SI-BONE Q2 2026 Earnings: Revenue Rises 15.2% as Loss Narrows

SI-BONE (Nasdaq: SIBN) reported Q2 2026 revenue of $56.0 million, up 15.2% from $48.6 million a year earlier, while diluted loss per share improved to $0.09 from $0.14. Revenue grew faster than operating expenses, narrowing the GAAP net loss and lifting adjusted EBITDA to $2.8 million, while U.S. procedure growth remained the main revenue driver.

Core Earnings Data

Operating expenses increased 7.7%, slower than revenue, despite higher commercial spending related to revenue growth and new product rollouts, as well as increased research and development spending. This operating leverage reduced the operating loss by 31.4% and the net loss by 33.6%.

Gross profit tracked revenue growth, although gross margin declined slightly to 79.5% from 79.8%. Dollar amounts below are rounded to the nearest $0.1 million except per-share figures.

Business and Segment Performance

The U.S. remained SI-BONE’s primary market, generating $53.2 million of quarterly revenue. U.S. growth was supported by a 14.9% increase in procedure volume, closely matching the 14.7% increase in revenue.

The active U.S. physician base expanded 19% to 1,715, while trailing-12-month average revenue per territory increased 5% to $2.2 million. These metrics indicate that growth included both broader physician participation and higher territory productivity.

International revenue grew faster than U.S. revenue, reflecting what the company described as strong initial reception for iFuse TORQ and iFuse TORQ TNT. However, international operations still represented only about 5% of total quarterly revenue.

SI-BONE submitted a 510(k) application in June for its third breakthrough device, which management plans to launch in the fourth quarter. CMS also finalized a new MS-DRG family that provides higher inpatient payments for certain complex spinal fusion procedures incorporating iFuse Bedrock Granite, effective October 1.

Profitability, Cash Flow, and Balance Sheet

Revenue growth outpaced expense growth, but SI-BONE remained unprofitable under GAAP. The difference between the $4.1 million net loss and positive adjusted EBITDA partly reflects $6.0 million of stock-based compensation and $1.7 million of depreciation and amortization excluded from the non-GAAP measure.

Quarterly cash from operations was positive at $0.8 million. Cash and short-term investments totaled $145.9 million at June 30, up $1.3 million sequentially from March 31.

The first-half figures remained negative despite the positive second-quarter cash result. For the six months ended June 30, operating cash outflow improved to $1.6 million from $4.7 million, while free cash flow improved to negative $4.2 million from negative $8.9 million.

Inventory increased to $38.4 million from $33.9 million at the end of 2025. That increase should be viewed alongside management’s disclosure that new surgical systems can require additional investment in instrument trays and implant inventory.

2026 Guidance

SI-BONE raised the lower end of its full-year revenue range by $1 million while leaving the upper end unchanged. It also reduced expected operating-expense growth, indicating a modestly improved cost outlook, while maintaining gross-margin and positive adjusted EBITDA expectations.

Management identified expanding physician engagement, the planned fourth-quarter product launch, improved reimbursement and broader commercial reach as potential drivers of future growth. The updated guidance nevertheless represents a relatively narrow revision rather than a major change in the full-year outlook.

Recent Insider Transactions

The supplied six-month summary reports 496,658 shares purchased across 11 transactions and 208,689 shares sold across 16 transactions, resulting in net purchases of 287,969 shares. The latest ten reported entries consisted of four sales and six zero-price stock awards; all were listed as direct ownership transactions.

The stock awards should not be treated as open-market purchases, and the disclosed sales alone do not establish insiders’ views on the company’s prospects.

Risks Investors Should Monitor

• Continued GAAP losses: Adjusted EBITDA was positive, but SI-BONE still recorded operating and net losses. Stock-based compensation remains a meaningful difference between GAAP and non-GAAP profitability.
• Dependence on U.S. procedure growth: The U.S. generated about 95% of quarterly revenue. Changes in patient demand, physician capacity or the healthcare operating environment could therefore have an outsized effect on results.
• Margin and supply-chain pressure: Gross margin declined by 0.3 percentage points. The company also identified tariffs, potential retaliation and supply-chain management as factors that could affect costs and elective procedures.
• Product and reimbursement execution: The planned fourth-quarter device launch follows a June 510(k) submission, while the new CMS reimbursement framework takes effect October 1. The benefit depends on regulatory, commercialization and physician-adoption execution.
• Working-capital requirements: Inventory increased during the first half, and management noted that new surgical systems may require further investment in instrument trays and implants.

Summary

SI-BONE’s second-quarter revenue growth, expanding physician base and slower expense growth narrowed its GAAP losses and increased adjusted EBITDA. The company also generated positive quarterly operating cash flow and modestly raised its full-year revenue outlook. The next points to monitor are execution of the planned product launch, the effect of improved inpatient reimbursement, preservation of the roughly 79% gross margin and progress from positive adjusted EBITDA toward sustained GAAP profitability and free cash flow.

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