While Wall Street focuses on shiny new implants and the promise of EBITDA breakeven, a quiet revolution is brewing within SI-BONE's Q1 2024 earnings call transcript. This revolution, hidden in plain sight, could propel the company to a level of dominance in the sacropelvic market that even the most optimistic analysts haven't dared to predict. The catalyst? A strategic alliance with interventional spine specialists, a group poised to reshape the SI joint fusion landscape.

SI-BONE has long reigned as the undisputed king of minimally invasive SI joint fusion, pioneering the procedure and achieving impressive market penetration. Yet, a vast untapped patient pool remains, representing a tantalizing growth opportunity. Enter the interventionalists, a group of anesthesiologists, physiatrists, and interventional radiologists increasingly drawn to minimally invasive SI joint procedures, particularly those involving cortical bone allografts.

Recognizing this trend, SI-BONE has shrewdly expanded its engagement with interventionalists over the past 15 months, going beyond mere product sales to provide comprehensive training and support. This strategy goes far beyond just offering allograft options like the newly launched iFuse INTRA. SI-BONE is actively equipping interventionalists with the skills to perform the gold-standard lateral SI joint fusion procedure using iFuse-TORQ, a technique traditionally dominated by spine surgeons.

The results? A surge in interest from the interventional community, with record numbers completing first-time trainings with SI-BONE in Q1. This enthusiasm speaks volumes about SI-BONE's strategic vision. By embracing interventionalists, the company is not only securing a new avenue for product sales but is also empowering this group to drive broader adoption of lateral SI joint fusion, arguably the more effective and durable solution for SI joint dysfunction.

"Laura Francis (CEO of SI-BONE) stated: "As we engage select interventional pain physicians, we're leading with iFuse-TORQ and also training them on iFuse INTRA our Allograft solution. The interventional pain physicians have expressed their excitement about our comprehensive portfolio as well as better surgical technique and intraoperative support that increase the likelihood of the best patient outcomes.""

The implications are profound. Interventionalists, with their distinct patient base and expertise in minimally invasive techniques, represent an army of potential SI joint fusion champions. By arming this group with the knowledge and tools to perform lateral procedures, SI-BONE is essentially creating a second sales force, one that can reach patients earlier in their treatment journey and potentially steer them towards the more lucrative TORQ-based procedures.

Active Physician Growth (Q1 2023 vs. Q1 2024)

The chart below illustrates SI-BONE's significant year-over-year growth in active U.S. physicians.

This strategy is already bearing fruit. While SI-BONE hasn't provided specific revenue breakdowns, the impressive growth in active physicians, coupled with the record-breaking training numbers, strongly suggests that interventionalists are playing a significant role in driving procedure volume. As these newly trained interventionalists gain experience and confidence, their contribution to SI-BONE's top-line is likely to grow exponentially.

Here's where the numbers get interesting. SI-BONE estimates a total addressable market of nearly half a million sacropelvic procedures annually. Assuming even a modest 20% penetration rate among the 4,500 target interventionalists, with an average of 5 procedures per physician per year, we're looking at an additional 22,500 procedures annually. This translates to a potential revenue boost of nearly $50 million, assuming a conservative average revenue per procedure of $2,200.

This back-of-the-envelope calculation doesn't even factor in the potential for interventionalists to adopt TORQ for lateral procedures, which, at an average of 3 implants per procedure, could further amplify SI-BONE's revenue growth.

While the market fixates on short-term metrics like EBITDA breakeven, SI-BONE is quietly laying the groundwork for long-term market dominance. By nurturing a strategic alliance with interventionalists, the company is tapping into a powerful force multiplier, one that could propel them far beyond current growth projections. As this quiet revolution unfolds, SI-BONE is poised to leave its competitors in the dust, cementing its position as the undisputed leader in the sacropelvic market.

"Fun Fact: SI-BONE's commitment to innovation extends beyond its products. The company actively supports research and education in the field of sacropelvic disorders, sponsoring fellowship programs and partnering with leading academic institutions to advance the understanding and treatment of these conditions."