Earnings Call Transcript - SIBN Q2 2022

Operator, Operator

Good afternoon, and welcome to SI-BONE's Second Quarter Earnings Conference Call. At this time, all participants are in listen-only mode. We will be facilitating a question-and-answer session towards the end of today’s call. As a reminder, this call is being recorded for replay purposes. I would now like to turn the call over to Matt Bacso from the Gilmartin Group for a few introductory comments.

Matt Bacso, Gilmartin Group

Thank you for participating in today's call. Joining me are Laura Francis, Chief Executive Officer; and Anshul Maheshwari, Chief Financial Officer. Earlier today, SI-BONE released financial results for the quarter ended June 30, 2022. A copy of the press release is available on the company's website. 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. Any statements contained in this call that relate to expectations or predictions of future events, results or performance are forward-looking statements. These forward-looking statements are based on the company's current expectations and inherently involve risks and uncertainties. These risks include the impact of the COVID-19 pandemic on the ability and desire of patients and physicians to undergo and perform procedures using the company's products, the duration of the COVID-19 pandemic and whether the COVID-19 pandemic will recur in the future. Other forward-looking statements include our examination of operating trends and our future financial expectations such as expectations for hiring, surgeon training and adoption, active surgeons, new products, clinical trial enrollment and reimbursement decisions and are based upon our current estimates and various assumptions. These statements involve material risks and uncertainties that could cause actual results or events to materially differ from those anticipated or implied by these forward-looking statements. Accordingly, you should not place undue reliance on these statements. 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. SI-BONE disclaims any intention or obligation, except as required by law, to update or revise any financial projections or forward-looking statements whether due to new information, future events or otherwise. This conference call contains time-sensitive information and is accurate only as of the live broadcast today, August 8, 2022. And with that, I'll turn the call over to Laura.

Laura Francis, CEO

Thanks, Matt. Good afternoon, and thank you for joining us. For today's call, I'll provide a business update, and Anshul will provide additional detail regarding our financial results. Before I cover our record second quarter results, let me highlight some recent wins for the company. At the end of May, we received FDA 510(k) clearance for iFuse Bedrock Granite, our breakthrough product that is intended to provide SI joint fusion in addition to sacropelvic fixation for adult spinal deformity procedures. This clearance follows the earlier designation by the FDA of iFuse Bedrock Granite as a breakthrough device. In August, CMS published the final decision, confirming the new technology add-on payment, or NTAP, of up to $9,828 for eligible cases using iFuse Bedrock Granite. The NTAP will be exclusive to iFuse Bedrock Granite and become effective October 1, 2022, for a period of up to 3 years. Based on the initial strong surgeon reception, we're really excited about the potential for iFuse Bedrock Granite to accelerate our penetration into a highly synergistic $250 million adult deformity market. In mid-June, we received FDA clearance for expanded indications of iFuse-TORQ for pelvic fracture fixation, including acute, nonacute and nontraumatic pelvic fractures. iFuse-TORQ was previously cleared for both SI joint fusion and fracture fixation. With this expanded clearance, we can now promote the use of iFuse-TORQ for treatment of patients with fragility and insufficiency fractures of the pelvis, which are fractures caused by low energy traumatic events. We estimate this patient population accounts for $300 million of our $350 million market opportunity. We believe the expanded indication will accelerate our growth in the trauma market as iFuse-TORQ's unique osseointegration features will be effective options to remobilize patients, many of whom have osteoporosis, who are suffering from fracture-related pain and disability, thereby improving quality of life while simultaneously reducing rehospitalization, which can provide cost savings to the healthcare system. We're confident that the clearance of iFuse Bedrock Granite and the expanded trauma indication for iFuse-TORQ will complement our core market and be catalysts for strong future top-line growth. Now moving to our performance in the second quarter of 2022. In the second quarter, we generated worldwide revenues of $25.6 million, representing growth of approximately 15% compared to the second quarter of 2021 and 14% growth over the first quarter of 2022. In the U.S., our revenue grew 18% in the quarter compared to a prior year period to a record $23.8 million, which was driven primarily by the robust demand for our procedures. We're pleased with the 23% U.S. procedure volume growth in the quarter, especially when considering that healthcare providers continue to navigate capacity and staffing issues due to the pandemic. We believe that the outpatient nature of our procedure, combined with the solid execution by our dedicated field organization, contributed to the robust volume growth. We exited the quarter with strong operating momentum with June being the highest procedure volume month in the company's history. Additionally, anecdotal feedback from surgeons suggests that the new patient funnel continues to grow, indicating that we're progressing towards a more normalized operating environment. Now let me provide you an update on our key initiatives as we look to extend our leadership position and drive long-term durable growth. Starting with sales infrastructure. Our dedicated sales force remains an important driver of growth as we expand our core market and grow our presence in trauma and adult deformity. Our sales force at the end of the second quarter included 85 territory managers and 76 clinical support specialists. In addition to growing our sales force to ensure high-quality coverage for surgeons, we remain focused on territory manager productivity. We're confident that the selective expansion of our sales force and improving territory management productivity will continue to support our surgeons and deliver strong top-line growth. Moving on to surgeon engagement, we ended the second quarter with a record 720 active surgeons who performed at least 1 procedure in the quarter. In addition to surgeon growth, we're also encouraged by the high single-digit increase in surgeon utilization, which reaffirms that our healthcare provider engagement initiatives and our expanded portfolio offering are working. We believe surgeon adoption and improving utilization are strong positive leading indicators of procedure demand for the rest of 2022 and beyond. Our expanding product portfolio positions us to accelerate surgeon engagement and activation as we progress through the year. We continue to experience a steady increase in the adoption rate of surgeons who have been trained on the simulator, which remains a valuable component in our surgeon training programs. Moving forward, we expect to leverage our simulator training along with in-person local training and regional training to drive cost-effective surgeon engagement. We also continue to expand our academic programs to educate residents and fellows. Since inception of the program, we've held training events in approximately 200 academic facilities in the U.S. and trained approximately 1,100 surgical residents and fellows. In the academic year that ended June 2022, we trained approximately 500 residents and fellows, demonstrating the growing interest in our products within academic facilities. Additionally, education on Bedrock and iFuse Bedrock Granite are now integral elements to each training. We're encouraged by the steady increase in these previously trained fellows and residents converting to active surgeons as they begin practicing. Turning to products and solutions, we're pleased with the strong performance of iFuse-TORQ, which delivered record revenue in the quarter. The strong uptake of iFuse-TORQ in the last 12 months reaffirms that our portfolio diversification strategy is resonating with our surgeons. With the expanded indication, we're excited about the potential opportunity in trauma for iFuse-TORQ to treat sacral fragility and insufficiency fractures, which are currently estimated to have an incidence of approximately 120,000 injuries per year in the U.S., most of which are currently not treated surgically. This fragility fracture market is of strategic importance since over 75% of patients with this condition are initially treated with Bedrock and have over a 25% 1-year mortality rate. With the indication on label, we've increased our targeted sales and marketing efforts to engage and educate trauma surgeons and believe trauma provides a huge growth opportunity for the company. More to iFuse Bedrock Granite. We're pleased with the strong initial reception for this unique solution that combines the strength of a solid implant with the porosity of 3D printed technology. iFuse Bedrock Granite was developed to address the surgeon's preference to augment stability at the base of long constructs used to treat adult spinal deformity. With an increasing user base of more than 300 surgeons who have performed a Bedrock procedure since 2019, we're optimistic about the adoption of iFuse Bedrock Granite. We also believe there will be a subset of surgeons who will want to use some combination of our products to get 2 points of fixation across the SI joint on either side, resulting in broader portfolio penetration and higher procedure ASP. The differentiated technology, the seamless workflow integration, and the exclusive NTAP for a period of up to 3 years provide a significant competitive advantage as we expand our presence in the adult deformity market. On the clinical research front, in June, we completed enrollment in SILVIA, a 2-year prospective international multicenter randomized controlled trial of 2 different methods for pelvic fixation in adult patients undergoing long construct spinal fusion. We anticipate the results for the primary endpoint in 2024. Consistent with our focus on clinical evidence and with the expanded iFuse-TORQ indication in place, we're in the process of initiating the SAFFRON study, a prospective randomized controlled trial of surgery using our iFuse-TORQ device versus nonsurgical management in patients with stable, but debilitating sacral fragility or insufficiency fractures. This landmark trial will enroll up to 120 patients at up to 20 sites across the U.S. We're targeting enrollment completion by the end of 2023 with early results available in late 2024. Moving to health economics and reimbursement. CMS recently posted the calendar year 2023 proposed rule for hospital outpatient and ASC payments. While preliminary, the current proposal would increase calendar year 2023 facility reimbursement for minimally invasive SI joint fusion procedures performed in ASCs and hospital outpatient settings by approximately 28% and 35%, respectively. Today, 80% of our procedures are performed in an outpatient setting or at surgery centers. As our procedures continue to move to ASCs, the potential higher reimbursement in 2023 could serve as a tailwind to demand and also allow us to maintain our pricing and site of service. In addition, in June, the American Medical Association posted its decision to add a new Category 3 CPT code or T code to describe SI joint procedures using interpositional products, more commonly referred to as dorsal allograft procedures. The AMA determined that in order to report CPT 27279, which is the current use to describe lateral iFuse procedures, a transfixing device must be used. Additionally, if the implant does not cross the SI joint and the trajectory is different from a lateral or transiliac approach than the new T code must be used. As a result, starting January 1, 2023, dorsal allograft procedures, which have no long-term evidence demonstrating durable outcomes or radiographic evidence of joint fusion, can no longer be reported as 27279 for reimbursement purposes. A recent multicenter retrospective study of 37 patients published in July highlighted that SI joint stabilization involving placement of standalone structural allografts using a dorsal approach has demonstrated complications, including persistent or recurrent postoperative pain, implant malpositioning, structural failures, and lack of joint fusion, further substantiating the AMA T code decision. Talking about our patient awareness initiative, in the second quarter, we further optimized our direct-to-patient outreach campaign, resulting in higher website traffic, patient engagement, and surgeon referrals. Specifically, our Find a Doctor locator metric continues to hit new records each month in the second quarter. We view the Find a Doctor metric as a leading indicator of patient engagement and potential future demand. As a reminder, these outreach programs are targeted at patients in chronic severe SI joint pain who have been in conservative care for an extended period. Our goal is to connect patients with surgeons in their area who perform minimally invasive SI joint procedures using our products. Before I turn it over to Anshul, I'd like to provide an organizational update. In July, Jeff Bertolini joined us as our Senior Vice President of Operations and Technology. Jeff, who was previously at NuVasive as the Vice President of Sales, Operations and Logistics, has over 25 years of experience in the life sciences and medical device industries. Given our expanding portfolio, Jeff's experience will be invaluable to optimize our supply chain and drive operating efficiencies to ensure we maintain industry-leading gross margins. With that, I'll now turn the call over to Anshul to provide more detail on our financial results.

Anshul Maheshwari, CFO

Thanks, Laura. Good afternoon, everyone. Our second quarter 2022 total revenue was $25.6 million, representing growth of approximately 15% compared to the prior year period. U.S. revenue was $23.8 million, increasing 18% compared to the prior year period. Growth in the U.S. was driven by strong demand for our solutions, which resulted in a 23% growth in procedure volumes versus the prior year period. We were encouraged by the steady sequential increase in monthly U.S. procedure volumes as we progress through the quarter, indicating that the operating environment continues to normalize. Consistent with our experience in the last few quarters, procedure volumes for minimally invasive SI joint fusion at ASCs continue to increase. ASC procedure volumes increased to the low 20% range, up from mid-teens in the prior year period. International revenue was $1.8 million, a decline of 8% compared to the prior year period. While procedure volume increased by low double-digit percent year-over-year, led by strong performance in France that was more than offset by lower ASP and FX headwinds from weakening of the euro. Gross margin for the second quarter of 2022 was 86% compared to 89% in the prior year period. The second quarter gross margin was impacted by an anticipated mid-single digit decline in ASP due to procedure and site of service mix and an increase in cost of operations to support the growth of the business, especially associated with the launch of new products and higher freight costs. Operating expenses increased 22% to $40 million in the second quarter of 2022 compared to $32.8 million in the prior year period. On a sequential basis, operating expenses grew approximately 10% compared to the first quarter of 2022. The sequential increase was driven by higher commission, increases in travel and freight costs, as well as the timing of our global sales meeting and certain training programs. As we look at the rest of the year, we expect total operating expenses in the second half of 2022 to be low single-digit percentage higher compared to the operating expenses in the first half of 2022. Our net loss was $18.5 million or $0.54 per diluted share for the second quarter of 2022, compared to a net loss of $14 million or $0.42 per diluted share in the prior year period. As of the end of the quarter, our cash and marketable securities were approximately $114.4 million and long-term borrowings were approximately $35.1 million. Our cash outflow in the first half of 2022 included over $8 million in strategic investments to support our facility expansion and build inventory and instrument trades to ensure the successful launch of iFuse Bedrock Granite and the expansion of iFuse-TORQ. Based on our anticipated investments and Q3 and Q4 operating expenses, we expect cash outflow to moderate in the second half of 2022. Moving to guidance. While we are experiencing strong demand momentum, we remain cognizant of the macroeconomic environment and its impact on healthcare. We are currently maintaining our 2022 total revenue guidance of approximately $106 million to $108 million, representing growth of 18% to 20% compared to the full year 2021. The guidance range reflects strong growth in the U.S., partially offset by foreign currency headwinds in the back half of the year. We also continue to expect gross margin to be in the mid-80% range for fiscal year 2022. With that, I will turn the call over for questions.

Operator, Operator

Our first question comes from David Saxon from Needham & Company.

David Saxon, Analyst

Maybe to start off just on procedure volumes going into the third quarter. I mean at times like June was a really strong month and returning to a more normal operating environment. How should we think about the normal seasonality we typically see in the third quarter? Are you expecting kind of a slowdown? Or do you think we could see some sequential growth, just given some of the building momentum with TORQ, Granite, and iFuse?

Anshul Maheshwari, CFO

David, I can address the question about the anticipated trends for the remainder of the year, and I appreciate your inquiry. It does feel similar to the situation we faced in 2020 and 2019, particularly due to the growth acceleration we experienced in the first half, increasing from 10% to 15%. This growth is global, with the U.S. performing even better, driven by a robust rebound in procedure volume. When we evaluate historical patterns, Q3 typically sees flat or slightly lower performance compared to Q2. However, considering the momentum we have in the business, we anticipate Q3 to show sequential growth, albeit at a low single-digit rate. Several factors contribute to this expectation. Firstly, we foresee continued strong volume in the U.S. Secondly, some staffing challenges we encountered in Q2 should begin to resolve as we move ahead, especially into Q4, where we expect a return to normality. Additionally, we faced foreign exchange challenges in Q2 that we expect will persist into Q3 and Q4. Looking at Q4, it traditionally stands out as our strongest quarter seasonally, as patients meet deductibles and elective procedures tend to increase. So, you can consider the sequential growth from Q3 to Q4 of 2022 to resemble the trends observed in 2019.

David Saxon, Analyst

Okay. That's super helpful. And then my follow-up is just on OpEx. I appreciate the color you provided in the script. Should we be starting at mid-80s for the back half in terms of OpEx? And then I guess just on the increase from the first half to second half, are you pulling forward any investments? Or is that just to support the higher revenue?

Anshul Maheshwari, CFO

Yes. So when you think about the first half OpEx, our OpEx was around $75 million, $76 million. And I'm just talking OpEx, not looking at COGS or anything. And our expectation is a low single-digit percentage increase in the second half versus the first half. If you recall, earlier in the year, we had talked about the productivity in the P&L, especially as we progress through the year, and some of that is going to play out in Q3 and Q4. And then also, there were some spend items that we knew coming into the year that would be more in the first half. We highlighted a few of those, specifically around global sales training, certain surgeon and employee training events, which don't get replicated in the second half of the year.

Operator, Operator

Next question comes from Craig Bijou from Bank of America.

Craig Bijou, Analyst

Let me start with the guidance for the second half. Based on my calculations, it's about 20% higher than the first half, which is a significant improvement. I also expect year-over-year growth to be nearly double what it was in the first half. I recognize the optimism you're expressing about the field performance, but I would appreciate more details on what supports your confidence in the expected increase. Furthermore, regarding the TORQ momentum and the launch of Granite, could you clarify what's driving the increased sales in the second half, especially in terms of core sales compared to TORQ and Granite? While I know all these factors contribute, any insight into their relative impact would be helpful.

Laura Francis, CEO

Yes, thank you for the question, Craig. We are very optimistic about how the business is developing, observing strong acceleration in the second quarter along with various supportive factors we've discussed earlier. You're correct that it involves several aspects. Primarily, our core business is driving this growth, with volume growth around 23% year-over-year in the second quarter in the United States, which translates to an 18% increase in revenue. This rebound in the business is mainly related to our core operations, benefiting from a more normalized environment. Additionally, factors like TORQ have helped us convert some competitive accounts using that technology. Anshul earlier noted that prior to the COVID pandemic, we experienced a similar acceleration in our core business, which at the time was solely our iFuse-3D product. Beyond this core growth, we have two additional opportunities that emerged in the last month of 2022. One is our Granite product for adult deformity, which addresses an unmet clinical need by providing fixation and fusion for spinal pelvic cases for the first time. There is a significant demand for this, as failures in long constructs, such as screw loosening and rod breakage, result in revision rates over 20%. We have also been collaborating with over 300 surgeons for nearly three years, who have expressed interest in this product. Granite represents a substantial advancement, integrating with long constructs and offering numerous advantages, including economic benefits associated with NTAP.

Craig Bijou, Analyst

I appreciate the information you've provided regarding operational expenses and your insights on the second half of the year. I understand you won't give guidance for 2023, but I would like to know how we should view your potential for operating leverage moving forward. Given that you anticipate some operating leverage in the latter half of this year, is there a chance we could see an increase in that leverage in 2023? Additionally, how do factors like inflation and other challenges impact your ability to achieve operating leverage in 2023 and possibly beyond?

Anshul Maheshwari, CFO

Yes, Craig, thanks. You're right; we're not going to be providing 2023 guidance at this point. But as we think about our business, and you look at the last 24 months, we've made a significant amount of investment to build out our commercial organization, to build a supporting operating infrastructure. We've continued to invest in R&D, and we've actually built a very solid foundation to be able to deliver strong sustainable growth as we come out of the pandemic into a more normalized environment. And we're getting to a scale now, Craig. We think about it as an inflection point where we're not focused on gaining leverage on that P&L. So as we think about 2023, you're not going to see us not invest in items that we now deliver top line growth. So R&D, Laura talked about a couple of examples of Granite and TORQ and what impact it can have on the business. So R&D will remain a very crucial investment for us in 2023 as well. And then it's going to be a lot of selective addition to our sales force. We've grown our sales force over 30% last year. And as that sales force matures, and you combine that with the broader portfolio that allows for deeper surgeon engagement and high utilization, both of them give us confidence in productivity growing as we get into Q4 and then accelerating into 2023, especially as we look to get to that adjusted EBITDA breakeven over time. So feel really good about the setup that we have and now it's about monetizing the investments that we've made, Craig.

Operator, Operator

Our next question comes from David Rescott from Truist Securities.

David Rescott, Analyst

I guess, first, on the reimbursement front. Obviously, that's been an expanding reimbursement for investment there. It's been a tailwind in the business over the past several years, and the proposals to increase reimbursement by 28% and 35% ASC outpatient setting next year is obviously a positive. So I guess, first, congrats on that. But just wondering how you're thinking about that at this point. And how we should be thinking about this either driving increased utilization, explain the active surgeon base. Just wondering how that improvement next year would impact the business.

Laura Francis, CEO

Thanks, David. So as you said, CMS recently proposed 2023 facility payment increases of 28% and 35% in ASCs and in the hospital outpatient settings, respectively. So the final proposal won't be out until November. So we don't want to speculate on that, but historically, the final rulings have not been materially far from the proposal. So that obviously is a significant increase. We think it's going to be significant to surgeons. We think it's going to be significant to hospitals and to surgery centers. In our case, 80% of our procedures are already in surgery centers or hospital outpatient facilities. So our procedure is already economically attractive at all sites of service, but assuming that the final decision is close to the current proposal, we do think that it's going to be beneficial for facilities that have been dealing with pressures from inflation and from COVID that, that is going to be a factor that they'll be considering. And then we think it should be accretive to our revenues as well in terms of demand or also potentially reduced ASP pressures as well at these various sites of service, especially as we continue to see a shift of procedures to ASCs.

David Rescott, Analyst

Okay. That's helpful. And I guess sticking on reimbursement. So this new AMA temporary code is expected to go into place next year. Just wondering if that is something that is specific to the iFuse product versus typical S2AI screws next year? And is there a significant difference in the reimbursement between those 2 segments? And how does that help you guys into 2023?

Laura Francis, CEO

Yes. Our iFuse product is a transfixing implant placed by a surgeon across the joint, typically with three implants placed laterally. This aligns with the description of CPT code 27279. The AMA has decided to establish a Category 3 code, rather than a permanent Category 1 code, for what is commonly known as the dorsal allograft procedure. This involves a posterior approach across the ilium to the sacrum at the SI joint, contrasting with the lateral approach used with our product. Due to a lack of evidence for these procedures and differences from minimally invasive lateral SI joint procedures like iFuse, the decision for a Category 3 code was made. We do not sell these dorsal allograft products or procedures; our iFuse product is strictly a transfixing lateral approach product. We anticipate that there will be a significant impact on reimbursement for these dorsal allograft procedures. We do not believe that commercial payers will cover the new T code in the near future, marking this as a significant development.

Operator, Operator

The next question comes from Drew Ranieri from Morgan Stanley.

Andrew Ranieri, Analyst

Just maybe one on the Bedrock NTAP. Just reading through the documents, it looks like CMS might have been expecting like 1,400 cases in the first year. Is that kind of how we should be thinking about the rollout? And Laura and Anshul, I mean would you be disappointed if you were only doing that level of Bedrock cases over the next 12 months, just given the significance of the product?

Laura Francis, CEO

Thank you for your question, Drew. Yes, you are correct that the information can be found in the federal register. The main issue is understanding the actual demand for the product. Bedrock is designed to meet an important clinical need related to screw loosening and the breakage of rods in about 30% of adult deformity cases, with over 20% of these needing revisions. Our product represents a major advancement because it offers both fixation at the base of long constructs and promotes fusion. We estimate that there is a market opportunity of around $250 million, targeting approximately 33,000 adult deformity cases that involve the base of the spine in these long construct scenarios. The key question is how quickly we can capture this market opportunity. As previously mentioned, we have an advantage because of our initial Bedrock technique; surgeons have utilized our iFuse-3D product at the base of long constructs and have already worked with over 300 of these surgeons on such procedures. They are already familiar with it. Granite introduces significant improvements as it integrates with the long construct and provides numerous benefits, including the economic advantages associated with the NTAP.

Andrew Ranieri, Analyst

Great. Laura, maybe just kind of thinking about R&D for a moment and just hearing Anshul's comments that you're going to continue to spend into next year on R&D. You just got a new indication for TORQ, Bedrock Granite and the NTAP. Just curious kind of what's next in the product portfolio as you're kind of shifting maybe more of the portfolio to trauma? Any additional products that we should be thinking about in the back half of the year into 2023?

Laura Francis, CEO

Thanks, Drew. So we're not talking about future launches. As you know, we are pretty tight with those sorts of announcements. But what I will say is that we are a sacral pelvic surgical solutions company. What we've done is really identified a space that was not well served by other companies in this space, and we have become the experts in the sacral pelvic space. So it all started out with our core products, our iFuse product and iFuse-3D targeting minimally invasive SI joint fusion. Then with our launch of TORQ around a year ago, also targeting the core market, but trauma as well. The new indication over the last few weeks really opens up that pelvic grain fracture market for us, and now with the Granite launch focusing on adult deformity. So what you can expect to see is for us to continue to, first of all, focus on the development of our core market. There's a multibillion-dollar market opportunity there. We have a very strong position. We're the clear market leader in this space. Our best estimate is that we have close to 70% market share in our core market, but we are diversifying our products and our business as well through TORQ and Granite by capturing more of this opportunity in sacral pelvic surgical solutions. So that's really the focus for our business. You can see that it's innovative product that's differentiated and putting us in a position of addressing unmet clinical needs where others have not.

Operator, Operator

The next question comes from Dave Turkaly from JMP Securities.

David Turkaly, Analyst

Great. Laura, maybe as we're looking at product differentiation, obviously, the original iFuse-3D was a lot different than other things out there, but some competitors did launch products that arguably are not at the same caliber without the data. But when you look at TORQ and Bedrock, I just like to get your thoughts sort of on iFuse protection and then competitors' responses. Is anyone else looking at these opportunities and maybe coming with products they already have approved? Or are you aware of anyone else maybe tweaking what they have today to potentially come at some of these opportunities as well? Or do you feel like you're really the game in town?

Laura Francis, CEO

Thank you. David, it's a good question that you're asking. And as I said as a response to the last question, we really are all about the differentiation of our products, protecting them with patents. In addition, having the most clinical data on these products and conditions that we can. So now over 100 peer-reviewed published papers at this point on our various products, techniques, biomechanics, economics, and so on. And so we're differentiating ourselves through product, patents, clinical data, education, sales force, and we really are unique in the industry from this perspective. There are others that are certainly trying to follow us into these areas. But in each case, what we do is we've built a lot of moats around our businesses. So in the case of iFuse-3D, the clinical data, the exclusive reimbursement, the patents that we have. In the case of Granite that we just talked about, the product itself, the breakthrough device designation, the NTAP that's out there. And if you look at the results of what we've done, we have seen our market share grow from the time that we became a public company where we were in the mid-50s to now approaching approximately 70%. So it really does tell you that we are developing strategies that are winning in the marketplace. And so our goal now is not so much to be capturing more market share; our goal is to grow the market overall in our core business and then to exploit the markets in adult deformity fixation, infusion, as well as with fragility fractures and trauma. These areas are unmet clinical needs that we are addressing with unique products and with a lot of data and education to support our positions.

Operator, Operator

There are no more questions in the queue. This concludes our question-and-answer session. I would like to turn the conference back over to Laura Francis for any closing remarks.

Laura Francis, CEO

Thank you, and thanks to all of you for joining us on the call today. As I've talked about, we have several tailwinds that we believe are going to accelerate our revenue growth over the next 18 months, and that includes our increasingly productive sales force, our new product launches, a favorable reimbursement landscape, and indication expansions into attractive new markets. We look forward to seeing you all at the upcoming Canaccord Conference in Boston, the Morgan Stanley Conference in New York as well as the Needham Virtual Conference. Thanks again, and goodbye.

Operator, Operator

The conference has now concluded. Thank you for attending today's presentation. You may now disconnect.