDA margin does come out on the lower end of the range. But when you think about some of the things we've done recently, we've really stepped up our investment in R&D spending. That's jumped out. We've invested a little bit more in Salesforce. That'll show, you know, that should show fruits as we move forward. But, you know, I talked a little bit about product mix in the quarter and the full year. Capital sales have a little bit of a headwind on overall profitability. But stepping back to that, we still feel that we're a mid-70s business. I mean, if you look at this year, specifically 2022, you know, the currency impact of $14 million was worth about 90 basis points to EBITDA. So, you know, when I look at that, I look at the business and I still see that, you know, we're healthy and we're driving the business forward. Places that we see inflation, obviously I've talked a lot about freight this year. I think in each quarter we've seen freight tick up, you know, just from fuel prices. Across the rest of the P&L, I think it's fair to assume that you're seeing some inflation in travel. You know, last year in 2021, the travel grew sequentially as COVID started to dissipate. But I think as you got really the Q4 and into this year, you saw inflation take hold as well while people continued to travel. So it's absolutely some of the driver that you're seeing in the increases there, which, you know, offset some of the leverage growth or the leverage benefit you might see in SG&A.
spk04: Thanks so much. Thank you. Thank you.
spk02: Our next question comes from the line of Vic Chopra. of Wells Fargo. Your question, please, Vic.
spk19: Hey, good afternoon, and thanks for taking the question. So two for me. First, related to the deal, I know you've said there's limited customer overlap, but can you talk about where some of the product overlap is and which assets or categories you think you may have to divest? My second question is one of the large orthopedic competitors has talked about coming out with a spine robot application in 2024. Can you perhaps talk about the market and competitive landscape and whether you expect any impact in 2023 to your ability to continue to sell Excelsior systems? Thank you.
spk13: Thanks, Vic. So, you know, I would just get through the second part of the question. We've always expected, we've always talked about how we're one of the first to move on this and the market will actually grow over time and become naturally competitive. So you kind of asked the question, what do you do to stay relevant? We've been talking continuously about our development of the ecosystem of multiple things that all fit together. We've talked about our procedural applications from pre-op planning through to post-op data and feedback loops. All of those items were well ahead of the curve. We're pushing out. We're driving. That will not only keep us relevant, but actually keep us as a leader here. And so, listen, competition will come. It's natural. They're coming because of our success, and we're going to go continue to innovate spend. We've talked continuously about our investment in R&D and how that's a pull-down because we're investing properly to build the strength for long-term gains here. That was the first part. And I apologize. Can you bring up your first part of the question again on the deal itself?
spk19: Yeah, sure. Just on the divestiture, can you talk about where some of the product overlap is and which assets or categories you think you may have to potentially divest?
spk13: No, it's a great question. I would tell you that given our size, we're not anticipating any significant divestitures at this time. We're in the middle of all of this filing. So again, we've got to place this in the hands of the government and wait. But we're not going in with any thought or concern that we're seeing right now that would trigger anything of significance.
spk04: Thank you. Thank you.
spk02: Our next question comes from the line of David Saxon of Needeman Company. Please go ahead, David.
spk15: Hi, guys. This is Joseph on for David.
spk16: Maybe just looking towards the upcoming knee robot launch, could you Maybe talk about some of the strategy behind that. What are the initial accounts you're going to be targeting? You can talk about the expansion of the sales force, but maybe could you also talk about maybe pricing and features that may be relative to currently available robots? And then if possible, could you quantify those commercial investments associated with the launch?
spk13: Thanks, Joseph. I wish I could, but we don't have all of that data just yet. So let me break your question into those chunks and go at them. I think it counts. Certainly we would have our eyes on ASCs and certainly hospitals. So I wouldn't say we're going to specialize in one or the other. We'll look to go at both with that type of approach. You are correct that our initial thought was capital reps and obviously implant reps will require us to take steps and investments, things that we've built into our projections. But again, if you know us, we don't go out and have a big bang. We use concentric circles. We'll hire a group, stabilize them, get it going, moving. We'll pay for them and go on and on, just as we've done in the past. So I wouldn't signal that there's a major drop or an anticipated investment that takes us off of our curve that way. And finally, with pricing, I would just tell you we'll price at the market appropriately. We recognize there's competition out there. We feel like we've got a viable solution that will add value to doctors. And like I said, depending on what the market bears, we're in a position to actually do that.
spk16: Okay, great. Yeah, that makes sense. And then maybe, could you maybe just give a quick update on the commercial team out in Japan, if things are maybe stabilized there, you know, there's still more wood to chop?
spk13: Yeah, I would tell you that it's in the stabilization phases. It's probably about a quarter behind where I would have wanted it to be. But what we're seeing right now is That is settling down into where I think it's actually at the point where we should expect to see some building up of it in the first half of this year.
spk14: Okay, great. Thank you for taking our questions, and congrats on the quarter.
spk04: Thank you.
spk02: Thank you. Our next question comes from the line of Steve Flickman of Oppenheimer. Please go ahead, Steve. Thank you.
spk18: Even guys looking at it to the 2023 sales guidance. I'm wondering if you can provide any color on components of growth. U.S. versus no U.S. fine, emerging tech, incremental trauma, and any color there.
spk09: Great question. Thanks. Thanks for it. You know, we typically don't break out the parts and pieces. But when I step back and look at the year that we're going into, I think we still feel very bullish about our U.S. spine business and its ability to grow. I think we came off a strong quarter between that, biologics, and trauma in the U.S. Enabling tech, I see that continuing to grow. Cognizant that we're entering into a recession. However, one of the things that we see happening is greater sales of those units internationally. So that's something that we feel good about going into next year. But that's about as much detail as I'll give in terms of breaking out the guidance.
spk13: Steve, one thing I'd add to that, which I'm pleased with, is we're not dependent upon one or two of these. It really seems like we're projecting forward as we've performed in the past. And while we'll never get each one of these exactly right, we have enough levers here that I feel strongly that we can get into this and achieve it.
spk18: Okay, thanks, Keith and Dan. And then just secondly, as you look ahead here near term, is there anything you feel you need to do to help retain reps and prevent any coaching ahead of the deal closing or just overall, what's the center of the group in the last couple three weeks here? Thanks.
spk13: It's a great question. And look, it's human nature in the state of change to have some discomfort. So the best thing to do is communicate because we don't need to beg here with this. Keep in mind that we as Globus and what we intend to do as the bigger company, is pay strongly for our reps, and we've been doing that historically without change, unlike other companies, so we're going to maintain that. At the same time, we have discussed in person with the field team our portfolio to understand the strengths that we're about to give them on the Nuvesa side, and they actually are in the process of doing the same for us on the Globus side with that. So we're talking about strong compensation, arguably the strongest offering for products in the spine market with that. And then, you know, our enabling technology along with the Pulse system can really become a powerful tool, and I think everybody can see that. And then, of course, we're always looking at what near-term yet future innovation can be to significantly tie these together through that ecosystem. When we offer that up with people, it's a tough thing to compete against, and a rep that is long-term focused and wise can recognize that within 12 months, they're going to have at their fingertips the most powerful offering in the industry.
spk03: Got it. Thanks, Dan.
spk02: Thank you. Our next question comes from the line of Matthew O'Brien of Piper Sandler. Please go ahead, Matthew.
spk17: Hey, I kind of broke up. Did you say Matthew O'Brien? He did. okay fantastic um thanks for taking my questions so i guess dan can you you are keith actually just talk about the timing of the nuva vote uh from the shareholders and then it is a take under at this point it's about five percent lower stock prices versus where it was traded before the announcement so how are you going to talk those investors into voting for this transaction between you and chris and um you know are you so committed to this deal that you would offer up a sweetener, be it more stock or even cash, if need be, to make sure this gets done. And I do have one more follow-up.
spk13: Thanks, Matt. So a lot of questions there. I would tell you that we're not going to be in a position yet to comment on what it is we're going to do. Certainly, we're going to talk to investors, show them why this deal makes sense, show them the math to get them lined up with this, and understand that this is a long-term gain that will create a significant acceleration versus if we stayed alone as standalones. I think that's probably the biggest thing with it. But to talk about any other steps at this point, we've premature, so I'll refrain from that.
spk17: Okay, but Dan, when we hear middle of the year closing, you think, all right, June 30th, so the vote would be sometime before then. I mean, is it the next few months where we could see the vote?
spk13: I'm sorry, I did leave that off. I wasn't avoiding that with that. Really what we need to do right now is create the joint proxy first and then get the vote. We're in the process of compiling that, as I said in my statements. You know, look, I don't have an exact date where we'll say that's done, but it's obviously the priority right now is to get the HSR filing in, get that working, get the joint proxy going so we can get this in motion.
spk17: Okay. And then the follow-up, Dan, is, again, more of a strategic question, because I think part of the reaction in the stock was kind of the adjustment to the strategic direction of the business that I think most were anticipating, because you were kind of more diversifying away from SPI, and now you're doubling down more. Is this part of a bigger push for the company longer term, you know, double down on SPI and get big there, get a lot of cash flow, and then invest in other areas of Orto to become a much bigger entity in the space? Excellent.
spk13: Thanks, Matt. Again, really good question. So, you know, it's obviously interesting from this seat. For years, for eight years, investors have asked, what are you going to do? How are you going to make an acquisition? What are you going to do? We've made an acquisition and folks are sort of stepping back by it. But the fact is we've been patient. We've looked, we've analyzed, we decided this was the right time to do it. We've looked through multiple scenarios throughout our portfolio and really came back to this being the strongest opportunity now to go do this. And what you touched on is exactly right. The combined company will be stronger than the individuals, and our cash flow itself, when we combine, will be significant, which will allow us then to move on to other larger acquisitions over time. It doesn't mean that we've just shifted and won't create innovation and launch organically. We're just saying we want to use the financial strength to our benefit as well as our engineering prowess. Got it. Makes a lot of sense. Thanks so much.
spk02: Thank you. Our next question comes from the line of Craig Bijou, Bank of America. Please go ahead, Craig.
spk10: Thanks, guys. Thanks for taking the questions. I wanted to focus on enabling tech here. And, you know, it did come in a little bit lower than the street was expecting. I know you guys had a record quarter. And you guys have talked about the strength internationally. So maybe kind of wanted to parse out U.S. versus OUS trends with enabling tech. And then really see kind of what you see in your funnel and has anything changed over the last, you know, three months or so since the last quarter with the funnel, either U.S. or OUS.
spk13: Yeah. Thanks, Greg. Thanks, Greg. Yeah, I guess my first thought is I'm not sure I would apologize for delivering 20% growth in a recession and a challenge market. I think that's very strong performance that was done by the team. And so I'll stay by that one. Certainly last year, 2021, you had a lot of sales robotically in the U.S. because of pent-up demand, a lot of activity along with COVID. And while I say we came close to that this year, the international has, I think, recovered economically a little bit better than the U.S. in some of these concerns. So what we're signaling is we've seen some great placements internationally that kind of put us back into a strong spot overall that way robotically. And as we've said, we've also put out the imaging system really U.S. right now with where that is and what we're doing with that and just continuing to take advantage of that market.
spk10: Got it. And just following up, I'll stick on enabling tech, but Keith made the comment about looking into a recession in response to one of the previous questions. But your view on 23, you still feel like there's a strong hospital appetite for capital and you don't see any concerns or any changes in either the thinking or the actions of hospitals?
spk13: I would say it's a little too soon for us to call. I mean, certainly, even getting all through COVID and into last year, we've seen behavioral changes and concerns and shorting of staff that they have to divert funds otherwise, all things like that that have been a ripple through this. So I don't know if we had a chance to look for really the last two to three years at a steady state and understand what's normal. And now we're in the face of a recession. So difficult to call. Again, what I would tell you is we've placed out standalone guidance, and in that, we have fairly strong numbers that we feel we can achieve, recognizing that there may be some pressure on the enabling tech. But again, there's enough levers throughout our overall portfolio. We feel confident we can achieve those numbers.
spk09: Yeah, and the only comment I would add to what Dan stated is if you step back and look at enabling tech, going back to 2018, that business delivered $47 million in sales in 2018. It delivered $47 in 2019. We went through COVID. and we delivered 41 million. And last year, we delivered 81 to finish this year at 96. So the business has really grown. Obviously, there's always issues that we're going to be faced with, but at the end of the day, we're going to really work to get through them and really get our capital in the hands of our customers.
spk11: Got it. Thanks for taking the questions, guys. Thank you.
spk02: Thank you. Our next question comes from the line of Kyle Rose of Canaccord Genuity. Please go ahead, Kyle.
spk04: Kyle Rose, your line is open.
spk26: Oh, sorry. I didn't hear my name there. Thank you for taking the question. I want to talk a little bit about top line guidance. You outlined some expectations for the usual sales dis-synergies once the deal closes. I'm just wondering how you're thinking about the first half of the year, pre-deal, close, any sort of people taking the eye off the ball, maybe guidance contemplates some of that on a standalone basis, and then there's a potential upside there if that doesn't play out. Any insights you could provide there would be helpful. And then secondarily on new products, you're still talking about the total joint application from a robotics perspective, but in the past you've detailed maybe some product gaps or a need to improve the underlying implant systems and total joints. Is it fair to expect that we should see some of those new product launches come along ahead of the robotics launch? Thank you.
spk09: All right, thanks for the question. I'll take the first part and hand the second part over to Dan. So as it relates to guidance, standalone guidance, and looking at 2023, I don't see or we don't see anybody taking their eye off the ball. We're happy with what we've seen thus far in the quarter. Sales are meeting expectations. So I don't see anyone taking their eye off the ball. It is we are running a business. and we're moving the business forward as we had intended prior to the deal announcement.
spk13: What I would say on your second question is we will launch out our robot that will have a knee application. We're working on other applications now. I would not think that you're going to see them come out before the knee application would be my initial thoughts. I think we'll start out with knee. We're going to migrate into hip, as we said, and then we have the ability to move into other applications over time that way.
spk04: Thank you.
spk02: Thank you. Our next question comes from the line of Matthew Blackman of Stifel. Your question, please, Matthew.
spk29: Hi, it's Matt Blackman from Stifel. Thank you for taking my question. Just one, just thinking about the inputs you put into your deal model, revenue, the synergies, synergies. Where do you think there's the most flex, or maybe better said, where's the most opportunity and perhaps the most risk as you think about those different inputs? Thanks.
spk13: Yeah, that's a great question. A little bit of a teasing question we probably don't want to answer, but what I would tell you is I feel like we were aggressive in what we think the synergies would be and light in what we think the synergies will be. We're a conservative group by nature, if you know us. And so I do think that we might be able to retain better than we've planned in the synergies. And I think that we could probably beat if we have the right focus on our synergies within those sales areas, but not product specific, just in general.
spk28: I appreciate it. Thank you.
spk02: Thank you. Our next question comes from the line of Richard Newitter of Truist.
spk25: Please go ahead, Richard. Hi, thanks for taking the question. Two for me. Just on the deal, you mentioned minimal customer overlap. I was hoping you could elaborate on what the threshold was for defining minimal overlap per surgeon between the two companies. I'm essentially just trying to gauge whether a surgeon that you consider you know, not to be overlapped, will that necessarily translate into minimal disruption in the region, especially in the way that territories are going to be grown? Because you still need to split those territories. So I was just hoping you could maybe elaborate a little bit on that.
spk13: Yeah, Rich, I'll do that in a certain way. There's not a lot I can reveal right now with where we're going on this, but I will give you what I think we can do along these lines. So during the diligence, of course, all of this data was blinded, and it was done by bankers, not us. And we traced it down to a surgeon level as the most logical way to go. And what we found is we had the vast majority as complementary, and what the definition of complementary is is that someone may either have 100%, 80%, 75% of a surgeon by themselves, And it was kind of after that, maybe if you're 50-50 or less, that would be the overlap. And so what we found is kind of, I can't really reveal this, but I would say, you know, extremely high in the 90s of the ability to match up. Now, as we unblind that, perhaps we see it differently, we adjust, we look and go. But even with a surgeon overlap, very well could be that the surgeon is using invasive pedicle screws in our inner body or vice versa. So It may not be a product conflict. The thought being that even along those lines where that is the case, we can decide between those reps what's best. Does one keep the surgeon? Do they both keep it that way? Our goal is to maintain all of the reps. We have enough space, enough growth, enough opportunity to do this, so it's not really about a rep rationalization. And what we're signaling out to the market is we believe that this is a very favorable thing for the deal that will minimize disruption.
spk25: Got it. And then I think you had referenced the new augmented reality headset product launch in 2023 on your last conference call. Just curious if that's still on track and what the timing might be there.
spk13: I'm speaking to you through it right now, Rich. No, I'm kidding. No, listen, it's on track. I think that, again, it can never say for sure what's going on with the FDA and the filings. But I would tell you that we signaled that with the thought that it would be out towards the latter part of this year. And by no means will we take our eye off that ball. That's going to be a great player for us to get out and continue to differentiate with this type of approach. So it's one of the top priorities.
spk25: Okay. And anything in there from a guidance standpoint baked in?
spk13: Well, you know how we always answer that, right? So in total, we feel good. It's one of the levers that we'll look at. but it's something that would not take us off our ability to achieve our numbers, whether it came to market or did not.
spk24: Great. Thanks a lot.
spk02: Thank you. Again, to ask a question, please press star 1-1 on your telephone. Again, that's star 1-1 on your telephone to ask a question. The next question comes from the line of Drew Rangieri of Morgan Stanley. Your question, please, Drew.
spk31: Hi, thanks for taking the question. Just one on international. I think in your prepared comments, you said international X Japan was up 20% year over year. Can you maybe give us a little bit more detail about the all-in number with Japan and then just comment on any kind of key moving drivers there in the international market? It seemed like from the acquisition call, you were putting a lot of emphasis on the global reach of the two companies. So any more detail that you could share there would be great. Thank you.
spk09: Thanks for the question. So as we look at international, the Japan sales were down. There's obviously some currency impacts in there as well. But what we really saw as we got to the back end of the quarter is touches on the stabilization that Dan commented on earlier. As we get into 2023, we expect to start to see this business to move forward and grow.
spk02: Thank you. With no further questions, this concludes the Globus Medical fourth quarter and full year 2022 analyst call. Thank you for your participation. You may now disconnect.
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