Globus Medical closed 2025 with a record fourth quarter, posting revenue of $826.4 million (up 25.7%) and non-GAAP EPS of $1.28 (up 52.1%), and full-year revenue of $2.939 billion with non-GAAP EPS of $3.98. U.S. spine grew about 10% for a third straight quarter, Enabling Technologies hit record revenue as elongated deals closed, and Nevro turned EPS accretive within nine months while base-business adjusted EBITDA returned to the mid-30s. Management guided FY2026 to mid to high single-digit base sales growth and at least 100 bps of gross margin expansion to 69%-70%, while flagging continued Nevro lumpiness and a higher mix of capital leases.
Thank you, Dana. Thank you everyone for being with us today. Joining today's call from Globus Medical will be Keith Pfeil, President and CEO, and Kyle Kline, 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 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 GAAP 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 Pfeil, our President and CEO.
Thanks, Brian, good afternoon, everyone. Momentum seen coming out of our second quarter continued and accelerated as we progressed through 2025, resulting in a record Q4 performance. Our team delivered, showing great poise and determination during a period of growth and change. I'm proud of our team, I'm thrilled to be here today discussing these results as well as provide insights into the future. Focusing first on our top-level financial performance for the full year 2025, Globus delivered $2.939 billion of revenue and $3.98 of fully diluted non-GAAP earnings per share, growing 16.7% and 30.8% as reported, respectively. Full year 2025 base business revenue, excluding the contributions from Nevro, grew 5% as reported, with Nevro adding $293.6 million in revenue for the full year.
Shifting into Q4, revenue totaled $826.4 million, growing 25.7% versus the prior year quarter, while non-GAAP EPS finished at $1.28, growing 52.1% versus Q4 2024. Digging into this further, our base business revenue of $726.7 million grew 10.6% versus the prior year quarter and included double-digit U.S. spine growth, as well as record Enabling Technologies revenue for the quarter. This performance serves to underscore my opening comments on the growing momentum in our business. Looking at the second half of 2025 versus the second half of 2024, our consolidated base business grew organically at 8.8%.
This, coupled with continued back-end execution, helps propel us to our sixth consecutive quarter of adjusted gross margin rate expansion, as well as returning the base business to mid-30s adjusted EBITDA, finishing at 35.7% in Q4 2025 and 33.4% for the full year. When we announced the NuVasive merger, we emphasized its compelling financial profile for shareholders and specifically cited our focus on delivering mid to high single-digit sales growth, as well as a mid-30s adjusted EBITDA profile by the end of the third year. Our Q4 and full year 2025 results demonstrates our performance against those objectives. Our U.S. spine business grew 10% in Q4 as compared to the prior year quarter, coming off a third quarter where U.S. spine also grew 10% versus the prior year third quarter.
We've seen this trend continue and now sit at 48 weeks of consecutive growth, with this momentum continuing thus far into our first quarter of 2026. We remain encouraged by this early look into the new year. Top to bottom, our spine business is executing. Commercially, we are meeting the needs of our customers while remaining aggressive on the recruiting front. Operationally, we've leaned into inventory and set production to feed this growth, instilling confidence in the sales force while ensuring we can meet the needs of our customers and the patients they serve. Looking across our U.S. spine product portfolio, growth was seen in the quarter across substantially all of our product categories, demonstrating the broad nature of this momentum.
However, I do want to highlight the continued success for our expandable TLIF products, including products such as SABLE, RISE, ALTERA, TLX, MODULIS, and CALIBER, our MIS pedicle screws, including CREO MIS, Reline MAS, CREO ONE, Reline-O, and REVOLVE, and our line of power tools, including DuraPro. Surgeons continue to provide positive feedback on DuraPro, specifically highlighting the ability to cut and remove bone around the neural elements, allowing them to feel more confident in the safety for their patients. Features such as proprietary brushes are helping to facilitate the removal of degenerated discs in a safer, more controlled fashion compared to the traditional methods and allowing them to perform these removals in less time. Overall, our investment in sets and inventory around these key products has fostered their continued growth and positions us well to use these products to springboard additional growth in 2026.
We launched a total of six products in spine during 2026, with four of those launches occurring in Q4, which are CREO Traction, Reline 3D Towers, AMS FreeHand instruments, and HEDRON C-MIS. CREO Traction is a reduction instrument system used with CREO screws and deformity correction. Reline 3D Towers are part of the Reline 3D pedicle screw system and are used for deformity and MIS fixation cases and enable MIS rod placement. AMS FreeHand is a software and instrumentation systems to use all of our AMS spacer portfolio with the EGPS and EHub systems. This completes the core Nuva products to be used with our EGPS, EHub, and E3D ecosystem. HEDRON C-MIS is a 3D printed cervical fusion spacer designed to stabilize cervical vertebra and promote bone growth and fusion, which uses a biomimetic lattice designed to promote bone growth onto and through the implant.
Spine product development remains a focal point moving forward as we step up our investment to bring new and exciting products to market, aligning with our reputation of leading with innovation. Q4 enabling technology sales were $55.6 million, growing 18.5% versus the prior year quarter, driven by increased sales of EGPS systems. We saw pipeline deals close during the quarter, which had been part of the elongation that we had experienced during the year. Examining further, the deal composition of capital sales during the quarter were primarily cash deals with immediate revenue recognition. Consistent with my comments last quarter, we remain nimble in how capital deals are structured and are quoting new pipeline deals with greater flexibility. We are positioned well and remain positive on this business as we enter 2026.
The Excelsius platform, which delivers a single vendor spine ecosystem across capital, implants, and software, provides for consistent workflow, data continuity, and training across the OR. When stepping back and looking at the broadening competitive I&R landscape, Globus continues to stand alone when it comes to effortlessly pairing imaging, navigation, and robotics together. Recent competitive offerings cleared only serve to reinforce the workflow of ExcelsiusGPS, which was introduced in 2017 as a floor-mounted, navigation-based robotic approach. If a surgeon desires robotic navigation and imaging, they can pair an EGPS with an E3D, bringing together best-in-class robotic functionality and state-of-the-art intra-op imaging capabilities, working seamlessly together. If the surgeon desires freehand navigation, they can combine the ExcelsiusHub and the XR augmented reality headset with the E3D imaging system. The features and benefits of these products working seamlessly together is second to none.
In a continually evolving market, ExcelsiusGPS remains one of a kind. As a reminder, ExcelsiusGPS is one mobile unit with all of its technologies contained within a native unified platform. In addition to spine, the EGPS robot has cranial applications and other orthopedic indications utilizing IP-protected advanced navigation features essential for safety, including surveillance markers, deflection and offset meters, as well as a tracked end effector. EGPS remains standalone in that it is a surgeon-controlled system via our draped touchscreen monitor, which is in the surgical field. All of this pairs with our industry-leading and continually refreshed implant portfolio. Pairing the features of the Excelsius suite of technologies, along with pricing and deal flexibility, our team is unbridled to aggressively go after market share and drive adoption.
A key focal point in 2026 is to penetrate and launch new programs and foster utilization and service excellence across the install base. To date, we've seen over 120,000 procedures and will continue to drive adoption as we move forward. Enabling technologies have and will remain a vital part of our ecosystem as we view it as the execution layer, helping to achieve improved surgical outcomes. We will continue to innovate with focus, speed, and execution, leveraging our resources to efficiently deliver solutions to address unmet clinical needs. Our trauma business delivered approximately 27% growth in Q4 versus the prior year quarter, driven by continued uptake of our legacy trauma line, as well as our precise limb lengthening products.
Looking back on 2025, our strategy of focusing on level one and level two trauma centers has shown results, coupled with meaningful product launches, including our ANTHEM elbow plating system, which was launched in the third quarter of 2025. This product has exceeded our expectations thus far in both revenue and sheer demand. While this helps to further fill our bag, increasing our ability to bid on primary or preferred vendor contracts, it is also a perfect example of Globus driving innovation in an established category. We will capitalize on this demand and continue to launch new products as we enter into 2026. The Nevro business delivered $99.7 million of revenue during the quarter, and adjusted EBITDA of 21.2%. Looking ahead, we remain positive on this business as we finalize its integration to ultimately drive profitable sales growth.
This path to growth may not be linear in the short term, but our expectations are high over the long term. We will focus on developing new SCS products, provide mechanical solutions, cross-sell with legacy Globus products while researching other types of neuromodulation devices. This, coupled with a renewed focus on competitive recruiting, are steps that will be taken over the medium to long term. Overall, we are thrilled to have this technology in our portfolio as it provides us with the ability to enter a market adjacency while expanding our continuum of care. As I reflect on Globus, I looked at 2025 and its past, as well as what I see ahead.
Thanks, Keith, good afternoon, everyone. To expand on Keith's comments, we've had a truly exceptional finish to 2025, with a record-setting quarter in both top and bottom-line results. Operationally, we continued to execute our integrations of the recent merger and acquisition of both NuVasive and Nevro. Our revenue growth was driven by our domestic spine business, growing 10% over the fourth quarter of 2024, and continuing to build upon the trend of above-market growth seen in Q2 and Q3 of this year. Our enabling technologies business also saw record growth, achieving over $55 million of revenue in the quarter, while posting record sales in terms of dollars and units. As we've mentioned in our Q3 earnings call, we updated our guidance to indicate our expectation was that Nevro would be accretive to earnings in the first nine months post-acquisition.
Today, I'm affirming that the Nevro business was EPS accretive within the first nine months post-acquisition. This is a phenomenal achievement by the broad Globus and Nevro teams, beating initial guidance by 15 months. Today's discussion will focus on providing insights into our quarterly and annual business performance, including the impacts of Nevro, a look back on synergy execution against our two most recent acquisitions, and an update on guidance for 2026. Full year 2025 revenue was $2.939 billion, growing 16.7% on an as-reported basis and 16.2% on a constant currency basis. Net income was $537.9 million, resulting in $3.92 of fully diluted earnings per share.
Non-GAAP net income was $545.6 million, delivering $3.98 of fully diluted non-GAAP earnings per share, or 30.8% of non-GAAP EPS growth over the prior year. Full-year adjusted EBITDA was 31.3%. Focusing on our fourth quarter results, revenue was $826.4 million, growing 25.7% on an as-reported basis and 24.7% on a constant currency basis as compared to the fourth quarter of 2024. GAAP net income in the fourth quarter of 2025 was $140.6 million, and GAAP fully diluted earnings per share was $1.03.
non-GAAP net income was $174.6 million, compared to $117.4 million in the prior year quarter, growing 48.7%. Our fully diluted non-GAAP earnings per share were $1.28, growing 52.1% over the prior year quarter. Consolidated adjusted EBITDA margin was 33.9%. Our Q4 2025 base business, Globus adjusted EBITDA margin, was 35.7%. Standalone Nevro adjusted EBITDA margin was 21.2% for the quarter, further expanding from the 16.2% adjusted EBITDA margin achieved in the third quarter of this year.
Our fourth quarter net sales of $826.4 million reflect base business Globus sales totaling $726.7 million, growing 10.6% as reported and on a day-adjusted basis, with the same number of selling days in the U.S. and International and Japan compared to the prior year. The growth in our legacy Globus sales was primarily driven by U.S. spine, which achieved 9.7% as-reported growth, enabling technologies which achieved 18.5% as-reported growth, and trauma, which achieved 26.8% as-reported growth. Nevro contributed $99.7 million of revenue during the quarter. Musculoskeletal revenue was $770.8 million, growing 26.3% over Q4 2024.
Legacy Globus Musculoskeletal revenue was $671.1 million, growing 9.9% as reported. Enabling Technologies revenue was $55.6 million, growing 18.5% as reported. As mentioned in my opening statements, Enabling Technologies achieved record sales in terms of dollars and units for both the total capital portfolio and our ExcelsiusGPS robotic system. U.S. revenue during the fourth quarter of 2025 was $665.3 million, growing 27.5% as reported. Legacy Globus U.S. revenue during the fourth quarter of 2025 was $576.6 million, growing 10.5% versus the prior year quarter. Our legacy Globus U.S. growth was primarily driven by our U.S. spine, neuromonitoring, trauma, and enabling tech businesses.
Our U.S. spine business continued the trend of above-market growth for the third straight quarter, achieving 9.7% as reported growth after notching 9.6% as reported growth in the third quarter and 7.4% day adjusted growth in the second quarter of this year. Q4 2025 international revenue was $161.1 million, growing 19% as reported and 14.2% on a constant currency basis. International revenue for the legacy Globus business was $150.1 million, growing 10.9% as reported and 6.5% on a constant currency basis compared to the prior year quarter. International growth was seen across the board, led by our enabling technologies and international spine businesses, headlined by the United Kingdom, Australia, Germany, Brazil, Mexico, and Poland.
As previously mentioned in 2025, our international spine business was impacted by supply chain shortages early in the year. Despite these challenges and the above-market growth in the U.S., which was prioritized from a supply chain perspective, we saw incremental improvement in each sequential quarter within the legacy Globus international spine business, culminating with a record sales quarter in the fourth quarter of 2025. GAAP gross profit margin in the quarter was 65.7%, compared to 57.2% in the prior year quarter, with the resulting improvement driven primarily by lower inventory step-up amortization. Adjusted gross profit margin was 69.2%, compared to 67.1% in the prior year quarter, primarily driven by favorable sales mix, sales leverage, and the impacts of synergy execution. Our legacy Globus adjusted gross profit margin was 68.7%.
Full year GAAP gross profit margin was 64.3%, compared to 55.6% in 2024. Full year adjusted gross profit margin was 68.1%, compared to 67.4% in 2024. We've seen improvement in adjusted gross profit metrics over each of the prior six sequential quarters as we've leaned into manufacturing initiatives, driving improvement quarter after quarter as we build back to a mid-70 adjusted gross profit target. We've seen impacts in cash spending on inventory and lower inventory on our balance sheet and have steadily seen the impacts in our adjusted gross profit margin.
As we look ahead to 2026, we expect at least a 100 basis point improvement on adjusted gross profit, with our full year adjusted gross margin landing in the range of 69%-70% as we continue to benefit from actioning manufacturing initiatives. We reiterate our long-term goal for mid-70s adjusted gross profit percentage, noting that the foundation has been laid over the past year to achieve this goal. Research and development expenses in Q4 2025 were $36.2 million, or 4.4% of sales, compared to $33.4 million, or 5.1% of sales in the prior year quarter. Legacy Globus R&D expenses totaled $32.1 million, or 4.4% of sales.
The resulting decline in legacy Globus R&D, both in dollars and as a percentage of sales, is attributable to synergy capture, resulting in lower headcount and leverage from higher sales volume. Nevro R&D was $4.1 million, or 4.1% of Nevro sales. Full year research and development expenses in 2025 were $147.2 million, or 5% of sales, compared to $163.8 million, or 6.5% of sales in 2024. Recall that 2024 R&D costs included an acquisition of in-process research and development worth $12.6 million. Without this charge, research and development expenses were $151.1 million, or 6% of sales.
We look ahead to 2026, we expect R&D expense to be in the range of 5%-6% of net sales as we ramp spend to further invest in innovation and technological advances in the spine, orthopedic, robotic, and the broader Musculoskeletal markets. SG&A expenses in the fourth quarter of 2025 were $318.5 million, or 38.5% of sales, compared to $253.2 million, or 38.5% of sales in the prior year quarter. Legacy Globus SG&A expenses were $268.7 million, or 37% of sales. Current period SG&A expenses included one-time net charges for estimated litigation of $13.4 million.