SI-BONE, Inc.
For the period ended Mar 31, 2026. Filed May 11, 2026.
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A company's report for each of its first three quarters. The financial statements are not audited. It shows how the business has moved since the last annual report, and what management says changed.
Mar 31, 2026 · Filed May 11, 2026
SIBN$24.24-0.1%Stored close · as of Nov 6, 2026
What changed in Management’s Discussion and Analysis?
Read the current filingPrevious report: 10-Q
Period ended 2025-09-30; filed 2025-11-10.
0001459839-25-000095
Item 2. Management’s Discussion and Analysis of Financial Condition and Results of OperationsCurrent report: 10-Q
Period ended 2026-03-31; filed 2026-05-11.
0001459839-26-000056
Item 2. Management’s Discussion and Analysis of Financial Condition and Results of OperationsThe baseline is this issuer’s latest earlier reporting period of the same form that was filed before the current report. A previous 10-Q is a different quarter, not a year-over-year comparison. Amendments are excluded.
Compared 105 previous paragraphs and 93 current paragraphs.
49 unchanged; 23 reworded; 21 added; 28 removed; 5 previous and 0 current paragraphs rearranged.
Tables are not compared: 10 previous and 6 current tables excluded. Dates, whitespace, punctuation and numbering changes are ignored; changes to financial figures remain significant.
A changed paragraph is not evidence that risk increased or decreased. An unchanged paragraph does not establish that risk stayed the same.
Added paragraphs (21)
Current report
We are a leader in developing and commercializing differentiated solutions targeting surgical and interventional procedures for patients with compromised bone. Since building solutions targeting the sacroiliac joint, we have expanded our platform to address adjacent indications, including spinopelvic fixation and pelvic trauma, leveraging our expertise in biomechanical design and anatomy-specific innovation.
Current report
Introduce Solutions Addressing New Markets
Current report
We believe we are the industry leader in pioneering anatomy-specific solutions that are grounded in our biomechanical design expertise and backed by strong clinical evidence. Our product development strategy focuses on addressing unmet clinical needs while leveraging our existing platform technologies, enabling us to expand surgeon adoption and increase procedure volumes over time. As pioneers of minimally invasive treatment for sacroiliac joint dysfunction and degeneration, we developed a deep competency in addressing the challenges of low-density bone in the sacrum. Over the years, we have expanded our platform of solutions to address spinopelvic fixation and pelvic trauma. Our focus on innovation has resulted in three of our platform technologies being designated as breakthrough devices by the FDA.
Current report
Our commercial growth is driven by expansion of our sales organization, increased surgical capacity, and broader site-of-service adoption. As of March 31, 2026, our U.S. commercial organization included 89 territory sales managers, 80 clinical support specialists, and 336 third-party sales agents, compared to 85 territory sales managers, 78 clinical support specialists, and 278 third-party sales agents as of March 31, 2025.
Current report
As of March 31, 2026, our international commercial organization included 10 direct sales representatives and 28 third-party sales agents and resellers, compared to 10 direct sales representatives and 29 third-party sales agents and resellers as of March 31, 2025.
Current report
Our expanded platform allows us to serve our physicians across all sites of care. Over 33% of U.S. sacroiliac joint procedures were performed in ambulatory surgical center (“ASC”) and office-based lab (“OBL”) settings during the quarter.
Current report
Engage and Educate Physicians
Current report
Physician adoption and utilization are key drivers of our revenue growth. We focus on:
Current report
•increasing the number of active physicians performing our procedures;
Current report
•improving time to first case following training; and
Current report
•increasing procedures per active physician.
Current report
Our training programs include hands-on cadaveric sessions, simulator-based training, and structured onboarding programs designed to accelerate adoption and improve procedural efficiency. In addition to training new physicians and working with our existing physician customers to grow their use of our products, we have several initiatives to re-engage inactive physicians.
Current report
Our ability to recruit and retain skilled personnel, particularly within our commercial organization, is a significant determinant of our success. We continue to focus on maintaining a competitive compensation structure and supporting sales force productivity and retention.
Current report
Each year, we conduct instructor-led trainings designed to build people leadership capabilities and train managers on delivering actionable feedback. We have also adopted a goal for each of our managers to have regular check-ins with employees to discuss their personal goals and career plans in furtherance of our commitment to career and professional development.
Current report
To support the growing demand for our solutions, we continue to focus on operational efficiency, including increasing sales force productivity, and optimizing utilization of our instrument trays.
Current report
We have made significant investments in instrument trays and implants to support procedural growth. We continue to focus on improving capital efficiency through optimized inventory management and maximize our asset utilization by having our instrument trays used in more surgeries in any given time period. We routinely work with our suppliers to improve supply chain efficiency, lower manufacturing costs and reduce our cash investment in inventory.
Current report
Research and Development Expenses. The decrease in research and development expenses for the three months ended March 31, 2026 as compared to the three months ended March 31, 2025 was due to timing and stage of product development across projects, as we continue to invest in recently launched products, next generation product development, and clinical and regulatory initiatives.
Current report
Cash requirement
Current report
(3)Consists of future non-cancelable rent payments under operating lease obligations, excluding expected tenant improvement allowance of $3.8 million related to our San Jose office lease.
Current report
During the three months ended March 31, 2026, net cash used in operating activities was $2.4 million, consisting of a net loss of $4.3 million and an increase in net operating assets of $5.9 million, partially offset by non-cash charges of $7.9 million. During the three months ended March 31, 2025, net cash used in operating activities was $4.9 million, consisting of a net loss of $6.5 million and an increase in net operating assets of $6.2 million, partially offset by non-cash charges of $7.8 million.
Current report
Significant changes in net operating assets during the three months ended March 31, 2026 included higher inventory levels to support new product introductions, higher accounts receivable due to timing of sales and cash collections, and lower accrued liabilities and higher accounts payable balance due to the timing of payments. Non-cash charges consisted primarily of stock-based compensation and depreciation.
Removed paragraphs (28)
Previous report
We are a medical device company dedicated to solving musculoskeletal disorders of the sacropelvic anatomy. Leveraging our knowledge of pelvic anatomy and biomechanics, we have pioneered proprietary minimally invasive surgical implant systems to address sacroiliac joint dysfunction as well as address unmet clinical needs in pelvic fixation and management of pelvic fractures.
Previous report
Our products include a series of patented titanium implants and the instruments used to implant them, as well as implantable bone products. Since launching our first generation iFuse in 2009, we have launched multiple implant product lines, including iFuse-3D in 2017, iFuse TORQ in 2021, iFuse Bedrock Granite in 2022, and iFuse INTRA and iFuse TORQ TNT in 2024. In the United States, iFuse, iFuse-3D, iFuse TORQ and iFuse Bedrock Granite have clearances for applications in sacroiliac joint dysfunction, adult spinal deformity and pelvic trauma. iFuse TORQ TNT has clearances for applications in pelvic trauma and sacroiliac joint dysfunction. In Europe, iFuse, iFuse-3D and iFuse TORQ are approved for applications in sacroiliac fusion, adult spinal deformity and pelvic fracture fixation.
Previous report
As we expand our portfolio, the experience, caliber, and strong clinician relationships of our sales force, including our network of third-party sales agents, will be crucial to drive adoption of our future products and procedures. Since our initial public offering in 2018, we have made significant investments in our commercial infrastructure to build a valuable sales team to expand the market, drive physician engagement and deliver revenue growth.
Previous report
While we will continue to selectively expand our sales force, we are also focused on increasing our sales managers' capacity and driving sales force productivity by adding more clinical support specialists and implementing hybrid models, including selectively adding third-party sales agents for case coverage, and by placing instrument trays and implants at select sites of service. This expansion of our sales force is one aspect of increasing the overall number of procedures in a given period that we can support with products, which is what we call “surgical capacity.” Our surgical capacity is also limited by the volume of implant inventory and the number of instrument trays held ready for surgery, either at our headquarters facility, forward deployed with our sales force or placed at customer facilities. As we grow, and as adoption of our solutions continues to mature, our overall surgical capacity may become an important driver of the amount of revenue that we can generate.
Previous report
As of September 30, 2025, our U.S. sales force consisted of 88 territory sales managers and 83 clinical support specialists directly employed by us and 302 third-party sales agents, compared to 82 territory sales managers and 76 clinical support specialists directly employed by us and 227 third-party sales agents as of September 30, 2024. As of September 30, 2025 and September 30, 2024, our international sales force consisted of 11 sales representatives directly employed by us and a total of 29 third-party sales agents and resellers.
Previous report
For the quarter ended September 30, 2025, over 30 percent of our procedures for sacroiliac joint dysfunction were performed at ambulatory surgery centers (ASCs) or Office-Based Labs (OBLs). With the steady increase in the numbers of minimally invasive procedures, including sacroiliac joint fusion procedures, being performed at ASCs or OBLs, we continue to actively engage with these facilities to educate their management groups on our clinical evidence, exclusive commercial payor coverage and focus on driving improved education and pathways between pain physicians and surgeons.
Previous report
Physician Engagement
Previous report
Engaging and educating physician and other healthcare professionals about the clinical merits and patient benefits of our solutions will be important to grow physician adoption. Our medical affairs team works closely with our sales team to increase physician engagement and activation. Physician activity includes both the number of physicians performing our procedures as well as the number of procedures performed per physician. In addition to training new physicians, we have several initiatives to re-engage inactive physicians.
Previous report
We use a combination of hands-on cadaveric and dry-lab training, as well as the SI-BONE SImulator - a portable, radiation-free, haptics and computer-based simulator - for training purposes, and optimize our programs to improve adoption rate, time to first case and ultimately physician productivity.
Previous report
We are currently targeting over 12,000 U.S. physicians, including over 8,000 orthopedic and neurological spine surgeons and approximately 4,500 interventional spine physicians, to perform our procedures. As of September 30, 2025 and 2024, in the United States more than 3,700 and 3,000 physicians, respectively, have been trained on our products and have treated at least one patient. Outside the United States, as of September 30, 2025 and 2024, more than 1,100 physicians have been trained on our product and have treated at least one patient. Since launching our academic training program in August 2018, we have trained residents and fellows in over 300 academic programs in the United States, resulting in the training of approximately 2,100 surgical residents and fellows.
Previous report
Expand Addressable Markets
Previous report
Expanding our platform of sacropelvic solutions to address sacroiliac joint dysfunction, pelvic fixation and pelvic trauma has been a key tenet of our strategy, and we have made substantial progress on this mission. With iFuse-3D, iFuse TORQ, iFuse Bedrock Granite and iFuse TORQ TNT, we believe that our innovative, versatile, and complementary product portfolio provides physicians with a comprehensive set of alternatives, and positions us as the top choice for physicians for sacropelvic solutions. We also offer an allograft bone implant for physicians who believe that this kind of implant can be important in addressing sacroiliac joint dysfunction.
Previous report
Demonstrating the safe and effective use of our implants in post-market clinical trials, including their use in ways that may not yet be part of standard-of-care practice, is an important component of our market-building strategy. In June 2022, we completed enrollment in SILVIA, a two-year prospective international multi-center randomized controlled trial comparing pelvic fixation with and without the addition of an iFuse-3D implant. iFuse-3D is used to provide sacroiliac fusion as part of multilevel spinal fusion procedures, both to improve the stability of the pelvic fixation construct and to decrease the incidence of new-onset postoperative SI joint pain. Data analysis from SILVIA showed that the study’s primary clinical endpoint was met, namely that placement of iFuse-3D implants adjacent to pelvic fixation screws in these procedures reduced the incidence of new-onset SI joint pain following the procedure. A manuscript describing these findings is currently under review.
Previous report
In September 2022, we began enrolling patients in our SAFFRON study, a prospective randomized controlled trial of surgery using our iFuse TORQ device compared to non-surgical management in patients with debilitating sacral fragility or insufficiency fractures. The study was completed using available data. Results from SAFFRON were published in May 2025 and showed a higher rate of recovery of mobility after surgical treatment using iFuse TORQ compared to non-surgical treatment.
Previous report
STACI is a prospective study on the use of iFuse TORQ in patients with sacroiliac joint dysfunction. The purpose of STACI is to provide information on the safety and effectiveness of minimally invasive sacroiliac joint fusion performed by interventional physicians using iFuse TORQ. Study enrollment completed in November 2024. Early results from STACI were published in June 2025 and showed that placement of iFuse TORQ by interventional pain management physician was associated with a low adverse event rate and early improvement in pain and function.
Previous report
Our ability to recruit, develop and retain highly skilled talent is a significant determinant of our success. To attract, develop and retain our talent, we seek to create a diverse and inclusive workplace with opportunities for our employees to thrive and advance in their careers. We support this with market-competitive compensation, comprehensive benefits, and health and wellness programs.
Previous report
To support our growing portfolio of solutions, we continue to evolve our business processes to identify, measure and improve operational efficiency. The information developed will allow us to optimize processes, increase sales force productivity and improve asset utilization.
Previous report
We have made significant investments in instrument trays used to perform surgeries. Our goal is to deploy instrument trays to the market where the demand exists to increase our asset utilization rates over time and use capital more effectively by having our instrument trays used in more surgeries in any given time period. Given supply chain disruptions impacting the industry, we are working closely with our suppliers to reduce lead time for our implants to ensure we can support our expanding physician footprint and over time build the resilience in our supply chain to reduce our cash investment in inventory. Additionally, we are partnering with our suppliers around design for manufacturing, specifically for newer products, to reduce the overall cost of the implants as we scale, and reduce waste and rework. Lastly, we are integrating our demand planning and manufacturing systems, to ensure we leverage actual usage trends as we build surgical capacity to support our growth.
Previous report
Research and Development Expenses. The research and development expenses for the three months ended September 30, 2025 is consistent with research and development expenses for the three months ended September 30, 2024.
Previous report
Comparison of the Nine Months Ended September 30, 2025 and 2024
Previous report
Revenue. The increase in revenue for the nine months ended September 30, 2025 as compared to the nine months ended September 30, 2024 was primarily driven by a $26.1 million increase in our U.S. revenue due to the increase in case volumes due to our expanded product portfolio.
Previous report
Gross Profit and Gross Margin. Gross profit increased $22.0 million for the nine months ended September 30, 2025 as compared to the nine months ended September 30, 2024, mainly driven by higher revenue. The gross margin was 79.8% for the nine months ended September 30, 2025 as compared to 79.0% for the nine months ended September 30, 2024. Gross margin increased in the nine months ended September 30, 2025 as compared to the nine months ended September 30, 2024, primarily due to changes in procedure and product mix, partially offset by higher royalties and reserves.
Previous report
Operating Expenses:
Previous report
Sales and Marketing Expenses. The increase in sales and marketing expenses for the nine months ended September 30, 2025 as compared to the nine months ended September 30, 2024 was primarily due to a $7.8 million increase in commissions and personnel costs driven by higher revenues, partially offset by $2.2 million decrease in travel costs and stock-based compensation.
Previous report
Research and Development Expenses. The research and development expenses for the nine months ended September 30, 2025 is consistent as compared to the research and development expenses for the nine months ended September 30, 2024.
Previous report
General and Administrative Expenses. The increase in general and administrative expenses for the nine months ended September 30, 2025 as compared to the nine months ended September 30, 2024 was primarily due to a $3.1 million increase in personnel costs and stock-based compensation associated with an increase in headcount within general and administrative departments, and a $3.0 million increase in legal, consulting, and bad debt expense.
Previous report
Interest Income. The decrease in interest income for the nine months ended September 30, 2025 as compared to the nine months ended September 30, 2024 was primarily due to lower interest rate on our investment balance.
Previous report
Net cash used in operating activities for the nine months ended September 30, 2025 of $2.4 million resulted from cash outflows due to a net loss of $17.3 million, adjusted for $25.1 million of non-cash items, and cash outflows from net changes in operating assets and liabilities of $10.2 million. Net cash used in operating activities for the nine months ended September 30, 2024 of $13.6 million resulted from cash outflows due to a net loss of $26.4 million, adjusted for $21.0 million of non-cash items, and cash outflows from changes in operating assets and liabilities of $8.2 million. The decrease in net loss, net of non-cash items for the nine months ended September 30, 2025 as compared to the nine months ended September 30, 2024 was mainly due to increased revenues. Net cash outflows from changes in operating assets and liabilities for the nine months ended September 30, 2025 was primarily due to higher inventory build-up related to our new product introductions, higher accounts payable and lower accrued liabilities attributable to the normal course timing of expenses, offset by lower account receivable balance resulting from improved collections. Net cash outflows from changes in operating assets and liabilities for the nine months ended September 30, 2024 was primarily due to higher accounts receivable due to timing of collections, higher inventory build-up related to new product introductions, higher accounts payable and lower accrued liabilities attributable to the normal timing of expenses.
Reworded paragraphs (23)
Previous wording
We market our products primarily with a direct sales force as well as a number of third-party sales agents in the United States, and with a combination of a direct sales force, and sales agents and resellers in other countries. As of September 30, 2025, over 130,000 procedures have been performed using our products by over 4,800 physicians in the United States and 38 other countries since we introduced iFuse in 2009.
Current wording
We market our products primarily with a direct sales force as well as a number of third-party sales agents in the United States, and with a combination of a direct sales force and sales agents in other countries. As of March 31, 2026, nearly 150,000 procedures have been performed using our technologies since initial commercialization.
Previous wording
We continue to invest in research and development initiatives to bring new and differentiated solutions to the market that deliver on our vision of improving patient quality of life through differentiated solutions to target segments with a clear unmet clinical need. Robust clinical evidence is central to drive adoption and favorable reimbursement, and we remain focused on continuing to set the industry standard in delivering evidence-based care through best-in-class clinical trials that demonstrate the efficacy, safety, and economic benefit of our solutions. During the nine months ended September 30, 2025, we spent $13.1 million on research and development, equating to 9% of our revenue. During the nine months ended September 30, 2024, we spent $12.7 million on research and development, equating to 11% of our revenue.
Current wording
We continue to invest in research and development initiatives to bring new and differentiated solutions to the market. Robust clinical evidence is central to drive adoption and favorable reimbursement, and we remain focused on continuing to set the industry standard in delivering evidence-based care through best-in-class clinical trials that demonstrate the efficacy, safety, and economic benefit of our solutions. During the three months ended March 31, 2026, we spent $4.2 million on research and development, equating to 8.0% of our revenue. During the three months ended March 31, 2025, we spent $4.5 million on research and development, equating to 9.6% of our revenue.
Previous wording
In addition to fostering an inclusive workplace and ensuring equitable compensation for our employees, we maintain a strong focus on enhancing employee retention and job satisfaction. To achieve this, we have established a feedback mechanism to continually monitor and respond to employee sentiment. Using this feedback, we deploy strategies that enhance the skills of our people managers and improve internal communications with employees. Furthermore, we provide ongoing learning and leadership training opportunities to support professional growth.
Current wording
In addition to ensuring equitable compensation for our employees, we maintain a strong focus on enhancing employee retention and job satisfaction. To achieve this, we have established a feedback mechanism to continually monitor and respond to employee sentiment. Using this feedback, we deploy strategies that enhance the skills of our people managers and improve internal communications with employees. Furthermore, we provide ongoing learning and leadership training opportunities to support professional growth.
Previous wording
We are focused on increasing our territory sales managers’ and sales representatives’ capacity, efficiency and productivity. We may do this by adding more clinical support specialists and third-party sales agents as part of hybrid arrangements for case coverage, and by consigning instrument trays and implants at select sites of service. As of September 30, 2025, our trailing twelve month average revenue per territory sales manager has increased to approximately $2.1 million from $1.8 million as of September 30, 2024.
Current wording
We are focused on increasing our territory sales managers’ and sales representatives’ capacity, efficiency and productivity. We may do this by adding more clinical support specialists and third-party sales agents as part of hybrid arrangements for case coverage, and by consigning instrument trays and implants at selective sites of service. As of March 31, 2026, our trailing twelve month average revenue per territory sales manager has increased to approximately $2.2 million from $2.0 million as of March 31, 2025.
Previous wording
Revenue. The increase in revenue for the three months ended September 30, 2025 as compared to the three months ended September 30, 2024 was primarily driven by a $8.1 million increase in our U.S. revenue from increased case volumes due to our expanded product portfolio.
Current wording
Revenue. The increase in revenue for the three months ended March 31, 2026 as compared to the three months ended March 31, 2025 was primarily driven by higher U.S. procedure volumes, supported by expanded adoption of our product portfolio, increased sales channel coverage, and continued growth in ASC and OBL settings.
Previous wording
Gross Profit and Gross Margin. Gross profit increased $6.9 million for the three months ended September 30, 2025 as compared to the three months ended September 30, 2024, mainly driven by higher revenue. The gross margin was 79.8% for the three months ended September 30, 2025 compared to a gross margin of 79.1% for the three months ended September 30, 2024 due to lower product costs, partially offset by higher royalties and reserves.
Current wording
Gross Profit and Gross Margin. Gross profit increased $4.2 million for the three months ended March 31, 2026 as compared to the three months ended March 31, 2025, mainly driven by higher revenue. The gross margin remained stable year-over-year, reflecting lower product costs partially offset by higher royalty expenses.
Previous wording
Sales and Marketing Expenses. The increase in sales and marketing expenses for the three months ended September 30, 2025 as compared to the three months ended September 30, 2024 was primarily due to a $3.2 million increase in commissions and personnel cost driven by higher revenues and increase in headcount, partially offset by a decrease of $0.7 million related to travel, stock-based compensation and consulting.
Current wording
Sales and Marketing Expenses. The increase in sales and marketing expenses for the three months ended March 31, 2026 as compared to the three months ended March 31, 2025 was primarily due to a $0.8 million increase in commissions and employee related costs driven by higher revenues and increase in headcount, and a $1.6 million increase in travel, training and marketing activities, partially offset by a decrease of $0.3 million related to stock-based compensation.
Previous wording
General and Administrative Expenses. The increase in general and administrative expenses for the three months ended September 30, 2025 compared to the three months ended September 30, 2024 was primarily due to a $1.1 million increase in personnel costs and stock-based compensation associated with an increase in headcount within general and administrative departments and a $0.8 million increase in legal and consulting.
Current wording
General and Administrative Expenses. The increase in general and administrative expenses for the three months ended March 31, 2026 compared to the three months ended March 31, 2025 was primarily due to a $0.3 million increase in personnel costs and stock-based compensation, partially offset by a $0.3 million decrease in professional service costs.
Previous wording
Interest Income. The decrease in interest income for the three months ended September 30, 2025 as compared to the three months ended September 30, 2024 was primarily due to lower interest rates on our investment balances.
Current wording
Interest Income. The decrease in interest income for the three months ended March 31, 2026 as compared to the three months ended March 31, 2025 was primarily due to lower interest earned on our investments in marketable securities, primarily as a result of lower interest rates.
Previous wording
Interest Expense. The decrease in interest expense for the three months ended September 30, 2025 as compared to the three months ended September 30, 2024 was due to lower interest rates associated with the First-Citizens Fourth Amended Loan Agreement.
Current wording
Interest Expense. The decrease in interest expense for the three months ended March 31, 2026 as compared to the three months ended March 31, 2025 was primarily due to lower interest rates associated with the First-Citizens Fourth Amended Loan Agreement.
Previous wording
As of September 30, 2025, we had cash and marketable securities of $145.7 million as compared to $150.0 million as of December 31, 2024. We have financed our operations primarily through the sale of our common stock in our public offerings and debt financing arrangements. As of both September 30, 2025 and December 31, 2024, we had $35.5 million in outstanding debt.
Current wording
As of March 31, 2026, we had cash and marketable securities of $144.7 million as compared to $147.8 million as of December 31, 2025. We have financed our operations primarily through our public offerings and debt financing arrangements. As of both March 31, 2026 and December 31, 2025, we had $35.6 million in outstanding debt.
Previous wording
As of September 30, 2025, we had an accumulated deficit of $448.6 million as compared to $431.4 million as of December 31, 2024. During the nine months ended September 30, 2025, we incurred a net loss of $17.3 million. During the years ended December 31, 2024 and 2023, we incurred a net loss of $30.9 million and $43.3 million, respectively, and expect to incur additional losses in the future. We have not achieved positive cash flow from operations for the nine months ended September 30, 2025 and all prior periods.
Current wording
As of March 31, 2026, we had an accumulated deficit of $454.6 million as compared to $450.3 million as of December 31, 2025. During the three months ended March 31, 2026, we incurred a net loss of $4.3 million. During the years ended December 31, 2025 and 2024, we incurred a net loss of $18.9 million and $30.9 million, respectively, and expect to incur additional losses in the future.
Previous wording
Based upon our current operating plan, we believe that our existing cash and marketable securities will enable us to fund our operating expenses and capital expenditure requirements over the next 12 months from the filing of this Form 10-Q. However, the financial impact of a potential economic downturn or capital market disruptions pose risks to and uncertainties in our future available capital resources. We may face challenges and uncertainties and, as a result, may need to raise additional capital as our available capital resources may be consumed more rapidly than currently expected due to, but not limited to (a) decreases in sales of our products and the uncertainty of future revenues from new products; (b) changes we may make to the business that affect ongoing operating expenses; (c) changes we may make in our business strategy; (d) regulatory and reimbursement developments affecting our existing products; (e) changes we may make in our research and development spending plans; and (f) other items affecting our forecasted level of expenditures and use of cash resources. In addition, as we seek to deploy new product offerings, the need for additional capital to fund the purchase of inventories of implants and instrument trays may become more acute and may limit the number of revenue opportunities that we pursue. Each new product family introduced typically requires the purchase of consumable implant inventory as well as investment in a fleet of instrument trays required to support procedures nationwide.
Current wording
Based upon our current operating plan, we believe that our existing cash and marketable securities will enable us to fund our operating expenses and capital expenditure requirements over the next 12 months from the filing of this Form 10-Q. However, the financial impact of a potential economic downturn or capital market disruptions pose risks and uncertainties in our future available capital resources. We may face challenges and uncertainties and, as a result, may need to raise additional capital as our available capital resources may be consumed more rapidly than currently expected due to, but not limited to (a) decreases in sales of our products and the uncertainty of future revenues from new products; (b) changes we may make to the business that affect ongoing operating expenses; (c) changes we may make in our business strategy; (d) regulatory and reimbursement developments affecting our existing products; (e) changes we may make in our research and development spending plans; and (f) other items affecting our forecasted level of expenditures and use of cash resources. In addition, as we seek to deploy new product offerings, the need for additional capital to fund the purchase of inventories of implants and instrument trays may become more acute and may limit the number of revenue opportunities that we pursue. Each new product family introduced typically requires the purchase of consumable implant inventory as well as investment in a fleet of instrument trays required to support procedures nationwide.
Previous wording
Our outstanding debt is related to a Loan and Security Agreement dated August 12, 2021 (the “Original Loan Agreement”), entered into by us and Silicon Valley Bank, a California corporation (“SVB”). Pursuant to the Original Loan Agreement, SVB provided us with a term loan in the aggregate principal amount of $35.0 million (the “Original Term Loan”).
Current wording
Our outstanding debt is related to a Loan and Security Agreement (the “Original Loan Agreement”) dated August 12, 2021 (the “Effective Date”), entered into by us and Silicon Valley Bank, a California corporation (“SVB”). Pursuant to the Original Loan Agreement, we borrowed a term loan in the aggregate principal amount of $35.0 million (the “Original Term Loan”).
Previous wording
On January 6, 2023, we entered into a First Amendment to Loan and Security Agreement with SVB (the “First Amendment” and together with the Original Loan Agreement, collectively the “Amended Loan Agreement”). Upon entry into the Amended Loan Agreement, we borrowed $36.0 million pursuant to a new term loan (the “First Amendment Term Loan”), which was substantially used to repay in full the $35.0 million Original Term Loan outstanding under the Original Loan Agreement, and we also obtained a secured revolving credit facility in an aggregate principal amount of up to $15.0 million (the “Revolving Line").
Current wording
On January 6, 2023, we entered into a First Amendment to Loan and Security Agreement with SVB to amend our Original Loan Agreement (the “First Amendment” and together with the Original Loan Agreement, collectively the “Amended Loan Agreement”). Upon entry into the Amended Loan Agreement, we borrowed a new term loan in the aggregate principal amount of $36.0 million (the “First Amendment Term Loan”), which was substantially used to repay in full the $35.0 million Original Term Loan outstanding under the Original Loan Agreement, and we also obtained a secured revolving credit facility in an aggregate principal amount of up to $15.0 million (the “Revolving Line"). The First Amendment also provided for a final payment fee payable to SVB of 2% of the original principal amount of the First Amendment Term Loan due upon the earlier of the First Amendment Term Loan Maturity Date, termination of the Amended Loan Agreement, acceleration by the Lender following an event of default, or prepayment of the First Amendment Term Loan.
Previous wording
On January 25, 2024, we entered into a Second Amendment to Loan and Security Agreement with Silicon Valley Bank, a division of First-Citizens Bank & Trust Company, as successor in interest to SVB (“First-Citizens”) which amended our Amended Loan Agreement (the “Second Amendment” and together with the Amended Loan Agreement, collectively, the “Second Amended Loan Agreement”). The Second Amendment revised certain provisions related to financial covenants and the periods in which such covenants applied.
Current wording
On January 25, 2024, we entered into a Second Amendment to Loan and Security Agreement with Silicon Valley Bank, a division of First-Citizens Bank & Trust Company, as successor in interest to SVB (“First-Citizens”) to further amend our Amended Loan Agreement (the “Second Amendment” and together with the Amended Loan Agreement, collectively, the “Second Amended Loan Agreement”). The Second Amendment revised certain provisions related to financial covenants and the periods in which such covenants applied.
Previous wording
On November 8, 2024, we entered into a Third Amendment to Loan and Security Agreement with First-Citizens (the “Third Amendment” and together with the Second Amended Loan Agreement, collectively, the “Third Amended Loan Agreement”), relative to a new term loan in the original aggregate principal amount of $36.0 million extended by First-Citizens to the Company (the “Third Amendment Term Loan”), which was substantially used to refinance and repay in full the then-outstanding $36.0 million existing First Amendment Term Loan. We also paid a certain final payment fee due relative to such prior First Amendment Term Loan. The Third Amendment set the maturity date for the Third Amendment Term Loan to September 1, 2029 (the "Third Amendment Term Loan Maturity Date"), and set the first principal repayment due date relative to the Third Amendment Term Loan to October 1, 2027; provided that upon the achievement of the Performance Milestone (as defined in the Third Amendment), the first principal payment shall become due on October 1, 2028. Interest on the outstanding principal balance of the Third Amendment Term Loan is payable monthly at a floating rate per annum equal to the greater of 4.25% and the WSJ prime rate minus 0.5%. We may elect to prepay the Third Amendment Term Loan in whole prior to the Third Amendment Term Loan Maturity Date, subject to a prepayment fee equal to 1.5% of the original principal amount of the Third Amendment Term Loan if the loan is prepaid within 18 months following the closing of the Third Amendment. The Third Amendment further revised certain provisions related to financial covenants and the periods in which such covenants apply, and we and First-Citizens also agreed to terminate the Revolving Line and an uncommitted accordion term loan provision.
Current wording
On November 8, 2024, we entered into a Third Amendment to Loan and Security Agreement with First-Citizens to further amend our Second Amended Loan Agreement (the “Third Amendment” and together with the Second Amended Loan Agreement, collectively, the “Third Amended Loan Agreement”). Upon entry into the Third Amended Loan Agreement, we borrowed a new term loan in the aggregate principal amount of $36.0 million (the “Third Amendment Term Loan”), which was substantially used to refinance and repay in full the then-outstanding $36.0 million First Amendment Term Loan. We also paid a certain final payment fee due related to such prior First Amendment Term Loan. The Third Amendment set the maturity date for the Third Amendment Term Loan to September 1, 2029 (the "Third Amendment Term Loan Maturity Date"), and set the first principal repayment due date for to the Third Amendment Term Loan to October 1, 2027, which date will, upon the achievement of the Performance Milestone (as defined in the Third Amendment), be October 1, 2028. Interest on the outstanding principal balance of the Third Amendment Term Loan is payable monthly at a floating rate per annum equal to the greater of 4.25% and the WSJ prime rate minus 0.5%. The Company may elect to prepay the Third Amendment Term Loan in whole prior to the Third Amendment Term Loan Maturity Date, subject to a prepayment fee equal to 1.5% of the original principal amount of the Third Amendment Term Loan if the loan is prepaid within 18 months following the closing of the Third Amendment. The Third Amendment revised certain provisions related to financial covenants and the periods in which such covenants apply, and First-Citizens and the Company also agreed to terminate the Revolving Line and an uncommitted accordion term loan provision.
Previous wording
On September 25, 2025, we entered into a Fourth Amendment to Loan and Security Agreement with First-Citizens which amended the Third Amended Loan Agreement (the “Fourth Amendment” and together with the Third Amended Loan Agreement, collectively, the “Fourth Amended Loan Agreement”). The Fourth Amendment revised the periods in which the financial covenants applied.
Current wording
On September 25, 2025, we entered into a Fourth Amendment to Loan and Security Agreement with First-Citizens to further amend our Third Amended Loan Agreement (the “Fourth Amendment” and together with the Third Amended Loan Agreement, collectively, the “Fourth Amended Loan Agreement”). The Fourth Amendment revised the periods in which the financial covenants applied.
Previous wording
Our material cash requirements include various contractual and other obligations consisting of long-term debt obligations with First-Citizens, operating lease obligations and purchase obligations with some of our suppliers and have not changed materially since the Form 10-K filed with the SEC on February 25, 2025. As of September 30, 2025, expected timing of those payments are as follows:
Current wording
Our material cash requirements include various contractual and other obligations consisting of long-term debt obligations with First-Citizens, purchase obligations with some of our suppliers and have not changed materially since the Form 10-K filed with the SEC on February 24, 2026. In February 2026, we entered into an operating lease for an office building in San Jose, California. As of March 31, 2026, expected timing of those payments are as follows:
Previous wording
(2)Represents the future interest obligations on our First-Citizens Fourth Amended Loan Agreement estimated using an interest rate of 6.75% as of September 30, 2025.
Current wording
(2)Represents the future interest obligations on our First-Citizens Fourth Amended Loan Agreement estimated using an interest rate of 6.25% as of March 31, 2026.
Previous wording
This compares to $48.1 million of contractual obligations as of December 31, 2024.
Current wording
This compares to $47.7 million of contractual obligations as of December 31, 2025.
Previous wording
Net cash used in investing activities in the nine months ended September 30, 2025 was $8.9 million as compared to cash provided by investing activities of $8.3 million in the nine months ended September 30, 2024. Net cash used in investing activities for the nine months ended September 30, 2025 consisted of maturities of our marketable securities net of purchases of $1.7 million, and purchases of property and equipment of $7.1 million primarily related to individual components in instrument sets to support revenue growth. Net cash provided by investing activities for the nine months ended September 30, 2024 consisted of purchases of our marketable securities net of maturities of $16.5 million, and purchases of property and equipment of $8.2 million primarily related to individual components in instrument sets to support revenue growth.
Current wording
Net cash used in investing activities in the three months ended March 31, 2026 was $6.2 million as compared to cash provided by investing activities of $10.6 million in the three months ended March 31, 2025. Net cash used in investing activities for the three months ended March 31, 2026 consisted of purchases of our marketable securities net of maturities of $5.2 million, and purchases of property and equipment of $1.1 million primarily related to individual components in instrument trays to support revenue growth. Net cash provided by investing activities for the three months ended March 31, 2025 consisted of maturities of our marketable securities net of purchases of $12.7 million, and purchases of property and equipment of $2.1 million primarily related to individual components in instrument trays to support revenue growth.
Previous wording
Cash provided by financing activities in the nine months ended September 30, 2025 and 2024 was $2.3 million and $2.0 million, respectively, resulting from the issuance of common stock under our stock-based incentive compensation plans.
Current wording
Cash provided by financing activities in the three months ended March 31, 2026 and 2025 resulted from the issuance of common stock under our stock-based incentive compensation plans.
Rearranged previous paragraphs (5)
Previous report — wording carried elsewhere
Revenue, Cost of Goods Sold, Gross Profit, and Gross Margin:
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We derive the majority of our revenue from sales to customers in the U.S. Revenue by geography is based on billing address of the customer. The table below summarizes our revenue by geography:
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Interest and Other Income (Expense), Net:
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Interest Expense. The decrease in interest expense for the nine months ended September 30, 2025 as compared to the nine months ended September 30, 2024 was primarily due to lower interest rates associated with the First-Citizens Third Amendment Term Loan.
Previous report — wording carried elsewhere
Other Income (Expense), Net. The change in other income (expense), net for the nine months ended September 30, 2025 as compared to the nine months ended September 30, 2024 was primarily due to foreign currency fluctuations.