SI-BONE Inc (SIBN) 2023 Q4 法說會逐字稿

Good afternoon, and welcome to SI-BONE Fourth Quarter 2023 Earnings Conference Call. (Operator Instructions)

下午好，歡迎參加 SI-BONE 2023 年第四季財報電話會議。（操作員說明）

I would now like to turn the call over to Saqib Iqbal, Senior Director of Investor Relations at SI-BONE for a few introductory comments.

我現在想將電話轉給 SI-BONE 投資者關係高級總監 Saqib Iqbal，請其發表一些介紹性意見。

Thank you for participating in today's call. Joining me are Laura Francis, Chief Executive Officer, and Anshul Maheshwari, Chief Financial Officer.

感謝您參加今天的電話會議。與我一起的還有執行長 Laura Francis 和財務長 Anshul Maheshwari。

Earlier today, SI-BONE released financial results for the quarter ended December 31st, 2020. A copy of the press release is available on the company's website.

今天早些時候，SI-BONE 發布了截至 2020 年 12 月 31 日的季度財務表現。該新聞稿的副本可在該公司網站上取得。

Before we begin, I'd like to remind you that management will make statements during this call that include forward-looking statements within the meaning of federal securities laws, which are made pursuant to the Safe Harbor provisions of the Private Securities Litigation Reform Act of 1995. And any statements contained in this call that relate to expectations or predictions of future events, results or performance are forward-looking.

在我們開始之前，我想提醒您，管理層將在本次電話會議期間發表聲明，其中包括聯邦證券法含義內的前瞻性聲明，這些聲明是根據美國《私人證券訴訟改革法案》的安全港條款制定的。1995 年。本次電話會議中包含的任何與對未來事件、結果或績效的預期或預測相關的陳述都是前瞻性的。

These forward-looking statements are based on the company's current expectations and inherently involve risks and uncertainties. These risks include SA bonds, ability to introduce and commercialize new products and indications, SA bonds, ability to maintain favorable reimbursement for its products and procedures, impact of potential economic weakness on the ability and desire of patients to undergo elective procedures as the bond's ability to manage risks to supply chain, the impact of future capital requirements driven by new product introductions and risks. The continued normalization of the health care operating income.

這些前瞻性陳述是基於公司目前的預期，本質上涉及風險和不確定性。這些風險包括SA 債券、引入和商業化新產品和適應症的能力、SA 債券、維持其產品和程序有利報銷的能力、潛在經濟疲軟對患者接受選擇性手術的能力和願望的影響（作為債券的能力）管理供應鏈風險、新產品推出和風險驅動的未來資本需求的影響。醫療保健營業收入持續正常化。

Other forward-looking statements include our examination of operating trends and our future financial expectations, such as expectations for physician training and adoption, active physicians, new product and clinical trial enrollment and are based upon our current estimates and various assumptions. These statements involve material risks and uncertainties. It could cause actual results or events to materially differ from those anticipated or implied by these forward-looking statements.

其他前瞻性陳述包括我們對營運趨勢的審查和未來的財務預期，例如對醫生培訓和採用、活躍醫生、新產品和臨床試驗註冊的預期，並且基於我們當前的估計和各種假設。這些陳述涉及重大風險和不確定性。它可能導致實際結果或事件與這些前瞻性陳述預期或暗示的結果或事件有重大差異。

During this call, management may discuss certain non-GAAP measures, including the company's adjusted EBITDA results. For a reconciliation of these non-GAAP measures to GAAP accounting, please see the company's full earnings release issued earlier today. Accordingly, you should not place undue reliance on these statements.

在這次電話會議中，管理階層可能會討論某些非公認會計原則措施，包括公司調整後的 EBITDA 結果。有關這些非公認會計原則措施與公認會計原則會計的調節，請參閱該公司今天稍早發布的完整收益報告。因此，您不應過度依賴這些陳述。

For a list and description of the risks and uncertainties associated with our business, please refer to the Risk Factors section of our most recent Form 10-K and Form 10-Q filed with the Securities and Exchange Commission.

有關與我們業務相關的風險和不確定性的清單和描述，請參閱我們向美國證券交易委員會提交的最新 10-K 表格和 10-Q 表格中的風險因素部分。

SI-BONE disclaims any intention or obligation except as required by law to update or revise any financial projections or forward-looking statements, whether because of new information, future events or otherwise. This conference call contains time-sensitive information and is accurate only as of the live broadcast today, February 26th, 2024.

除法律要求外，SI-BONE 不承擔任何更新或修改任何財務預測或前瞻性聲明的意圖或義務，無論是由於新資訊、未來事件或其他原因。本次電話會議包含時效性訊息，僅截至今天（2024 年 2 月 26 日）直播時準確。

With that, I'll turn the call over to Laura.

這樣，我就把電話轉給勞拉。

Thanks, Iqbal. Good afternoon, and thank you for joining us. 2023 was a stellar year for SI-BONE. Our physician customers and their patients as we delivered record worldwide revenue and attained new heights and physician engagement for the full year 2023, we generated worldwide revenue of $138.9 million, reflecting 31% growth compared to the full year 2022. This worldwide performance was led by robust U.S. demand as over 1,600 US physicians performed more than 15,000 procedures.

謝謝，伊克巴爾。下午好，感謝您加入我們。 2023 年對 SI-BONE 來說是輝煌的一年。我們的醫生客戶及其患者在2023 年全年創造了創紀錄的全球收入，並達到了新的高度和醫生參與度，我們的全球收入達到1.389 億美元，與2022 年全年相比增長了31 %。這項全球業績主要由美國的強勁需求帶動，超過 1,600 名美國醫生實施了超過 15,000 例手術。

We started 2023 with an initial revenue expectation of $124 million to $127 million. But the strong demand for our highly differentiated solutions, growing physician engagement and increases in our surgical capacity allowed us to significantly exceed that expectation the momentum in the business was clearly evident at our national sales meeting in February.

2023 年伊始，我們的初始營收預期為 1.24 億至 1.27 億美元。但對我們高度差異化解決方案的強勁需求、不斷增長的醫生參與度以及手術能力的提高使我們能夠大大超出預期，在 2 月份的全國銷售會議上，業務勢頭顯而易見。

Our sales organization was not only enthusiastic about our performance in 2023, but was even more energized by the potential opportunity ahead of us in 2024, having been at the company for almost nine years, I can say the mood in the company and the confidence in our future has never been stronger.

我們的銷售團隊不僅對2023年的業績充滿熱情，更對2024年的潛在機會感到振奮，在公司工作了近九年，我可以說公司的氣氛和信心我們的未來從未如此強大。

Our foresight and discipline over the last few years in building scalable operating infrastructure in methodical fashion drove approximately 40% improvement in adjusted EBITDA in fiscal year 2023. We also reduced our cash usage while continuing to invest in R&D and clinical evidence to support the planned portfolio expansion in 2024.

過去幾年，我們以有條不紊的方式建構可擴展營運基礎設施的遠見和紀律推動了 2023 財年調整後 EBITDA 提高了約 40%。我們也減少了現金使用，同時繼續投資於研發和臨床證據，以支持 2024 年計畫的投資組合擴張。

Before I provide an update on our strategic priorities, I'd like to recognize our team working together to deliver 25% cumulative annual US procedure volume growth since 2018. Our 1st year as a public company is a testament to your hard work.

在介紹我們的策略重點的最新情況之前，我想對我們的團隊表示認可，自 2018 年以來，我們的團隊共同努力實現了美國每年累積手術量 25% 的成長。我們作為上市公司的第一年證明了您的辛勤工作。

We transformed into a multiproduct company that is solving unmet clinical needs across multiple procedures. We're just getting started given the nearly 0.5 million target sacral pelvic procedures per year. Your focus on delivering for our customers is allowing us to capture this large market opportunity and deliver strong and sustainable revenue growth.

我們轉型為多產品公司，致力於解決多個程序中未滿足的臨床需求。鑑於每年近 50 萬例骶骨盆腔手術的目標，我們才剛開始。您對為客戶提供服務的專注使我們能夠抓住這個巨大的市場機會並實現強勁且可持續的收入成長。

Now let me provide an update on our key initiatives as we look to extend our leadership position and drive strong long-term growth, starting with sales infrastructure, we're extremely proud of our sales and commercial team known for their industry-leading expertise and extensive experience across our target markets.

現在，讓我介紹一下我們的關鍵舉措的最新情況，因為我們希望擴大我們的領導地位並推動強勁的長期增長，從銷售基礎設施開始，我們對我們的銷售和商業團隊感到非常自豪，他們以其由業界領先的專業知識和技術而聞名。我們在目標市場擁有豐富的經驗。

Our execution has allowed us to build new markets and deliver several quarters of record revenue. We ended the year with 82 quota-carrying U.S. territory managers. We complement our territory manager bandwidth with clinical support specialists as well as a growing network of third-party sales agents for case coverage.

我們的執行力使我們能夠開拓新市場並實現幾個季度創紀錄的收入。截至年底，我們擁有 82 位持有配額的美國地區經理。我們透過臨床支援專家以及不斷擴大的第三方銷售代理網絡來補充我們的區域經理的頻寬，以涵蓋病例。

This hybrid strategy has worked well as we continue to see growth in revenue per territory in 2023, revenue per territory was $1.6 million, reflecting 39% growth compared to the prior year. We're confident in our ability to further increase revenue per territory and get closer to the high end of our $1.5 million to $2 million target over time. In addition to growing territory productivity, we plan to selectively add to our 82 territories over the next few years.

這種混合策略效果很好，我們在 2023 年繼續看到每個地區的收入成長，每個地區的收入為 160 萬美元，與前一年相比成長了 39%。我們對進一步增加每個地區的收入並隨著時間的推移更接近 150 萬至 200 萬美元目標的上限充滿信心。除了提高地區生產力外，我們還計劃在未來幾年內選擇性地增加 82 個地區。

The expanded territory footprint will enable us to maximize the potential of our growing portfolio and facilitate deeper engagement with our physicians to capture the over $3 billion total addressable market opportunity moving on the physician engagement, we exited the fourth quarter with nearly 1,130 active physicians, an increase of over 200 active positions in the quarter compared to the prior year period. The 22% growth in US active physicians over the fourth quarter of 2022 was the 12th consecutive quarter of double digit year-over-year growth this elevated level of physician interest and engagement is a great forward-looking indicator and underscores the long-term growth trajectory of our business.

擴大的領土覆蓋範圍將使我們能夠最大限度地發揮我們不斷增長的投資組合的潛力，並促進與我們的醫生進行更深入的接觸，以抓住醫生參與方面超過30 億美元的潛在市場機會，我們在第四季度擁有近1,130 名活躍醫生，與去年同期相比，本季活躍職位增加了 200 多個。2022 年第四季度美國活躍醫生數量增長 22%，這是連續第 12 個季度實現兩位數同比增長。醫生興趣和參與度的提高是一個很好的前瞻性指標，強調了長期增長我們的業務軌跡。

Patients suffering from SI joint dysfunction can undergo different types of care ranging from nonsurgical pain management for short term relief interventional procedures, which will provide medium term relief and surgical procedures that provide long-term durable pain relief over the last few years, we've seen an increase in interest and FA joint stabilization procedures from interventionalists, particularly for cortical bone allograft. Given that the SI joint fusion market is less than 10% penetrated today and the interventional spine physicians' growing interest in the space. We've expanded our engagement with the specialty. We believe the partnership with our surgeons as well as interventional spine physicians, which include anesthesiologists, physical medicine and rehabilitation specialists and interventional radiologists will accelerate our ability to capture this market opportunity.

患有骶髂關節功能障礙的患者可以接受不同類型的護理，從非手術疼痛管理到短期緩解介入手術，這將提供中期緩解，而外科手術則在過去幾年中提供長期持久的疼痛緩解，我們已經介入醫生對 FA 關節穩定手術的興趣增加，特別是皮質骨同種異體移植。鑑於目前 SI 關節融合市場的滲透率不到 10%，而且介入脊椎醫師對該領域的興趣與日俱增。我們擴大了對該專業的參與。我們相信，與我們的外科醫生以及介入性脊椎醫生（包括麻醉師、物理醫學和復健專家以及介入放射科醫生）的合作將加快我們抓住這一市場機會的能力。

Over the last 15 months, we've been targeting a subset of the estimated 4,500 interventionalists in the U.S., we have prior experience with other minimally invasive spine procedures. We've engaged and trained highly skilled interventionalist in our lateral technique using iFuse torque While still early, we're encouraged by the level of interest, the caliber of interventionalists we have trained and their pace of adoption.

在過去 15 個月中，我們一直針對美國約 4,500 名介入醫生中的一部分，我們之前有其他微創脊椎手術的經驗。我們已經使用iFuse 扭力聘請並培訓了高技能的介入治療師，讓他們掌握我們的橫向技術。雖然還處於早期階段，但我們對我們培訓的介入治療師的興趣程度、能力以及他們的採用速度感到鼓舞。

Clinical evidence has always been an important part of SI-BONE commitment to its patients and physicians in June 2023. We also initiated the Stacey study, which is a prospective study on the use of IP's torque in patients with sacroiliac joint dysfunction by interventionalists. Enrollment is ongoing, and we expect to publish early results by the end of 2024 as the market leader, we believe that our broad product portfolio training expertise, clinical evidence, an experienced sales force are clear differentiators that are leading to strong interventional engagement going forward. We expect active physician growth to remain strong as we engage the nearly 8,000 target surgeons and 4,500 target interventionalists. We also expect our growing product portfolio and published clinical evidence to drive deeper engagement and increased procedures per physician over time.

臨床證據一直是 SI-BONE 於 2023 年 6 月向患者和醫生做出承諾的重要組成部分。我們也啟動了Stacey研究，這是一項關於介入醫生在骶髂關節功能障礙患者中使用IP扭矩的前瞻性研究。招募正在進行中，我們預計在2024 年底之前作為市場領導者發布早期結果，我們相信我們廣泛的產品組合培訓專業知識、臨床證據和經驗豐富的銷售隊伍是明顯的差異化因素，將導致未來強有力的干預參與。我們預計，隨著近 8,000 名目標外科醫生和 4,500 名目標介入醫生的參與，積極的醫生成長將保持強勁。我們也預計，隨著時間的推移，我們不斷增長的產品組合和已發布的臨床證據將推動更深入的參與並增加每位醫生的手術量。

Turning to products and solutions, we have a demonstrated track record of building innovative products and surgical techniques to address unmet clinical needs and improve patient outcomes. The robust procedure volume growth we've experienced in the US substantiates the value of our innovation in 2024.

談到產品和解決方案，我們在開發創新產品和手術技術來解決未滿足的臨床需求和改善患者治療效果方面擁有良好的記錄。我們在美國經歷的手術量的強勁增長證實了我們 2024 年創新的價值。

We're launching new products in each of our target markets to further extend our leadership position within SI joint dysfunction and degeneration. I Phase 3 and ICs to our provider physicians with the most comprehensive solutions are for minimally invasive SI joint fusion procedures reimbursed under CPT code two seven two seven nine effective January 1, 2024.

我們正在每個目標市場推出新產品，以進一步擴大我們在骶髂關節功能障礙和退化領域的領導地位。I 期 3 和 IC 為我們的提供者醫生提供最全面的解決方案，用於微創 SI 關節融合手術，根據 CPT 代碼二七二七九報銷，自 2024 年 1 月 1 日起生效。

The AMA adopted a separate CPT code two seven two seven eight to describe minimally invasive sacroiliac procedures. One performed using an intra-articular implants. Typically a cortical bone allograft placed directly into joined from a posterior approach. As I shared earlier, this technique is more commonly used by interventional spine physicians with the new CPT code two seven two seven eight established for both facility and off base procedures and with coverage likely available from some payers.

AMA 採用單獨的 CPT 代碼二七二七八來描述微創骶髂手術。其中一項使用關節內植入物進行。通常，皮質骨同種異體移植物直接從後路連接。正如我之前分享的，這項技術更常被介入脊椎醫生使用，新的 CPT 代碼為設施和基地外手術建立的二七二七八，並且某些付款人可能會提供承保。

We expanded our interventionalist training to also include our new allograft product ICs, intra i2's interim built on ICs bone, which was launched in 2019 with enhanced surgical techniques that enable accurate placement of the implant into the joint using a posterior approach. We recently completed the first IPUs entered procedure in an office-based lab setting with IPs, torque and ICs intra. We now offer interventionalist multiple products to address their treatment preferences.

我們擴大了介入治療訓練範圍，還包括我們新的同種異體移植產品IC，即基於IC 骨的Intra i2 臨時產品，該產品於2019 年推出，採用增強的手術技術，能夠使用後路入路將植入物準確地放置到關節中。我們最近在辦公室實驗室環境中完成了第一個 IPU 進入程序，其中包含 IP、扭力和 IC。我們現在提供多種介入治療產品來滿足他們的治療偏好。

Moving to pelvic fixation. Based on the strong adoption demand and growing surgeon interest, we believe our breakthrough device ICs, Bedrock, Granite can become the standard of care for fixation and fusion of the SI joint providing a strong foundation at the base of long construct adult deformity procedures.

轉向骨盆固定。基於強烈的採用需求和日益增長的外科醫生興趣，我們相信我們的突破性設備 IC、Bedrock、Granite 可以成為 SI 關節固定和融合的護理標準，為長結構成人畸形手術奠定堅實的基礎。

A recent publication with early Silvio results highlighted the prevalence of SI joint pain in 16% of the patients undergoing spinal deformity surgery, further underscoring the need for inclusion of pelvic fixation infusion as part of these procedures and the Granite line extension at the end of January, we received five 10 K clearance from the FDA from a 9.5 millimeter diameter implant with S. one and pediatric deformity indication. Since Granite was launched in 2022.

最近發表的一份包含Silvio 早期結果的出版物強調了16% 接受脊柱畸形手術的患者普遍存在骶髂關節疼痛，進一步強調了將骨盆固定輸注作為這些手術的一部分以及在一月底進行Granite 線延伸的必要性，我們從 FDA 獲得了 5 個 9.5 毫米直徑植入物的 10 K 許可，具有 S.1 和兒科畸形適應症。自 Granite 於 2022 年推出以來。

Approximately 40% of our Granite case volume has been in shorter two to four level constructs, which are generally degenerative spine fusion procedures based on published data, post-operative SI joint incidents and shorter level surgeries is estimated to be up to 20%. Additionally, some patients undergoing shorter level lumbar fusion procedures are at a higher risk of revision due to screw loosening and other hardware failure from underlying conditions such as high pelvic incidents, osteoporotic bone for high BMIs.

我們的 Granite 病例量中約 40% 是較短的兩到四級結構，根據已發表的數據，這些通常是退化性脊椎融合手術，術後 SI 關節事件和較短級手術估計高達 20%。此外，一些接受較短水平腰椎融合手術的患者因螺絲鬆動和其他硬體故障而面臨較高的翻修風險，這些潛在條件包括高​​骨盆事故、高體重指數導致的骨質疏鬆。

The current adoption of the larger diameter Granite in these shorter level fusion procedures illustrates the increasing interest among the surgeon community and including pelvic fixation in the high risk patients. We believe the availability of the smaller diameter implant will provide an offering for the approximately 100,000 annual degenerative spine procedures that ended the satcom as well as engage deformity surgeons who have expressed a preference for smaller diameter implants. We plan to launch the smaller diameter granted implant in the second quarter.

目前在這些較短水平的融合手術中採用較大直徑的花崗岩表明外科醫生界越來越感興趣，包括對高風險患者進行骨盆固定。我們相信，較小直徑植入物的出現將為每年約 100,000 例退化性脊椎手術提供服務，從而結束衛星通信，並吸引那些表示偏好較小直徑植入物的畸形外科醫生。我們計劃在第二季推出直徑較小的植體。

In trauma surgery, we've made significant progress over the last 12 months to develop the market for treating sacral insufficiency fractures we're engaged with major trauma center. Thought leaders are encouraged by the pace of i2's torque adoption for treating these patients. For the end of 2024, we will launch another product targeting the pelvic trauma market.

在創傷外科領域，我們在過去 12 個月中取得了重大進展，以開發與主要創傷中心合作的骶骨功能不全骨折治療市場。i2 採用扭力來治療這些病人的步伐令思想領袖感​​到鼓舞。2024年底，我們將推出另一款針對骨盆創傷市場的產品。

We believe the new product, combined with the initial results from a Saffron trial in late 2024, will be key to capturing the trauma opportunity with over 120,000 sacral insufficiency fractures a year and one year mortality rate of up to 25% for the patients who are treated with bad risks, the trauma market will be a crucial long-term growth driver for us.

我們相信，該新產品結合 2024 年底 Saffron 試驗的初步結果，將成為抓住創傷機會的關鍵，因為每年有超過 120,000 起骶骨功能不全性骨折，患者一年死亡率高達 25%。如果面臨嚴重風險，創傷市場將成為我們重要的長期成長動力。

With that, I'll hand the call over to Anshul to discuss our financial performance.

接下來，我會將電話轉交給 Anshul，討論我們的財務表現。

Thanks, Laura, and good afternoon, everyone. My comments today will be focused on fourth quarter and fiscal year revenue growth, gross margin, productivity and liquidity. Additionally, all the comparisons provided while the versus the same period in the prior year, unless noted otherwise.

謝謝勞拉，大家下午好。我今天的評論將集中於第四季和財年的收入成長、毛利率、生產力和流動性。此外，除非另有說明，所有比較均是與去年同期進行的。

Starting with revenue growth, our fourth quarter worldwide revenue was $38.9 million, representing growth of approximately 22%. US revenue was $36.7 million, representing approximately 22% growth, predominantly from increase in procedure volume. International revenue in the fourth quarter was $2.2 million, representing approximately 12% growth. For the full year 2023, we generated worldwide revenue of $138.9 million, reflecting 31% growth.

從營收成長開始，我們第四季的全球營收為 3,890 萬美元，成長約 22%。美國收入為 3,670 萬美元，成長約 22%，主要來自手術量的增加。第四季國際營收為 220 萬美元，成長約 12%。2023 年全年，我們的全球營收為 1.389 億美元，成長 31%。

Our US revenue grew approximately 32% to $130.6 million. U.s. revenue growth was driven by approximately 32% increase in procedure volume growth. International revenue for the full year 2023 was $8.3 million, representing 8% growth.

我們在美國的營收成長了約 32%，達到 1.306 億美元。我們。收入增長是由手術量增長約 32% 推動的。2023 年全年國際營收為 830 萬美元，成長 8%。

Moving to gross margin and productivity of gross margin for the fourth quarter and the full year 2023 was approximately 74% and 79%, respectively. The fourth quarter gross margin includes an approximate four percentage point impact from a $1.7 million excess inventory reserve.

再來看2023年第四季和全年的毛利率和生產力，分別約為74%和79%。第四季毛利率包括 170 萬美元的超額庫存儲備帶來的約 4 個百分點的影響。

To provide some context when we launched IP's torque in 2021, we introduced two designs fully threaded and a partially threaded Laggan plant to meet physician preference we are seeing physicians prefer the fully-integrated ICUs talk across all our target markets.

為了提供一些背景信息，當我們在2021 年推出IP 扭矩時，我們引入了兩種全螺紋設計和一種部分螺紋Laggan 裝置，以滿足醫生的偏好，我們發現醫生更喜歡在我們所有目標市場中使用完全整合的ICU。

And in fact, demand for this implant type has exceeded our expectations. Accordingly, the reserve is related to our Laggan plant operating expenses were $41.2 million in the quarter, representing approximately 8% growth.

事實上，對這種植入物類型的需求已經超出了我們的預期。因此，與我們 Laggan 工廠營運費用相關的儲備金在本季為 4,120 萬美元，成長約 8%。

For the full year 2023, operating expenses increased approximately 4% to $156.4 million. The increase was driven by increased compensation, higher commissions related to revenue growth and research and development investments. Our net loss was $11 million or $0.27 per diluted share for the fourth quarter of 2023 as compared to a net loss of $11.2 million or $0.32 per diluted share in the prior year period.

2023 年全年，營運費用增加約 4%，達到 1.564 億美元。這一增長是由於薪酬增加、與收入成長和研發投資相關的佣金增加所致。2023 年第四季度，我們的淨虧損為 1,100 萬美元，或稀釋後每股 0.27 美元，而去年同期的淨虧損為 1,120 萬美元，或稀釋後每股 0.32 美元。

For the full year 2023, net loss improved by approximately 29%, $43.3 million or $1.13 per diluted share as compared to a net loss of $61.3 million or $1.79 per diluted share in 2022. Net loss per diluted share for Q4 2023 and full year 2023 includes the impact of increase in shares outstanding because of the follow-on stock offering in May 2023. Our adjusted EBITDA loss in the fourth quarter was $4.8 million compared to $4.2 million in the comparable period. Adjusted EBITDA loss in 2023 was $17.3 million compared to 33.2 million in 2022, reflecting approximately 48% improvement adjusted EBITDA for Q4 2023 and full year 2023 was negatively impacted by the $1.7 million inventory reserve highlighted earlier.

2023 年全年淨虧損改善約 29%，為 4,330 萬美元或稀釋每股 1.13 美元，而 2022 年淨虧損為 6,130 萬美元或稀釋每股 1.79 美元。2023 年第四季和 2023 年全年的攤薄每股淨虧損包括因 2023 年 5 月後續股票發行而導致的已發行股票增加的影響。第四季調整後 EBITDA 虧損為 480 萬美元，而同期為 420 萬美元。2023 年調整後EBITDA 損失為1,730 萬美元，而2022 年為3,320 萬美元，反映出2023 年第四季調整後EBITDA 改善約48%，2023 年全年受到先前強調的170 萬美元庫存儲備的負面影響。

Turning to liquidity, we exited 2023 with a strong balance sheet including $166 million in cash and marketable securities. Our total cash usage in the fourth quarter was less than $800,000. Our strong liquidity position combined with our continued progress towards adjusted EBITDA breakeven provides us the flexibility to self-fund our long-term growth priorities.

談到流動性，我們在 2023 年結束時擁有強勁的資產負債表，其中包括 1.66 億美元的現金和有價證券。我們第四季的現金使用總額不到 80 萬美元。我們強大的流動性狀況加上我們在調整後 EBITDA 盈虧平衡方面的持續進展，使我們能夠靈活地為我們的長期成長重點提供資金。

Finally, moving to our outlook for 2024. As Laura noted, we have several tailwinds and growth initiatives coming into 2024, we expect 2024 worldwide revenue of $162 million to $165 million, implying year-over-year growth of approximately 17% to 19%. Our guidance assumes low to mid-single-digit ASP deterioration driven by site of service and procedure mix, modest impact from new product launches, accounting for timing of launch and pace of adoption and modest international revenue growth.

最後，展望 2024 年。正如 Laura 指出的那樣，我們在 2024 年將迎來多項有利因素和成長舉措，我們預計 2024 年全球收入將達到 1.62 億至 1.65 億美元，這意味著同比增長約 17% 至 19%。我們的指導假設由於服務站點和程序組合、新產品發布的適度影響、發佈時間和採用速度以及適度的國際收入增長，導致平均售價下降到中個位數。

We expect 2024 annual gross margin to be approximately 78% based on current revenue guidance, planned product launches as well as commercial footprint expansion. We expect 2024 annual operating expense to grow approximately 9%. Considering the anticipated operating leverage in the business, we expect significant year-over-year adjusted EBITDA improvement for full year 2024, putting us within reach of our adjusted EBITDA breakeven goal.

根據目前的收入指引、計劃的產品發布以及商業足跡的擴張，我們預計 2024 年的年度毛利率約為 78%。我們預計 2024 年全年營運費用將成長約 9%。考慮到該業務的預期營運槓桿，我們預計 2024 年全年調整後 EBITDA 年比將顯著改善，使我們能夠實現調整後 EBITDA 損益平衡目標。

With that, I will turn the call over to Laura.

這樣，我就把電話轉給勞拉。

Thanks, Anshul. I hope you can feel our excitement and confidence built on consistent innovation and execution coming into 2024. We believe the procedure demand will strengthen in 2024 as we rollout complementary products in each of our target markets. With a strong balance sheet, I believe we're uniquely positioned to deliver sustainable growth over the long term and have a clear line of sight to adjusted EBITDA breakeven.

謝謝，安舒爾。我希望您能感受到我們在 2024 年持續創新和執行的基礎上的興奮和信心。我們相信，隨著我們在每個目標市場推出互補產品，2024 年手術需求將會增強。憑藉強勁的資產負債表，我相信我們擁有獨特的優勢，能夠實現長期可持續增長，並且對調整後的 EBITDA 盈虧平衡有著清晰的視野。

With that, we're happy to take questions. Operator?

因此，我們很樂意回答問題。操作員？

Thank you. (Operator Instructions)

謝謝。（操作員說明）

Craig Bijou, Bank of America.

克雷格‧比茹，美國銀行。

Good afternoon, guys. Thanks for taking the questions and congrats on a good finish to the year. And I wanted to start with kind of what you're seeing in the SI joint fusion market and with respect to the new allograft product. So does the recent focus on allograft by Pandox? Is that adding to say, joint fusion procedures or are they potentially taken away from the traditional implant market? And then maybe if you could just give us a little bit of more color on the strategy behind allograft and what do you expect contribution either on a procedure basis or from a revenue perspective?

下午好，夥計們。感謝您提出問題，並祝賀您今年取得了良好的成績。我想從您在 SI 關節融合市場和新的同種異體移植產品中看到的情況開始。那麼 Pandox 最近關注的焦點是同種異體移植嗎？這是否會增加關節融合手術，或者它們有可能從傳統植入物市場中消失？然後，也許您能給我們更多關於同種異體移植背後的策略的信息，以及您期望在程序基礎上或從收入角度做出什麼貢獻？

Yes, Craig, thanks for the question. And what I first wanted to do is just kind of wrap up it an outstanding year for hitting new highs on revenue, growing 31% worldwide surgeon engagement growing to over 1,100 surgeons territory productivity growing almost 40%. There and then the operating leverage, 48% improvements in our in our adjusted EBITDA.

是的，克雷格，謝謝你的提問。我首先想做的就是為這一年畫下一個圓滿的句點：收入創下新高，全球外科醫生參與度增長 31%，超過 1,100 名外科醫生，地區生產力增長近 40%。然後，我們的調整後 EBITDA 的營運槓桿率提高了 48%。

So and what we're doing is we're coming into this business. Let's go to the line and the bottom line. And so what we're excited about as well is some of the opportunities that we have in 2024. So building on the momentum that we had in 2018 over to Roberto for building up the opportunity for underground Airgas, I Joint Commission and capitalizing on the launch of Granite's nine five in order to capture more of the opportunity. It's the same procedure and also with the new introduction of a product toward the end of the year.

所以我們正在做的就是進入這個行業。讓我們看看底線和底線。因此，我們也對 2024 年擁有的一些機會感到興奮。因此，在 2018 年羅伯託為地下 Airgas 創造機會的勢頭的基礎上，我聯合委員會並利用 Granite 九五的推出來抓住更多機會。這是相同的程序，並且在年底推出新產品時也是如此。

But that's targeting sacral insufficiency fractures. And so when I when I talk a little bit about the the primary SI joint fusion market. We're the undisputed leader in that market space, and we were the original pioneer this here. And when you think about the patient journey in patients that are suffering from a joint committee just started. And what you're seeing is there's there's what I would call the continuum of care. And so they they start out with them and medications, physical therapy injections.

但這是針對骶骨機能不全骨折。因此，當我談論主要 SI 聯合融合市場時。我們是該市場領域無可爭議的領導者，而我們是這方面的最初先驅。當你想到剛開始的聯合委員會正在遭受痛苦的患者的患者旅程時。你看到的是我所說的連續護理。因此，他們從這些藥物和藥物、物理治療注射開始。

And but there's there's also this interest in what I would call the next level or continue on that continuum of care, which are these post-acute care initiators and fusion procedures. And those are typically performed by interventional spine specialists and they are done with cortical bone allograft and many have the the traditional lateral procedure that we have pioneered with our IP. three D product and then more recently with our torque products. And so as I mentioned in my script.

但也有人對我所說的下一個級別或繼續護理的連續性感興趣，即這些急性後護理啟動器和融合程序。這些手術通常由介入性脊椎專家進行，並採用同種異體皮質骨移植，許多手術採用我們透過 IP 首創的傳統側向手術。三個 D 產品，最近又推出了我們的扭力產品。正如我在劇本中提到的。

Okay, third or for 15 months now, our Stacey study was working directly with those interventionalists and they were actually trained on our lateral procedure with torque. And we've seen good progress with that particular study.

好的，第三個月或 15 個月以來，我們的史黛西研究直接與那些介入醫生合作，他們實際上接受了我們的側向扭力手術培訓。我們已經看到這項特定研究取得了良好進展。

Now at the beginning of the year, we actually launched a new allograft product called IP.s intra, and we think that it fit it act, fleet. It states that it's somewhere in between where they're receiving injections and where they're potentially receiving a lateral procedure at the end of their journey. So what we did is as the market leader, we want to provide a broad product portfolio.

今年年初，我們實際上推出了一款新的同種異體移植產品，名為 IP.s intra，我們認為它適合它的行為，fleet。它指出，這介於他們接受注射和他們在旅程結束時可能接受橫向手術之間的某個位置。因此，作為市場領導者，我們希望提供廣泛的產品組合。

And then what we do on top of it is use our training expertise, our clinical evidence and then our experience. It has to lead to strong interventional engagement. So we believe we've targeted we've taken a targeted approach, and it's really allowed us to thoughtfully leverage our experienced sales force to train this specialty medicine, Augment to our current strategy to reach more than the 280,000 target patients. But there.

然後我們在此之上所做的是利用我們的訓練專業知識、我們的臨床證據，然後是我們的經驗。它必須導致強有力的干預參與。因此，我們相信我們已經瞄準了目標，採取了有針對性的方法，這確實使我們能夠深思熟慮地利用我們經驗豐富的銷售隊伍來培訓這種特殊藥物，增強我們當前的戰略，以覆蓋超過280,000 名目標患者。但就在那裡。

Great. Thanks. Thanks for that color. And maybe for onshore, you guys obviously saw a tremendous operating leverage in 2023, and you're forecasting more operating leverage in 24, but not to the same extent. So that may just be conservative to start the year, but can you just talk about the guide and how you're balancing driving that top line growth and still working towards EBITDA breakeven? And I'm going to throw this in, could we see EBITDA breakeven come in 2025?

偉大的。謝謝。謝謝那個顏色。也許對於陸上業務，你們顯然會在 2023 年看到巨大的營運槓桿，並且預計 24 年營運槓桿會更高，但程度不同。因此，今年開始時可能比較保守，但您能否談談該指南以及您如何在推動營收成長和仍努力實現 EBITDA 盈虧平衡方面取得平衡？我想問一下，我們能在 2025 年看到 EBITDA 損益平衡嗎？

Correct.

正確的。

Thank you for that question. And in case it's difficult to hear because I started, please let me know. So we are really proud of the operating leverage that we've demonstrated over the last couple of years as we've benefited from the investments in the scalable infrastructure we build throughout the pandemic would be when you look at 2020 for corn because outpaces OpEx growth rate in and you can see that at the midpoint of our guidance range and the OpEx growth rate expectation of 9%. That's about two times operating leverage.

謝謝你提出這個問題。如果因為我開始聽而很難聽清，請告訴我。因此，我們對過去幾年所展示的營運槓桿感到非常自豪，因為我們受益於我們在整個大流行期間建立的可擴展基礎設施的投資，當你看看2020 年玉米時，因為超過了運營支出的成長您可以看到，該成長率處於我們指導範圍的中點，營運支出成長率預期為 9%。這大約是營運槓桿的兩倍。

Now we do have a huge opportunity ahead of us, and we want to make sure we're making thoughtful investments to capture the growth opportunities. Laura talked about several of those coming into 2024, and we think that that investment will allow us to maintain that you may have to accelerate our journey towards adjusted EBITDA breakeven. So when you think about our guide at 9%, what does that incorporate? You've got the standard merit increase that you build in.

現在，我們確實面臨著巨大的機遇，我們希望確保我們進行深思熟慮的投資，以抓住成長機會。Laura 談到了 2024 年即將到來的幾個項目，我們認為這項投資將使我們能夠堅持認為，您可能必須加快我們實現調整後 EBITDA 盈虧平衡的進程。那麼，當您考慮我們的 9% 指南時，它包含了什麼？您已經獲得了內建的標準績效加薪。

You've got the higher commissions and our strategy to add more territory, especially as we've expanded our portfolio coming into 2024. So we're going to add some more territories there. You've got some more sales and marketing spend. When it comes to the new product that we're going to launch, we'll probably have a lot of activity there, including training with the interventional side and then just R&D as we think about the portfolio into the future as well.

您可以獲得更高的佣金，我們的策略是增加更多的領土，特別是我們在 2024 年擴大了我們的投資組合。因此，我們將在那裡添加更多地區。您還有更多的銷售和行銷支出。當談到我們要推出的新產品時，我們可能會在那裡進行很多活動，包括幹預方面的培訓，然後在我們考慮未來的產品組合時進行研發。

But again, we feel really good about being able to continue to get the leverage and stay committed to it now in terms of and in terms of timing, right, we're pretty confident that the operating leverage will translate into significant adjusted EBITDA improvement as we progress through the second, we have a strong fourth quarter of 24 up. Our approach to when we get to breakeven is just get there versus, you know, sort of project when that timing will be but we're really happy with the progress that we're making, and we have a clear line of sight to that to that milestone.

但同樣，我們對能夠繼續獲得槓桿感到非常高興，並在時機方面繼續致力於它，對吧，我們非常有信心運營槓桿將轉化為調整後 EBITDA 的顯著改善，因為我們在第二季度取得了進展，第四季度我們取得了24 分的強勁表現。當我們達到損益平衡時，我們的方法就是達到目標，而不是在那個時間點進行某種項目，但我們對我們正在取得的進展感到非常滿意，並且我們對此有清晰的認識到那個里程碑。

Great. Thanks for taking the questions.

偉大的。感謝您提出問題。

Thank you.

謝謝。

Drew Ranieri, Morgan Stanley.

德魯‧拉涅利，摩根士丹利。

Hi, Laura. Hi Anshul, and thanks for taking the question. Maybe just to follow up on one of Craig's questions about the on the allograft product that you're launching, it just to be absolutely clear. I just want to make sure that we're understanding this that you're not seeing really a significant change in underlying market dynamics from a from these products taking basically the surgeries procedures away from surgeons.

嗨，勞拉。您好，安舒爾，感謝您提出問題。也許只是為了跟進克雷格關於您正在推出的同種異體移植產品的問題之一，只是為了絕對清楚。我只是想確保我們理解這一點，即您並沒有看到這些產品基本上將手術程序從外科醫生手中奪走，從而導致潛在的市場動態發生重大變化。

Just want to get a better read on that of like kind of what you're seeing on the underlying market? And then I'm sure you did talk about some investments you're putting behind on the IPUs Entra products. So maybe just help us parse out like how much is actually going to be hitting the OpEx? How much are you spending there to really kind of start this journey with this new specialty what is excited about the opportunity with interventional.

只是想更了解您在基礎市場上看到的情況嗎？然後我確信您確實談到了您對 IPU Entra 產品的一些投資。那麼也許只是幫助我們解析一下實際上有多少會影響營運支出？您在那裡花了多少錢來真正開始這個新專業的旅程，對介入的機會感到興奮。

If you think about our journey, we've been in business for 15 years at this point, we pioneered minimally invasive SI joint fusion. We've really built this market. We are the market leader in this space and yet we're less than 10% penetrated into the market right now. And so what we see is an opportunity in the third instance, our primary call point has always been spine surgeons, but we do think that we can reach more of these patients and by working with interventionalists as well as spine surgeons and having multiple products that will fit will meet their specific needs.

如果你想想我們的歷程，我們已經營業了 15 年，我們開創了微創骶髂關節融合術。我們確實建立了這個市場。我們是這個領域的市場領導者，但目前我們的市場滲透率不到 10%。因此，我們在第三種情況中看到了一個機會，我們的主要呼叫點一直是脊椎外科醫生，但我們確實認為，透過與介入科醫生和脊椎外科醫生合作並擁有多種產品，我們可以接觸到更多的此類患者。將適合將滿足他們的特定需求。

In addition, there's a lot of our food as my prepared remarks to seven to seven eight, which is specifically for these some post steer your procedures typically allograft procedures, the the the physician fee is around 40% less than what it is for a lateral to be economically done with our IP. three D or torque product. And then recently, so fees are around 20% less on. But with that said, once again, what it does is it gives us the opportunity in order to reach more of these patients and further build out the market.

此外，我們有很多食物，正如我準備的七到七八的評論，這是專門針對這些一些後期引導您的手術（通常是同種異體移植手術）的，醫生的費用比橫向移植的費用低約40%利用我們的知識產權以經濟的方式完成任務。三個 D 或扭矩乘積。最近，費用降低了 20% 左右。但話雖如此，它的作用還是讓我們有機會接觸到更多的患者並進一步擴大市場。

So if you look at our performance in 2023, we had a great year and that that performance was driven by our core market in primary SI joint fusion as well as decent market. So pelvic fixation primarily as well as trauma which is developing. But so what we see is this opportunity to more rapidly capture this market opportunity that we've been pursuing for all of these years. And we're really excited to do it with that in both spine surgeons and international plants and it provides unique recruits?

因此，如果你看看我們 2023 年的業績，你會發現我們度過了偉大的一年，這一業績是由我們的初級 SI 聯合融合核心市場以及良好的市場推動的。因此，主要是骨盆固定以及正在發展的創傷。但我們看到的是更快地抓住我們這些年來一直在追求的市場機會的機會。我們真的很高興能在脊椎外科醫生和國際工廠中做到這一點，並且它提供了獨特的新兵？

Secondly, Andrew, to your question on the OpEx side, you know, majority of our OpEx increase is just the commissions, the pay increases that come standard as well as some territory expansions that we had always contemplated as we think about a model where we can do 2 million per territory. We've always said in the U.S., we want to look at on the territories to have a business that can do 200 million of revenue. We ended the year in 18. And to do that, you're going to have some more training spend as well. But that's across the board between interventional and surgeons, especially with the DJ and opportunity with the nine five granted as well. So I wouldn't say that, you know, there is any material shift in our in our OpEx strategy because of interventional. We've just got the opportunities that we've always wanted to go after.

其次，安德魯，對於你關於營運支出方面的問題，你知道，我們的營運支出成長的大部分只是佣金、標準加薪以及我們在考慮模型時一直考慮的一些領土擴張。每個地區可以做200萬個。我們一直說，在美國，我們希望在這些地區擁有一家能夠實現2億收入的業務。我們在 18 歲結束了這一年。為此，您還需要更多的培訓支出。但這是介入醫生和外科醫生之間的全面問題，特別是在 DJ 和九五的機會也被授予的情況下。所以我不會說，我們的營運支出策略因幹預而發生任何重大轉變。我們剛剛得到了我們一直想要追求的機會。

Got it. And maybe just overall on some of the newer product launches, including it drove those small construct in the trauma product coming you laid out, you kind of expect another robust year of active surgeon adds. Can you be a little bit more specific there? And just how are you thinking about maybe the utilization or underlying utilization of active surgeons improving with some of these newer products. Thanks for taking the question.

知道了。也許只是整體上一些新產品的發布，包括它推動了你即將推出的創傷產品中的那些小結構，你有點期待活躍外科醫生又一個強勁的一年。能說得更具體一點嗎？您如何看待透過這些新產品改善活躍外科醫生的利用率或潛在利用率。感謝您提出問題。

Thank you. Have some of the usage in both growing the number of physicians that we're working with, as well as increasing the number of procedures per physician as well. So you're talking about interventional by and large, those will be new physicians that are performing the procedure. So it gives us this opportunity. And as I said, there's around 4,500 interventionalists that are targets to this. And in terms of increasing the number of procedures. We have always focused on increasing the number of primary SI joint fusion procedures that our surgeons are performing.

謝謝。在增加與我們合作的醫生數量以及增加每位醫生的手術數量方面都有一些用途。因此，總的來說，您談論的是介入治療，這些將是執行該手術的新醫生。所以它給了我們這個機會。正如我所說，大約有 4,500 名幹預主義者是這目標的目標。並且在增加程序數量方面。我們始終致力於增加外科醫生實施的初次骶髂關節融合手術的數量。

And then with the addition of torque and with Granite It gave us the opportunity to further increase those number either in our primary market or in our backlog in that business permits are granted 95 product does is it gives us a product that's very specifically targeted toward these degenerative spine procedures and the market opportunity there. There's there's around 100,000 procedures per year, very short construct procedures that go to the safe grounds at. And so that's our bread-and-butter surgeon that that business some are already preleased and SI joint fusion. And now they have the opportunity to perform pelvic fixation with our new Granite product. So a great opportunity to deepen our relationship with our surgeons and increase the number of procedures that they're performing with us.

然後，透過增加扭矩和花崗岩，它使我們有機會在我們的主要市場或我們的積壓訂單中進一步增加這些數量，因為獲得了商業許可95 個產品的作用是它為我們提供了一種非常專門針對這些產品的產品退化性脊椎手術和那裡的市場機會。每年大約有 100,000 個程序，非常短的建造程序可以到達安全地點。這就是我們賴以生存的外科醫生，該業務中的一些已經預發布，並且有 SI 關節融合。現在他們有機會使用我們的新花崗岩產品進行骨盆固定。這是加深我們與外科醫生關係並增加他們與我們一起進行的手術數量的絕佳機會。

So quarterly annually.

所以每年季一次。

Thank you.

謝謝。

David Saxon, Needham & Company.

大衛‧撒克遜，李約瑟公司。

Good afternoon, Laura and Anshul. Thanks so much for taking my questions. And congrats to a strong end to the year. And maybe I wanted to talk about torque to begin with.

下午好，勞拉和安舒爾。非常感謝您回答我的問題。並祝賀今年取得了強勁的成績。也許我想先談談扭矩。

And Laura, in your script, you talked a little about a little bit about Stacy, but I think another talk study SaaS front, and I think it's nearing enrollment. So how should we think about SaaS front as it relates to the market development for talk is that can that trial capitalized torque adoption? Or will it kind of continue to be more of a gradual ramp?

勞拉（Laura），在你的劇本中，你談到了一些關於史黛西（Stacy）的事情，但我認為另一個談話是研究 SaaS 前沿，而且我認為它已經接近招生了。那麼，我們應該如何看待 SaaS 前沿，因為它與市場發展相關，因為該試驗能否資本化扭矩採用？或者它會繼續是一個漸進的斜坡嗎？

Thanks for the question, David. So on torque, you're right. The state study was actually specifically engaging interventional spine, special local as for the implant arm. And as I said, that's going well. Saffron is actually a study that is engaging surgeons performing sacral insufficiency fractures. And so this is pelvic green fractures. It's a what we call our trauma product, and I do see a pretty significant opportunity there for us. Certainly with the expecting us to have a publication that shows the results from from Saffron by the end of 2024.

謝謝你的提問，大衛。所以關於扭矩，你是對的。該州的研究實際上專門涉及脊椎介入治療，特別是植入臂的局部治療。正如我所說，一切進展順利。Saffron 實際上是一項讓外科醫生參與骶骨功能不全骨折的研究。這就是骨盆綠色骨折。這就是我們所說的創傷產品，我確實看到了我們的一個非常重要的機會。當然，預計我們將在 2024 年底之前發布一份出版物，展示 Saffron 的研究結果。

We're encouraged by what we're seeing currently with that and then in terms of also what we're seeing on trauma, as I said, toward the end of the year, we expect to launch another product to the theater. And so I think given that these patients that have sacral insufficiency fractures there around 120 associations per year in the United States, they typically are treated in rehab, say they're conservative care they're typically not treated surgically.

我們對目前所看到的情況感到鼓舞，然後就我們在創傷方面所看到的情況而言，正如我所說，到今年年底，我們預計將在影院推出另一款產品。因此，我認為，考慮到美國每年約有 120 家患有骶骨功能不全骨折的患者，他們通常會接受復健治療，並表示他們接受的是保守治療，他們通常不會接受手術治療。

There's a big opportunity that's here for us. We do think the clinical data is going to be really important. And because of the fact that surgeons typically don't treat these patients. We want to show the efficacy of infection. So it's will important there. And then I'm not giving much information about the new products, but the new products will be another important part of targeting that particular market. So really excited about how we're going to finish 2024 in trauma and the opportunity to see that as a significant growth driver in 2020. Bye.

我們面臨著一個巨大的機會。我們確實認為臨床數據非常重要。因為外科醫生通常不治療這些患者。我們想要展示感染的功效。所以這很重要。然後，我不會提供有關新產品的太多信息，但新產品將是針對該特定市場的另一個重要部分。對於我們將如何在創傷中結束 2024 年，以及將其視為 2020 年重要成長動力的機會，我們感到非常興奮。再見。

Great. Super helpful. Thanks for that. And this one's probably for onshore. I wanted to ask about the cadence of revenue throughout the throughout the year. Is there anything to call out in terms of seasonality? I think consensus is about $37 million for the first quarter, so down kind of mid-single digits sequentially. I think in '23, you're actually up in the first quarter than sequentially. So anything to call out from a cadence perspective on any we added into that this quarter?

偉大的。超有幫助。感謝那。這個可能是陸上用的。我想問一下全年的收入節奏。季節性方面有什麼需要注意的嗎？我認為第一季的共識約為 3700 萬美元，因此比上一季下降了中個位數。我認為在 23 年，第一季的業績實際上比上季有所上升。那麼，從節奏的角度來看，我們本季添加了什麼內容呢？

Yes, Dave, thank you for that question. So from a seasonality standpoint, for a company in our stage of growth and innovation, we believe our seasonality in 2024 will continue to be impacted by the timing and pace of the rollout of the products, not different than what we saw in 2023 that the seasonality was not comparable to what we've historically seen from our perspective, we don't believe this should have the right way to look at the business and given the initiatives in 2024. But from a modeling standpoint, if you're looking at a proxy, the Q1 tends to be about 67% lower than the fourth quarter. So yes, that's a good enough proxy. And then our focus on productivity is that through execution, we can improve on that. But I would say that historical trend of 6% to 7% is a good proxy for Chicago, Illinois versus Q4?

是的，戴夫，謝謝你提出這個問題。因此，從季節性的角度來看，對於處於成長和創新階段的公司來說，我們相信2024 年的季節性將繼續受到產品推出的時間和節奏的影響，這與我們在2023 年看到的情況沒有什麼不同。從我們的角度來看，季節性與我們歷史上看到的情況無法相提並論，考慮到 2024 年的舉措，我們認為這不應該有正確的方式來看待業務。但從建模的角度來看，如果您查看代理，第一季往往比第四季低 67% 左右。所以是的，這是一個足夠好的代理。然後我們對生產力的關注是透過執行，我們可以改進它。但我想說，6% 至 7% 的歷史趨勢可以很好地代表伊利諾伊州芝加哥市與第四季的情況？

Yes. Okay. Great.

是的。好的。偉大的。

Thank you.

謝謝。

Thank you.

謝謝。

Sam Brodovsky, Truist Securities.

薩姆·布羅多夫斯基 (Sam Brodovsky)，Truist 證券公司。

Hey, thanks for taking the question. I guess just first one on the short power short contract launch on, can you kind of just walk us through the puts and takes on that rolling out in 2Q versus the initial longer contract up launch that we saw with Granite? And how should we think be thinking about the impact of that versus the initial rollout?

嘿，謝謝你提出問題。我想這只是關於短期電力短期合約推出的第一個，您能否向我們介紹一下第二季度推出的看跌期權和承接期權，以及我們在 Granite 上看到的最初的長期合約推出？我們該如何考慮這項影響與最初推出的影響？

Yes. Good question, Sam. So I think that you'll see a more rapid rollout here. First of all, we were a little surprised at how quickly we received clearance.

是的。好問題，山姆。所以我認為您會在這裡看到更快的推出。首先，我們對如此快速獲得許可感到有點驚訝。

Please standby, your conference will resume with her and Shannon.

請稍候，您的會議將繼續由她和香農主持。

So we are ready.

所以我們準備好了。

Hello, you're coming in loud and clear.

你好，你的聲音響亮而清晰。

So. Okay. Thank you.

所以。好的。謝謝。

And Sam, I'm going to answer your question once again on that. So what's the cotton? What's the bid.

山姆，我將再次回答你的問題。那麼棉花是什麼？出價多少。

And so on the short construct lines, I was saying that he actually was surprised at how quickly --

所以在短的構造線中，我是說他實際上對如此快的速度感到驚訝--

Bill, please stand by. Your conference will resume resume in a moment. Please standby, your conference will resume shortly.

比爾，請稍等。您的會議稍後將恢復。請等待，您的會議很快就會恢復。

We didn't Andrew stage either because you were not speaking or because of a bad connection to disconnect, press one to record your message two, are you still there to disconnect, press one to record your message, Chris, it was previously follow question 20, given that no one, truly like what you're coming in loud and clear right now.

我們沒有安德魯登台，要么是因為您沒有說話，要么是因為連接不良而斷開連接，請按一記錄您的消息二，您是否仍然在那裡斷開連接，按一記錄您的消息，克里斯，這是之前的問題20、考慮到沒有人真正喜歡你現在大聲而清晰地表達出來的內容。

Okay. Can you pass me, you are live your life loud and clear.

好的。你能通過我嗎，你正在大聲而清晰地過著你的生活。

Thank you. Sorry about that. Some technical difficulties at Sam, I'm not sure would you comment on your question on short construct? Would you like me to restate that? Or did you cap and capture most of it?

謝謝。對於那個很抱歉。Sam 的一些技術困難，我不確定您是否會評論您關於簡短構造的問題？您需要我重申嗎？或者你已經限制並捕獲了其中的大部分內容嗎？

I think it would be great if you could just run it backwards.

我認為如果你能向後運行就太好了。

Great, great. And so a store concept launch Tom, we were actually quite excited about the opportunity we have with our grant at nine five products. The product was actually cleared earlier than we anticipated. Just a great team effort here with our product team as well as our regulatory team and the clearance, it was a line extension for us. And so we added a couple of different some areas to the high, if you first of all, this S. one trajectory, which is really targeting shorter constructs and then also pediatric deformity as well.

很棒很棒。因此，湯姆推出了商店概念，我們實際上對九五產品的資助機會感到非常興奮。該產品實際上比我們預期的更早被清除。這只是我們的產品團隊、監管團隊和許可的巨大團隊努力，這對我們來說是產品線的延伸。因此，我們在高處添加了一些不同的區域，如果您首先是這個 S.one 軌跡，它實際上針對的是較短的結構，然後也是兒科畸形。

And to get at your question of rollout this is a little bit different than the original grant at launch, primarily because the instrument trays that are currently in the field that are meeting our demand for our current Granite business, we will use those same instrument trays. So we already have the trays out in the field. The our territory managers have been speaking with our our surgeons on these topics we are in these hospitals on the approved list. And so we are we think that this should be a more rapid rollout. And ultimately, the goal primarily is to go after these 100,000 short construct cases in the U.S.

為了解決您的推出問題，這與啟動時的原始撥款有點不同，主要是因為目前該領域的儀器托盤滿足我們當前花崗岩業務的需求，我們將使用相同的儀器托盤。所以我們已經把托盤放在現場了。我們的地區經理一直在與我們的外科醫生討論我們在批准名單上的這些醫院中的這些主題。因此，我們認為這應該是一個更快的推出。最終，我們的主要目標是追蹤美國的這 10 萬個短期構造案例。

Great, thanks.

萬分感謝。

And then just a last one on Entra as well. Just in terms of the pricing relative to our views Can you level set us there and how that's factored into the pricing?

然後是 Entra 上的最後一張。就相對於我們的觀點的定價而言，您能否為我們設定一個水平，以及如何將其納入定價中？

I'm sorry, what was the question?

抱歉，問的是什麼問題？

Sorry?

對不起？

Just in terms of pricing for the allograft, you just level set us where that is relative to our views.

就同​​種異體移植物的定價而言，您只是根據我們的觀點為我們設定了水平。

Yes, from a pricing standpoint, what I would say, Sam, is you've got to think about it as a construct pricing in terms of what a construct would be for a multi implant primary SI joint fusion procedure, and our expectation is that should be pretty comparable.

是的，從定價的角度來看，Sam，我想說的是，您必須將其視為一種構造定價，即多種植體初次 SI 關節融合手術的構造，我們的期望是應該是相當有可比性的。

Appreciate the questions.

感謝您提出的問題。

Caitlin Cronin, Canaccord Genuity.

凱特琳·克羅寧，Canaccord Genuity。

You may have received prior to taking the questions and congrats on a great quarter. Just that, you know, touching on the new focus on interventionalists. So we are training them in lateral procedures, figure training them in 3D and torque. And then it's the new allograft products employing a posterior approach.

在回答問題之前，您可能已經收到了，並祝賀您度過了一個美好的季度。就是這樣，你知道，涉及到對幹預主義者的新關注。因此，我們正在對他們進行橫向程序訓練，對他們進行 3D 和扭矩的數位訓練。接著是採用後路入路的新同種異體移植產品。

Hey, Caitlin, thanks for the question. We're actually training them with our torque product for the lateral procedure. And then we are also training on the allograft product, typically not the ICUs 3D triangular shaped implant given the the needs of interventionalist.

嘿，凱特琳，謝謝你的提問。實際上，我們正​​在使用我們的扭力產品來訓練他們進行橫向手術。然後，考慮到介入醫生的需求，我們也正在對同種異體移植產品進行培訓，通常不是 ICU 3D 三角形植入物。

Got it. And then so the revenue per procedure would that be less for an interventionalist versus a surgeon that perform that procedure?

知道了。那麼，介入醫師每次手術的收入會比執行該手術的外科醫師少嗎？

The pricing is similar.

定價類似。

So on with the last question that we got from Sam, that was asking about allograft pricing. But the pricing overall is very similar. Whether we're selling to interventional or to spine surgeons.

那麼，我們從 Sam 那裡得到的最後一個問題是詢問同種異體移植物的定價。但整體定價非常相似。無論我們是向介入外科醫生還是脊椎外科醫生銷售產品。

Okay, got it. And then just on briefly on the OUS business, what is your expectations for this year? And when do you expect clearance for torque in Amea that happened?

好，知道了。然後簡單介紹一下 OUS 業務，您對今年的期望是什麼？您預計 Amea 的扭力間隙何時會發生？

Yes.

是的。

So the OUS business, Caitlin, is about 6% of our worldwide revenue in 2023. And when we think about the guide for the year in France has been performing really well for us last year and the recovery in some of the other markets like UK and Germany, they will take longer than we had previously anticipated. And what our current guidance for the year at 17 to 19 does assume a low to mid single digit year-over-year increase in international revenue. So US revenue will be closer to 18% to 20%.

因此，到 2023 年，Caitlin 的 OUS 業務約占我們全球營收的 6%。當我們考慮到去年法國的指南對我們來說表現非常好，以及英國和德國等其他一些市場的復甦時，它們將需要比我們之前預期的更長的時間。我們目前對 17 至 19 年的指導確實假設國際收入同比增長為低至中個位數。因此美國的收入將接近 18% 至 20%。

Now the international market is important for us and the team's been doing a lot of work around training, new physicians, modifying our go-to-market models up, which should reap benefits in 2025. And then in terms of torque, we are working really hard to get talking to EMEA, which we believe could be a growth driver for the business, but likely to be in early 2025 when you start seeing any impact from that just given the regulatory process.

現在，國際市場對我們來說很重要，團隊一直在培訓、新醫生、修改我們的市場模式等方面做了大量工作，這些工作應該會在 2025 年獲得收益。然後就扭力而言，我們正在努力與歐洲、中東和非洲地區進行對話，我們相信這可能會成為業務成長的推動力，但很可能要到2025 年初，考慮到監管流程，您才會開始看到由此產生的任何影響。

Got it.

知道了。

Thank you.

謝謝。

Thank you. (Operator Instructions)

謝謝。（操作員說明）

Ross Osborn, Cantor Fitzgerald.

羅斯·奧斯本，康托·菲茨杰拉德。

Congrats on the progress and thanks for taking the questions.

恭喜您的進展，並感謝您提出問題。

And maybe just one for me. Would you discuss the pediatric deformity market just in terms of size, the current standard of care and where you see GRANITE playing a role?

也許對我來說只是一個。您能否僅從規模、當前護理標準以及您認為 GRANITE 發揮作用的角度來討論兒科畸形市場？

And if so, and it's small is a short answer to I think the target market size is around 10,000 procedures per year, Ross. And so it's not it's not a big area of focus for us. The the opportunity in DJ and spine is 100,000. So it's 10 times that size but we have received inquiries from pediatric deformity surgeons who are interested in pelvic fixation. We wanted to make sure it was an option for them on label.

如果是這樣，而且規模很小，我認為目標市場規模約為每年 10,000 例手術，羅斯。所以這並不是我們關注的重點領域。DJ 和脊椎的機會是 100,000。所以它的尺寸是這個尺寸的 10 倍，但我們收到了對骨盆固定有興趣的兒科畸形外科醫生的詢問。我們想確保這是他們在標籤上的一個選擇。

And so the new grant at nine five does provide that for us.

因此，九點五分的新撥款確實為我們提供了這一點。

Thank you. Now I will turn it over to Laura.

謝謝。現在我將把它交給勞拉。

Thank you so much for your time. I really apologize for the technical issues. I hope that we've given you all the answers that you need. It is, as I said earlier, we're thrilled with the year that we just came off of and really excited about 2024 with all the new opportunities in front of us and building on the momentum that we generated in 2023. So thank you again, and goodbye.

非常感謝您的參與。對於技術問題我真的很抱歉。我希望我們已經為您提供了您需要的所有答案。正如我之前所說，我們對剛結束的這一年感到非常興奮，並對 2024 年感到非常興奮，因為我們面前有所有新的機遇，並在 2023 年產生的勢頭的基礎上再接再厲。再次感謝您，再見。

Thank you for your participation. You may now disconnect.

感謝您的參與。您現在可以斷開連線。