Our first quarter results demonstrate our ongoing focus as we continue to scale and capture share while maintaining operational discipline, driving margin expansion, favorably impacting Q1 and our full-year results looking ahead. As we progress through 2026, look for market share taking top-line growth coupled with exciting product launches while increasing gross margins and driving meaningful earnings expansion. We sit here today debt-free, generating significant free cash, and have launched over 30 new products during this timeframe. Turning attention to our top-level performance, Q1 revenue totaled $759.9 million, growing 27% as reported and 25.5% on a constant currency basis.
Fully diluted non-GAAP earnings per share was $1.12, growing 64.7% over the prior year quarter. Digging further into US Spine, this business continues to show strength and resilience as it grew 10% in Q1 versus the prior year quarter, marking the third consecutive quarter of 10% growth. We've seen this momentum continue and are now sitting at 58 weeks of consecutive growth. Cross-selling, competitive recruiting, and robotics pull-through are key to this strategy as we continue to capture volume and drive meaningful share growth across the category.
Robotics pull-through remains a key driver, and as we demonstrate greater flexibility in how customers acquire capital, we seek to more aggressively drive the recurring revenue, whether through implants, disposables, service, or case coverage. Our first quarter saw Enabling Technologies post revenue of $26.9 million, growing 21% over the prior year quarter. However, the mix of pipeline deals is shifting with a greater focus on leases and rentals compared to the historical mix of outright sales, which historically resulted in higher upfront revenue recognition. Our international spine business grew 16.4% as reported and 9.8% on a constant currency basis, as we did not repeat the supply chain disruptions which occurred in the first quarter of the prior year.
| Metric | Period | Current guidance |
|---|---|---|
| Adjusted gross profit margin | FY2026 | 69%-70% (reiterated) |
| R&D expense | FY2026 | 5%-6% of net sales (reiterated) |
| Non-GAAP EPS | FY2026 | raised again (third time this year per analyst) (raised) |
| Total revenue | FY2026 | reiterated (reiterated) |
| Metric | YoY | Note |
|---|---|---|
| Total revenue | +27% as reported (+25.5% constant currency) | Strength across substantially all underlying businesses plus Nevro contribution |
| Base business revenue | +13.2% as reported | Led by U.S. Spine, with improved Enabling Technologies and international spine |
| U.S. Spine | +9.6% as reported (~10%) | Cross-selling, competitive recruiting, and robotics pull-through driving share gains |
| Trauma | +30.4% | Core trauma share taking plus Precice limb lengthening, with ANTHEM elbow plating exceeding expectations |
| Enabling Technologies | +21.1% as reported | Bounce back in sales dollars and units versus a softer Q1 2025, primarily cash sales |
| International spine | +16.4% as reported (+9.8% constant currency) | Did not repeat prior-year Q1 supply chain disruptions; strength in EMEA and LATAM |
| Adjusted gross profit margin | 69.2% vs 67.3% | Fixed cost leverage from higher sales, favorable mix, and synergy execution |
| Topic | Previous mention | Current period | Trend |
|---|---|---|---|
| Enabling Technologies capital strategy | Focus on outright robot sales with higher upfront revenue recognition | Greater flexibility with higher mix of leases and rentals to drive implant pull-through | Shifting |
| U.S. Spine momentum | Two prior quarters of 10% growth | Third consecutive quarter of 10% growth, 58 weeks of consecutive growth | Sustained |
| Gross margin trajectory | Sequential improvement each quarter from Q3 2024 | Maintained 69.2% from Q4 to Q1, targeting mid-70s long term | Improving |
| Nevro integration | Cost actions drove EPS accretion in first three quarters of ownership | Cost control sustained but revenue declined as anticipated; expected to worsen before improving and return toward historical norms late in 2H | Lumpy |