Si-bone (SIBN) Q2 Revenue Jumps 22%

Si-bone (SIBN -2.07%), a medical device innovator focused on minimally invasive surgery for joint dysfunction and pelvic conditions, released its second quarter 2025 results on August 4, 2025. The company reported GAAP revenue of $48.6 million and a GAAP net loss per share of $(0.14) for Q2 2025. Both figures surpassed analyst forecasts of $48.12 million and $(0.18) GAAP, respectively. The period marked a solid quarter for Si-bone, with double-digit revenue growth, posted positive adjusted EBITDA, and raised its full year outlook. U.S. revenue drove results, while international sales remained flat.

Source: Analyst estimates provided by FactSet. Management expectations based on management's guidance, as provided in Q1 2025 earnings report.

Si-bone’s Business Model and Key Drivers

Si-bone designs and sells implant systems and related instruments for spinal and pelvic surgeries. Its core focus is on the sacroiliac (SI) joint, a frequent cause of lower back pain, as well as pelvic trauma and complex spinal cases. The company’s products, including iFuse-3D (a 3D-printed titanium implant), iFuse TORQ (a screw-like implant for trauma fixation), and iFuse Bedrock Granite (used for pelvic anchoring in spinal fusion), are supported by clinical studies and aim to simplify surgery and improve patient outcomes.

The company's recent focus areas include developing new and enhanced implants, winning expanded reimbursement coverage so hospitals are better compensated for using its devices, and scaling up direct and agent-based sales teams. Key factors for success remain strong innovation, staying ahead of regulatory requirements, physician adoption, and expanding the number of procedure types each doctor performs using Si-bone technology.

Quarter in Review: Financials, Launches, and Regulatory Developments

GAAP revenue climbed 21.7% year-over-year in Q2 2025, topping estimates and driven almost exclusively by U.S. market growth. U.S. sales increased 22.8% year-over-year, fueled by continued strong procedure demand, while international revenue remained flat at $2.2 million (GAAP), highlighting limited growth in non-U.S. markets. Gross margin (GAAP) advanced slightly, rising 0.8 percentage points to 79.8%, benefiting from favorable product and procedure mix and supply chain improvements. Gross profit (GAAP) rose to $38.8 million, a 22.9% increase over Q2 2024.

Operating expenses grew 10.0% to $45.8 million, with the sharpest gains in general and administrative spending. Sales and marketing expenses were $30.8 million (GAAP), while research and development remained steady year-over-year. Si-bone’s operating loss narrowed to $7.0 million, and its adjusted EBITDA swung positive to $1.0 million, showing the company’s ability to drive improved profitability metrics on an adjusted (non-GAAP) basis.

The second quarter saw momentum for several product families. The iFuse TORQ TNT trauma screw platform, designed for sacral fractures, gained U.S. market adoption ahead of internal targets following a new reimbursement add-on approval from the Centers for Medicare and Medicaid Services (CMS) scheduled to take effect in October 2025. The company also launched iFuse TORQ in Europe in July, expanding its international footprint. Demand for iFuse Bedrock Granite, the company’s implant for pelvic fixation during spine procedures, remained solid, driven by favorable reimbursement proposals and strong surgeon uptake. Meanwhile, iFuse INTRA, a minimally invasive SI joint solution, continued to expand reach among interventional spine doctors.

Si-bone reported strong engagement with U.S. physicians. The number of active U.S. doctors increased 25%, reaching 1,440. Revenue per territory climbed 23% to $2.1 million on a trailing 12-month basis. There was a 43% increase in physicians performing more than one procedure type.

Regulatory and reimbursement dynamics were a major theme this quarter. CMS confirmed a New Technology Add-On Payment (NTAP) for hospital procedures using iFuse TORQ TNT, providing up to $4,136 extra per case effective October 1, 2025. CMS also proposed an 8-9% increase in spinal fusion reimbursement tied to cases using Bedrock Granite as part of the CMS fiscal year 2026 proposal, though a pending reassignment that could further raise payments remains under review. Such payment changes influence hospital economics and can accelerate adoption of new technologies. The company continued to highlight the clinical evidence underpinning its products, supported by four randomized trials and over 175 peer-reviewed publications.

No dividends were declared.

Looking Ahead: Guidance and Key Areas to Watch

Si-bone raised its FY2025 guidance following the quarter’s results. Management now projects revenue between $195 million and $198 million for FY2025, representing 17% to 18% annual growth, up from earlier guidance. The company expects gross margin will land between 78.5% and 79.0% for FY2025, implying stability rather than substantial improvement. Operating expenses are expected to grow about 10% at the midpoint of revenue expectations, with full-year adjusted EBITDA (non-GAAP) to remain positive for FY2025.

Management’s outlook signals continued confidence in the underlying demand for its procedures, powered by product launches, physician expansion, and ongoing reimbursement tailwinds. Investors may wish to track progress on the international rollout, the launch and ramp of new products like the next-generation SI joint solution planned for early 2026, and updates on pending reimbursement policy changes that could materially affect adoption. Sustained profitability on a GAAP basis remains a medium-term goal.

Revenue and net income presented using U.S. generally accepted accounting principles (GAAP) unless otherwise noted.