SI-BONE, Inc. — Call Transcript 2026

All right. Good morning, everyone. Welcome to the 2026 TD Cowen Healthcare Conference. My name is Matt Blackman, and I am the newest member of the MedTech research team. Along with Joshua Jennings, my partner, we now have a two-headed MedTech research monster. I'm pleased to kick off our conference with SI-BONE. We're really very grateful to have with us from the company Anshul Maheshwari, CFO and recently appointed COO. Congratulations, by the way. Most importantly, thank you so much for joining us. Really appreciate your time. No, we appreciate you guys having us. Thank you. I'm gonna start with some bigger picture questions. We'll talk through maybe some recent announcements, including Anshul being named COO and talk to what his new responsibilities are and if he has any marching orders. I thought maybe we'd start big picture because the company's evolved quite a bit over the last five years. We've seen it evolve from what was once a single product company to now a portfolio of products, treating a variety of disease states. The language you're now using to describe the strategy is something akin to position to solve unmet needs for patients with compromised bone. Mm-hmm. Maybe help us understand what that means, what the mission is from here, how you're thinking about the company and the portfolio. I guess what I'm really getting at is where can you go from here, within the SI anatomy or broader? Thank you again for having us. You're right. When we started the company, we were the SI joint dysfunction company. We were solving an unmet need of SI joint dysfunction, and we started with the Triangle, and since then we've evolved into additional technologies that solve the disease state of SI joint dysfunction. As you know, the sacrum has one of the most poorest quality bone in the human body, and our technology's ability to drive fixation and fusion provided us a very strong platform from which we've built into multiple other technologies addressing additional disease states all within the SI joint. What we've been able to do is we've been able to use our biomechanical expertise, our expertise in designing and manufacturing, and additive manufacturing, which is 3D-printed solutions, and have been able to expand that into the deformity side with Granite, and then most recently on the trauma side with our recently launched TNT product. It's now been out for about 15 months. We actually have a pretty good track record of working with patients and solving unmet needs, where you have compromised bone. When you think about compromised bone as a guiding principle, our focus has been targeting markets where there is an unmet need or where the current standard of care is subpar that leads to high revision rates and high failure rates. We've done that in three markets already. Now what we wanna do is we wanna take that skill set, work with our core call points, which is spine and interventional and now in trauma, to be able to come up with solutions that are clinical adjacencies that can leverage this biomechanical engineering to come up with new solutions, go after new TAMs. What you've seen is an evolution of a company from one solution anatomy and different disease states to now focusing on multiple disease states that are in adjacent clinical cases with the same call point. Many of these ideas are sort of inbound from some of your physicians who say, I've used your technology here. You know, it'd be really great if we could do something here. If you think about the evolution of our portfolio, we had the Triangle, and we had a 3D-printed Triangle in 2017, sorry. What we saw was our physicians were using the Triangle as what we call a Bedrock technique when they were doing deformity procedures. If you simplistically think about what leads to failure rates in a lot of deformity procedures over time is rod fracture, screw breakage, or screw loosening. The simplest analogy is if you put a flagpole in quicksand over time, the flagpole will tilt. What Bedrock Granite as a technique, which was using our Triangles at the base in the sacrum did, was it provided you a solid foundation for these deformity procedures. The feedback we got was, I see the benefit of the Bedrock technique, but I would love to have a solution that fits within my workflow, that attaches to my long construct, fits my workflow. That was the evolution of Granite. Basically, Granite was a 3D-printed sleeve with a shank and a tulip head that attached a long construct, provided fixation and fusion, which is why it got Breakthrough Device when we launched it. Trauma is very similar. We started with TORQ in trauma, physicians loved TORQ, and their feedback was, look, I'm very used to getting a screw that goes from one side of the sacrum to the other side of the sacrum. Would love to have a technology that incorporates the form factors of TORQ, but provides me something that is akin to my workflow. That was TNT. Not all 3D implants are the same. The biomechanics that you need to understand when you're trying to fuse two sides of a joint is very complex. TORQ launched in 2021. TNT came out in 2024, Q4 of 2024. That's how long it took us to develop. Similar to that, as we think about disease states where our physicians know of high failure rates, we're focused on those. It is inbound, but it is also us looking at these markets where we can drive deeper physician engagement, grow our physician base and more products per procedure. Let's transition about interesting amount to call the partnership with Smith+Nephew. To back talk about the relationship in general, what it Smith+Nephew, the reach and resources that they bring to the table that you are unable to replicate today? TNT, which launched in the fourth quarter of 2024, has been a really good product for us. It's exceeded our own internal expectations. What it is targeting is sacral insufficiency fractures. Before TNT came out, there was no real good treatment for patients who had pelvic ring fractures. You either had bed rest, or you were using cement, or you were using traditional screws, which as we know from our history in SI joint dysfunction, tend to back out. TNT solves for that problem, which is why it was given Breakthrough Device Designation. Again, that was our second Breakthrough Device. We've seen really strong adoption of TNT in trauma, simply because trauma is not where you see a lot of innovation as well. This was one of the most innovative products in trauma. It is a separate call point for us. A lot of these procedures happen in Level I, Level II trauma sites. Our approach always with TNT was that to truly unleash the potential for this product, we wanted to leverage a hybrid sales force. It is not a new concept for us. We've done that with our Granite product line. When we launched Granite, we used the hybrid network to be able to really unleash the potential for that product, and it's worked out really well for us in that franchise. Our focus always with TNT was how do you replicate that? Because we don't think the best use of our reps time is to be sitting in Level I, Level II trauma centers. We want our reps, which is our biggest asset, to be out in the field, to be training surgeons, spine and interventionalists, and to be getting other procedures and go deeper with that call Smith+Nephew checks the box for us. It really allows us to scale the opportunity with TNT and TORQ in trauma. It gets us in front of a large segment of trauma surgeons at Level I and Level II trauma sites and allows those surgeons to get access to a product in the most effective way. Effect also, what it does for us is takes our reps out of that trauma call point. It allows them to focus on the larger TAMs that we have. Trauma is about a $300 million TAM for us. Overall, our TAM's $3.5 billion. You think about the $3 billion TAM is where we want our reps to be focused on, and that's with interventional and spine. It's worked out really well for us. We signed the agreement two weeks ago. We're in the phase of figuring out how we do the launch. We're gonna put out surgical capacity in Q2 and Q3, and then we're off to the races. We're really excited about what this can do to the trauma business as we go through the year in 2026, but more importantly, as you set yourself up for 2027 and 2028. I don't think you've included it in your 2026 guide, right? Not to a significant magnitude. Yeah. For us, trauma was always a distribution model, and we were gonna be either doing a Smith+Nephew, or you were gonna bring on multiple agents, which would have been a much more time-consuming process and would have taken us longer. What this does is, in a very efficient way, gets us access to a large group of trauma surgeons at several Level I and Level II trauma sites. It actually accelerates our ability to get more than what we would have gotten ourselves just building it out. In the scale of that footprint Smith+Nephew has in trauma or any sort of metric that helps us understand the level of presence, the magnitude of presence they have in. Yeah. I would think if you think about the orthopedic franchise, you know, you've got DePuy Synthes, you got Stryker, and you Smith+Nephew. that's sort of the playing field for us. We've been very Smith+Nephew in identifying sites where they have the presence and the support, and we know that we can get access to the talks. Have you talked about the economics? I don't think so. We don't disclose the economics. For us, the way to think about it is it accelerates the opportunity within trauma, which is accretive to top-line growth. It frees up our reps from focusing on trauma and being able to focus on degen deformity, SI joint dysfunction, plus the new technologies that we wanna launch with spine and interventional. That also becomes accretive to top-line growth. For us, the focus is how do we make sure we're delivering strong top-line growth similar to what we've delivered since our IPO. Mm-hmm. This allows us to be able to do that. Yes, in two different manners. In two different methods. Gotcha. I think you mentioned this, Q2, Q3, build surgical capacity, training Smith+Nephew reps, it's sort of off to the races. Exactly. Okay. Maybe next, another sort of taking a step back. You know, I know we cover the orthopedic space, you know, hips and knees, spine in particular. The other broad orthopedic markets have stepped up in growth a little bit. I want to, you know, calm my horses a little bit here. Talking about 2%-3% is now maybe 3%-4%. That's a big number in percentage terms. Maybe just if you could just frame the different end markets you're involved in, what you're seeing just in terms of underlying trends, whether it's SI joint dysfunction, pelvic fixation, trauma, just the sort of the state of the union on those markets, as you think about 2026 and beyond. Are you seeing the same Again, you're in market penetration, market share mode, but just your sense of what the underlying procedure environment is? Right. When you think about SI-BONE, and you go back to our IPO, we've effectively grown anywhere between, you know, 4x to 6x the underlying, let's call it spine ortho growth, industry growth. Our CAGR growth's been about 20% since our IPO, we're really proud of that. What differentiates us is we're not a me-too product company. We identify these unmet needs, we develop those markets, and then we basically build a platform technology that becomes an industry leader in that market. We feel very good about our position and continuing to perform better than the overall market and multiples better than the overall market. When you think about the breakdown of the different markets, I'm not gonna give you specifics on where our growth breakdowns are from a percent perspective, but what I would tell you is if you look at 2025, we had double-digit procedure volume growth across all our markets. If you look at from a call point perspective, we had record number of interventionalists do our procedure. We had a record number of trauma docs do our procedure. We had a record number of surgeons do our procedure exiting the Q4. Again, really seeing good traction there, and those were all double-digit percent growths. Overall, we continue to be very well positioned there. Even when you think about a market like deformity, which is sort of a 5%, 6% grower, by coming out with unique technology like Granite, we've been able to grow our market in deformity multiples of what the underlying market growth is. What you're gonna see from us going forward, as we continue to focus on identifying these procedures where you've got high failure rates or no real good standard of care today, is we wanna be able to come out with technologies like we have in the past and deliver that above market growth rate, right? We have a proven track record of that, and we feel very confident that with the investments that we're making in R&D, with the investments that we're making in direct and hybrid commercial infrastructure, that we should be able to do that. Okay. That's actually a good segue. As we sort of think about your 2026 guide, I'm sure you've gotten it. I've gotten the feedback as well that, you know, your guide implies a deceleration from that sort of typical type top-line trajectory. I guess some folks are confused, maybe, concerned might be a strong word, but just in the context of juxtaposing 2025, where you had another robust year of growth, but no real new product launches, and now 2026. At least one. We know a second one is coming. Smith+Nephew partnership. You know, I appreciate it's early days. There may be some conservatism, but is there anything we should be sensitive to in terms of the guide and the modest step down versus what's implied versus 2025? Yeah. When you think about our guide philosophy, we always wanna be thoughtful about the tailwinds that we have in the business. When you think about coming into 2026 and tailwinds we have in the business, you're spot on. You've got tailwinds. These are the most amount of tailwinds we've had in the company's history in any given year. You've got reimbursement tailwinds, starting with a 17% increase in office-based lab, reimbursement, which is where our allograft product with interventionalists does really well. We believe it's become the preferred solution for interventionalists in that side of service. You've got the NTAP for TNT. That went effective October 1, 2025, so you've got a three-year tailwind on that as well. That's around $4,100, which is quite meaningful, between 20% and 30% increase in Medicare reimbursement. You've got the potential for Granite being used in an outpatient setting with the new Level 7 APC code being established for spine procedures. Granite has a TPT, which basically has a zero device offset. For Medicare cases, you get fully reimbursed for Granite when used in an outpatient setting. You've got great reimbursement tailwinds there. You've got a commercial footprint that continues to grow both organic, the direct commercial footprint, where we wanna add more territories, you've also got this hybrid model that continues to grow for us as well on the interventional side, on the trauma side and the deformity side. We're feeling good about the commercial framework. You've got the benefit of new product launches. You've got the product launch of INTRA Ti, which you just launched a week before earnings, so two weeks ago, that effectively uses the best of what we have from our allograft solution, iFuse INTRA X, which is a posterior approach, a percutaneous posterior approach to put the implant into the anatomy. It is a single-use kit, it's a very workflow efficient model. The reason it's important is it aligns with the same trajectory that interventional docs are very comfortable with. We think that's a nice huge opportunity for us to continue driving growth in the interventional market for SI joint dysfunction. You've got this third Breakthrough Device that we expect to file 510(k) for in the third quarter, and looking to commercialize it as early as late 2026, but definitely in 2027. A lot of tailwinds in the business. What we wanna be thoughtful about is it's still early days. We wanna grow into those tailwinds. The most important thing about those tailwinds is as you go through the years and those tailwinds materialize, those are secular tailwinds that will continue to 2027 and 2028. It actually sets the business up really well over the longer term, not just for this year, but for the next few years. Then when you overlay on top of that the innovation pipeline that we have for new products to be commercialized in 2027, 2028, we're set up really, really well. Yeah. I'm gonna get to the innovation super cycle in a moment. I wanted to finish though in this sort of big picture section that we were looking at the new COO. I'm just curious what your new responsibilities are, and if you have any specific marching orders? Well, one, I just appreciate Laura and the management team and the board supporting me in that new role. Really grateful for that. I don't think anything's changed for us. Our focus remains growth. You know, I have a function within our project management office that's now reporting under me, but that function is purely focused on how do we make sure we're getting products out at a regular cadence every year going forward. That's number one. The second piece is field efficiency, so we have IT. Our focus over the last 18 months has been how do we make sure that we're reducing the admin responsibilities on our field? How do we go automate? How do we get more predictability on the workflow and things that they're doing? How do we get better traction on asset utilization? 'Cause that impacts gross margins quite a bit. The third piece is operations, which is again, focused on gross margin expansion. How do we bring our supply chain efficiencies into play, so we can continue to maintain industry-leading gross margins? We right now are 78%, 79%. Productivity, working capital- Innovation. Manufacturing innovation. Okay. Well, good luck. Maybe we'll talk we sort of teased some of them, but we'll talk about some of the key products that are gonna drive the top line, not only this year, but over the next several years. You did mention INTRA Ti, just maybe in very recent early days. I appreciate that. How do we think about the adoption curve in 2026 and in 2027? Is this sort of a slow burn, sort of build then hit critical mass, or is there some sort of inflection point that you hit where it's sort of off and to the races? Just help us understand how it builds and to the top line over the next couple of years. If you actually take a step back, we started working with interventionalists in 2023. When we did that, we started with TORQ. TORQ had been in the market for quite a bit time. We actually did the STACI study. We launched the STACI study, which was looking at interventionalists using TORQ to do SI joint dysfunction. We provided preliminary data on safety and effectiveness, and it was really good, and you published on that. In 2024, we launched our allograft solution, which was INTRA X, which was the posterior percutaneous solution for interventionalists that may have not wanted to use metal as the first line of defense or did not wanna use the lateral approach initially. The allograft product was an office-based lab product. It's done really well for us. What we want to make sure is that we have a robust solution set for interventionalists to be able to perform SI joint dysfunction procedures. INTRA Ti is an evolution of that. When you think about application of INTRA Ti, I would put it in a few buckets. The first bucket is in markets where 27278, which is our allograft solution, is not reimbursed. INTRA Ti, because it has the same workflow, it's a single-use kit, it's very efficient, can be used. That's application number one. We know physicians liked the INTRA X workflow. INTRA Ti solved for that. We knew physicians like the simplicity of a single-use kit. INTRA Ti supports that as well, it's got nationwide reimbursement under 27279. That's number one. Number two is, there are docs that don't wanna use allograft, that do wanna use, that do wanna use metal. INTRA Ti, because of its approach, provides interventionalists a convenient way and an efficient way of incorporating metal in their workflow practice when doing SIJ dysfunction procedures. Number three is for physicians that are using TORQ, it provides them with just another alternative based on patient demographics on being able to provide them another solution. I've always been interested, you know, there's sometimes friction between the spine channel and the interventional pain channel. Just how you manage that. Is that a consideration? Do you have to be sensitive to that when you think about your customer base and going after different customers? Yes. Surgeons still account for the vast majority of our business, whether it's SI joint dysfunction or degenerative deformity. When we went into the interventional spine world, we were very deliberate in our approach. The approach we took was, we know that there is a subset of patients that are in interventional pain that are being managed conservatively, and they're not being referred to surgeons. We were very targeted in our approach to go after interventional docs that today were not doing referrals to surgeons. This was an incremental funnel for us that we weren't gonna access any which way through the surgeon network. I think we've done a really good job in managing both sides by making sure there is no cannibalization, by making sure this is incremental, and by making sure that the conflict, the inherent conflict that you talked about, doesn't really exist. The reality is interventional pain docs that have a symbiotic relationship with surgeons, the referral relationship, don't wanna disrupt that to start with anyways. I think our approach has worked. I think it's been respected both by the spine side and the interventional side, and you can see that in our physician metrics, which have all hit record numbers in Q4. Okay. I'm gonna skip ahead in my question list because I do wanna hear you talk about, well, tease us again, on the new product that's on track. I think you said 510(k) submission 3Q, maybe launch late 2026, maybe 2027. Just as best you can, give us some flavor for what that is, and maybe another way to frame it, whether it's sort of TAM expanding into a new adjacency, or is it something that drives incremental penetration in existing disease state functions? Just anything to help sort of, help us dream the dream about what this could be. Well, look, it's. This is our third Breakthrough Device. We're one of the few companies that can claim that they have three Breakthrough Devices in med device. We're really proud of what the team's been able to do. You're right, we're gonna be filing for 510(k) in the third quarter and hope to commercialize this by late 2026. This product is addressing one of the most known unmet needs in spine. Let's start with that. Physicians know about it. There's no good solution out there. They've seen what our technology can do, and this is what allowed us to focus on developing this new solution platform. Let's start with that. Number two is, I'm not going to say a lot more about what the applications are, but I will tell you the characteristics of this product that make us really excited. The reason Granite's done so well was it was an unmet need, it was a known disease issue, it was a known failure rate. Let's start with that. It was training light because it fit physicians' workflow, and it had favorable reimbursement. This product has a lot of those characteristics. It's a known issue. It's an unmet need. It fits the physician workflow. The fact that it has Breakthrough Device designation. We will apply for NTAP, assuming we are successful. That NTAP will be additional reimbursement for the solution as well. The other thing it does is it's within the same call point that today uses Granite and that today uses iFuse-TORQ in SI joint dysfunction. It allows us to work with that same call point, get more docs to adopt our procedure, get more products per procedure, and get more procedures per doc. It actually sets us up really well for the second metric that we're really focused on, which is driving physician density over time. Yeah. Okay, that's helpful. Maybe I teased it a little bit earlier, but the pipeline in general, the innovation super cycle, what does that mean exactly? I think relative obviously to what you've seen over the last several years, you've been a very innovative company, but it makes it sound like there's even more. Right Innovation coming. I guess maybe if you could frame it, again, in sort of a similar vein. Is it a TAM expanding? Is it increased revenue per procedure? You know, dollar share per procedure. Is it still capital light, still the focus? Just any sort of flavor on that. Yep. Is this a two to three-year phenomenon or a three to five-year phenomenon? Any sort of time horizon would be helpful. Sure. When you think about our business, because we're developing differentiated technologies, it'll take us a couple of years to develop a platform, right? When we start talking about this product that we wanna commercialize at the end of this year, which is a whole new TAM for us, the Breakthrough Device, we started working on it a couple years ago. We started talking a little bit about it with investors to sort of show them a little bit under the hood on what the company is doing. If you think about the business over the next five years, you're gonna see us launch products at a very regular cadence every year. We have already identified several areas where you have high failure rates, especially when you think about compromised bone. Whatever failure rates or revision rates you see in traditional procedure types, you can multiply that in compromised bone patients as well. There are multiple TAMs out there that we're targeting, that we're developing technologies for, that are gonna be targeted to spine and interventional. Again, the same call points allows us to get in front of them sooner with technologies that they know will help them improve patient outcomes. Those products are already in the works, right? You'll see us on a regular cadence launch new products. The best way to think about it is, if you look at what we did between 2021 and 2024, we launched three new products, which was iFuse-TORQ, Granite, and another version of Granite. You saw what it did to the growth rate of the business. You're entering a very similar period. Those were all TAM expanding, right? You're entering a very similar period of new products that are going after these unmet needs, and those are TAM expanding. We feel really good about that. On your question around change in business model, there's gonna be no change. We're gonna be focused on differentiated technologies that have high gross margins that stay true to our asset-light model and allow us to get the commercial leverage by going after the same call point. Great. I'm gonna squeeze one question in the last three seconds. You did give us sort of directional guidance for EBITDA in 2026. I think you said positive. I think the street has landed sort of $10 million-$12 million. Is that the right ballpark? Are we hearing you correctly? I appreciate you wanna give yourself some flexibility, but just, you know, are we thinking about positive correctly as the sell side? Yeah. I'll give you a bit more longer term answer for adjusted EBITDA or even free cash flow. Our focus is top line growth. The reason our focus is top line growth is if you look at what happened in the last three years, you know, we had a 50% or 40% drop-through of whatever dollar we had in the top line to the bottom line. Now, we are going to make investments in the business this year, which is expanding our sales force, preparing for the new product launches, but we're not putting all the potential impact of that on the top line into our expectations right now. You've got upside there. More importantly, if you think about the business over the medium to long term, we've said externally that our leverage, which is our revenue growth versus OpEx growth, will range between 1.2x and 1.7x. I expect that to play out. What that does is if you extrapolate, let's say, the midpoint at 1.5x leverage for the next three to five years, you get a pretty healthy adjusted EBITDA, and you get a pretty healthy free cash flow. Again, that is coming from not OpEx expense management. That is coming from accelerating that top line growth, which is where our focus remains. Okay. All right. We'll leave it there. It was really great to have you. Really appreciate your time. Thank you everyone for joining us. Thanks so much.

Speaker 2: All right. Good morning, everyone. Welcome to the 2026 TD Cowen Healthcare Conference. My name is Matt Blackman, and I am the newest member of the MedTech research team. Along with Joshua Jennings, my partner, we now have a two-headed MedTech research monster. I'm pleased to kick off our conference with SI-BONE. We're really very grateful to have with us from the company Anshul Maheshwari, CFO and recently appointed COO. Congratulations, by the way. Most importantly, thank you so much for joining us. Really appreciate your time. All right. all right Good morning, everyone. good morning everyone Welcome to the 2026 TD Cowen Healthcare Conference. welcome to the 2026 td cowen healthcare conference My name is Matt Blackman, and I am the newest member of the MedTech research team. my name is matt blackman and i am the newest member of the medtech research team Along with Joshua Jennings, my partner, we now have a two-headed MedTech research monster. along with joshua jennings my partner we now have a two-headed medtech research monster I'm pleased to kick off our conference with SI-BONE. i'm pleased to kick off our conference with si-bone We're really very grateful to have with us from the company Anshul Maheshwari, CFO and recently appointed COO. we're really very grateful to have with us from the company anshul maheshwari cfo and recently appointed coo Congratulations, by the way. congratulations by the way Most importantly, thank you so much for joining us. most importantly thank you so much for joining us Really appreciate your time. really appreciate your time

Speaker 1: No, we appreciate you guys having us. Thank you. No, we appreciate you guys having us. no we appreciate you guys having us Thank you. thank you

Speaker 2: I'm gonna start with some bigger picture questions. We'll talk through maybe some recent announcements, including Anshul being named COO and talk to what his new responsibilities are and if he has any marching orders. I thought maybe we'd start big picture because the company's evolved quite a bit over the last five years. We've seen it evolve from what was once a single product company to now a portfolio of products, treating a variety of disease states. The language you're now using to describe the strategy is something akin to position to solve unmet needs for patients with compromised bone. I'm gonna start with some bigger picture questions. i'm gonna start with some bigger picture questions We'll talk through maybe some recent announcements, including Anshul being named COO and talk to what his new responsibilities are and if he has any marching orders. we'll talk through maybe some recent announcements including anshul being named coo and talk to what his new responsibilities are and if he has any marching orders I thought maybe we'd start big picture because the company's evolved quite a bit over the last five years. i thought maybe we'd start big picture because the company's evolved quite a bit over the last five years We've seen it evolve from what was once a single product company to now a portfolio of products, treating a variety of disease states. we've seen it evolve from what was once a single product company to now a portfolio of products treating a variety of disease states The language you're now using to describe the strategy is something akin to position to solve unmet needs for patients with compromised bone. the language you're now using to describe the strategy is something akin to position to solve unmet needs for patients with compromised bone

Speaker 1: Mm-hmm. Mm-hmm. mm-hmm

Speaker 2: Maybe help us understand what that means, what the mission is from here, how you're thinking about the company and the portfolio. I guess what I'm really getting at is where can you go from here, within the SI anatomy or broader? Maybe help us understand what that means, what the mission is from here, how you're thinking about the company and the portfolio. maybe help us understand what that means what the mission is from here how you're thinking about the company and the portfolio I guess what I'm really getting at is where can you go from here, within the SI anatomy or broader? i guess what i'm really getting at is where can you go from here within the si anatomy or broader

Speaker 1: Thank you again for having us. You're right. When we started the company, we were the SI joint dysfunction company. We were solving an unmet need of SI joint dysfunction, and we started with the Triangle, and since then we've evolved into additional technologies that solve the disease state of SI joint dysfunction. As you know, the sacrum has one of the most poorest quality bone in the human body, and our technology's ability to drive fixation and fusion provided us a very strong platform from which we've built into multiple other technologies addressing additional disease states all within the SI joint. Thank you again for having us. thank you again for having us You're right. you're right When we started the company, we were the SI joint dysfunction company. when we started the company we were the si joint dysfunction company We were solving an unmet need of SI joint dysfunction, and we started with the Triangle, and since then we've evolved into additional technologies that solve the disease state of SI joint dysfunction. we were solving an unmet need of si joint dysfunction and we started with the triangle and since then we've evolved into additional technologies that solve the disease state of si joint dysfunction As you know, the sacrum has one of the most poorest quality bone in the human body, and our technology's ability to drive fixation and fusion provided us a very strong platform from which we've built into multiple other technologies addressing additional disease states all within the SI joint. as you know the sacrum has one of the most poorest quality bone in the human body and our technology's ability to drive fixation and fusion provided us a very strong platform from which we've built into multiple other technologies addressing additional disease states all within the si joint What we've been able to do is we've been able to use our biomechanical expertise, our expertise in designing and manufacturing, and additive manufacturing, which is 3D-printed solutions, and have been able to expand that into the deformity side with Granite, and then most recently on the trauma side with our recently launched TNT product. It's now been out for about 15 months. We actually have a pretty good track record of working with patients and solving unmet needs, where you have compromised bone. When you think about compromised bone as a guiding principle, our focus has been targeting markets where there is an unmet need or where the current standard of care is subpar that leads to high revision rates and high failure rates. We've done that in three markets already. What we've been able to do is we've been able to use our biomechanical expertise, our expertise in designing and manufacturing, and additive manufacturing, which is 3D-printed solutions, and have been able to expand that into the deformity side with Granite, and then most recently on the trauma side with our recently launched TNT product. what we've been able to do is we've been able to use our biomechanical expertise our expertise in designing and manufacturing and additive manufacturing which is 3d-printed solutions and have been able to expand that into the deformity side with granite and then most recently on the trauma side with our recently launched tnt product It's now been out for about 15 months. it's now been out for about 15 months We actually have a pretty good track record of working with patients and solving unmet needs, where you have compromised bone. we actually have a pretty good track record of working with patients and solving unmet needs where you have compromised bone When you think about compromised bone as a guiding principle, our focus has been targeting markets where there is an unmet need or where the current standard of care is subpar that leads to high revision rates and high failure rates. when you think about compromised bone as a guiding principle our focus has been targeting markets where there is an unmet need or where the current standard of care is subpar that leads to high revision rates and high failure rates We've done that in three markets already. we've done that in three markets already Now what we wanna do is we wanna take that skill set, work with our core call points, which is spine and interventional and now in trauma, to be able to come up with solutions that are clinical adjacencies that can leverage this biomechanical engineering to come up with new solutions, go after new TAMs. What you've seen is an evolution of a company from one solution anatomy and different disease states to now focusing on multiple disease states that are in adjacent clinical cases with the same call point. Now what we wanna do is we wanna take that skill set, work with our core call points, which is spine and interventional and now in trauma, to be able to come up with solutions that are clinical adjacencies that can leverage this biomechanical engineering to come up with new solutions, go after new TAMs. now what we wanna do is we wanna take that skill set work with our core call points which is spine and interventional and now in trauma to be able to come up with solutions that are clinical adjacencies that can leverage this biomechanical engineering to come up with new solutions go after new tams What you've seen is an evolution of a company from one solution anatomy and different disease states to now focusing on multiple disease states that are in adjacent clinical cases with the same call point. what you've seen is an evolution of a company from one solution anatomy and different disease states to now focusing on multiple disease states that are in adjacent clinical cases with the same call point

Speaker 2: Many of these ideas are sort of inbound from some of your physicians who say, I've used your technology here. You know, it'd be really great if we could do something here. Many of these ideas are sort of inbound from some of your physicians who say, I've used your technology here. many of these ideas are sort of inbound from some of your physicians who say i've used your technology here You know, it'd be really great if we could do something here. you know it'd be really great if we could do something here

Speaker 1: If you think about the evolution of our portfolio, we had the Triangle, and we had a 3D-printed Triangle in 2017, sorry. What we saw was our physicians were using the Triangle as what we call a Bedrock technique when they were doing deformity procedures. If you simplistically think about what leads to failure rates in a lot of deformity procedures over time is rod fracture, screw breakage, or screw loosening. The simplest analogy is if you put a flagpole in quicksand over time, the flagpole will tilt. What Bedrock Granite as a technique, which was using our Triangles at the base in the sacrum did, was it provided you a solid foundation for these deformity procedures. If you think about the evolution of our portfolio, we had the Triangle, and we had a 3D-printed Triangle in 2017, sorry. if you think about the evolution of our portfolio we had the triangle and we had a 3d-printed triangle in 2017 sorry What we saw was our physicians were using the Triangle as what we call a Bedrock technique when they were doing deformity procedures. what we saw was our physicians were using the triangle as what we call a bedrock technique when they were doing deformity procedures If you simplistically think about what leads to failure rates in a lot of deformity procedures over time is rod fracture, screw breakage, or screw loosening. if you simplistically think about what leads to failure rates in a lot of deformity procedures over time is rod fracture screw breakage or screw loosening The simplest analogy is if you put a flagpole in quicksand over time, the flagpole will tilt. the simplest analogy is if you put a flagpole in quicksand over time the flagpole will tilt What Bedrock Granite as a technique, which was using our Triangles at the base in the sacrum did, was it provided you a solid foundation for these deformity procedures. what bedrock granite as a technique which was using our triangles at the base in the sacrum did was it provided you a solid foundation for these deformity procedures The feedback we got was, I see the benefit of the Bedrock technique, but I would love to have a solution that fits within my workflow, that attaches to my long construct, fits my workflow. That was the evolution of Granite. Basically, Granite was a 3D-printed sleeve with a shank and a tulip head that attached a long construct, provided fixation and fusion, which is why it got Breakthrough Device when we launched it. Trauma is very similar. We started with TORQ in trauma, physicians loved TORQ, and their feedback was, look, I'm very used to getting a screw that goes from one side of the sacrum to the other side of the sacrum. The feedback we got was, I see the benefit of the Bedrock technique, but I would love to have a solution that fits within my workflow, that attaches to my long construct, fits my workflow. the feedback we got was i see the benefit of the bedrock technique but i would love to have a solution that fits within my workflow that attaches to my long construct fits my workflow That was the evolution of Granite. that was the evolution of granite Basically, Granite was a 3D-printed sleeve with a shank and a tulip head that attached a long construct, provided fixation and fusion, which is why it got Breakthrough Device when we launched it. basically granite was a 3d-printed sleeve with a shank and a tulip head that attached a long construct provided fixation and fusion which is why it got breakthrough device when we launched it Trauma is very similar. trauma is very similar We started with TORQ in trauma, physicians loved TORQ, and their feedback was, look, I'm very used to getting a screw that goes from one side of the sacrum to the other side of the sacrum. we started with torq in trauma physicians loved torq and their feedback was look i'm very used to getting a screw that goes from one side of the sacrum to the other side of the sacrum Would love to have a technology that incorporates the form factors of TORQ, but provides me something that is akin to my workflow. That was TNT. Not all 3D implants are the same. The biomechanics that you need to understand when you're trying to fuse two sides of a joint is very complex. TORQ launched in 2021. TNT came out in 2024, Q4 of 2024. That's how long it took us to develop. Similar to that, as we think about disease states where our physicians know of high failure rates, we're focused on those. It is inbound, but it is also us looking at these markets where we can drive deeper physician engagement, grow our physician base and more products per procedure. Would love to have a technology that incorporates the form factors of TORQ, but provides me something that is akin to my workflow. would love to have a technology that incorporates the form factors of torq but provides me something that is akin to my workflow That was TNT. that was tnt Not all 3D implants are the same. not all 3d implants are the same The biomechanics that you need to understand when you're trying to fuse two sides of a joint is very complex. the biomechanics that you need to understand when you're trying to fuse two sides of a joint is very complex TORQ launched in 2021. torq launched in 2021 TNT came out in 2024, Q4 of 2024. tnt came out in 2024 q4 of 2024 That's how long it took us to develop. that's how long it took us to develop Similar to that, as we think about disease states where our physicians know of high failure rates, we're focused on those. similar to that as we think about disease states where our physicians know of high failure rates we're focused on those It is inbound, but it is also us looking at these markets where we can drive deeper physician engagement, grow our physician base and more products per procedure. it is inbound but it is also us looking at these markets where we can drive deeper physician engagement grow our physician base and more products per procedure

Speaker 2: Let's transition about interesting amount to call the partnership with Smith+Nephew. To back talk about the relationship in general, what it Smith+Nephew, the reach and resources that they bring to the table that you are unable to replicate today? Let's transition about interesting amount to call the partnership with Smith+Nephew. let's transition about interesting amount to call the partnership with smith+nephew To back talk about the relationship in general, what it Smith+Nephew, the reach and resources that they bring to the table that you are unable to replicate today? to back talk about the relationship in general what it smith+nephew, the reach and resources that they bring to the table that you are unable to replicate today

Speaker 1: TNT, which launched in the fourth quarter of 2024, has been a really good product for us. It's exceeded our own internal expectations. What it is targeting is sacral insufficiency fractures. Before TNT came out, there was no real good treatment for patients who had pelvic ring fractures. You either had bed rest, or you were using cement, or you were using traditional screws, which as we know from our history in SI joint dysfunction, tend to back out. TNT solves for that problem, which is why it was given Breakthrough Device Designation. Again, that was our second Breakthrough Device. We've seen really strong adoption of TNT in trauma, simply because trauma is not where you see a lot of innovation as well. This was one of the most innovative products in trauma. It is a separate call point for us. TNT, which launched in the fourth quarter of 2024, has been a really good product for us. tnt which launched in the fourth quarter of 2024 has been a really good product for us It's exceeded our own internal expectations. it's exceeded our own internal expectations What it is targeting is sacral insufficiency fractures. what it is targeting is sacral insufficiency fractures Before TNT came out, there was no real good treatment for patients who had pelvic ring fractures. before tnt came out there was no real good treatment for patients who had pelvic ring fractures You either had bed rest, or you were using cement, or you were using traditional screws, which as we know from our history in SI joint dysfunction, tend to back out. you either had bed rest or you were using cement or you were using traditional screws which as we know from our history in si joint dysfunction tend to back out TNT solves for that problem, which is why it was given Breakthrough Device Designation. tnt solves for that problem which is why it was given breakthrough device designation Again, that was our second Breakthrough Device. again that was our second breakthrough device We've seen really strong adoption of TNT in trauma, simply because trauma is not where you see a lot of innovation as well. we've seen really strong adoption of tnt in trauma simply because trauma is not where you see a lot of innovation as well This was one of the most innovative products in trauma. this was one of the most innovative products in trauma It is a separate call point for us. it is a separate call point for us A lot of these procedures happen in Level I, Level II trauma sites. Our approach always with TNT was that to truly unleash the potential for this product, we wanted to leverage a hybrid sales force. It is not a new concept for us. We've done that with our Granite product line. When we launched Granite, we used the hybrid network to be able to really unleash the potential for that product, and it's worked out really well for us in that franchise. Our focus always with TNT was how do you replicate that? Because we don't think the best use of our reps time is to be sitting in Level I, Level II trauma centers. A lot of these procedures happen in Level I, Level II trauma sites. a lot of these procedures happen in level i level ii trauma sites Our approach always with TNT was that to truly unleash the potential for this product, we wanted to leverage a hybrid sales force. our approach always with tnt was that to truly unleash the potential for this product we wanted to leverage a hybrid sales force It is not a new concept for us. it is not a new concept for us We've done that with our Granite product line. we've done that with our granite product line When we launched Granite, we used the hybrid network to be able to really unleash the potential for that product, and it's worked out really well for us in that franchise. when we launched granite we used the hybrid network to be able to really unleash the potential for that product and it's worked out really well for us in that franchise Our focus always with TNT was how do you replicate that? our focus always with tnt was how do you replicate that Because we don't think the best use of our reps time is to be sitting in Level I, Level II trauma centers. because we don't think the best use of our reps time is to be sitting in level i level ii trauma centers We want our reps, which is our biggest asset, to be out in the field, to be training surgeons, spine and interventionalists, and to be getting other procedures and go deeper with that call Smith+Nephew checks the box for us. It really allows us to scale the opportunity with TNT and TORQ in trauma. It gets us in front of a large segment of trauma surgeons at Level I and Level II trauma sites and allows those surgeons to get access to a product in the most effective way. Effect also, what it does for us is takes our reps out of that trauma call point. It allows them to focus on the larger TAMs that we have. Trauma is about a $300 million TAM for us. Overall, our TAM's $3.5 billion. We want our reps, which is our biggest asset, to be out in the field, to be training surgeons, spine and interventionalists, and to be getting other procedures and go deeper with that call Smith+Nephew checks the box for us. we want our reps which is our biggest asset to be out in the field to be training surgeons spine and interventionalists and to be getting other procedures and go deeper with that call smith+nephew checks the box for us It really allows us to scale the opportunity with TNT and TORQ in trauma. it really allows us to scale the opportunity with tnt and torq in trauma It gets us in front of a large segment of trauma surgeons at Level I and Level II trauma sites and allows those surgeons to get access to a product in the most effective way. it gets us in front of a large segment of trauma surgeons at level i and level ii trauma sites and allows those surgeons to get access to a product in the most effective way Effect also, what it does for us is takes our reps out of that trauma call point. effect also what it does for us is takes our reps out of that trauma call point It allows them to focus on the larger TAMs that we have. it allows them to focus on the larger tams that we have Trauma is about a $300 million TAM for us. trauma is about a $300 million tam for us Overall, our TAM's $3.5 billion. overall our tam's $3.5 billion You think about the $3 billion TAM is where we want our reps to be focused on, and that's with interventional and spine. It's worked out really well for us. We signed the agreement two weeks ago. We're in the phase of figuring out how we do the launch. We're gonna put out surgical capacity in Q2 and Q3, and then we're off to the races. We're really excited about what this can do to the trauma business as we go through the year in 2026, but more importantly, as you set yourself up for 2027 and 2028. You think about the $3 billion TAM is where we want our reps to be focused on, and that's with interventional and spine. you think about the $3 billion tam is where we want our reps to be focused on and that's with interventional and spine It's worked out really well for us. it's worked out really well for us We signed the agreement two weeks ago. we signed the agreement two weeks ago We're in the phase of figuring out how we do the launch. we're in the phase of figuring out how we do the launch We're gonna put out surgical capacity in Q2 and Q3, and then we're off to the races. we're gonna put out surgical capacity in q2 and q3 and then we're off to the races We're really excited about what this can do to the trauma business as we go through the year in 2026, but more importantly, as you set yourself up for 2027 and 2028. we're really excited about what this can do to the trauma business as we go through the year in 2026 but more importantly as you set yourself up for 2027 and 2028

Speaker 2: I don't think you've included it in your 2026 guide, right? Not to a significant magnitude. I don't think you've included it in your 2026 guide, right? i don't think you've included it in your 2026 guide right Not to a significant magnitude. not to a significant magnitude

Speaker 1: Yeah. For us, trauma was always a distribution model, and we were gonna be either doing a Smith+Nephew, or you were gonna bring on multiple agents, which would have been a much more time-consuming process and would have taken us longer. What this does is, in a very efficient way, gets us access to a large group of trauma surgeons at several Level I and Level II trauma sites. It actually accelerates our ability to get more than what we would have gotten ourselves just building it out. Yeah. yeah For us, trauma was always a distribution model, and we were gonna be either doing a Smith+Nephew, or you were gonna bring on multiple agents, which would have been a much more time-consuming process and would have taken us longer. for us trauma was always a distribution model and we were gonna be either doing a smith+nephew, or you were gonna bring on multiple agents which would have been a much more time-consuming process and would have taken us longer What this does is, in a very efficient way, gets us access to a large group of trauma surgeons at several Level I and Level II trauma sites. what this does is in a very efficient way gets us access to a large group of trauma surgeons at several level i and level ii trauma sites It actually accelerates our ability to get more than what we would have gotten ourselves just building it out. it actually accelerates our ability to get more than what we would have gotten ourselves just building it out

Speaker 2: In the scale of that footprint Smith+Nephew has in trauma or any sort of metric that helps us understand the level of presence, the magnitude of presence they have in. In the scale of that footprint Smith+Nephew has in trauma or any sort of metric that helps us understand the level of presence, the magnitude of presence they have in. in the scale of that footprint smith+nephew has in trauma or any sort of metric that helps us understand the level of presence the magnitude of presence they have in

Speaker 1: Yeah. I would think if you think about the orthopedic franchise, you know, you've got DePuy Synthes, you got Stryker, and you Smith+Nephew. that's sort of the playing field for us. We've been very Smith+Nephew in identifying sites where they have the presence and the support, and we know that we can get access to the talks. Yeah. yeah I would think if you think about the orthopedic franchise, you know, you've got DePuy Synthes, you got Stryker, and you Smith+Nephew. that's sort of the playing field for us. i would think if you think about the orthopedic franchise you know you've got depuy synthes you got stryker and you smith+nephew. that's sort of the playing field for us We've been very Smith+Nephew in identifying sites where they have the presence and the support, and we know that we can get access to the talks. we've been very smith+nephew in identifying sites where they have the presence and the support and we know that we can get access to the talks

Speaker 2: Have you talked about the economics? I don't think so. Have you talked about the economics? have you talked about the economics I don't think so. i don't think so

Speaker 1: We don't disclose the economics. For us, the way to think about it is it accelerates the opportunity within trauma, which is accretive to top-line growth. It frees up our reps from focusing on trauma and being able to focus on degen deformity, SI joint dysfunction, plus the new technologies that we wanna launch with spine and interventional. That also becomes accretive to top-line growth. For us, the focus is how do we make sure we're delivering strong top-line growth similar to what we've delivered since our IPO. We don't disclose the economics. we don't disclose the economics For us, the way to think about it is it accelerates the opportunity within trauma, which is accretive to top-line growth. for us the way to think about it is it accelerates the opportunity within trauma which is accretive to top-line growth It frees up our reps from focusing on trauma and being able to focus on degen deformity, SI joint dysfunction, plus the new technologies that we wanna launch with spine and interventional. it frees up our reps from focusing on trauma and being able to focus on degen deformity si joint dysfunction plus the new technologies that we wanna launch with spine and interventional That also becomes accretive to top-line growth. that also becomes accretive to top-line growth For us, the focus is how do we make sure we're delivering strong top-line growth similar to what we've delivered since our IPO. for us the focus is how do we make sure we're delivering strong top-line growth similar to what we've delivered since our ipo

Speaker 2: Mm-hmm. Mm-hmm. mm-hmm

Speaker 1: This allows us to be able to do that. This allows us to be able to do that. this allows us to be able to do that

Speaker 2: Yes, in two different manners. Yes, in two different manners. yes in two different manners

Speaker 1: In two different methods. In two different methods. in two different methods

Speaker 2: Gotcha. I think you mentioned this, Q2, Q3, build surgical capacity, training Smith+Nephew reps, it's sort of off to the races. Gotcha. gotcha I think you mentioned this, Q2, Q3, build surgical capacity, training Smith+Nephew reps, it's sort of off to the races. i think you mentioned this q2 q3 build surgical capacity training smith+nephew reps, it's sort of off to the races

Speaker 1: Exactly. Exactly. exactly

Speaker 2: Okay. Maybe next, another sort of taking a step back. You know, I know we cover the orthopedic space, you know, hips and knees, spine in particular. The other broad orthopedic markets have stepped up in growth a little bit. I want to, you know, calm my horses a little bit here. Talking about 2%-3% is now maybe 3%-4%. That's a big number in percentage terms. Maybe just if you could just frame the different end markets you're involved in, what you're seeing just in terms of underlying trends, whether it's SI joint dysfunction, pelvic fixation, trauma, just the sort of the state of the union on those markets, as you think about 2026 and beyond. Okay. okay Maybe next, another sort of taking a step back. maybe next another sort of taking a step back You know, I know we cover the orthopedic space, you know, hips and knees, spine in particular. you know i know we cover the orthopedic space you know hips and knees spine in particular The other broad orthopedic markets have stepped up in growth a little bit. the other broad orthopedic markets have stepped up in growth a little bit I want to, you know, calm my horses a little bit here. i want to you know calm my horses a little bit here Talking about 2%-3% is now maybe 3%-4%. talking about 2%-3% is now maybe 3%-4% That's a big number in percentage terms. that's a big number in percentage terms Maybe just if you could just frame the different end markets you're involved in, what you're seeing just in terms of underlying trends, whether it's SI joint dysfunction, pelvic fixation, trauma, just the sort of the state of the union on those markets, as you think about 2026 and beyond. maybe just if you could just frame the different end markets you're involved in what you're seeing just in terms of underlying trends whether it's si joint dysfunction pelvic fixation trauma just the sort of the state of the union on those markets as you think about 2026 and beyond Are you seeing the same Again, you're in market penetration, market share mode, but just your sense of what the underlying procedure environment is? Are you seeing the same Again, you're in market penetration, market share mode, but just your sense of what the underlying procedure environment is? are you seeing the same again you're in market penetration market share mode but just your sense of what the underlying procedure environment is

Speaker 1: Right. When you think about SI-BONE, and you go back to our IPO, we've effectively grown anywhere between, you know, 4x to 6x the underlying, let's call it spine ortho growth, industry growth. Our CAGR growth's been about 20% since our IPO, we're really proud of that. What differentiates us is we're not a me-too product company. We identify these unmet needs, we develop those markets, and then we basically build a platform technology that becomes an industry leader in that market. We feel very good about our position and continuing to perform better than the overall market and multiples better than the overall market. Right. right When you think about SI-BONE, and you go back to our IPO, we've effectively grown anywhere between, you know, 4x to 6x the underlying, let's call it spine ortho growth, industry growth. when you think about si-bone and you go back to our ipo we've effectively grown anywhere between you know 4x to 6x the underlying let's call it spine ortho growth industry growth Our CAGR growth's been about 20% since our IPO, we're really proud of that. our cagr growth's been about 20% since our ipo we're really proud of that What differentiates us is we're not a me-too product company. what differentiates us is we're not a me-too product company We identify these unmet needs, we develop those markets, and then we basically build a platform technology that becomes an industry leader in that market. we identify these unmet needs we develop those markets and then we basically build a platform technology that becomes an industry leader in that market We feel very good about our position and continuing to perform better than the overall market and multiples better than the overall market. we feel very good about our position and continuing to perform better than the overall market and multiples better than the overall market When you think about the breakdown of the different markets, I'm not gonna give you specifics on where our growth breakdowns are from a percent perspective, but what I would tell you is if you look at 2025, we had double-digit procedure volume growth across all our markets. If you look at from a call point perspective, we had record number of interventionalists do our procedure. We had a record number of trauma docs do our procedure. We had a record number of surgeons do our procedure exiting the Q4. Again, really seeing good traction there, and those were all double-digit percent growths. Overall, we continue to be very well positioned there. When you think about the breakdown of the different markets, I'm not gonna give you specifics on where our growth breakdowns are from a percent perspective, but what I would tell you is if you look at 2025, we had double-digit procedure volume growth across all our markets. when you think about the breakdown of the different markets i'm not gonna give you specifics on where our growth breakdowns are from a percent perspective but what i would tell you is if you look at 2025 we had double-digit procedure volume growth across all our markets If you look at from a call point perspective, we had record number of interventionalists do our procedure. if you look at from a call point perspective we had record number of interventionalists do our procedure We had a record number of trauma docs do our procedure. we had a record number of trauma docs do our procedure We had a record number of surgeons do our procedure exiting the Q4. we had a record number of surgeons do our procedure exiting the q4 Again, really seeing good traction there, and those were all double-digit percent growths. again really seeing good traction there and those were all double-digit percent growths Overall, we continue to be very well positioned there. overall we continue to be very well positioned there Even when you think about a market like deformity, which is sort of a 5%, 6% grower, by coming out with unique technology like Granite, we've been able to grow our market in deformity multiples of what the underlying market growth is. What you're gonna see from us going forward, as we continue to focus on identifying these procedures where you've got high failure rates or no real good standard of care today, is we wanna be able to come out with technologies like we have in the past and deliver that above market growth rate, right? We have a proven track record of that, and we feel very confident that with the investments that we're making in R&D, with the investments that we're making in direct and hybrid commercial infrastructure, that we should be able to do that. Even when you think about a market like deformity, which is sort of a 5%, 6% grower, by coming out with unique technology like Granite, we've been able to grow our market in deformity multiples of what the underlying market growth is. even when you think about a market like deformity which is sort of a 5% 6% grower by coming out with unique technology like granite we've been able to grow our market in deformity multiples of what the underlying market growth is What you're gonna see from us going forward, as we continue to focus on identifying these procedures where you've got high failure rates or no real good standard of care today, is we wanna be able to come out with technologies like we have in the past and deliver that above market growth rate, right? what you're gonna see from us going forward as we continue to focus on identifying these procedures where you've got high failure rates or no real good standard of care today is we wanna be able to come out with technologies like we have in the past and deliver that above market growth rate right We have a proven track record of that, and we feel very confident that with the investments that we're making in R&D, with the investments that we're making in direct and hybrid commercial infrastructure, that we should be able to do that. we have a proven track record of that and we feel very confident that with the investments that we're making in r&d with the investments that we're making in direct and hybrid commercial infrastructure that we should be able to do that

Speaker 2: Okay. That's actually a good segue. As we sort of think about your 2026 guide, I'm sure you've gotten it. I've gotten the feedback as well that, you know, your guide implies a deceleration from that sort of typical type top-line trajectory. I guess some folks are confused, maybe, concerned might be a strong word, but just in the context of juxtaposing 2025, where you had another robust year of growth, but no real new product launches, and now 2026. At least one. We know a second one is coming. Smith+Nephew partnership. You know, I appreciate it's early days. There may be some conservatism, but is there anything we should be sensitive to in terms of the guide and the modest step down versus what's implied versus 2025? Okay. okay That's actually a good segue. that's actually a good segue As we sort of think about your 2026 guide, I'm sure you've gotten it. as we sort of think about your 2026 guide i'm sure you've gotten it I've gotten the feedback as well that, you know, your guide implies a deceleration from that sort of typical type top-line trajectory. i've gotten the feedback as well that you know your guide implies a deceleration from that sort of typical type top-line trajectory I guess some folks are confused, maybe, concerned might be a strong word, but just in the context of juxtaposing 2025, where you had another robust year of growth, but no real new product launches, and now 2026. i guess some folks are confused maybe concerned might be a strong word but just in the context of juxtaposing 2025 where you had another robust year of growth but no real new product launches and now 2026 At least one. at least one We know a second one is coming. we know a second one is coming Smith+Nephew partnership. smith+nephew partnership You know, I appreciate it's early days. you know i appreciate it's early days There may be some conservatism, but is there anything we should be sensitive to in terms of the guide and the modest step down versus what's implied versus 2025? there may be some conservatism but is there anything we should be sensitive to in terms of the guide and the modest step down versus what's implied versus 2025

Speaker 1: Yeah. When you think about our guide philosophy, we always wanna be thoughtful about the tailwinds that we have in the business. When you think about coming into 2026 and tailwinds we have in the business, you're spot on. You've got tailwinds. These are the most amount of tailwinds we've had in the company's history in any given year. You've got reimbursement tailwinds, starting with a 17% increase in office-based lab, reimbursement, which is where our allograft product with interventionalists does really well. We believe it's become the preferred solution for interventionalists in that side of service. You've got the NTAP for TNT. That went effective October 1, 2025, so you've got a three-year tailwind on that as well. That's around $4,100, which is quite meaningful, between 20% and 30% increase in Medicare reimbursement. Yeah. yeah When you think about our guide philosophy, we always wanna be thoughtful about the tailwinds that we have in the business. when you think about our guide philosophy we always wanna be thoughtful about the tailwinds that we have in the business When you think about coming into 2026 and tailwinds we have in the business, you're spot on. when you think about coming into 2026 and tailwinds we have in the business you're spot on You've got tailwinds. you've got tailwinds These are the most amount of tailwinds we've had in the company's history in any given year. these are the most amount of tailwinds we've had in the company's history in any given year You've got reimbursement tailwinds, starting with a 17% increase in office-based lab, reimbursement, which is where our allograft product with interventionalists does really well. you've got reimbursement tailwinds starting with a 17% increase in office-based lab reimbursement which is where our allograft product with interventionalists does really well We believe it's become the preferred solution for interventionalists in that side of service. we believe it's become the preferred solution for interventionalists in that side of service You've got the NTAP for TNT. you've got the ntap for tnt That went effective October 1, 2025, so you've got a three-year tailwind on that as well. that went effective october 1 2025 so you've got a three-year tailwind on that as well That's around $4,100, which is quite meaningful, between 20% and 30% increase in Medicare reimbursement. that's around $4,100 which is quite meaningful between 20% and 30% increase in medicare reimbursement You've got the potential for Granite being used in an outpatient setting with the new Level 7 APC code being established for spine procedures. Granite has a TPT, which basically has a zero device offset. For Medicare cases, you get fully reimbursed for Granite when used in an outpatient setting. You've got great reimbursement tailwinds there. You've got a commercial footprint that continues to grow both organic, the direct commercial footprint, where we wanna add more territories, you've also got this hybrid model that continues to grow for us as well on the interventional side, on the trauma side and the deformity side. We're feeling good about the commercial framework. You've got the benefit of new product launches. You've got the potential for Granite being used in an outpatient setting with the new Level 7 APC code being established for spine procedures. you've got the potential for granite being used in an outpatient setting with the new level 7 apc code being established for spine procedures Granite has a TPT, which basically has a zero device offset. granite has a tpt which basically has a zero device offset For Medicare cases, you get fully reimbursed for Granite when used in an outpatient setting. for medicare cases you get fully reimbursed for granite when used in an outpatient setting You've got great reimbursement tailwinds there. you've got great reimbursement tailwinds there You've got a commercial footprint that continues to grow both organic, the direct commercial footprint, where we wanna add more territories, you've also got this hybrid model that continues to grow for us as well on the interventional side, on the trauma side and the deformity side. you've got a commercial footprint that continues to grow both organic the direct commercial footprint where we wanna add more territories you've also got this hybrid model that continues to grow for us as well on the interventional side on the trauma side and the deformity side We're feeling good about the commercial framework. we're feeling good about the commercial framework You've got the benefit of new product launches. you've got the benefit of new product launches You've got the product launch of INTRA Ti, which you just launched a week before earnings, so two weeks ago, that effectively uses the best of what we have from our allograft solution, iFuse INTRA X, which is a posterior approach, a percutaneous posterior approach to put the implant into the anatomy. It is a single-use kit, it's a very workflow efficient model. The reason it's important is it aligns with the same trajectory that interventional docs are very comfortable with. We think that's a nice huge opportunity for us to continue driving growth in the interventional market for SI joint dysfunction. You've got this third Breakthrough Device that we expect to file 510(k) for in the third quarter, and looking to commercialize it as early as late 2026, but definitely in 2027. You've got the product launch of INTRA Ti, which you just launched a week before earnings, so two weeks ago, that effectively uses the best of what we have from our allograft solution, iFuse INTRA X, which is a posterior approach, a percutaneous posterior approach to put the implant into the anatomy. you've got the product launch of intra ti which you just launched a week before earnings so two weeks ago that effectively uses the best of what we have from our allograft solution ifuse intra x which is a posterior approach a percutaneous posterior approach to put the implant into the anatomy It is a single-use kit, it's a very workflow efficient model. it is a single-use kit it's a very workflow efficient model The reason it's important is it aligns with the same trajectory that interventional docs are very comfortable with. the reason it's important is it aligns with the same trajectory that interventional docs are very comfortable with We think that's a nice huge opportunity for us to continue driving growth in the interventional market for SI joint dysfunction. we think that's a nice huge opportunity for us to continue driving growth in the interventional market for si joint dysfunction You've got this third Breakthrough Device that we expect to file 510(k) for in the third quarter, and looking to commercialize it as early as late 2026, but definitely in 2027. you've got this third breakthrough device that we expect to file 510(k) for in the third quarter and looking to commercialize it as early as late 2026 but definitely in 2027 A lot of tailwinds in the business. What we wanna be thoughtful about is it's still early days. We wanna grow into those tailwinds. The most important thing about those tailwinds is as you go through the years and those tailwinds materialize, those are secular tailwinds that will continue to 2027 and 2028. It actually sets the business up really well over the longer term, not just for this year, but for the next few years. Then when you overlay on top of that the innovation pipeline that we have for new products to be commercialized in 2027, 2028, we're set up really, really well. A lot of tailwinds in the business. a lot of tailwinds in the business What we wanna be thoughtful about is it's still early days. what we wanna be thoughtful about is it's still early days We wanna grow into those tailwinds. we wanna grow into those tailwinds The most important thing about those tailwinds is as you go through the years and those tailwinds materialize, those are secular tailwinds that will continue to 2027 and 2028. the most important thing about those tailwinds is as you go through the years and those tailwinds materialize those are secular tailwinds that will continue to 2027 and 2028 It actually sets the business up really well over the longer term, not just for this year, but for the next few years. it actually sets the business up really well over the longer term not just for this year but for the next few years Then when you overlay on top of that the innovation pipeline that we have for new products to be commercialized in 2027, 2028, we're set up really, really well. then when you overlay on top of that the innovation pipeline that we have for new products to be commercialized in 2027 2028 we're set up really really well

Speaker 2: Yeah. I'm gonna get to the innovation super cycle in a moment. I wanted to finish though in this sort of big picture section that we were looking at the new COO. I'm just curious what your new responsibilities are, and if you have any specific marching orders? Yeah. yeah I'm gonna get to the innovation super cycle in a moment. i'm gonna get to the innovation super cycle in a moment I wanted to finish though in this sort of big picture section that we were looking at the new COO. i wanted to finish though in this sort of big picture section that we were looking at the new coo I'm just curious what your new responsibilities are, and if you have any specific marching orders? i'm just curious what your new responsibilities are and if you have any specific marching orders

Speaker 1: Well, one, I just appreciate Laura and the management team and the board supporting me in that new role. Really grateful for that. I don't think anything's changed for us. Our focus remains growth. You know, I have a function within our project management office that's now reporting under me, but that function is purely focused on how do we make sure we're getting products out at a regular cadence every year going forward. That's number one. Well, one, I just appreciate Laura and the management team and the board supporting me in that new role. well one i just appreciate laura and the management team and the board supporting me in that new role Really grateful for that. really grateful for that I don't think anything's changed for us. i don't think anything's changed for us Our focus remains growth. our focus remains growth You know, I have a function within our project management office that's now reporting under me, but that function is purely focused on how do we make sure we're getting products out at a regular cadence every year going forward. you know i have a function within our project management office that's now reporting under me but that function is purely focused on how do we make sure we're getting products out at a regular cadence every year going forward That's number one. that's number one The second piece is field efficiency, so we have IT. Our focus over the last 18 months has been how do we make sure that we're reducing the admin responsibilities on our field? How do we go automate? How do we get more predictability on the workflow and things that they're doing? How do we get better traction on asset utilization? 'Cause that impacts gross margins quite a bit. The third piece is operations, which is again, focused on gross margin expansion. How do we bring our supply chain efficiencies into play, so we can continue to maintain industry-leading gross margins? We right now are 78%, 79%. The second piece is field efficiency, so we have IT. the second piece is field efficiency so we have it Our focus over the last 18 months has been how do we make sure that we're reducing the admin responsibilities on our field? our focus over the last 18 months has been how do we make sure that we're reducing the admin responsibilities on our field How do we go automate? how do we go automate How do we get more predictability on the workflow and things that they're doing? how do we get more predictability on the workflow and things that they're doing How do we get better traction on asset utilization? 'Cause that impacts gross margins quite a bit. how do we get better traction on asset utilization 'cause that impacts gross margins quite a bit The third piece is operations, which is again, focused on gross margin expansion. the third piece is operations which is again focused on gross margin expansion How do we bring our supply chain efficiencies into play, so we can continue to maintain industry-leading gross margins? how do we bring our supply chain efficiencies into play so we can continue to maintain industry-leading gross margins We right now are 78%, 79%. we right now are 78% 79%

Speaker 2: Productivity, working capital- Productivity, working capital- productivity working capital-

Speaker 1: Innovation. Innovation. innovation

Speaker 2: Manufacturing innovation. Okay. Well, good luck. Maybe we'll talk we sort of teased some of them, but we'll talk about some of the key products that are gonna drive the top line, not only this year, but over the next several years. You did mention INTRA Ti, just maybe in very recent early days. I appreciate that. How do we think about the adoption curve in 2026 and in 2027? Is this sort of a slow burn, sort of build then hit critical mass, or is there some sort of inflection point that you hit where it's sort of off and to the races? Just help us understand how it builds and to the top line over the next couple of years. Manufacturing innovation. manufacturing innovation Okay. okay Well, good luck. well good luck Maybe we'll talk we sort of teased some of them, but we'll talk about some of the key products that are gonna drive the top line, not only this year, but over the next several years. maybe we'll talk we sort of teased some of them but we'll talk about some of the key products that are gonna drive the top line not only this year but over the next several years You did mention INTRA Ti, just maybe in very recent early days. you did mention intra ti just maybe in very recent early days I appreciate that. i appreciate that How do we think about the adoption curve in 2026 and in 2027? how do we think about the adoption curve in 2026 and in 2027 Is this sort of a slow burn, sort of build then hit critical mass, or is there some sort of inflection point that you hit where it's sort of off and to the races? is this sort of a slow burn sort of build then hit critical mass or is there some sort of inflection point that you hit where it's sort of off and to the races Just help us understand how it builds and to the top line over the next couple of years. just help us understand how it builds and to the top line over the next couple of years

Speaker 1: If you actually take a step back, we started working with interventionalists in 2023. When we did that, we started with TORQ. TORQ had been in the market for quite a bit time. We actually did the STACI study. We launched the STACI study, which was looking at interventionalists using TORQ to do SI joint dysfunction. We provided preliminary data on safety and effectiveness, and it was really good, and you published on that. In 2024, we launched our allograft solution, which was INTRA X, which was the posterior percutaneous solution for interventionalists that may have not wanted to use metal as the first line of defense or did not wanna use the lateral approach initially. The allograft product was an office-based lab product. It's done really well for us. If you actually take a step back, we started working with interventionalists in 2023. if you actually take a step back we started working with interventionalists in 2023 When we did that, we started with TORQ. when we did that we started with torq TORQ had been in the market for quite a bit time. torq had been in the market for quite a bit time We actually did the STACI study. we actually did the staci study We launched the STACI study, which was looking at interventionalists using TORQ to do SI joint dysfunction. we launched the staci study which was looking at interventionalists using torq to do si joint dysfunction We provided preliminary data on safety and effectiveness, and it was really good, and you published on that. we provided preliminary data on safety and effectiveness and it was really good and you published on that In 2024, we launched our allograft solution, which was INTRA X, which was the posterior percutaneous solution for interventionalists that may have not wanted to use metal as the first line of defense or did not wanna use the lateral approach initially. in 2024 we launched our allograft solution which was intra x which was the posterior percutaneous solution for interventionalists that may have not wanted to use metal as the first line of defense or did not wanna use the lateral approach initially The allograft product was an office-based lab product. the allograft product was an office-based lab product It's done really well for us. it's done really well for us What we want to make sure is that we have a robust solution set for interventionalists to be able to perform SI joint dysfunction procedures. INTRA Ti is an evolution of that. When you think about application of INTRA Ti, I would put it in a few buckets. The first bucket is in markets where 27278, which is our allograft solution, is not reimbursed. INTRA Ti, because it has the same workflow, it's a single-use kit, it's very efficient, can be used. That's application number one. We know physicians liked the INTRA X workflow. INTRA Ti solved for that. We knew physicians like the simplicity of a single-use kit. INTRA Ti supports that as well, it's got nationwide reimbursement under 27279. That's number one. What we want to make sure is that we have a robust solution set for interventionalists to be able to perform SI joint dysfunction procedures. what we want to make sure is that we have a robust solution set for interventionalists to be able to perform si joint dysfunction procedures INTRA Ti is an evolution of that. intra ti is an evolution of that When you think about application of INTRA Ti, I would put it in a few buckets. when you think about application of intra ti i would put it in a few buckets The first bucket is in markets where 27278, which is our allograft solution, is not reimbursed. the first bucket is in markets where 27278 which is our allograft solution is not reimbursed INTRA Ti, because it has the same workflow, it's a single-use kit, it's very efficient, can be used. intra ti because it has the same workflow it's a single-use kit it's very efficient can be used That's application number one. that's application number one We know physicians liked the INTRA X workflow. we know physicians liked the intra x workflow INTRA Ti solved for that. intra ti solved for that We knew physicians like the simplicity of a single-use kit. we knew physicians like the simplicity of a single-use kit INTRA Ti supports that as well, it's got nationwide reimbursement under 27279. intra ti supports that as well it's got nationwide reimbursement under 27279 That's number one. that's number one Number two is, there are docs that don't wanna use allograft, that do wanna use, that do wanna use metal. INTRA Ti, because of its approach, provides interventionalists a convenient way and an efficient way of incorporating metal in their workflow practice when doing SIJ dysfunction procedures. Number three is for physicians that are using TORQ, it provides them with just another alternative based on patient demographics on being able to provide them another solution. Number two is, there are docs that don't wanna use allograft, that do wanna use, that do wanna use metal. number two is there are docs that don't wanna use allograft that do wanna use that do wanna use metal INTRA Ti, because of its approach, provides interventionalists a convenient way and an efficient way of incorporating metal in their workflow practice when doing SIJ dysfunction procedures. intra ti because of its approach provides interventionalists a convenient way and an efficient way of incorporating metal in their workflow practice when doing sij dysfunction procedures Number three is for physicians that are using TORQ, it provides them with just another alternative based on patient demographics on being able to provide them another solution. number three is for physicians that are using torq it provides them with just another alternative based on patient demographics on being able to provide them another solution

Speaker 2: I've always been interested, you know, there's sometimes friction between the spine channel and the interventional pain channel. Just how you manage that. Is that a consideration? Do you have to be sensitive to that when you think about your customer base and going after different customers? I've always been interested, you know, there's sometimes friction between the spine channel and the interventional pain channel. i've always been interested you know there's sometimes friction between the spine channel and the interventional pain channel Just how you manage that. just how you manage that Is that a consideration? is that a consideration Do you have to be sensitive to that when you think about your customer base and going after different customers? do you have to be sensitive to that when you think about your customer base and going after different customers

Speaker 1: Yes. Surgeons still account for the vast majority of our business, whether it's SI joint dysfunction or degenerative deformity. When we went into the interventional spine world, we were very deliberate in our approach. The approach we took was, we know that there is a subset of patients that are in interventional pain that are being managed conservatively, and they're not being referred to surgeons. We were very targeted in our approach to go after interventional docs that today were not doing referrals to surgeons. This was an incremental funnel for us that we weren't gonna access any which way through the surgeon network. Yes. yes Surgeons still account for the vast majority of our business, whether it's SI joint dysfunction or degenerative deformity. surgeons still account for the vast majority of our business whether it's si joint dysfunction or degenerative deformity When we went into the interventional spine world, we were very deliberate in our approach. when we went into the interventional spine world we were very deliberate in our approach The approach we took was, we know that there is a subset of patients that are in interventional pain that are being managed conservatively, and they're not being referred to surgeons. the approach we took was we know that there is a subset of patients that are in interventional pain that are being managed conservatively and they're not being referred to surgeons We were very targeted in our approach to go after interventional docs that today were not doing referrals to surgeons. we were very targeted in our approach to go after interventional docs that today were not doing referrals to surgeons This was an incremental funnel for us that we weren't gonna access any which way through the surgeon network. this was an incremental funnel for us that we weren't gonna access any which way through the surgeon network I think we've done a really good job in managing both sides by making sure there is no cannibalization, by making sure this is incremental, and by making sure that the conflict, the inherent conflict that you talked about, doesn't really exist. The reality is interventional pain docs that have a symbiotic relationship with surgeons, the referral relationship, don't wanna disrupt that to start with anyways. I think our approach has worked. I think it's been respected both by the spine side and the interventional side, and you can see that in our physician metrics, which have all hit record numbers in Q4. I think we've done a really good job in managing both sides by making sure there is no cannibalization, by making sure this is incremental, and by making sure that the conflict, the inherent conflict that you talked about, doesn't really exist. i think we've done a really good job in managing both sides by making sure there is no cannibalization by making sure this is incremental and by making sure that the conflict the inherent conflict that you talked about doesn't really exist The reality is interventional pain docs that have a symbiotic relationship with surgeons, the referral relationship, don't wanna disrupt that to start with anyways. the reality is interventional pain docs that have a symbiotic relationship with surgeons the referral relationship don't wanna disrupt that to start with anyways I think our approach has worked. i think our approach has worked I think it's been respected both by the spine side and the interventional side, and you can see that in our physician metrics, which have all hit record numbers in Q4. i think it's been respected both by the spine side and the interventional side and you can see that in our physician metrics which have all hit record numbers in q4

Speaker 2: Okay. I'm gonna skip ahead in my question list because I do wanna hear you talk about, well, tease us again, on the new product that's on track. I think you said 510(k) submission 3Q, maybe launch late 2026, maybe 2027. Just as best you can, give us some flavor for what that is, and maybe another way to frame it, whether it's sort of TAM expanding into a new adjacency, or is it something that drives incremental penetration in existing disease state functions? Just anything to help sort of, help us dream the dream about what this could be. Okay. okay I'm gonna skip ahead in my question list because I do wanna hear you talk about, well, tease us again, on the new product that's on track. i'm gonna skip ahead in my question list because i do wanna hear you talk about well tease us again on the new product that's on track I think you said 510(k) submission 3Q, maybe launch late 2026, maybe 2027. i think you said 510(k) submission 3q maybe launch late 2026 maybe 2027 Just as best you can, give us some flavor for what that is, and maybe another way to frame it, whether it's sort of TAM expanding into a new adjacency, or is it something that drives incremental penetration in existing disease state functions? just as best you can give us some flavor for what that is and maybe another way to frame it whether it's sort of tam expanding into a new adjacency or is it something that drives incremental penetration in existing disease state functions Just anything to help sort of, help us dream the dream about what this could be. just anything to help sort of help us dream the dream about what this could be

Speaker 1: Well, look, it's. This is our third Breakthrough Device. We're one of the few companies that can claim that they have three Breakthrough Devices in med device. We're really proud of what the team's been able to do. You're right, we're gonna be filing for 510(k) in the third quarter and hope to commercialize this by late 2026. This product is addressing one of the most known unmet needs in spine. Let's start with that. Physicians know about it. There's no good solution out there. They've seen what our technology can do, and this is what allowed us to focus on developing this new solution platform. Let's start with that. Well, look, it's. well look it's This is our third Breakthrough Device. this is our third breakthrough device We're one of the few companies that can claim that they have three Breakthrough Devices in med device. we're one of the few companies that can claim that they have three breakthrough devices in med device We're really proud of what the team's been able to do. we're really proud of what the team's been able to do You're right, we're gonna be filing for 510(k) in the third quarter and hope to commercialize this by late 2026. you're right we're gonna be filing for 510(k) in the third quarter and hope to commercialize this by late 2026 This product is addressing one of the most known unmet needs in spine. this product is addressing one of the most known unmet needs in spine Let's start with that. let's start with that Physicians know about it. physicians know about it There's no good solution out there. there's no good solution out there They've seen what our technology can do, and this is what allowed us to focus on developing this new solution platform. they've seen what our technology can do and this is what allowed us to focus on developing this new solution platform Let's start with that. let's start with that Number two is, I'm not going to say a lot more about what the applications are, but I will tell you the characteristics of this product that make us really excited. The reason Granite's done so well was it was an unmet need, it was a known disease issue, it was a known failure rate. Let's start with that. It was training light because it fit physicians' workflow, and it had favorable reimbursement. This product has a lot of those characteristics. It's a known issue. It's an unmet need. It fits the physician workflow. The fact that it has Breakthrough Device designation. We will apply for NTAP, assuming we are successful. That NTAP will be additional reimbursement for the solution as well. Number two is, I'm not going to say a lot more about what the applications are, but I will tell you the characteristics of this product that make us really excited. number two is i'm not going to say a lot more about what the applications are but i will tell you the characteristics of this product that make us really excited The reason Granite's done so well was it was an unmet need, it was a known disease issue, it was a known failure rate. the reason granite's done so well was it was an unmet need it was a known disease issue it was a known failure rate Let's start with that. let's start with that It was training light because it fit physicians' workflow, and it had favorable reimbursement. it was training light because it fit physicians' workflow and it had favorable reimbursement This product has a lot of those characteristics. this product has a lot of those characteristics It's a known issue. it's a known issue It's an unmet need. it's an unmet need It fits the physician workflow. it fits the physician workflow The fact that it has Breakthrough Device designation. the fact that it has breakthrough device designation We will apply for NTAP, assuming we are successful. we will apply for ntap assuming we are successful That NTAP will be additional reimbursement for the solution as well. that ntap will be additional reimbursement for the solution as well The other thing it does is it's within the same call point that today uses Granite and that today uses iFuse-TORQ in SI joint dysfunction. It allows us to work with that same call point, get more docs to adopt our procedure, get more products per procedure, and get more procedures per doc. It actually sets us up really well for the second metric that we're really focused on, which is driving physician density over time. The other thing it does is it's within the same call point that today uses Granite and that today uses iFuse-TORQ in SI joint dysfunction. the other thing it does is it's within the same call point that today uses granite and that today uses ifuse-torq in si joint dysfunction It allows us to work with that same call point, get more docs to adopt our procedure, get more products per procedure, and get more procedures per doc. it allows us to work with that same call point get more docs to adopt our procedure get more products per procedure and get more procedures per doc It actually sets us up really well for the second metric that we're really focused on, which is driving physician density over time. it actually sets us up really well for the second metric that we're really focused on which is driving physician density over time

Speaker 2: Yeah. Okay, that's helpful. Maybe I teased it a little bit earlier, but the pipeline in general, the innovation super cycle, what does that mean exactly? I think relative obviously to what you've seen over the last several years, you've been a very innovative company, but it makes it sound like there's even more. Yeah. yeah Okay, that's helpful. okay that's helpful Maybe I teased it a little bit earlier, but the pipeline in general, the innovation super cycle, what does that mean exactly? maybe i teased it a little bit earlier but the pipeline in general the innovation super cycle what does that mean exactly I think relative obviously to what you've seen over the last several years, you've been a very innovative company, but it makes it sound like there's even more. i think relative obviously to what you've seen over the last several years you've been a very innovative company but it makes it sound like there's even more

Speaker 1: Right Right right

Speaker 2: Innovation coming. I guess maybe if you could frame it, again, in sort of a similar vein. Is it a TAM expanding? Is it increased revenue per procedure? You know, dollar share per procedure. Is it still capital light, still the focus? Just any sort of flavor on that. Innovation coming. innovation coming I guess maybe if you could frame it, again, in sort of a similar vein. i guess maybe if you could frame it again in sort of a similar vein Is it a TAM expanding? is it a tam expanding Is it increased revenue per procedure? is it increased revenue per procedure You know, dollar share per procedure. you know dollar share per procedure Is it still capital light, still the focus? is it still capital light still the focus Just any sort of flavor on that. just any sort of flavor on that

Speaker 1: Yep. Yep. yep

Speaker 2: Is this a two to three-year phenomenon or a three to five-year phenomenon? Any sort of time horizon would be helpful. Is this a two to three-year phenomenon or a three to five-year phenomenon? is this a two to three-year phenomenon or a three to five-year phenomenon Any sort of time horizon would be helpful. any sort of time horizon would be helpful

Speaker 1: Sure. When you think about our business, because we're developing differentiated technologies, it'll take us a couple of years to develop a platform, right? When we start talking about this product that we wanna commercialize at the end of this year, which is a whole new TAM for us, the Breakthrough Device, we started working on it a couple years ago. We started talking a little bit about it with investors to sort of show them a little bit under the hood on what the company is doing. If you think about the business over the next five years, you're gonna see us launch products at a very regular cadence every year. We have already identified several areas where you have high failure rates, especially when you think about compromised bone. Sure. sure When you think about our business, because we're developing differentiated technologies, it'll take us a couple of years to develop a platform, right? when you think about our business because we're developing differentiated technologies it'll take us a couple of years to develop a platform right When we start talking about this product that we wanna commercialize at the end of this year, which is a whole new TAM for us, the Breakthrough Device, we started working on it a couple years ago. when we start talking about this product that we wanna commercialize at the end of this year which is a whole new tam for us the breakthrough device we started working on it a couple years ago We started talking a little bit about it with investors to sort of show them a little bit under the hood on what the company is doing. we started talking a little bit about it with investors to sort of show them a little bit under the hood on what the company is doing If you think about the business over the next five years, you're gonna see us launch products at a very regular cadence every year. if you think about the business over the next five years you're gonna see us launch products at a very regular cadence every year We have already identified several areas where you have high failure rates, especially when you think about compromised bone. we have already identified several areas where you have high failure rates especially when you think about compromised bone Whatever failure rates or revision rates you see in traditional procedure types, you can multiply that in compromised bone patients as well. There are multiple TAMs out there that we're targeting, that we're developing technologies for, that are gonna be targeted to spine and interventional. Again, the same call points allows us to get in front of them sooner with technologies that they know will help them improve patient outcomes. Those products are already in the works, right? You'll see us on a regular cadence launch new products. The best way to think about it is, if you look at what we did between 2021 and 2024, we launched three new products, which was iFuse-TORQ, Granite, and another version of Granite. You saw what it did to the growth rate of the business. Whatever failure rates or revision rates you see in traditional procedure types, you can multiply that in compromised bone patients as well. whatever failure rates or revision rates you see in traditional procedure types you can multiply that in compromised bone patients as well There are multiple TAMs out there that we're targeting, that we're developing technologies for, that are gonna be targeted to spine and interventional. there are multiple tams out there that we're targeting that we're developing technologies for that are gonna be targeted to spine and interventional Again, the same call points allows us to get in front of them sooner with technologies that they know will help them improve patient outcomes. again the same call points allows us to get in front of them sooner with technologies that they know will help them improve patient outcomes Those products are already in the works, right? those products are already in the works right You'll see us on a regular cadence launch new products. you'll see us on a regular cadence launch new products The best way to think about it is, if you look at what we did between 2021 and 2024, we launched three new products, which was iFuse-TORQ, Granite, and another version of Granite. the best way to think about it is if you look at what we did between 2021 and 2024 we launched three new products which was ifuse-torq granite and another version of granite You saw what it did to the growth rate of the business. you saw what it did to the growth rate of the business You're entering a very similar period. Those were all TAM expanding, right? You're entering a very similar period of new products that are going after these unmet needs, and those are TAM expanding. We feel really good about that. On your question around change in business model, there's gonna be no change. We're gonna be focused on differentiated technologies that have high gross margins that stay true to our asset-light model and allow us to get the commercial leverage by going after the same call point. You're entering a very similar period. you're entering a very similar period Those were all TAM expanding, right? those were all tam expanding right You're entering a very similar period of new products that are going after these unmet needs, and those are TAM expanding. you're entering a very similar period of new products that are going after these unmet needs and those are tam expanding We feel really good about that. we feel really good about that On your question around change in business model, there's gonna be no change. on your question around change in business model there's gonna be no change We're gonna be focused on differentiated technologies that have high gross margins that stay true to our asset-light model and allow us to get the commercial leverage by going after the same call point. we're gonna be focused on differentiated technologies that have high gross margins that stay true to our asset-light model and allow us to get the commercial leverage by going after the same call point

Speaker 2: Great. I'm gonna squeeze one question in the last three seconds. You did give us sort of directional guidance for EBITDA in 2026. I think you said positive. I think the street has landed sort of $10 million-$12 million. Is that the right ballpark? Are we hearing you correctly? I appreciate you wanna give yourself some flexibility, but just, you know, are we thinking about positive correctly as the sell side? Great. great I'm gonna squeeze one question in the last three seconds. i'm gonna squeeze one question in the last three seconds You did give us sort of directional guidance for EBITDA in 2026. you did give us sort of directional guidance for ebitda in 2026 I think you said positive. i think you said positive I think the street has landed sort of $10 million-$12 million. i think the street has landed sort of $10 million-$12 million Is that the right ballpark? is that the right ballpark Are we hearing you correctly? are we hearing you correctly I appreciate you wanna give yourself some flexibility, but just, you know, are we thinking about positive correctly as the sell side? i appreciate you wanna give yourself some flexibility but just you know are we thinking about positive correctly as the sell side

Speaker 1: Yeah. I'll give you a bit more longer term answer for adjusted EBITDA or even free cash flow. Our focus is top line growth. The reason our focus is top line growth is if you look at what happened in the last three years, you know, we had a 50% or 40% drop-through of whatever dollar we had in the top line to the bottom line. Now, we are going to make investments in the business this year, which is expanding our sales force, preparing for the new product launches, but we're not putting all the potential impact of that on the top line into our expectations right now. You've got upside there. Yeah. yeah I'll give you a bit more longer term answer for adjusted EBITDA or even free cash flow. i'll give you a bit more longer term answer for adjusted ebitda or even free cash flow Our focus is top line growth. our focus is top line growth The reason our focus is top line growth is if you look at what happened in the last three years, you know, we had a 50% or 40% drop-through of whatever dollar we had in the top line to the bottom line. the reason our focus is top line growth is if you look at what happened in the last three years you know we had a 50% or 40% drop-through of whatever dollar we had in the top line to the bottom line Now, we are going to make investments in the business this year, which is expanding our sales force, preparing for the new product launches, but we're not putting all the potential impact of that on the top line into our expectations right now. now we are going to make investments in the business this year which is expanding our sales force preparing for the new product launches but we're not putting all the potential impact of that on the top line into our expectations right now You've got upside there. you've got upside there More importantly, if you think about the business over the medium to long term, we've said externally that our leverage, which is our revenue growth versus OpEx growth, will range between 1.2x and 1.7x. I expect that to play out. What that does is if you extrapolate, let's say, the midpoint at 1.5x leverage for the next three to five years, you get a pretty healthy adjusted EBITDA, and you get a pretty healthy free cash flow. Again, that is coming from not OpEx expense management. That is coming from accelerating that top line growth, which is where our focus remains. More importantly, if you think about the business over the medium to long term, we've said externally that our leverage, which is our revenue growth versus OpEx growth, will range between 1.2x and 1.7x . more importantly if you think about the business over the medium to long term we've said externally that our leverage which is our revenue growth versus opex growth will range between 1.2x and 1.7x I expect that to play out. i expect that to play out What that does is if you extrapolate, let's say, the midpoint at 1.5x leverage for the next three to five years, you get a pretty healthy adjusted EBITDA, and you get a pretty healthy free cash flow. what that does is if you extrapolate let's say the midpoint at 1.5x leverage for the next three to five years you get a pretty healthy adjusted ebitda and you get a pretty healthy free cash flow Again, that is coming from not OpEx expense management. again that is coming from not opex expense management That is coming from accelerating that top line growth, which is where our focus remains. that is coming from accelerating that top line growth which is where our focus remains

Speaker 2: Okay. All right. We'll leave it there. It was really great to have you. Really appreciate your time. Thank you everyone for joining us. Okay. okay All right. all right We'll leave it there. we'll leave it there It was really great to have you. it was really great to have you Really appreciate your time. really appreciate your time Thank you everyone for joining us. thank you everyone for joining us

Speaker 1: Thanks so much. Thanks so much. thanks so much