Si-Bone at Canaccord Genuity: Strong Growth and Future Prospects

On Tuesday, 12 August 2025, Si-Bone (NASDAQ:SIBN) presented at Canaccord Genuity’s 45th Annual Growth Conference, showcasing robust second-quarter results and an optimistic outlook. Despite some challenges, the company highlighted strong revenue growth, improved margins, and strategic plans for future product launches.

Key Takeaways

• Si-Bone reported a 22% worldwide revenue growth and a 23% increase in U.S. revenue, driven by a 25% rise in procedure volume.
• The company achieved positive adjusted EBITDA for the third consecutive quarter and reached cash flow breakeven.
• Si-Bone plans to launch a next-generation SI joint solution in late Q1 2026 and has a second breakthrough device in development.
• The company estimates a total addressable market of close to $4 billion, with current penetration at about 5%.
• Reimbursement tailwinds, including potential NTAP approval, support the company’s outlook.

Financial Results

• Q2 2025 results showed a 22% worldwide revenue growth, with U.S. revenue up by 23%.
• Procedure volume increased by 25%, contributing to strong financial performance.
• Full-year guidance projects revenue growth between 17% and 18%, with gross margins expected to range from 79.5% to 79%.
• Si-Bone achieved cash flow breakeven for the first time, marking a significant milestone.

Operational Updates

• Si-Bone’s product portfolio is expanding, with accelerating adoption of Granite 9.5 and strong performance from the TNT product.
• The company reported double-digit growth in its physician base, ending the quarter with 1,440 active physicians.
• An active R&D pipeline includes several products in development, supporting future growth and innovation.
• Annual capital expenditure is projected to be between $7 million and $8 million.

Future Outlook

• Si-Bone anticipates modest cash burn in the second half of the year due to investments in surgical capacity and product launches.
• The company expects to be cash flow breakeven again in 2026.
• Operating leverage is projected to average 1.5 turns, depending on the innovation cycle.
• Si-Bone plans to launch a next-generation SI joint solution in late Q1 2026, with a 510(k) submission for a second breakthrough device targeted for the second half of 2026.
• Favorable reimbursement outcomes are expected to continue, driven by a focus on unmet needs and clinical data.

Q&A Highlights

• Reimbursement tailwinds include an NTAP payment of around $4,100 for iFuse TORQ TNT and a potential 17% increase in reimbursement for office-based lab procedures by CMS.
• The company remains focused on internal R&D and is not actively pursuing acquisitions.

Readers are encouraged to refer to the full transcript for a detailed account of Si-Bone’s presentation and strategic insights.

Full transcript - Canaccord Genuity’s 45th Annual Growth Conference:

Caitlin Cronin, Medical Advice Analyst, Canaccord Genuity: Good afternoon, and welcome to the forty fifth Annual Canaccord Genuity Global Growth Conference. My name is Caitlin Cronin, and I’m one of the medical advice analysts here at Canaccord Genuity. SI BONE, a long standing pioneer of solutions in the sacropelvic solution space with its expanding portfolio of products addressing unmet clinical needs, is joining us today. And we’re very pleased to be joined by Anshul Maheshwari, CFO. We’ve

Anshul Maheshwari, CFO, SI BONE: got a

Caitlin Cronin, Medical Advice Analyst, Canaccord Genuity: fireside chat followed by, you know, any q and a after. And I have a list of questions hoping to get through, but also want to make this, you know, as value added as possible. So if there’s, you know, anything, just please raise your hand if you have any questions, and we’ll make sure to get to it. But before we begin, I want to remind everyone of any relevant disclosures which can be found on our conference and our firm website. And with that, we’ll get started.

So I think the best place to start here is the q two, as Anshul, you guys recently released q two results. And, you know, you raised both your revenue and gross margin guidance. What now gives you the confidence in generating 17% to 18% growth and gross margins of 70.5% to 79% for the full year?

Anshul Maheshwari, CFO, SI BONE: Yes. Thanks, Caitlin. Thanks for inviting us to the conference. Q2 was a very strong quarter for us. Our worldwide growth was 22%.

Our U. S. Growth was 23% revenue growth. That was led by 25% procedure volume growth. So, if you actually look at the business since the IPO, we’ve consistently grown at a 20% CAGR during that time and that growth has actually accelerated in the last three years.

So, feeling really good about the way the business is performing. Now that growth has been broad based. We’ve seen double digit procedure volume growth across all the modalities that we serve. We’ve seen double digit growth in all the call points that we work with. So, that gives us a lot of confidence that our strategy to build out a platform of technologies is really working well for us.

When you go down the P and L as well, you’ve seen really good traction from that top line growth translate into gross margin expansion. Our gross margin expectations for the year were 77% to 78% when we started the year. We’re obviously well ahead of that at close to 80%. So, really proud of how the team’s done on the gross margin side and some of the operational efforts we’ve taken on there. And that’s translated into a third consecutive quarter of positive adjusted EBITDA as well as our first quarter of achieving cash flow breakeven, which at our scale we’re really proud of.

It sort of again goes back to our asset light business model that we’ve been talking about and that’s showing up in our numbers as well. Now, a lot of the things that impacted our first half of the year strong performance are secular in nature. So, the double digit physician growth, which ended up having a 25% growth overall in active physicians at fourteen forty exiting the quarter, that gives you a really nice forward looking indicator of what the potential growth potential of the business is. When you add on to that a lot of the tailwinds that we have in the business with regards to the strength of Granite 9.5 adoption, which will only accelerate with the launch of additional Granite capacity. The TNT product, which is doing really well for us with additional capacity and the potential for NTAP coming out on October 1, which is 4,100, which is quite significant when you compare it to what the reimbursement would have been is a really nice tailwind for the business there as well.

And then the continued strength that we’re seeing in the SI joint dysfunction business where we’ve also seen double digit physician growth, but double digit procedure volume growth as well. Those are the things that give us confidence not just to end 2025 at a strong note, but also give us confidence going into 2026.

Caitlin Cronin, Medical Advice Analyst, Canaccord Genuity: And you mentioned that you saw earlier than expected cash flow in the quarter, but you also expect a modest cash burn in the second half. Maybe just walk us through the rationale behind that modest cash burn expectation.

Anshul Maheshwari, CFO, SI BONE: Yes. So again, the algorithm that we’ve seen in our business is twelve months after you get to adjusted EBITDA breakeven, you should be able to get to cash flow breakeven. We’re not a heavy CapEx business. Our annual CapEx spend is 7,000,000 to $8,000,000 on instrument trace, so it’s pretty asset light from that perspective. And so you’ve seen that manifest in the P and L already from a profitability standpoint, but that was now reflected in the cash flow as well, getting to breakeven.

We do have a lot of opportunity ahead of us, especially as we look at the back half. Q4 tends to be our biggest quarter. We’re going to be putting out more surgical capacity for Granite 95 to capture the demand there and also preparing for the NTAP going effective. We’re going be putting out more TNT capacity out there. So you’re going to see us use a modest amount of cash, so not a lot of cash, but a modest amount of cash in the third quarter to be ready for that strong fourth quarter rollout as well as sort of preparing for the first quarter rollout of this next SI joint dysfunction product that we want to launch.

Caitlin Cronin, Medical Advice Analyst, Canaccord Genuity: And then you also noted expectations for positive adjusted EBITDA for the full year as you’ve had kind of quarterly adjusted EBITDA positivity. I mean, what has your OpEx leverage been in the recent past and is that something that’s sustainable going forward? I believe you spoke on the call about a range 1.25 to 1.7 times operating leverage in your model depending on the investments made.

Anshul Maheshwari, CFO, SI BONE: Yes. So, our operating leverage has been a direct outcome of the strong top line growth that we’ve seen. It’s almost been linear as the growth has accelerated, the leverage has accelerated as well. More recently, you’ve seen that leverage sort of be in that two times range, so our revenue growth has been a little bit over two times our OpEx expense growth. And as we look at it going forward, our assumption is we have a lot of opportunity ahead of us.

We’ve got a very active R and D pipeline. We’ve got a lot of products that will be backed by clinical evidence, so we’ll continue to invest in R and D. We are going to expand our sales force, although we’ll continue to see leverage on the sales force side as well with the hybrid models. On the G and A side, it’s going to be more incremental, so you’ll see a lot more leverage come out in the G and A side. When you combine those three things together, our best expectation is operating leverage depending on where we are in the cycle of innovation could be average 1.5 turns, some years it could be 1.25, some years 1.75 or even two.

We feel very comfortable with that. And when you think about the high gross margins sort of in the high 70s, that kind of leverage, you can easily see how much drop through you can have to the bottom line as you continue that top line growth.

Caitlin Cronin, Medical Advice Analyst, Canaccord Genuity: And then just with the number of investments you’re speaking about, do you believe kind of the twelve to fifteen month time frame that you mentioned for cash flow positivity after the adjusted EBITDA breakeven? Do you see that, you know, these investments could potentially extend that timeline?

Anshul Maheshwari, CFO, SI BONE: Yes. It’s so from a cash flow breakeven standpoint, we actually got there already, right, in the second quarter. So, sort of highlights the strength of the platform, the diversification is driving the high gross margins, which is translating into profitability and strong cash flow. So, from our perspective, the investments that we’re making is in anticipation of the demand that we see in the back half of this year and all through 2026. And these investments can actually accelerate our timeline to cash flow versus delay the timeline to cash flow.

So, we feel really good about our ability to get to cash flow breakeven again in 2026 and then sustain it going forward, all driven by that top line growth, which is what these investments will drive.

Caitlin Cronin, Medical Advice Analyst, Canaccord Genuity: Got it. And then maybe let’s touch on your recent launches and the reimbursement tailwinds there. So, the recent launches over the past few years have really given you a number of, sacropelvic solutions addressing unmet clinical needs across the SI joint dysfunction, pelvic trauma insufficiency fractures, and spinal deformity in degen spaces. Can you just give the audience a sense of how large your your TAM is now along with, you know, the overall market penetration for for SI BONE and and, competitors.

Anshul Maheshwari, CFO, SI BONE: Sure. So SI BONE plays in three main markets. The first one is the SI joint dysfunction market, which is our biggest market and the market that the company was founded on. Our best estimate is there’s potentially 300,000 target patients annually in that market and we estimate that market to be about $2,500,000,000 in total addressable market. In 2022, we launched Granite, which was a breakthrough device from the FDA designated as a breakthrough device from the FDA.

That mark that product was specifically targeting the pelvic fixation market and I would break it down into two. You’ve got the adult deformity market, which is approximately 30,000 procedures and you’ve got the degenerative spine market, which we estimate about a quarter of the fusion procedures in the spine, so about 100,000 target procedures that end at the sacrum are the target markets there. The reason Granite was developed was to address the failure rate, a failure incidence rate of about twenty four percent in deformity procedures. It’s done really well for us. So when you think about that market at thirty thousand cases a year at $12,000 ASP, that’s around a $400,000,000 market there.

And on the degen side, you’ve got 100,000 potential target procedures assuming on average they do two implant cases, that’s $600,000 So that’s another billion dollar opportunity for us that we’ve been able to develop with granite. And then last year, we made a foray deeper into trauma with the launch of iFuse Torque TNT, which was our second breakthrough device in two years and that’s targeting sacral insufficiency fractures. Our best estimate is there are about 60,000 target procedures that could benefit from our iFuse Torque TNT implant and that would be an estimated on a two implant basis another $300,000,000 market. So, you add it all together, you’ve got a market that’s got close to a 5,000,000 target procedures a year and a TAM of close to 4,000,000,000 so very sizable market. If you think about what we’ve done from a revenue standpoint and our most recent guide even if you round it up to 200,000,000, that’s looking at about 5% of the total TAM being penetrated.

So, we have a huge opportunity ahead of us to penetrate that TAM and that’s even before we start adding new products that are going to further increase our TAMs that we’re going after.

Caitlin Cronin, Medical Advice Analyst, Canaccord Genuity: And is SI joint dysfunction a majority of your procedures or, you know, put another way, how much more diverse is your procedure mix now than it it was a few years ago?

Anshul Maheshwari, CFO, SI BONE: Yeah. So we’ve been on a very thoughtful expansion strategy, and a lot of our platform expansion has come from physicians looking at our implants and asking our help in developing solutions that allow their implants to be used in different modalities. So, SI joint dysfunction, as I said, is the biggest TAM for us. It continues to be the biggest market for us from a revenue standpoint. And what’s encouraging is, again, even with the diversification of the portfolio, it’s actually having a huge benefit on the SI joint dysfunction market because you’re getting a nice halo on the SI joint dysfunction business because now we’re able to go to docs that are using granite and be able to work with them on SI joint dysfunction and vice versa.

Do the same thing with SI joint dysfunction docs, work on granite. So the synergistic nature of our portfolio is playing out really well and that’s reflected in the broad based procedure volume growth and also the broad based physician growth that we’re seeing.

Caitlin Cronin, Medical Advice Analyst, Canaccord Genuity: And you seem to have a number of reimbursement tailwinds related to, you know, CMFs, and other payer sentiment towards spine procedures in general and the rate, you know, at which they should be reimbursed, and also specific to SI BONE. Can you talk through some of those recent updates and then, you know, also how those could relate to, you know, the movement of spine procedures to the ASC and outpatient settings?

Anshul Maheshwari, CFO, SI BONE: So, the beauty of our business is because we are targeting unmet needs, we’re coming up with unique solutions and then backing it up with clinical data. We’re very uniquely positioned to be able to get favorable reimbursement. It started with the NTAP for Granite a couple of years ago and now if you look at just this year, we were able to get a TPT for granite for outpatient procedures with zero device offset. What it effectively means if granite is used in an outpatient setting on for a Medicare covered patient, their facility would be reimbursed 100 of the cost of granite. That’s very rare, but that sort of highlights the differentiation and the uniqueness of the solution.

So, that’s one example that started at the start of the year, that’s up to three years. So, CMS has already proposed extension of that in 2026. So, that’ll be a nice tailwind and I’ll get to how that can be beneficial with some of the APC changes in a second. The second piece from a reimbursement standpoint again is our iFuse TNT torque is also a breakthrough device. CMS has proposed and finalized last week the NTAP payment of around $4,100 for iFuse TORQ TNT just to provide you the potential magnitude of impact that’s anywhere between 2030% increase in reimbursement for Medicare cases done inpatient.

Most of these patients are inpatient procedures and are Medicare patients. So, again, a really nice tailwind there as we look to drive access of this solution with physicians and patients. The third piece on the reimbursement side that’s specific to SI BONE is we have an allograft product that fits in the office based lab setting really well. It’s we believe the only percutaneous office based lab SI joint dysfunction procedure on the market. And the proposal from CMS is to increase the reimbursement for the office based lab procedure by close to 17% starting oneonetwenty twenty six.

So, that could be a really nice tailwind for the allograft side of the business with Interventional as well. So, that’s specific to SI BONE. That’s very exciting for us from a reimbursement standpoint and again, sort of sets us up well for not just this year, but 2026 and 2027. The other change that has been proposed by CMS is this APC level seven code, which is moving some of the complex spine procedures, fusion three sixty procedures to an outpatient setting as well and also taking out the CPT 2728 o code for physician payment from an in outpatient only inpatient only list. The reason this is important is we believe forty percent of the dGen procedures that granite was used in could be outpatient eligible procedures.

With this new APC code in that’s being proposed, assuming it’s finalized, if it goes into place, what that allows is for granite to be used more actively in the outpatient setting on degen procedures. Deformity is always going to be inpatient on the degen side and then benefit from the TPT.

Caitlin Cronin, Medical Advice Analyst, Canaccord Genuity: Great. And then, you know, let’s touch on the product pipeline. You have a couple of products in your, you know, near to medium term pipeline that you’ve talked about. Let’s start with your, you know, next upcoming product, which you noted is a NextGen SI joint solution, expected to launch in late Q one twenty twenty six. You noted plans to further engage interventionists and optimize the product for EASC.

And when you say further engage interventionists, is this really going deeper into about a thousand surgically inclined target docs that you’ve noted? Or could this product really help broaden your focus to the full, you know, 4,000, interventionalist space?

Anshul Maheshwari, CFO, SI BONE: Yeah. So the SI joint dysfunction business, as I said earlier, we’re seeing really strong growth across the call points. We’ve seen double digit physician growth and the procedure volume growth has followed that with double digit procedure volume growth. Surgeons continue to be majority of our SI joint dysfunction business and as you know when we entered the interventional market with our SI joint fusion product, we were very targeted. We’ve always viewed the interventional opportunity as an incremental opportunity for us that’s accretive to everything that we do on the surgeon side and we’ve stayed true to that.

We today have two products that we market to interventionists, the TORQ product which is what we started the interventionist journey with in 2023 and launched the STACEY study. And then in 2024, we launched our allograft product Intra, which is targeting physicians who like a percutaneous approach to be able to do it in an office based lab and don’t want to use the the lateral approach as their first line of defense. So both of those products have done really well for us on the interventional side. This new product that we want to launch that we will be launching in q one of next year, it effectively takes our learnings from our intra product, our Allograft product that is reimbursed from twenty seven thousand two and seventy eight. Our experience with titanium implants combines the two.

So it streamlines the workflow for the ASC setting. It fits the workflow that could be a preferred workflow for interventionists, especially those that use the allograft or the percutaneous approach, and it fits right into the ASC and the 27279 reimbursement code as well. So, it’s still targeting the same amount of interventionalists but it gives them an opportunity to have another solution that is going to allow them to have preference on workflow and technique.

Caitlin Cronin, Medical Advice Analyst, Canaccord Genuity: And then you also noted a, you know, second half twenty six submission for your second product in development, a breakthrough device product. And you’ve also noted it was, you know, novel and could become the standard of care. Any more color you’re willing to, you know, share on the product? Is this, you know, a product you would need to establish reimbursement for? Is there a pathway to an NTAP?

And then, you know, how about in terms of surgeon education? What what do you think the learning curve, will be for the product?

Anshul Maheshwari, CFO, SI BONE: Yeah. So we’re really excited about this third breakthrough device product that we’re working on. And, you know, we’re one of the few companies that can claim that they have three breakthrough devices in our industry, so it’s a feat in itself. This is another unique solution where we know there is an unmet clinical need and clinical failure rates quite elevated and we’re using our knowledge of understanding fore bone quality, understanding biomechanics to address this unmet need. The beauty is it builds on all our learnings from products like granite.

It is with the same call point where today Granite is used, so there’s a lot of synergy there from a call point perspective and from a training standpoint, so that’s on the synergy side. It is a unique solution that we do believe can become the standard of care because this unmet need is very well known. In terms of additional details, I’m not going to share much more. We did talk about hitting a major engineering milestone in the quarter which is why we want to share that with the investor community. We will be filing the five ten in the back half of next year.

Given our experience with Granite and IFUS TNT IFUS TNT on the NTAP side, we feel very good about the opportunity to be able to get an NTAP. Now we’ll have to work through the process and and get to the other side. There’s never guarantees, but we feel good about our experience there. From a trading standpoint, we view this very similar to the Granite training, which is a lot more of a trader view versus actual cadaveric training. What’s made Granite really successful is it fits the physician workflow, there is no incremental training required, and it’s addressing an unmet need.

This product that we’re working on right now actually checks all of those three boxes as well. So, it should be a really exciting opportunity for us and should set us up really well for 2027 and beyond.

Caitlin Cronin, Medical Advice Analyst, Canaccord Genuity: And then as you think about expanding your portfolio and going through further r and d, just thoughts on branching out into enabling technologies?

Anshul Maheshwari, CFO, SI BONE: We like the fact that we’re agnostic to a lot of the enabling technologies. We’re compatible with all of them. What we’re focused on is addressing these unmet needs with unique solutions and making sure that we can support our physicians with the procedures. So, we’re pretty we’re compatible with all the enabling technologies and NAV technologies as well. And I think that’s the path we’re going to be on.

Caitlin Cronin, Medical Advice Analyst, Canaccord Genuity: You know, you have a great internal R and D engine as we’ve talked about, but you know, thoughts on M and A to either acquire differentiated technology or maybe consolidate competition in the space?

Anshul Maheshwari, CFO, SI BONE: Yeah, so I’d venture to say we have probably the best engineering and design team in the industry and that’s reflected in a highly differentiated products that we’ve launched. If you think about the journey of the company, we’ve always focused on identifying unmet needs, coming up with unique solutions, backing it up with clinical data that allows us to get favorable reimbursement. And these are core competency of the company, so we’re going to stay true to our core competencies. We’ve talked about two additional products at this point, one in Q1, the other one a five ten being filed in the back half of next year. But we have a very active pipeline of additional products that we’re working on that all in itself would be addressing, each one of themselves will be addressing unmet needs.

So we feel very excited about what we see in the pipeline that’s where our focus is gonna be. Mhmm. You

Caitlin Cronin, Medical Advice Analyst, Canaccord Genuity: know, and I’m sure larger companies look at you and and see the internal r and d engine and the growth that’s coming with it and the platform of technologies that you already have. I mean, would you be open to being part of a larger company at this point?

Anshul Maheshwari, CFO, SI BONE: So, the way we run our business is, again, we want to be able to make sure that we stay highly differentiated. We come up with unique solutions. We maintain our high gross margins. We maintain our profitability and scale our business that way. And like I said earlier, we have a very active pipeline of R and D products so that’s where our focus is.

Now, we also know that you know we are highly complementary to other companies but that’s not how we think about our business. For us, it’s all about how do we add another granite, another iFuse TNT, another product that goes into the SI joint dysfunction space. How do we go deeper with that call point whether it be more implants per procedure or more different modalities per doc? And we have the framework to be able to drive that strong top line growth with profitability ourselves.

Caitlin Cronin, Medical Advice Analyst, Canaccord Genuity: And then just with all of these current products launched and products in your pipeline, do you see these new products as helping you to maintain current growth or potentially accelerating it in the future?

Anshul Maheshwari, CFO, SI BONE: Yes. So if you look at what’s happened with the business in the last three years versus since the IPO, you’ve actually seen new products accelerate growth. So they’ve been all accretive to top line growth. And when you look at the products that we have in the hopper right now, even the ones that we launched last year, we’re still in the early stages of driving growth from those products. So, there’s a significant amount of runway with our Allograft product Granite 9.5 and TNT to continue to drive strong top line growth.

Torque continues to be the most versatile implant that we have in our portfolio and that continues to drive growth as well. These new products that we are launching are going to be accretive to top line growth. They’re complementary to the solution set. And like I said, a lot of these solutions are geared towards achieving two outcomes. One is being able to service the doc across multiple modalities, so maybe even add more modalities or being able to be in the same case and be able to support the doc with multiple solutions.

So, we feel very good about these being all accretive to the top line growth.

Caitlin Cronin, Medical Advice Analyst, Canaccord Genuity: I think we’ll end it there. Thanks Anshul.

Anshul Maheshwari, CFO, SI BONE: Thank you.

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