Globus Medical Inc (GMED) Q2 2026 Earnings Call Transcript

Welcome to Globus Medical's second quarter 2026 earnings call. At this time, all lines will be on mute, and a Q&A session will be held after the prepared remarks. I will now turn the call over to Brian Kearns, Senior Vice President of Business Development and Investor Relations. Mr. Kearns, please go ahead.

Thank you, Sarah, and thank you, everyone, for being with us today. Joining today's call from Globus Medical will be Keith Feil, President and Chief Executive Officer, and Kyle Klein, Chief Financial Officer. This review is being made available via webcast accessible through the Investor Relations section of the Globus Medical website at www.globusmedical.com. Before we begin, let me remind you that some of the statements made during this review are are or may be considered forward-looking statements. Our Form 10-K for the 2025 fiscal year and our subsequent filings with the Securities and Exchange Commission identify certain factors that could cause our actual results to differ materially from those projected in any forward-looking statements made today. Our SEC filings, including the 10-K, are available on our website. We do not undertake to update any forward-looking statements as a result of new information or future events or developments. Our discussion today will also include certain financial measures that are not calculated in accordance with generally accepted accounting principles or GAAP. We believe these non-GAAP financial measures provide additional information pertinent to our business performance. These non-GAAP financial measures should not be considered replacements for and should be read together with the most directly comparable GAAP financial measures. Reconciliations to the most directly comparable gap measures are available in the schedules accompanying the press release and on the Investor Relations section of the Globus Medical website. With that, I will now turn the call over to Keith Feil, our President and CEO.

Thanks, Brian, and good afternoon, everyone. Thank you for joining us on today's call. We completed an exceptional second quarter, positioning us for a strong 2026 as we move into the second half of the year. At a top level, Q2 revenue was $789.6 million, growing 6% as reported. Excluding Nevro, Q2 revenue growth was 9%, led by 7% U.S. spine growth and 14% growth in international spine. Fully diluted non-GAAP earnings per share was $1.34, growing 56% compared to the prior year quarter, while Q2 adjusted EBITDA was 35.4%, growing 34% in dollars and 740 basis points over the prior year quarter. During the quarter, we also deployed $136 million to repurchase 1.6 million shares. Looking back, since 2022, Globus has more than tripled our top line and earnings while developing a scalable working model to deliver these results over the long term. Our focus on organic growth, combined with the scale from the NuVasive merger and the Nevro acquisition underscores our commitment to delivering value creation for our shareholders. We've successfully demonstrated our ability to bring together the two best-in-class buying portfolios while expanding our commercial distribution and operating with a sense of urgency in a manner that exhibits financial discipline through earnings accretion and increasing returns on capital. Our team has launched over 25 products over the past 36 months, demonstrating our unwavering focus on organic product development the combination of new products and our significantly expanded worldwide sales force has allowed us to continue taking market share the acquisition of Nevro with a clinically superior pain product opens the door for us expanding our addressable market into many exciting areas while bringing that franchise into our business model with all the changes occurred the past three years it's easy to look past what has been accomplished while still maintaining the ethos of what Globus was founded upon now let's move into sales musculoskeletal sales were seven hundred sixty three point five million dollars growing eight percent versus the prior year quarter and four percent sequentially the growth drivers are spine both US and international as well as trauma US spine continues to take significant market share growing seven percent as reported on strong procedural volumes competitive recruiting pull through from robotics and product launches continue to fuel growth. Our competitive hires in the second quarter were double the amount hired in Q1, and it represents the second highest onboarding in the past eight quarters. Strategically, competitive recruiting has and will remain at the forefront of our growth strategy. Growth remains broad across U.S. Spine, with double-digit growth seen in many products, such as Sable, Elsa, Hedron C, Reline C, and Reline Open. Power Tools continues to drive uptake, with Durapro growing over 250% in the second quarter. International Spine grew 14% as reported and 12% on a constant currency basis, led by mid-teens growth across key EMEA markets, namely Italy, Spain, and Poland. APAC growth was broad-based across the region, while LATAM generated its growth mainly from Brazil and Colombia. Overall, Q2 International Spine performance reflects our strategy of going deeper in the territories in which we operate. The focus and infrastructure are such that we can position ourselves to see continued above-market growth moving ahead. Trauma revenue grew 31% versus a prior year quarter and 18% sequentially as we continue to drive share growth in our core trauma line while returning to normal with supply in our precise product line, allowing us to fully satisfy US demand while also turning on numerous OUS markets. We are actively capturing market share and attracting top sales talent as our product portfolio has grown and has become differentiated. We are also beginning to see tremendous interest from surgeons, hospitals, and competitive sales reps in our product portfolio as a full portfolio trauma alternative. We see our trauma business as a long-term growth driver moving ahead. Enabling tech sales were $26.1 million, declining 26% in the second quarter, driven by our continued shift towards greater flexibility in our capital acquisition model. Despite the decline in INR revenue, we are seeing early evidence of success with our new model as eGPS and eHUB units deployed, whether sold, leased, or rented, grew 11% sequentially and 25% versus the prior year quarter. Both data points validating the demand for Excelsius technology. Robotic utilization continues to expand with over 137,000 procedures performed. We remain steadfast and confident in the long-term strategy of our revised approach to capital deployment. Our overarching focus is to achieve above-market growth of our in-plant technology, disposables, and service by launching successful capital programs, creating the catalyst for pull-through revenue. Q2 Nevro sales were essentially flat to Q1, consistent with our comments made last quarter and in line with our expectations as we rapidly integrate Nevro into the Globus business model of sustained share growth gains driven by new product development, Salesforce expansion, and disciplined operational execution. Recruiting has been the primary area of focus within the Salesforce, and we've seen success in filling open roles with roughly 75% of those roles filled during the quarter. Looking ahead, we remain active on both the recruiting and training fronts. Our near-term goals are focused around driving trial volumes higher, where we expect to see improvement as we move through the back half of the year with the goal of returning to historical trial levels late in Q4. During the quarter, we launched three new products, two in trauma and one in spine, which I will touch on quickly. The trauma products include the Audubon hip fastener and the Tensor suture button system. Spinal product is Reline One. The Audubon hip fastener is engineered to offer robust fixation and resistance to enhance stability with minimal disruption to workflow. This product is designed to allow surgeons to treat patients with poor bone quality, with a greater level of confidence, and uniquely positions our Audubon intramedullary nailing system. The Tenture Suture Button System is engineered to redefine suture management in the OR. The system features a self-locking suture and an inserter with integrated tensioning handles, which provide a more streamlined approach for tensioning through a single incision. Tensure is compatible with Anthem ankle and one-third tubular plates to offer surgeons a complete ankle solution. Reline 1 is designed to address the unmet need for true single-step screw placement in order to reduce procedural steps, increase efficiency, and minimize patient risk. The ratchet retraction handle, screw design, and stylet tip geometry work together to achieve these benefits through a differentiated procedural solution. Reline 1 is a premier solution for mass T-LIF and minimally invasive posterior fixation. Last quarter, I had mentioned receiving FDA 510 clearances for both our surgeon-designed patient-specific script spacer system comprising of seven patient-specific lumbar interbody systems as well as our surgeon-designed patient-specific script rods. Script lumbar spacers are static, static-integrated, and expandable thoracolumbar interbody fusion devices additively manufactured with patient-matched M-plate topography for maximum stability. We're expecting to launch these systems later in Q3. The patient-specific script spacers may be placed using Excelsius GPS insurance for navigation with Excelsius GPS, Excelsius Hub, and Excelsius XR. Scripps patient rods are precision bent to the surgeon's pedicle screw placement plan and designed to reduce time spent on intraoperative rod bending. Rods are compatible with our Creo, Reline, and Revere pedicle screw systems for both open NMIS procedures. Scripps studio screw plans can be uploaded to our Excelsius GPS and Excelsius Hub systems for robotically navigated screw placement intraoperatively. Our platform keeps the physician at the center of the design and planning process with an intuitive interface, allowing the surgeon to efficiently design disc height restoration, spinal alignment, and pedicle screw placement, translating their precise clinical intent directly into the implant design. Our software is treated as an advanced tool rather than a replacement for clinical judgment, ensuring the implant perfectly executes to the surgeon's operative strategy. Our expandable offering incorporates our proven technology, allowing surgeons to insert the implant at a lower height designed to minimize nerve retraction and reduce the impaction forces required to implant the spacers. Once in the disc space, the spacer can be expanded to restore optimal disc height. Our patient-matched spacers and rods are bundled with our high-quality implants and best-in-class disc prep and retractor systems while integrating with our Excelsius suite thus ensuring final placement matches a digital pre-op plan to ensure proper navigated placement with our script clearances we will be the only company positions to offer a complete portfolio of patient specific lumbar inner body spacers and rods integrated with our enabling technology truly establishing us as the one-stop shop for lumbar patient specific implants. Looking ahead, specific focus is centered around organic product development with well over 60 projects in process. We're committed to leading with innovation and purpose. Our in-house development team is expanding to account for greater project complexity as we work to bring new and exciting products to market that address unmet clinical needs. We are continually working to improve the efficient flow of organic product development from concept to production such that we can speed up the launch of new products moving forward. The last few years were spent largely building a broader platform within musculoskeletal care across spine, trauma, enabling tech, and neuromodulation. We've assembled a stronger Globus bag that is the platform for the future, allowing us to expand our research into various new areas of unmet clinical needs. We're leaning into data, analytics, and AI. It's not just about treating one patient, it's how we treat that patient and learn so we can help others more effectively and faster. It's how we become smarter to further assist our surgeon partners and clinicians in patient selection and surgical execution. We are developing a surgical intelligence ecosystem that will accelerate digital solutions through strategic investments so we can bring together intelligent patient selection, enabling tech-driven proceduralization of surgical technique, while constantly adding to our complimentary implants and instruments to improve surgical outcomes it's not about the next quarter rather it's about driving long-term sustainable development to drive market disruption and differentiation I'm thankful to all of our Globus team members for their hard work and dedication and helping us deliver upon this fantastic quarter your teamwork dedication and focus are how we continually work to unsolve unmet clinical needs. I'll now turn the call over to Kyle.

Thanks Keith and good afternoon everyone. Our second quarter results delivered above market top line growth including share taking domestic and international spine sales growth, our seventh consecutive quarter of adjusted gross profit margin expansion, and a quarterly record for fully diluted non-gap earnings per share. Sales grew six percent as reported compared to the second quarter of the prior year with nine percent growth in the base business, excluding Nevro. U.S. Spine, again, led the way in growth for the organization, up over 7% compared to the second quarter of the prior year, marking our fifth straight quarter of above market growth. Adjusted gross profit margin took another step forward, notching 69.4% in the second quarter, a 200 basis point improvement over that we continue to execute our supply chain initiatives. On the bottom line, we achieved record Q2 fully dilutive non-GAAP earnings per share of $1.34. In today's prepared remarks, I will provide insights into our quarterly business performance, comment on share repurchases and capital allocation priorities, and provide an update on guidance for 2026. Second quarter 2026 results were highlighted by revenue of $789.6 million, growing 5.9% on an as-reported basis and 5.6% on a constant currency basis. Gap net income was $151.6 million, resulting in $1.10 of fully diluted non-gap net income was $184.3 million, delivering $1.34 of fully diluted non-gap earnings per share, or 55.8% of non-gap EPS growth over the prior year quarter. Total company adjusted EBITDA margin was 35.4% in the second quarter compared to 28% in the prior year quarter. Our Q2 2026 base business Globus adjusted EBITDA margin 36.9% compared to 32.3% in the prior year quarter and standalone Nevereux adjusted EBITDA margin was 22.4% for the quarter compared to negative 1.4% in the prior year quarter. Our second quarter net sales of $789.6 million reflects base business Globus sales totaling $708.6 million, growing 8.9% as reported and 9% on a day-adjusted basis, with the same number of selling days in the U.S. and international and one less selling day in Japan compared to the prior year. Base business Globus sales grew 8.5% on a constant currency basis. Sales growth was led by U.S. Spine, which achieved 7.3% as-reported growth, and International Spine, which grew 13.8% on an as-reported basis and 12.2% on a constant currency basis. Our trauma and neuromonitoring businesses each grew over 30% and have now had four straight quarters of double-digit sales growth. Sales growth across these underlying businesses were offset by a 14.3% decline in Nevro and a $9 million decline in enabling technologies. Nevro saw a $1.7 million sequential sales decline from the first quarter to the second quarter of 2026. As mentioned previously, we enacted significant structural changes within the product development, sales and marketing, and general administrative functions of the Nevro business in 2025. We remain on track with our integration of the Nevro business and expect trial volume recovery by the end of this year. Despite the expected decline on the top line, we feel confident in the trajectory of the Nevro business and our ability to improve top line by the end of 2026. Additionally, we continue to see the lasting and sustainable impact of cost control actions taken in 2025 on profitability, highlighted by sequential quarterly EBITDA margin expansion from 11.8% in the first quarter to 22.4% in the second quarter of this year. Pivoting back to overall results, musculoskeletal revenue achieved $763.5 million, growing 7.5% over Q2 2025, despite the decline in Nevro. Base Business Globus musculoskeletal revenue grew 10.9%. Enabling Technologies' revenue was $26.1 million, declining 25.8% as reported. The Enabling Technologies business saw a softer quarter in sales dollars when compared to Q2 2025. However, we have continued down the path, laid out in the back half of 2025, of being flexible in the way we, quote, alternative ways of acquiring our capital. To that end, we have executed more alternative offerings in this quarter than ever before. While the majority of our units this quarter remain cash sales, we've continued to see the shift quarter after quarter towards alternative acquisition models and expect this trend to continue as we execute our revised approach to capital deployment. U.S. revenue during the second quarter of 2026 was $619.1 million, growing 3% as reported. Growth in our domestic business was led by our U.S. spine, neural businesses, and partially offset by declines in NEVRO and enabling technologies. Q2-2026 international revenue was 170.5%, growing 18% as reported, and 16.2% on a constant currency basis. International growth was seen across the board as we focus on deeper penetration within our existing markets. The international spine business led the way with 13.8% as reported and 12.2% constant currency growth and double-digit gains across EMEA, Latin America, and APAC regions. In the first half of 2026, we have grown the international spine business by 14.5% as reported and 10.6% on a constant currency basis and are targeting sustained double-digit growth in the back half of the year. Transitioning to the rest of the P&L, gap gross profit margin in the quarter was 66.8% compared to 63.3% in the prior year quarter. Adjusted gross profit margin was 69.4% compared to 67.4% in the prior year quarter, primarily driven by increased sales, resulting in fixed cost leverage, favorable sales mix, and the impacts of synergy execution through our manufacturing and supply chain initiatives, and partially offset, manufacturing and supply chain initiatives continue to be a focal point of our operations team, as we target a return to a mid-70s adjusted gross profit margin. Quarter after quarter, we are seeing consistent progress as we work towards this goal, with a 200 basis point improvement over the prior year's second quarter and a 20 basis point sequential improvement over the first quarter of this year. We reiterate our expectation of adjusted gross profit margin falling in the range of 69 to 70 percent in 2026, representing a 90 to 190 basis point improvement over 2025. Research and development expenses in Q2 2026 were $36.3 million dollars or 4.6% of sales or 5.4% of sales in the prior year quarter. The resulting decline in R&D both in dollars and as a percentage sales is attributable to synergy capture resulting in lower employee of incremental investment in product development. As Keith mentioned in his prepared remarks, we are expanding investment in our in-house product development capabilities as we work to bring new and exciting products to market. To that end, we are ramping investment and product development in the back half of 2026, we reiterate our expectation of 2026 R&D expense to be in the range of five to six percent of net sales. SG&A expenses in the second quarter of 2026 were $286.8 million or 36.3 percent of sales compared to $303.6 million or 40.7 percent of sales in the prior year quarter. The decrease in spend is primarily attributable to decreased employee related costs from synergy actions and lower employee benefit costs from the timing of claims, partially offset by increased sales compensation costs from higher volume. Q2 2026 net interest income was 7.1 million dollars compared to 0.7 million dollars in the prior year quarter. The six point four million dollar favorable change is being driven by an increase in interest income from cash reserves. The gap tax rate for the second quarter of 2026 was twenty point one percent compared to negative seven point eight percent in the prior year quarter. The prior year quarter gap tax rate was impacted by a thirty four point eight million dollar one-time tax benefit which was primarily driven by the discrete nature of the release of a valuation allowance against previously reserved R&D credits acquired in the NuVasive merger. Our non-GAAP tax rate for the quarter was 20.9% compared to 25% in the prior year quarter. Our GAAP and non-GAAP tax rate in the current period were favorably impacted by stock option exercise benefits. Given the favorability seen in tax rate in the first half of 2026, we are revising our expectation of non-GAAP tax rate to be in the range of 23 to 24 percent down from our previous guide of 24 to 25 percent equivalents and marketable securities were eight hundred and forty point five million dollars at June 30th 2026 compared to six hundred and twenty nine point one million dollars at December 31st 2025 the increase in cash is driven by operating cash flow of four $412.1 million, primarily from higher net income and partially offset by $136.1 million of share repurchases and cash spend on capital expenditures of $72.8 million or 4.7% of sales. In Q2 2025, we announced a new share repurchase program of $500 million, under which we have purchased $110 million worth of shares in 2025. In the second quarter of 2026, we repurchased 136.1 million dollars or 1.6 million shares and have 253.9 million dollars of authorization remaining under this program as of June 30th, 2026. Share repurchases have been and continue to be an integral part of our capital allocation strategy, with repurchases in 2026 representing 40 percent of our year-to-date free cash flow. Since closing the Nuvasiv merger in September 2023, we have invested $747 million in share repurchases, representing over 50% of our free cash flow generation in that period and buying back 11.9 million shares, or 30% of the dilution from the Nuvasiv merger. We reiterate our capital allocation strategy, which prioritizes internal investment in innovative product development efforts above all else. We focus our capital spending efforts on building sets for our worldwide sales force and investing in facilities, machinery, and equipment to continue to increase our manufacturing footprint. We will continue to buy back shares through our share repurchase program, minimizing dilution and increasing shareholder value. Finally, we will continue to evaluate complementary M&A while focusing the use of our capital on driving investment for long-term profitable growth. Pivoting to financial guidance, Globus Medical reaffirms its full year 2026 revenue guidance of $3.18 to $3.22 billion and we are increasing our guidance for non-GAAP fully diluted earnings per share to be in the range of $4.95 to $5.05 from the previous range of $4.70 to $4.80. The revenue guidance implies growth over 2025 ranging from 8.2 to 9.6%. The revised, fully diluted non-GAAP earnings per share guidance implies growth over 2025 ranging from 24.4 to 26.9%. The upward revision of fully diluted non-GAAP earnings per share guidance reflects a favorable increase in expectations from the margin expansion and operating leverage seen in the first half of 2026, which we expect to have a favorable impact on our full-year results. The second quarter of 2026 has been highlighted by share-taking domestic and international spine top-line growth, 200 basis points of adjusted gross margin expansion, and a definitive return to mid-30s EBITDA margin. The year-to-date top and bottom-line performance has set us up for a record-breaking year in 2026. I'm proud of the Globus team for their execution in the first half of 2026. their unrelenting pursuit of excellence, and our drive to be the leading musculoskeletal technology company in the industry. Operator, we will now open the call for questions.

Thank you, Mr. Klein. We'll now conduct the Q&A session. If you would like to ask a question, please press star 11 on your telephone and wait for your name to be announced. To remove yourself from the queue, please dial star 11 again. To keep the queue moving efficiently, please ask one question, and if needed, one follow-up. Please stand by while we compile the Q&A roster. To begin, we will bring Lawrence Spiegelson from Wells Fargo to the stage. Lawrence, your line is open.

Hi, this is Ross Osborne on for Larry. Thanks for taking our questions. So maybe starting off with your international piece of the business, you guys obviously had a strong quarter, but we are hearing from competitors of some softness in Europe due to transient headwinds such as strikes and heat waves. Have you guys seen this pick up as a 2Q and do you expect a more seasonally soft 3Q?

This is Keith. Thanks for the question. Generally speaking, our performance across EMEA was pretty in line with expectations. Countries go up and down from quarter to quarter, but when I look at EMEA, I look at it in the aggregate and what I see as a business that's moving forward as we look through look forward to the rest of the year Kyle had mentioned earlier that we see international business as a stronger or as we as we look ahead yeah and the only thing that there is you know back to their prepared remarks we had noted double-digit growth across our international space including EMEA they grew double digits in the second quarter Thank you for your question.

Next, we have Vic Chopra with BMO. Vic, your line is open.

Hey, good afternoon, and thanks for taking the questions. Congrats on a nice quarter. Two for me. You know, you reported, I think, U.S. buying growth of 7% in the second quarter. I think that stepped down from the last couple of quarters.

Can you just provide an update on what's going on there and if this is the most sustainable run rate going forward and I had a quick follow-up please okay you know and this is Keith you know we had we came off of a couple of strong quarters sure we had basically 10% growth as we got as we get into the second half of the year our comps get a little more difficult as we move through but that doesn't take away from our confidence in the business we see our US buying businesses performing really well and we're confident as we look into the rest of the year but like I said as we get further into the second half our comps get a little more difficult year over year.

Understood. And a quick follow-up, if I could. You beat on the growth margin line. You've talked about a return to a mid-70s adjusted gross profit profile. Given the performance we've seen to date, over what time frame do you expect to achieve that? Thank you.

Thanks for the question, Vic, and yet highlight what we talked about during the prepared remarks. This is the seventh straight quarter of gross profit margin expansion you know we expect to finish the year somewhere in the 69 to 70 percent range and seek sequential uplift quarter after quarter as we've seen over the past seven quarters as well we're likely into and touching 70s by the end of the year probably very very low in the 70s and I think we look back to getting into that mid 70s here and in the year or two after that yeah I think that I agree with Kyle's point because if you think about what we've done over the last couple of years you know we we announced new base that we said we want to get back to mid 70s gross margin profile and mid 30s EBITDA by the end of the third year we're going to touch on we think

we're already achieved getting back to mid 30s before we got through through three full years to Kyle's point we'll get into the low 70s this year there's a lot of other actions that have occurred with acquiring Nevro and other steps that occur within our business that may may have to have that been a little bit slower but as I see the overall business and everything that's happening in manufacturing and operations from an initiatives perspective, we feel confident on getting back to that in early in 2027.

Thank you. The next question is from the line of Richard Neuter with Truist Securities. Richard, your line is open.

Hi, good afternoon. This is Robbie on for Rich. Thank you for taking the questions. So I guess I have two questions. I'll ask them up front, please. One, can you just maybe talk about the NEVRO cadence and your guidance for the rest of the year and then the M&A strategy in that division? And then maybe second, you know, this lumbar spacer launch coming in 3Q. Can you maybe talk about, you know, how quickly can you get that from the doctor designing the case to production to in their hands? Just curious, you know, what the lag looks like, and are you able to kind of capitalize on some of these new DRGs that are going live in the fall? Thanks. Okay.

Could you repeat your first question again?

Hi, I was just asking about Nevro cadence for the remainder of the year, and then just what do we think about M&A strategy? I didn't really hear much of that on the call in terms of Nevro. Thanks.

No, that's fair. So Nevro cadence, you know, it's consistent really with what we talked about last quarter. As we move through the rest of this year, we're looking to, you know, get better as year moves on, and our early read is we're going to look at trial volumes. As we get through Q3 and into Q4, our expectation of those trial volumes translate into sales starting to move higher. You know, Nevro, as we think about it, is a business that we want to, you know, return to our historical level of sales. Secondly, on M&A, I have no comments on Nevro M&A specifically at this point you know we've been very active on the M&A front the last several years and really the focus right now is stabilizing this business and getting it to back to a path of returning it to to growth your second question oh I just kind of wanted to learn a little bit about the timing of the case planning to surgical kind of your production so what when you think about lumbar spacers and patient specific it's about a week to ten days we expect to be able to turn it around so you know we're we're working with our manufacturing team to make sure that they can deliver in that time frame and that's our expectation at this point and as you think about reimbursement we think that our strong strong reimbursement codes are already in place so as we think about launching this business in this product line we're confident in the reimbursement profile that this business and products would have thank you our next question comes from the line of Matt Taylor with Jeffrey.

Hi guys, thanks for taking the question. The first question I want to ask was just whether you could put a finer point on revenue guidance because the range for the second half implies something like two to five percent growth bottom to top. You know, are you more comfortable anywhere within the range? Can you help us zero in on that recognizing you have the the tough comps and the net road dynamics?

Hey Matt, this Kyle, thanks for the question. So, you know, as we think about the second half of the year, yeah, we have a range of 3.18 to 3.22 billion. You know, we're not going to point to a specific point in the range that we feel comfortable with, but what I would say is if you look at where we've performed so far this year, how we feel about our ability to perform in the second half, those areas we continue to feel very, very positive about. The two areas we touched on throughout the call this quarter and last quarter has been the change in strategy on enabling tech as well as the Nevro business and getting that back to a stability level so that we can start growing those represent the you know the the downside risk within our guide overall I guess I would say we feel comfortable with where I'm you know the full range and can I ask a follow-up on hiring it looked like that was really strong this quarter and kind of picked up was there anything specific there or is this more continuation and was a really good quarter just a continuation of what we of what we're doing it's

something that I personally want the sales team focused on and being aggressive with you know when I think about our products we have a very broad spine product portfolio we I comment on how many projects we have in process in my prepared remarks we're innovating we're driving and we have you know our exclusive direct selling force really gives us an ability to touch our accounts and provide them with a comprehensive product offering I think it's something that strongly differentiates us and it's something that I want our sales leaders to accentuate as they go out trying to find competitive recruits thank you Matt our next question is with Caitlin Roberts from can accord genuity Caitlin your line is open great thanks so much for

taking the question. I would love if you could provide a bit more color on the expectations for enabling tech growth in the back half, just given the growing financing flexibility dynamic that you called out. Thanks.

Thanks, Kinklyn. This is Keith. We don't break out our guidance into the parts and pieces, but what I would say, and it really would fall back on my prepared remarks, you know, we're looking to get our capital in the hands of our customers to drive implant growth over the long term i talked about that you know that capital driving implant growth disposables growth and service growth so you know i i you know if you extrapolate that what i think about is how that's going to drive enhanced sales and musculoskeletal understood and maybe just a quick one on the the rep ads you called that particular strength there what do you think um was happening this quarter that was you know stronger versus the the recent quarters um for for rep hiring i would say keeping after their sales leaders to make sure that we're closing down deals.

Thank you, Caitlin. Next, our question will be from Tom Steffen with Steeple. Tom, your line is open.

Great. Hey, guys. Thanks for taking the questions. I'll start with OUS Spine. Can you guys elaborate a bit more on the strength there? I know the comp was a bit easy in 2Q, And, you know, I think you said kind of sustained double-digit growth in the back half. But, you know, just wondering if you could potentially put a finer point around that. You know, what's the level of confidence in accelerating OUS spine in the back half versus the first half? And what would be the tailwinds and or the headwinds, you know, allowing that from happening? And then I'll have a follow-up.

This is Keith. Thanks for the question. You know, as I think about international spine, you know, we did have some softer comps last year. but I would say that this year, much happier with set deliveries and inventory availability. That's been something that's been a catalyst to us to go deeper in the countries that we're operating in. I caution to say that our growth is going to accelerate. Overall, we think that this is a strong business that can grow double digits by going deeper where we're at. But if I think about overall, the biggest improvement I've seen year over year, it's set deliveries and inventory availability.

Got it. That's great. And then maybe taking a step back a bit, You know, I wanted to ask about kind of the spine market health, and notably the U.S. Just curious if you can comment on trends, demand, volumes that you've seen year-to-date. Any differences or changes as the year has progressed? And then what does guidance assume as it relates to market outlook?

Yes, this is Keith again. I would say that the spine market appears healthy. You know, we haven't seen any drop-off in procedural demand. It's remained pretty constant. So I think about looking ahead, my view on the market is that it's going to continue to be fairly stable. As I look across the industry, I think there's still ample competition. It's still a fragmented market. So I think the market is operating in a manner that it's healthy. And for us specifically, we're confident in our U.S. buying business.

Thank you, Tom. Matt Blackman with TD Cohen. Your line is open, so feel free to ask your question.

Hi, this is Drew on from Matt. Just a couple quick ones for me. Just on the R&D spend for the year going to 5% to 6% or still keeping it at 5% to 6%. I mean, it's a pretty big uptick in the back half. I was just hoping that you could touch on that a little bit more, Keith or Kyle.

You kind of mentioned it on the call that you're doing a lot of in-house development, but hoping you could put a firing point on where you're putting that development is it just all in the software side to drop AI and England technology you're just building out the spine implant portfolio more that's a great question this is Keith so I would say that you know what we're doing I commented that we're investing in our team we're investing in more headcount across our business that's going to be in our core areas the spine trauma joints there's going to be some in in neuro and pain but then also software you know it really touches back on building out our software capabilities when you think about our enabling tech and bringing together the procedure and the procedural solution. I talked a little bit about ecosystem. The broadness of the 5% to 6% really gets back to the timing of when those heads come on board and just think about the back half of the year.

Yeah, and the only thing I'd add, Drew, is from a cadence perspective as you think about it, right? We had been messaging that as we got Nevereaux into our business and into our process that there would be some synergy actions there. we saw that impact last year into early this year in my prepared remarks I called out the fact that there was some delay in investment so it's been a plan for investment it's just a matter of how it is kind of come in through the year but yeah to get into that five to six percent I agree with you there there will be a significant ramp here in the back half of the year from a spend perspective got it and just on kind of that digital ecosystem that you're looking to build does the current Excelsius portfolio have that compute power or do we kind of need to see the next generation of Excelsius to really

kind of push that forward that's more than just it's more than just Excelsius when you think about it so you know what we're thinking of building is really starts with our implants and instruments our implants and instruments are one of the pillars enabling tech so eGPS that's another one of the pillars then And it's thinking about our procedural solutions, T-lifx, lift deformity, that's another pillar of what we think about from an ecosystem. And then lastly, it's a surge in intelligence. I talked about learning and going along the journey with a patient. We want to improve our outcomes, so as we go through these procedures, we want to continually take that data and learn and retrain so that the next time that procedure happens with that specific type of patient, that we know more and we're ultimately improving outcomes in spine procedures. Thanks for taking the questions.

Thank you. Our next question will be from Matthew O'Brien with Piper Sandler. Matthew, your line is open.

Hi, this is Samantha on for Matt. Thanks for taking our question. I guess first we want to touch on the revenue guide for the back end of the year. Why the decision not to bump up the revenue guide given the performance this quarter?

Thanks, Samantha. So this is Kyle. I'll take that. You know, I think as we look at what consensus was versus what we actually came in with, I think we had a beat by a little under $7 million. So a beat, but not a significant beat. What I'd point to is our prepared remarks around the change in enabling tech strategy, as well as Nevro and kind of finding the bottom there and building up from there. Those two things, you know, have us cautious, you know, in terms of the second half where we had a strong first half, but we would just want to remain cautious and appropriate with our guidance range. Thanks for that.

Yeah, go ahead.

As I think about the guide in the second half, the only thing I would add is, you know, we're coming off of tough comps. We still feel very confident in the spine business. But to Kyle's point, you know, we talked about the strategy shift with enabling tech. We talked about returning never to health. Those are all things, but we don't break out the individual parts and pieces to the guide Okay, thank you.

I'm just one more on Excelsius and do you have a second-generation Excelsius robot in development and if so when when might we see it?

I have no specific comment on that. We're always continually looking to develop and get ourselves better as a company, but no specific comment on second-gen Thank you Thank you, Samantha.

Our next question is from Travis Steed with Bank of America. Travis, your line is open.

Hey, congrats on the recorder. I guess one on enabling tech, and I know it's harder for us to see with the leasing, but just kind of the momentum you're getting in underlying placements and any way to kind of help us understand that and, you know, is the flexible leasing going to drive extra placements and any way to kind of talk about the pull through of the spine business through to the robots and how you're seeing that impact the spine growth rates yes it was Travis this is key so as we think about the leasing taking hold or the more flexible options you know this year to me I view is a transition year we're looking we're still selling to Kyle's comments we'd still majority of our sales we're outright purchases or a majority of our units moved or outright purchases but

what I see is the mix starting to shift where we're seeing more of these placements happen you think about the long term the goal here is drive the incremental implant pull through service revenue and disposables you know that comes after the capital is is launched at the facility and everyone's trained on it so as you think about that you put the capital out today they'll probably there's be a little bit of a lag until those sales start to kick in but the goal here is to drive enduring musculoskeletal growth namely in US spine and or international spine.

That's helpful. And the follow-up, I wanted to go back and touch on Navro. You talked about trial volume higher historical rates by Q4. I'm curious, kind of the momentum you're seeing and the Salesforce expansion there and kind of the confidence in that business and what it can grow next year and anything else to say on margins, given it was such a big step up from Q3 to Q4 and the margins for Navro.

So when you think about Salesforce, I commented that we talked about, you know, adding back open positions in the second quarter, and we rehired about 75% of those. There's still hiring going on. With that comes training. So, you know, I'm cautious to give specifics around that because we're not breaking out the guide, but as I think about the back half of the year, now that we're getting restaffed and folks are getting trained, we want them to be aggressive out in the field to, you know, drive those trial volumes because those trial volumes are an early indicator of future sales so you know I really fall back on my comments talking about Q4 trial volumes starting to see that improvement translate in the sales anything on the margin piece margin piece yeah and this is Kyle on the on the margin piece if you go back to last year right we acquired Nevro in April we didn't really execute any synergy

actions until the very, very tail end of Q2 2025, and so you saw the negative 1.4 percent EBITDA margin back in Q2. Those actions took place really across the back half of 2025, and ultimately that's what you're seeing kind of show up in the P&L here in 2026 in terms of profitability and that 20 plus percent EBITDA margin.

Thank you, Travis. At this time, I'm showing no further questions in the queue. So this will conclude the Globus medical earnings call. Thank you for your participation today. You may now disconnect.