Third Quarter 2026
Filed Nov 2, 2026SI-BONE reported third-quarter worldwide revenue growth of 14.5%, improved operating and net losses, positive adjusted EBITDA, and reaffirmed 2026 revenue and gross margin guidance while reducing its operating expense growth expectation.
Revenue, procedure volume, international sales, adjusted EBITDA and operating cash generation improved year over year. Gross margin declined modestly and U.S. average selling price was pressured by procedure and site-of-care mix, while the company remains in a GAAP net-loss position.
Actuals vs. the company’s prior outlook
from its previous release| Metric | Guided | Reported | Verdict |
|---|---|---|---|
| Fiscal Year 2026 Revenue | $231M - $233M ~15-16% growth | Not reported | n/a |
| Fiscal Year 2026 Gross Margin | ~79.0% | Not reported | n/a |
| Fiscal Year 2026 Operating Expenses | ~12.0% growth at revenue midpoint | Not reported | n/a |
| Fiscal Year 2026 Adjusted EBITDA | Positive | Not reported | n/a |
Key metrics
shortened, hover for the filing’s print| Metric | Value | q/q | y/y |
|---|---|---|---|
| Worldwide revenue, third quarter 2026GAAP | $55.7M | – | 14.5% |
| Worldwide revenue, nine months ended September 30, 2026GAAP | $164.3M | – | – |
| U.S. revenue, third quarter 2026GAAP | $52.8M | – | 13.9% |
| International revenue, third quarter 2026GAAP | $2.9M | – | 27.0% |
| Cost of goods sold, third quarter 2026GAAP | $11.54M | – | – |
| Cost of goods sold, nine months ended September 30, 2026GAAP | $33.64M | – | – |
| Gross profit, third quarter 2026GAAP | $44.2M | – | 13.7% |
| Gross profit, nine months ended September 30, 2026GAAP | $130.7M | – | – |
| Gross margin, third quarter 2026GAAP | 79.3% | – | – |
| Sales and marketing expense, third quarter 2026GAAP | $33.85M | – | – |
| Sales and marketing expense, nine months ended September 30, 2026GAAP | $100.7M | – | – |
| Research and development expense, third quarter 2026GAAP | $4.56M | – | – |
| Research and development expense, nine months ended September 30, 2026GAAP | $13.97M | – | – |
| General and administrative expense, third quarter 2026GAAP | $10.11M | – | – |
| General and administrative expense, nine months ended September 30, 2026GAAP | $30.25M | – | – |
| Total operating expenses, third quarter 2026GAAP | $48.5M | – | 9.7% |
| Total operating expenses, nine months ended September 30, 2026GAAP | $144.9M | – | – |
| Loss from operations, third quarter 2026GAAP | $4.4M | – | improved by 19.2% |
| Loss from operations, nine months ended September 30, 2026GAAP | −$14.25M | – | – |
| Interest income, third quarter 2026GAAP | $1.35M | – | – |
| Interest expense, third quarter 2026GAAP | −$608K | – | – |
| Net loss, third quarter 2026GAAP | $3.6M | – | improved by 20.7% |
| Net loss, nine months ended September 30, 2026GAAP | −$12.04M | – | – |
| Net loss per share, basic and diluted, third quarter 2026GAAP | $ (0.08) | – | – |
| Net loss per share, basic and diluted, nine months ended September 30, 2026GAAP | $ (0.27) | – | – |
| Weighted-average number of common shares used to compute basic and diluted net loss per share, third quarter 2026GAAP | 44,899,517 | – | – |
| Weighted-average number of common shares used to compute basic and diluted net loss per share, nine months ended September 30, 2026GAAP | 44,451,298 | – | – |
| Adjusted EBITDA, third quarter 2026non-GAAP | $3M | – | improving by 32.4% |
| Adjusted EBITDA, nine months ended September 30, 2026non-GAAP | $8.43M | – | – |
| Cash from operations, third quarter 2026GAAP | $5.9M | – | improvement of 154.4% |
| Net cash generated, third quarter 2026other | $400K | – | – |
| Net cash provided by (used in) operating activities, nine months ended September 30, 2026GAAP | $4.36M | – | – |
| Purchases of property and equipment, nine months ended September 30, 2026GAAP | −$8.99M | – | – |
| Free cash flow, nine months ended September 30, 2026non-GAAP | −$4.63M | – | – |
Segments
| Segment | Revenue | q/q | y/y |
|---|---|---|---|
| U.S.Revenue growth benefited from approximately 19.5% growth in procedure volume, partially offset by lower average selling price due to procedure mix and growing interventional spine physician demand for the INTRA platform in office-based and ASC sites of care. | $52.8M | – | 13.9% |
| InternationalGrowth reflects increasing adoption of iFuse TORQ and iFuse TORQ TNT. | $2.9M | – | 27.0% |
Amounts quoted below without a unit are in thousands, as in the filing’s tables. Per-share figures are as printed.
Fiscal Year 2026 outlook
- Revenue$231M - $233M ~15-16% growth
- Gross margin~79.0%
- Operating expenses~10.5% growth at revenue midpoint
- NoteAdjusted EBITDA: Positive
What drove it
- Worldwide revenue increased 14.5% to $55.7 million.
- U.S. procedure volume grew approximately 19.5%.
- International revenue growth reflected increasing adoption of iFuse TORQ and iFuse TORQ TNT.
- The company had 1,770 active U.S. physicians, representing growth of ~16%.
- In September, SI-BONE received 510(k) clearance for iFuse Granite Onyx.
- New MS-DRGs for complex spinal fusion procedures incorporating iFuse Bedrock Granite took effect in October, increasing average hospital inpatient payments by up to ~$50,000 per qualifying procedure.
Concerns
- Gross margin was 79.3%, compared to 79.8% in the corresponding period in 2025, driven by procedure and site of care mix.
- U.S. revenue growth was partially offset by lower average selling price due to procedure mix and growing interventional spine physician demand for the INTRA platform in office-based and ASC sites of care.
- SI-BONE reported a net loss of $3.6 million and loss from operations of $4.4 million in the third quarter 2026.
- Free cash flow for the nine months ended September 30, 2026 was $ (4,634) (in thousands).
What to watch
- Execution against fiscal 2026 revenue guidance of $231M - $233M ~15-16% growth.
- Delivery of gross margin guidance of ~79.0% amid procedure and site-of-care mix effects.
- Operating expense growth targeted at ~10.5% growth at revenue midpoint, reduced from ~12.0% growth at revenue midpoint.
- Early uptake from the alpha launch of iFuse Granite Onyx and commercialization following September 510(k) clearance.
- Effect of October MS-DRG changes on procedures incorporating iFuse Bedrock Granite.
Balance sheet and cash flow
- Cash and equivalents as of September 30, 2026 were $146.3 million, compared to $145.9 million as of June 30, 2026.
- Cash and cash equivalents were $ 35,311 (in thousands) as of September 30, 2026, compared to $ 42,240 (in thousands) as of December 31, 2025.
- Short-term investments were $ 110,949 (in thousands) as of September 30, 2026, compared to $ 105,583 (in thousands) as of December 31, 2025.
- Long-term borrowings were $ 35,657 (in thousands) as of September 30, 2026, compared to $ 35,569 (in thousands) as of December 31, 2025.
- Net cash provided by operating activities was $ 4,355 (in thousands) for the nine months ended September 30, 2026, compared to $ (2,403) (in thousands) in the prior-year period.
- Free cash flow was $ (4,634) (in thousands) for the nine months ended September 30, 2026, compared to $ (9,529) (in thousands) in the prior-year period.
Analysis
SI-BONE delivered $55.7 million of worldwide revenue in the third quarter 2026, up 14.5% from $48.7 million in the corresponding 2025 period. U.S. revenue increased 13.9% to $52.8 million, while international revenue rose 27.0% to $2.9 million. U.S. growth benefited from approximately 19.5% procedure-volume growth, and international performance reflected increasing adoption of iFuse TORQ and iFuse TORQ TNT.
Profitability improved despite continued GAAP losses. Gross profit rose 13.7% to $44.2 million, while gross margin declined to 79.3% from 79.8% because of procedure and site-of-care mix. Operating expenses increased 9.7% to $48.5 million, led by higher sales commissions, marketing for new product launches and continued research and development investment. The operating loss improved to $4.4 million from $5.4 million, and net loss improved to $3.6 million, or $0.08 per diluted share, from $4.6 million, or $0.11 per diluted share.
Non-GAAP adjusted EBITDA was positive at $3.0 million, compared with $2.3 million in the prior-year quarter. The release also reported positive cash from operations of $5.9 million, an improvement of 154.4%, and net cash generated of $0.4 million versus $0.2 million in the corresponding 2025 period. For the nine months ended September 30, 2026, operating cash flow was $4.4 million, but free cash flow remained negative at $4.6 million because purchases of property and equipment were $9.0 million.
The company reported $146.3 million in cash and equivalents as of September 30, 2026, compared with $145.9 million as of June 30, 2026. SI-BONE reaffirmed fiscal 2026 revenue guidance of $231M - $233M and gross margin guidance of ~79.0%, maintained positive adjusted EBITDA guidance, and reduced its operating expense growth expectation to ~10.5% growth at revenue midpoint from ~12.0% growth at revenue midpoint. Operationally, the record active physician base, September 510(k) clearance for iFuse Granite Onyx and October MS-DRG changes are the stated drivers for the fourth quarter and beyond.
Management, verbatim
Robust third-quarter growth in procedure volumes and active physicians underscores rising demand for our diversified and differentiated platform technologies.
Laura Francis, Chief Executive Officer
We enter the fourth quarter with a record number of active physicians, favorable DRG changes and exceptional early uptake in our alpha launch of iFuse Granite Onyx, our new platform technology that expands our estimated total addressable market to approximately $5 billion.
Laura Francis, Chief Executive Officer
Not in the filing
stated, not guessed- Fiscal Year 2026 actual revenue, gross margin, operating expenses and adjusted EBITDA are not reported; therefore, a performance verdict versus prior full-year guidance cannot be determined.
- Third-quarter 2026 free cash flow is not reported.
- Third-quarter 2025 cash from operations is not reported on the same line item.
- Tax rate is not reported.
- Capital returns, including share repurchases and dividends, are not reported.
- Quarterly non-GAAP EPS is not reported.
- Prior-quarter revenue, gross margin, operating income, net loss, EPS and adjusted EBITDA are not reported.
Written by an AI language model from the company’s SEC earnings filing (Form 8-K Item 2.02, or Form 6-K for a foreign private issuer). Every figure is checked against the filing text, and a metric the filing does not print, or whose value, prior period and change do not add up, is dropped from the metrics. The model can still misread a table, in the metrics or in the text, so check a number in the filing before you rely on it. Consensus estimates, price targets and share-price reactions are not shown because they are not in the filing. AI-generated research, not investment advice.