SI-BONE Q3 Revenue Rises 14.5% as Procedure Growth Supports Positive Adjusted EBITDA

SI-BONE Inc. (NASDAQ: SIBN) reported third-quarter 2026 worldwide revenue of $55.7 million, up 14.5% from a year earlier, as higher U.S. procedure volume and an expanding physician base supported growth. The medical-device company also remained adjusted EBITDA positive, generated cash from operations and reaffirmed its full-year revenue outlook.

U.S. revenue increased 13.9% to $52.8 million from $46.4 million in the third quarter of 2025. U.S. procedure volume rose about 20% to 6,325 from 5,290, outpacing revenue growth during the period.

The number of active U.S. physicians using SI-BONE products reached a record 1,770, an increase of about 16%, or 240 physicians, from a year earlier. The company defines active physicians as surgeons and interventionalists who performed a procedure during the quarter. SI-BONE said it has recorded nearly six years of double-digit quarterly growth in its U.S. active physician base.

Profitability and cash generation

Gross margin was 79.3% in the quarter. Adjusted EBITDA rose to $3.0 million from $2.3 million a year earlier, an increase of about 32%. SI-BONE uses adjusted EBITDA as a non-GAAP measure that excludes interest income, interest expense, depreciation and amortization, and stock-based compensation from net loss.

On a GAAP basis, the company recorded a third-quarter net loss of $3.6 million, compared with a loss of $4.6 million in the prior-year period. Stock-based compensation was $5.7 million, down from $6.2 million.

Cash provided by operating activities totaled $5.9 million for the quarter, while the company reported $0.4 million of net cash generation. SI-BONE ended the period with $146.3 million in cash and equivalents.

For the nine months ended September 30, operating activities provided $4.4 million of cash, compared with a $2.4 million use of cash in the same period of 2025. Free cash flow remained negative at $4.6 million after $9.0 million of property and equipment purchases, but the deficit was smaller than the $9.5 million reported a year earlier. Free cash flow is a non-GAAP measure defined as operating cash flow less purchases of property and equipment.

The company said third-quarter operating leverage was approximately 1.5 times, calculated as revenue growth divided by operating-expense growth.

Full-year outlook reaffirmed

SI-BONE reaffirmed its 2026 worldwide revenue guidance of $231 million to $233 million, implying annual growth of approximately 15% to 16%. It continues to expect a gross margin of about 79%.

At the midpoint of the revenue range, the presentation indicated operating-expense growth of approximately 10.5%, compared with the company’s prior expectation of about 12%.

Product expansion and reimbursement

SI-BONE highlighted the September 2026 launch of iFuse Granite Onyx following FDA clearance. The device, the company’s third product to receive Breakthrough Device designation, is designed for fixation at the upper and lower instrumented vertebrae. Management estimates the platform addresses a $1.5 billion annual market covering adult spinal deformity, compromised bone and revision procedures.

The company has filed an application for a New Technology Add-on Payment for iFuse Granite Onyx. If approved, the additional payment would take effect October 1, 2027.

New diagnosis-related group classifications for iFuse Bedrock Granite became effective October 1, 2026. SI-BONE said the reimbursement change could increase payment by as much as approximately $50,000. The company estimates that its broader portfolio addresses 650,000 annual target procedures in the U.S., representing an annual opportunity of roughly $5 billion.

SI-BONE’s product platform spans sacroiliac joint dysfunction, pelvic trauma and spinopelvic fixation. As of November 2, the company reported more than 160,000 procedures performed worldwide since inception, 107 issued patents and nearly 200 peer-reviewed publications.

Risks and uncertainties

SI-BONE said its growth and financial outlook remain subject to its ability to introduce and commercialize new products and indications, maintain favorable reimbursement, and manage supply-chain risks. The company also identified future investment requirements for instrument trays and implant inventory, the pace of normalization in the healthcare operating environment, and the willingness and ability of physicians and patients to perform or undergo procedures as potential constraints.

Economic weakness, tariffs and retaliation by U.S. trading partners could also affect demand for elective procedures, the company said. Actual results may differ materially from management’s current expectations.