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Globus Medical (NYSE: GMED) reported a strong start to 2026, with first-quarter revenue and earnings rising sharply as the company pointed to continued momentum in U.S. spine, margin expansion and contributions from its Nevro acquisition.
President and Chief Executive Officer Keith Pfeil said the company is “moving with purpose and in the right direction,” citing market share gains, new product launches and operational discipline. He also highlighted progress since fiscal 2022, including that revenue has more than tripled, free cash flow has increased sixfold, nearly $1 billion in debt has been extinguished and more than $600 million has been used to repurchase over 10 million shares.
For the first quarter, Globus reported revenue of $759.9 million, up 27% on a reported basis and 25.5% on a constant-currency basis. GAAP net income was $124.3 million, or $0.90 per diluted share.
Non-GAAP net income was $154.9 million, resulting in fully diluted non-GAAP earnings per share of $1.12, up 64.7% from the prior-year quarter.
Globus’ base business revenue totaled $677.2 million, up 13.2% as reported. Pfeil said U.S. spine revenue grew 10% in the quarter, marking the third consecutive quarter of 10% growth, while Chief Financial Officer Kyle Kline cited 9.6% as-reported growth for the category.
Pfeil said the U.S. spine business has now recorded 58 consecutive weeks of growth. He attributed the performance to cross-selling, competitive sales representative recruiting and robotics pull-through. Growth was described as broad across categories including standard fixation, minimally invasive pedicle screws, expandable TLIF, ALIF, posterior cervical and cervical plating.
During the question-and-answer session, Pfeil said most of the U.S. spine growth was coming from share gains, estimating the underlying market was growing “3%, give or take.”
International spine revenue increased 16.4% as reported and 9.8% on a constant currency basis. Pfeil said the company did not repeat the supply chain disruptions that affected the prior-year quarter and noted strength in the EMEA and LATAM regions. Kline said international growth was broad-based, including direct and distributor businesses, and that the company is working to finalize international integrations in the second half of 2026.
Enabling Technologies revenue was $26.9 million, up 21.1% from the prior-year quarter. Pfeil said the company saw a typical sequential step down from the fourth quarter but maintained momentum in closing deals and expanding internationally.
Management described a shift in how Globus places its robotic systems with customers. Pfeil said the company has historically focused more on outright robot sales but is now becoming more flexible with leases and rentals. He said the goal is to increase implant and recurring revenue pull-through from implants, disposables, service and case coverage, rather than focusing solely on upfront capital revenue.
Kline noted that first-quarter Enabling Technologies results were primarily from cash sales. Both executives said the future pipeline includes a larger mix of leases and rentals, which is already included in the company’s 2026 revenue guidance.
On robot demand, Pfeil described the environment as healthy and said the company entered the year with a strong pipeline. He also said competition has lengthened the time required to close some deals as hospitals evaluate multiple offerings. Pfeil said Globus primarily competes with Medtronic in robotics and that ExcelsiusGPS remains well positioned.
Nevro contributed $82.7 million of revenue in the quarter, down $17.1 million, or 17.1%, from the fourth quarter of 2025. Management said the decline was expected as Globus continues to integrate the business and revise its selling model.
Pfeil said the company is recruiting new sales personnel, mapping product introduction plans and implementing enhanced training protocols. Globus expects Nevro to return toward a more historical revenue run rate late in the second half of the year as new associates are trained and enter the market.
Kline said Globus anticipated “lumpiness” in Nevro’s revenue in the early stages of ownership. He said Nevro revenue “will probably get a little bit worse before it gets better,” while pointing to Pfeil’s comments about improvement later in the year.
Globus reported GAAP gross margin of 66.4%, compared with 63.6% in the prior-year quarter. Adjusted gross margin was 69.2%, up from 67.3%. Kline said the improvement was driven by higher sales, fixed cost leverage, favorable sales mix and manufacturing and supply chain synergies.
The company reiterated its expectation for adjusted gross margin of 69% to 70% in 2026 and its long-term goal of reaching the mid-70% range. Pfeil said the company expects continued progress at roughly the same cadence as recent quarters, supported by supply chain initiatives. Kline said cost initiatives are a major driver, while new differentiated products may also provide opportunities for pricing premiums.
Adjusted EBITDA margin was 32.3% in the first quarter. Base business Globus adjusted EBITDA margin was 34.8%, while standalone Nevro adjusted EBITDA margin was 11.8%.
Globus reaffirmed its full-year 2026 revenue guidance of $3.18 billion to $3.22 billion, implying growth of 8.2% to 9.6% over 2025. The company raised its full-year non-GAAP diluted EPS guidance to $4.70 to $4.80, up from the prior range of $4.40 to $4.50. Kline said the increase reflected higher expectations from margin expansion seen in the first quarter.
Asked why revenue guidance was not raised despite the strong first quarter, Pfeil said it was still early in the year and cited the altered Enabling Technologies deal mix and Nevro’s revenue lumpiness as reasons for caution.
Pfeil said Globus received two FDA 510(k) clearances early in the second quarter for its patient-specific SCRIPT spacer system and patient-specific SCRIPT rods. He said the products are designed using ScriptStudio surgical planning software and integrate with the company’s Excelsius technology platform.
The company also reported 30.4% growth in trauma revenue, driven by its core trauma line and Precice limb-lengthening portfolio. Pfeil said the ANTHEM elbow plating system continued to exceed expectations and that manufacturing output for Precice now exceeds historical levels at the former NuVasive facility.
Globus ended the quarter with $799.3 million in cash, cash equivalents and marketable securities, up from $629.1 million at the end of 2025. Operating cash flow was $202.4 million, partially offset by $39.6 million in capital expenditures. Kline said the company had $390 million remaining under its share repurchase authorization as of March 31, 2026.
Kline said Globus’ capital allocation priorities remain internal investment in product development, spending on sets and manufacturing capacity, share repurchases and evaluation of complementary mergers and acquisitions.
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