On the new standard of care in neuromodulation. That conviction is becoming a shared belief with healthcare providers around the world, as demonstrated by the continued acceleration of physician adoption in our numbers. This is underscored by the 55% year-over-year increase in U.S. patient implants in Q3. These numbers reflect the success of the execution of the commercial strategy that we laid out on previous calls. All aspects of commercial operations are tracking with our internal plans, from recruitment and training of new reps, to codification and scaling of a repeatable sales process, to competitive compensation plans. These all underpin our confidence to increase fiscal year 2026 guidance. We also continue to add seasoned leadership that know what good looks like and know how to rapidly scale a business like Saluda.
In addition, we continue to place a strong emphasis on the culture that will attract and retain the best talent in the industry. This, combined with the growth numbers we share publicly, mean that we have a strong pipeline of very high-quality candidates who want to join our team as we continue to grow our sales force. As a reminder, there exists a substantial opportunity for market expansion of a mature and underserved patient population in the U.S. Almost one in four American adults suffer from chronic pain, with an estimated $23 billion total addressable market for patients eligible for SCS treatment under their insurance plans. Today, there is only 6% market penetration in the SCS space, and we believe that with an improved and differentiated technology, we can unlock this opportunity. In terms of the traditional fixed-dose SCS for chronic pain, it is a well-established treatment.
It works by applying electricity to the spinal cord, interrupting pain signals from traveling to the brain. For several decades, large strategic medtech companies have applied what is known as fixed-dose therapy, very much depending on subjective patient feedback and manual remote control adjustments to help minimize pain. It has provided mixed outcomes for patients with efficacy and durability challenges. It also requires a significant therapy burden after the implant procedure, most of which falls on the manufacturing company. In terms of Saluda's closed-loop technology, the Evoke System disrupts the space with innovative software-driven technology. For the first time, we can objectively measure the nerve's response to stimulation. Measuring and amplifying these tiny signals while filtering out the noise in the spinal column is a breakthrough in engineering that took over 12 years to develop.
Once several thousand patients' spinal cord activation dosing-response curves were mapped, our sophisticated algorithms were then able to calculate a personalized optimal dosing range for each patient based on objective data as opposed to subjective patient feedback. Finally, our technology continually senses neural activation and continually adjusts the stimulation up to 250 x per second, ensuring that patients are always receiving an optimal analgesic effect. This means that our patients only require a service call once a year instead of six reprogramming visits per year. This means our reps can focus on new patients compared to fixed-dose SCS reps who spend half of their time on non-revenue generating service calls. In terms of the clinical data, we undertook the most comprehensive clinical study ever conducted in the SCS space. We ran a three-year double-blinded study that has been broadly published by leading medical organizations.
The outcomes were compelling. Almost 60% of patients experienced greater than 80% pain relief that continued through three years. 55% of patients either eliminated or significantly reduced opioid use. There were zero patient explants for loss of efficacy at three years. This compares to 22%-30% for current fixed-dose systems. All of this data underscores a substantial improvement in patient outcomes when using Saluda's closed-loop technology. With that overview, I will now pass it over to Jim to review the quarter's results and highlights.
Thanks, Barry. I'll spend the next few minutes walking through the financial results for the March quarter, touching on revenue performance, some commercial execution highlights, and then a quick update on cash and guidance. The points on the screen are the same highlights outlined in our activity report from filed yesterday. All dollar amounts are in U.S. dollar. Starting with revenue, Q3 was another strong quarter, and importantly, one where we continued to see acceleration in the business. Total global revenue for the quarter was $23.8 million, up 34% year-over-year.
That growth was driven by continued momentum in the U.S. and solid performance internationally as we continue to increase the number of active physicians using our product and take share globally. Breaking that out a bit, U.S. revenue was $16.4 million, up 35% year-over-year, and international revenue was $7.4 million, up 31% year-over-year. On a year-to-date basis through Q3, total revenue is $63.2 million, representing almost 23% growth versus last year, which puts us in a strong position heading into the fourth quarter. Turning to the U.S. performance in a bit more detail, the underlying story continues to be expansion across all key operating metrics. In the quarter, the number of U.S. patients implanted increased 55% versus the prior year, which reflects growth in both the number of active implanting physicians and increased utilization per physician.
Average quarterly active implanting physicians were also up about 32% year-over-year. The continued expansion of our U.S. sales team was an important driver of this growth in the third quarter and will continue to support our planned growth in the fourth quarter. Our U.S. implanted patient growth was also supported by share gains in higher volume ambulatory surgery centers or ASCs. The higher volume ASC portion of the SCS market was a part of the market we were not competitive in a year ago and has been an important focus area for us as we expand our commercial footprint. These ASC share gains also helped to support an 18% increase in U.S. physician utilization during the quarter.
Our implanted patient growth outpaced revenue growth in Q3, driven by this mix shift toward higher volume ASC accounts where volume-based pricing applies, combined with the timing of inventory placements relative to implant procedures. We are pleased to see this acceleration of U.S. patient growth in the quarter, showing continued momentum in the second half of our fiscal year. Internationally, Q3 was another solid quarter. Revenue grew 31% year-over-year, supported by continued demand in Europe across several of our countries and increased patient volumes in Australia. About $ 700,000 of the international revenue growth in the quarter related to a change in revenue recognition in certain European markets following the launch of EVA. This aligns European revenue recognition more closely with how we recognize revenue in the U.S. post our EVA launch there, particularly for products sold to customers prior to implantation.
This international momentum in the quarter was supported by the launch of our EVA automated programming platform. Specifically, we received approval for EVA in Europe and Australia in December and began limited launches in both geographies during Q3. Driven by positive customer feedback and early field experience, we began the full commercial launch of EVA throughout our European countries during the third quarter. We trained more than 200 physicians and staff internationally on the EVA platform as part of these launch activities. The excitement of the new product launch and the benefits of the new platform on both commercial execution and patient therapy optimization drove positive commercial momentum in Q3 and we expect will continue to have positive impact on the international business into Q4. On the commercial execution front, progress during the quarter was very much in line with our strategic plan.
In the U.S., sales force hiring, training, and productivity initiatives stayed on track. For FY 2026, we continue to expect an average of around 89 fully trained sales representatives. Based on current progress, we continue to expect to surpass our prior forecast of 154 total reps by year end. We're seeing continued improvements in new rep ramp up and field effectiveness driven by refinements in onboarding, training processes, and the growing impact of EVA as a commercial enablement tool. Physician and education also remains an important focus area as we continue our U.S. commercial expansion. During the quarter, we engaged more than 800 healthcare professionals through national, regional, and local programs. Year- to- date, we've more than doubled U.S. physician engagements versus the prior year.
Briefly on clinical and regulatory items, we had two peer-reviewed publications in Pain and Therapy that were issued during the quarter, which we believe further validate the performance and usability of the Evoke System, and specifically the new EVA programming platform. These publications help to reinforce Evoke's ability to streamline both programming workflows and the ability to individualize patient therapy with objective patient biomarkers from the spinal cord. We view these publications as independent validation of our closed-loop differentiation in real-world clinical practice. On the regulatory side, during the third quarter, we continued interactive discussions with the FDA regarding our paddle lead PMA supplement. We formally responded to FDA questions during the quarter, we expect feedback before the end of June 2026. Turning to cash and operating items, we ended Q3 with $121 million in cash on hand.
Cash used in operations was $21.1 million in Q3, up modestly from Q2. Higher receipts from customers offset increased staff costs associated with sales force expansion and the timing of staff payments compared to the prior quarter. As previously communicated, we also executed a phased reduction in force at the end of Q2, impacting approximately 50 non-commercial roles or about 20% of non-commercial headcount. That action is already helping to moderate operating expense growth while maintaining momentum in our frontline commercial organization. Given year-to-date performance, we continue to expect to improve upon the FY 2026 cash used in operations estimate that was outlined in our IPO prospectus. Based on the continued momentum we're seeing in the business globally, we're increasing our full year FY 2026 revenue guidance to $87 million, representing approximately 24% growth versus full year fiscal 2025.
That's up from our prior guidance of $85 million and above the initial IPO forecast. It reflects confidence in both current demand trends and our ability to execute operationally as we move into Q4. Overall, Q3 was another quarter of strong execution, accelerating revenue growth, continued expansion of our commercial platform, disciplined cost management, and continued momentum in the business. With that, I'll turn it over to NWR. Then we'll be happy to take a few questions.
Thanks for that, Jim. Just a few questions that have come through. First of all, perhaps for you, Barry. You talked about taking share in the high volume ASC market. Is this as a result of your increase in sales rep footprint, or was this a specific focus of the business during this quarter?
Thanks for the question, Simon. This has actually been a strategic focus area of ours going back several quarters. These high volume ASC centers often can demand volume-based rebates to get to lower net pricing. We had steered clear of this part of the market in the early days after launch. However, as we began our expansion and got a larger base of physician users and became more established, we've been able to start to compete here more. Look, it takes time to break into these accounts. You need to build trust with the physicians. You need to show the value of your technology to their patients in the early trialing, then over time you can begin to earn share if your product and your team show up well.
We know that our revenue per patient will come down a little bit over time as we gain more share in this part of the market, given their ability to demand some volume-based pricing. It's something we've always planned for in our long-term modeling.
Next question's from Melissa Benson at Barrenjoey. Just regarding the U.S., is there any feedback you can share on reimbursement win rates and coverage? Have you seen any changes in the past quarter in PA initial success rates or pushback or general reimbursement or insurer coverage pressure within the broader U.S. healthcare segment coverage?
I think the short answer is that we haven't seen any changes of note in terms of reimbursement. You know, this sector continues to be broadly coveraged. You know, when we brought our technology to market, we're leveraging existing CPT codes that have been out there for quite a while. Nothing of note really this quarter. In terms of the prior authorizations, you know, we continue to see a very high conversion rate. We've got an internal team that works closely with our physicians and is helping them through those processes. We actually see that as a competitive advantage, and we've got some, really positive feedback from our customer base in terms of support that we're giving them and the success rates that we're seeing in getting those prior auths converted over for them.
You talked about engaging more than 800 providers in the quarter and more than doubling engagements year- to- date with your physician education. Can you just give us a little bit of color on what kind of indicator that is for the business going forward?
Look, professional education is a very important and typical part of a med-device company's path to engaging new users and expanding the knowledge base for technologies. Using peer-respected physicians is a true and tried and true path for driving adoption. We've got a fantastic group of physicians and advanced practice providers we use as consultants to help deliver this peer-to-peer education on the technology and the therapy. I think the number of engagements we've had, not just in the quarter, but really all year, is a reflection of the growing interest in our technology and growing interest in how closed-loop therapy works and why it matters for the patients.
Look, a big part of the growth for sure is because we've grown our sales force, but also a big part is an increased investment post the IPO in educating physicians on the value of objective data and why closed-loop therapy is better for patients. Yeah, these participation metrics are a leading indicator for us as regards future growth of new physicians and, you know, it's been paying off really nicely for us so far.
Right. You did talk to, scaling the U.S. sales force. Perhaps you can just give us a bit of an update on that , please.
Yeah. Yeah, sure. This was obviously a key part of our strategy and something we talked a lot about as part of our prospectus and our road shows. We've been executing against a clear phased plan to scale the U.S. commercial organization. I am happy to report that recruitment, onboarding, training, territory deployment are all tracking to plan. You know, we've had quite a number of new additions to the sales force. These new reps, we've got them focused on priority geographies with the highest near-term opportunity. This allows us to expand coverage while maintaining a very high level of sales process quality and discipline and rigor. We're seeing encouraging early productivity indicators from the new reps.
This supported by our targeted training of physicians, strong clinical engagement, and just generally an increasing level of interest from new physicians is help driving this growth that we've reported today. We continue to be happy with both the quality and the quantity of reps that are applying for open sales roles as they come up.
Question from Melissa Benson at Barrenjoey, just regarding you lifting revenue guidance. How is gross margin guidance tracking? You'd purposely set a goal to exceed 45.9% gross margin for FY 2026.
Yeah. I'd say it's for the year, it's tracking well. You know, we're slightly ahead as we reported in our half yearly. I think that, while, you know, there's modest improvement that, you know, we're gonna be sharing as we get to the end of the year here. Probably more importantly is that the major strategic programs that we discussed in our prospectus and our ongoing meetings with investors around the introduction of a new IPG, the implantable part of our device, and the introduction of new leads. Both of those combined, it's probably well over 80% of our bill of material cost. We're on track to submit submissions for both of those projects to the FDA, you know, later this year.
We expect them to be fully commercialized next year. They will be, you know, two of the biggest drivers of increasing and expanding our gross margin up to mid-50s, you know, as soon as next year, and then into mid-60s in 2028. Those programs are all progressing extremely well and are on track, if not slightly ahead.
Yes, Simon. Sorry, the only thing I'll add is we, you know, we did say at our half year that we'd be out ahead of our 46% that was in the prospectus. We still believe that to be true, even though we haven't reported anything specific this quarter on gross margin.
That concludes the Q&A segment. Barry, I might just hand it back to you for closing remarks.
Yeah, yeah, sure. Thanks, Simon. Look, you know, as we said at the top of the call, we retain a strong conviction that Saluda's closed-loop technology will become the standard of care in spinal cord stimulation, and that conviction is supported by the continued and ongoing acceleration of physician adoption that we've reflected in our numbers this quarter. More importantly, all aspects of our commercial operations plans are tracking to, you know, what we had previously communicated. We look forward to continued momentum in Q4 and look forward to sharing this progress in our next update. With that, you know, thank you all for joining the call today, and thank you, Simon.
Thank you. Thanks, Jim. Thanks all.