Total Q4 Net Sales
Total global net sales of $218.6 million in Q4, up 3% pro forma (constant currency, excluding M6 disc).
Spine Fixation Growth and Channel Progress
Global Spine Fixation net sales grew 10% for the year (U.S. Spine +6% for the year and +5% in the quarter). Top 30 U.S. distributor partners grew net sales 25% year-over-year and 27% on a trailing 12-month basis; >75% of U.S. net sales now driven by these top 30 partners (up ~55 percentage points vs start of 2024).
Bone Growth Therapies Outperformance
BGT Q4 net sales $68.3 million, up 7% (more than double market growth of ~2–3%); increased utilization and higher prescribing velocity across spine fusion and fracture management.
Limb Reconstruction Momentum
U.S. Limb Reconstruction grew 8% in Q4 and 16% for the full year, driven by launches (TrueLok Elevate, FITBONE bone transport and trochanteric lengthening nails) and portfolio focus.
Enabling Technologies Traction (7D & Voyager)
7D FLASH navigation placements grew ~30% in 2025; Voyager earnout placements grew 30% and earnout customers are buying >50% more than committed volume, validating the earnout model and utilization.
Margin and EBITDA Expansion
Q4 pro forma non-GAAP adjusted gross margin of 71.4%; Q4 adjusted EBITDA $29.2 million (13.4% of net sales) with year-over-year margin expansion of ~230 basis points; eighth consecutive quarter of adjusted EBITDA growth.
Free Cash Flow and Cash Position
Strong Q4 free cash flow of $16.8 million; full-year free cash flow excluding M6-related restructuring was $3.1 million; ending cash balance $85.1 million.
2026 Guidance and Multi-Year Targets
2026 guidance: net sales $850–$860M (midpoint $855M, ~5.5% pro forma growth), adjusted EBITDA $95–$98M, positive full-year free cash flow (excluding legal settlements). Updated 2026–2028 targets: 6.5%–7.5% CAGR, mid‑teens adjusted EBITDA % by 2028, and positive FCF 2026–2028.
Pipeline and Product Launch Roadmap
Planned full market release of VIRATA Spinal Fixation System in H2 2026 (addressing a ~$2B U.S. pedicle screw market); >12 product launches/upgrades expected over next 18 months, including VIRATA MIS alpha launch and enhancements across Limb Reconstruction and BGT.