of their Q4 update and presentation as released to the ASX yesterday morning. The audience will have an opportunity to submit questions via the Q&A function at any stage through today's presentation at the bottom of your screen throughout the session. Research analysts may also raise their hands should they wish to ask a verbal question of the management team. We'll aim to get through the majority of questions asked, in some cases combining submitted questions on the same or similar topic, and seek to have this session wrapped up in approximately 30 minutes, including Q&A. Thank you, and over to you, Barry.
Thanks, Sam, and good morning, everyone, and welcome to our call. Yesterday we reported our Q4 and full year fiscal 2026 results. Today we'll provide some additional color on those results, as well as an update on the overall business. We continue to retain a strong conviction that closed-loop spinal cord stimulation, powered by the Evoke System and EVA platform, will become the new standard of care in neuromodulation. That conviction continues to be reinforced by the results we are delivering across the business and the increasing adoption we are seeing from healthcare providers around the world. This was a particularly important quarter for Saluda. We exceeded our full year 2026 revenue guidance, delivering full year revenue of $90.2 million. We exited the year with accelerating commercial momentum, delivering Q4 revenue growth of 43% versus the prior year.
We continue to expand our physician footprint and increase physician utilization. We exceeded our sales force expansion targets. Importantly, we received FDA approval of our CAP24 paddle lead, which expands the Evoke platform into a significant segment of the spinal cord stimulation market that historically we've not served. These results reflect the successful execution of our commercial strategy that we've discussed on previous calls. All aspects of our commercial plan continue to track well. From recruiting and training new sales reps, to scaling a repeatable commercial process, to increasing physician education and awareness around objective closed-loop therapy. This all underpins our confidence as we enter fiscal year 2027. As a reminder, there remains a substantial opportunity within what is already a large established market. Nearly 1:4 American adults suffer from chronic pain.
Despite the significant burden of chronic pain, and despite established reimbursement pathways for spinal cord stimulation, market penetration remains relatively low. Today, only a small percentage of eligible patients receive Spinal Cord Stimulation System therapy. We believe that is because historical technologies have not always delivered the consistency, durability, and ease of use that patients and physicians are looking for. Our view remains that improved therapy options can expand the market and unlock a significant opportunity for patients, physicians, and companies capable of delivering differentiated outcomes. Traditional spinal cord stimulation is a well-established therapy. It works by applying electricity to the spinal cord and interrupting pain signals before they reach the brain. For decades, manufacturers have relied on what is essentially a fixed-dose stimulation system. These systems depend heavily on subjective patient feedback and repeated manual adjustments to therapy.
While this approach has helped many patients, it can create challenges around consistency of therapy and often requires significant ongoing management after implantation. That burden falls on patients, physicians, and ultimately on the device manufacturer supporting the therapy. Saluda takes a fundamentally different approach. For the first time, we can objectively measure the nerve's response to stimulation. Measuring and amplifying these neural signals while filtering out background noise required more than 12 years of development and represents a major engineering breakthrough. Once we mapped thousands of patient response curves, our algorithms were able to identify an individualized optimal physiologic dosing range for each patient. Rather than relying on the patient to continually adjust stimulation, our system continuously senses neural activation and automatically adjusts stimulation in real time. The result is therapy that is individualized, objective, and responsive to the patient's needs throughout daily life.
Importantly, this technology is supported by the most comprehensive clinical study ever conducted in spinal cord stimulation. We completed a three-year double-blinded study that has been broadly published in leading peer-reviewed journals. The outcomes were compelling. Nearly 60% of patients experienced greater than 80% pain relief through three years. More than half of the patients either significantly reduced or completely eliminated opioid use. Importantly, there were zero explants due to loss of efficacy through three years. We believe this body of evidence remains unmatched in the industry and continues to help differentiate Evoke in the marketplace. I'd like to spend a moment on this slide because we think it highlights one of the most important and often overlooked benefits of closed-loop therapy. Our commercial experience continues to show dramatically lower reprogramming requirements compared to traditional systems. This benefits patients because they spend less time managing therapy.
It benefits physicians because it reduces the clinical burden associated with ongoing patient management. Importantly, it benefits Saluda because our field organization can now spend more time helping new patients access therapy and less time performing non-revenue-generating service activities. Historically, one of the challenges in spinal cord stimulation has been that a very significant amount of a rep's time is consumed supporting existing patients. Our technology fundamentally changes that equation. We believe this reduction in therapy burden is not only important clinically, but ultimately becomes an important driver of scalability, sales force productivity, and long-term profitability. With that overview, I now pass it over to Jim to review the quarter results, discuss our continued commercial momentum, and provide an update on the CAP24 launch. Jim?
Thanks, Barry. I'll spend the next few minutes walking through the quarter, touching on revenue performance, commercial execution, operating metrics, liquidity, and then the CAP24 paddle lead launch. The points on this slide are the same highlights outlined in the activity report filed yesterday. Stepping back, there are really four things I'd like to highlight from the quarter. First, we delivered a strong finished FY 2026 with full-year revenue of $90.2 million, exceeding our guidance of $87 million. Second, growth accelerated as we exited the year, with Q4 revenue increasing 43% versus the prior year. Third, we continued to see progress across all our key commercial metrics, including physician adoption, physician utilization, implanted patients, and sales force productivity. Finally, we achieved FDA approval of the CAP24 paddle lead, which opens a significant new segment of the spinal cord stimulation market for Saluda.
With that, let me move into the operating results in more detail. Starting with revenue. Q4 was another strong quarter, importantly, one where we continued to see acceleration in the business. Total global revenue for the quarter was $27 million, up 43% versus the prior year. U.S. revenue was $18.4 million, up 45%. International revenue was $8.5 million, up 39%, driven by growth across several countries in Europe and Australia. International revenue in Q4 also included approximately $600,000 of revenue recognized related to a change in revenue recognition method in Europe. This represents the final quarter in which previously deferred revenue will be recognized related to this change.
For the full year, total revenue reached $90.2 million, representing 28% growth over FY 2025 and exceeding our guidance for the year. Looking beyond revenue, the underlying story continues to be expansion across all of our key operating metrics. During the quarter, U.S. implanted patients increased 50% to 769 patients. Average active implanting physicians increased 22%, the average physician utilization of the system increased approximately 23%. We're not only adding new physicians to the platform, we're also seeing existing physicians become more productive and treat more patients with Evoke.
The continued expansion of the U.S. commercial organization remains an important driver of this performance. For FY 2026, we averaged approximately 89 U.S. fully trained sales representatives and exited the year with 161 total U.S. sales representatives, exceeding our original year-end target. We're also continuing to see improvements in rep productivity, onboarding efficiency, and field effectiveness as our commercial processes mature and as EVA becomes more deeply integrated into our workflows. Physician education remains another important driver of growth.
During FY 2026, we engaged more than 2,000 healthcare professionals through national, regional, and local education programs, representing more than 90% growth over the prior year. Following quarter end, we also had a significant presence at the ASPN Conference in Miami. We participated in multiple scientific presentations, physician education programs, customer meetings, and launch-related activities around Evoke, EVA, and our CAP24 paddle lead. The level of physician engagement we saw at ASPN was very encouraging and we believe is another indicator of the growing interest we're seeing in objective closed-loop therapy. Briefly on liquidity and operating items, we ended the quarter with $116.4 million in cash on hand. During June, we also drew the second available tranche under our existing debt facility, providing an additional $24.6 million of cash net of transaction costs.
Combined with the remaining undrawn portion of the facility, we exited the quarter with approximately $141 million of a total available funding and continue to expect full-year cash used in operations to be better than our original IPO forecast. Overall, we were pleased with the continued commercial momentum we saw exiting FY 2026 and the progress we're making in building a scalable commercial organization. Before I hand things back to Barry, I'd like to spend a few minutes on our CAP24 paddle lead because we believe this was one of the most important milestones for the company this year. Historically, Saluda's focused almost entirely on the percutaneous segment of the spinal cord stimulation market. With CAP24, we're now able to offer surgeons a paddle lead solution incorporating the same closed-loop capabilities that have driven adoption of our existing platform.
This is important because orthopedic spine surgeons and neurosurgeons account for approximately 30% of the U.S. spinal cord stimulation implant market today. Until now, this was a segment of the market that we largely could not address. The opportunity represented by this market is significant. The paddle lead segment generated approximately $670 million of revenue in 2024 and expands our potential surgeon customer base by approximately 2,100 physicians. We received FDA approval at the end of June and subsequently announced the first U.S. surgical cases using the newly approved CAP24 paddle lead. We'll be pursuing a phased launch through the second half of calendar 2026 as surgeon training and inventory deployment continue. We expect revenue contribution to build gradually, but s trategically this expands our addressable market, opens a meaningful new growth opportunity, and provides another potential driver of growth as we move into FY 2027 and beyond.
With that, I'll hand it back to Barry for some closing comments.
Yeah. Thanks, Jim. That concludes our update on our Q4 results. I'm now going to hand it back to Sam for questions and answers.
Sorry, Jim, Barry, are you still there?
Yeah.
Yeah. I'm still here. Yeah.
Sorry. It looks like we had some technical issues there. If you could just go back to the first question, Jim, apologies, on the go-to-market for the paddle lead. Does the existing sales force have the clinical relationships to execute this launch, or does the approval trigger dedicated surgical channel hiring? And how much can existing reps leverage current pain physician relationships? Again, apologies for the technical issue.
Yeah. Sorry. It sounds like maybe we had a hiccup there. I'll go through this one again. Yeah. It's a good question. The answer is, our existing U.S. sales channel is equipped and can and will be the one selling the paddle lead. Most of the neurosurgeons that are implanting a paddle lead are generally getting a referral patient from an existing pain specialist. That pain specialist is generally the decision-maker, the physician decision-maker on the technology. That physician, however, is simply rather than being trained as an implanter themselves, they've got an established relationship to have a neurosurgeon implanter who prefers to implant a surgical paddle lead. There are some neurosurgeons that may control the patients, may be the decision-maker. That decision-making process is very similar to a pain specialist. These are relationships that are very intertwined to the pain clinics.
Our sales force is there, has relationships. They are equipped to do the selling. The real critical difference is that the paddle markets, the geographies in the U.S. or the cities in the U.S. where there are some where they are more paddle heavy than perc heavy, where just over time there's been more physicians or more practices that are referring into neurosurgeons implanting paddles. In those cities, we were very planful and strategic about when we added salespeople. We held off for a while and then added them, although still ahead of the paddle approval in anticipation of that approval, so that we've got some salespeople in those heavy paddle markets ready to hit the ground running once we move into commercial launch. It is still a single sales channel, if you will.
Thank you. Just on revenue ramp, the paddle launch is expected to generate a gradual contribution with, I think, successful cases already commencing through July with a full rollout later in calendar year 2026.
Yes. We did say about those exact things in the release that we had. We are in a limited launch. We did note that we'll have a full commercial launch later this calendar year. First, what I'd say is I'd emphasize this is a very typical process for a medical device company and a new product medical device launch. Even when you've got a product with FDA approval, companies generally don't move immediately to nationwide rollout. Instead, they begin with a limited launch, a small number of experience centers, trying to make sure every aspect of the commercial model is working the way we expect it to before we move into a scaled launch. In our case, we're doing initial procedures. We announced the first clinical use just a few weeks ago.
Our key opinion leaders and our experienced neurosurgeons are doing the first implants to get real-world experience around the implantation workflow, the translation from trial to perm therapy, programming protocols, physician training, field support requirements. These are all things that we've planned for, but what you do is you get some real-life experience to make sure and test run all of those things, our training, our methodologies, our workflows, just to make sure there aren't any tweaks or adjustments we want to make before we head to move into that full launch. I wouldn't characterize the surgeon training as a bottleneck. We began preparing for the FDA approval and already have physician and field training programs underway.
This is more about intentionally pacing the rollout to make sure that when we go broad, we are as effective as we can with that broad launch and not taking two steps forward and one step back. Making sure that we're confirming all the planning that we've done. We'll do a phase I. We often will move to a phase II that broadens the limited launch a bit further but is still somewhat controlled, and then we'll move into more of a commercial launch as we get a little bit further into the calendar year. As we progress, we'll likely talk more openly about when that commercial launch is expected. First, we're going to focus on this limited launch, make sure we can learn everything we can learn. The real important part is there's over 2,000 neurosurgeons that are doing SCS today.
It's about 30% of a $2.2 billion U.S. market that exists already today. It's $700 million worth of revenue that is now a market we were not accessing before, that we get to access now.
Great. Thank you. Just as a reminder, covering research analysts may raise their hand if they'd like to ask a verbal question. There's a couple of other questions on sales force productivity. You ended FY 2026 with 121 reps total, but averaged only 89 fully trained. Just remind us of the typical hire-to-productivity timeline and maturity timeline, and how we should think about revenue contribution from the large cohort that's still ramping into FY 2027.
Yeah, I can take that one, Sam, I'm not sure if you said 121, but I know you meant 161. You're right, we did end the year with 161 reps. Only about 60% of those reps were fully trained in Q4. That percentage will step up again in 2027, in fiscal 2027, where we're going to get closer to a 70%-80% of our reps being fully trained. Then we get into more of a steady state growth model, so that as we're adding reps that either replace reps that may have turned over, or as we add incremental coverage across territories, it means that we'll be able to stay in that 75%-85% of reps being at fully trained levels.
In terms of the timing and how long it takes to get them to full productivity, we put all of our reps through six months of training and onboarding before they get their quota. Then it generally takes about another six to nine months to get them paying for themselves. Then at about two years, on average, you've got reps fully productive by that stage. What all that means is that we still have a lot of growth ahead of us from all these new sales reps that we hired and onboarded in fiscal 2026. This is where EVA, our automated programming solution we've talked about before, that's really helping us with acceleration and we believe is a real competitive advantage for us.
I've mentioned maybe in a previous call that I was in Europe at one of the large pain conferences, and as one key opinion leader put it, he said, "At Saluda now every rep is your best rep because of the EVA programming solution." Yeah, that's the way. It was a good question. People should think about our reps and where they are in terms of being fully trained and on quotas. This year, 2026 was a huge year for us in terms of adding new reps, but we're heading into a more steady state growth model, I would say now going forward.
Thank you. Next question is from Melissa Benson at Barrenjoey. The comment that cash positioning is better than IPO forecast, what's the driver for this? Is it cost efficiencies found or reduced active spend in certain areas?
A good question. The comment that we made really runs to our cash used in operations. It is better than what we had forecasted in the prospectus, as noted. I think we have done a better than forecasted job of controlling some of our general, I'll say mostly non-commercial costs, and making sure that we're focused in where we spend that money and how we spend that money, even though we are still moving product development projects forward. The other area where we also saw some real benefit was on inventory management, and just our ability to bring down the amount of inventory and stock that we had on hand that was a bit elevated based on the size and scale of where we were. We were able to start to bring that down through some just good supply chain management.
A little bit of a combination of cost control on some of our projects and focused spend, but also inventory management.
Okay. Great. Thank you. A follow-up question from Melissa just on pricing. ASP is stabilizing, I think at +1 minor lift versus Q3. Does this reflect reaching a good mix between hospitals and ASC volume, in terms of that balance? What do you expect the impact from the paddle lead launch to have on ASP?
Two good questions. I will say, as our mix of volume shifts over time, each quarter you can see a little bit of flex up and down. I would tell you we are not yet. I think the ASC volume will continue to grow a bit as a percentage of our revenue. I think there are real opportunities we have ahead of us there. We love where the revenue per patient landed this quarter. It was a nice positive. I don't think we have hit steady state. We're not really into the mix where we actually want to be. We want to have a little bit more of that high volume ASC mix. We will see a little bit more revenue per patient pressure as we get into FY 2027, but this is what we planned for. We're not afraid of it, but you will see it.
The paddle will help to offset that. Generally speaking in the marketplace, paddle leads are in the market sold at a premium to the perc lead. As the paddle grows, that will help offset some of the mix shift in where we are selling the perc business in the U.S.
Okay. Great. Thank you. Next question from Derek Jellinek at Morgans. You've now built much of the commercial infrastructure and reduced non-commercial headcount by around 50 people. When should investors expect revenue growth to start translating into a meaningful reduction in cash burn?
Yeah, good question. I think, look, as we said in our release, we will give some FY 2027 guidance in August when we give our full P&L results. I think I can answer that question a bit more fulsomely in August when we start to talk about what does FY 2027 look like. I guess what I will say is, to the point that Derek's making, while we will still add salespeople, we will be adding them at a slower rate than we were in FY 2026, and they will start to, or continue to add to the top line. I think we will be able to demonstrate and guide the business to some very meaningful leverage on the P&L, and specifically leverage on that sales and marketing line.
I think, in FY 2027, we have an expectation that we will see some good positive P&L leverage on that line, and I think in August we'll be able to give people a finer point to what that could look like specifically in FY 2027.
Great. Thank you. Just a final follow-up from Derek. At IPO, you discussed the potential for one to three times higher rep productivity than traditional SCS and around, I think, $1.6 million revenue per rep. Based on what you're seeing today, do you still believe those targets to be achievable?
Yeah, my punchline is yes. What you will start to likely hear us talk a little bit about in August and beyond is also just now what is the revenue at the territory level, then what is the cost at the territory level. I say that in the context of, with some of our more tenured territories, we've got some good growing volume of business where we are already starting to add some of what we talked about at IPO, some junior reps that are supporting those territories because of the volume of the business that they're supporting.
Getting to that revenue per rep and getting to the cost that supports that territory revenue, we're already in the world where, call it 10% or so of our field force or of our territories, I should say, are in the cost structure support that we would target long term. We're seeing good green shoots of the productivity level we think we need to get to get to that profitability we talked about. It's early with a lot of Barry mentioned it, only about 60% of our sales force at the end of the year and that fourth quarter was fully trained, we still got a lot of new people early in their ramp.
The people that are later in their ramp, we are seeing good signs of an ability to get to the productivity, but ultimately the profitability, at that territory level we think we need to see.
Thank you. I think that's all the time we have for questions today. If there are any follow-ups, please feel free to shoot them through to Jim or myself. Maybe with that, I'll just pass it back to you, Barry, for any closing comments.
Yeah. Thanks, Sam. Look, I know a lot of the analysts on this call have been following us now for a while. It's hard to believe it's been over seven months from our IPO, but I think at the end of the fiscal year, it's good just to reflect briefly on the journey we've come on. Look, 2026 was a pivotal and transformational year for Saluda. After some subdued growth in 2025, we saw an acceleration of growth throughout the course of the year, with U.S. quarterly growth in particular growing 9% in Q1, then 17% in Q2, 34% Q3, and now over 45% in Q4. This growth is down to the execution of a detailed and thoughtful sales force expansion in parallel with the sales process and organizational transformation across recruitment, training, talent, compensation, marketing, and sales process.
There were other important accomplishments which will set us up for continued success in 2027 in addition to that. As mentioned in the Q&A, the execution of a significant reduction in force and streamlining of operations, which will improve our cash burn rate, and the advancement of our next generation IPG and lead submissions to the FDA. With these new products, we expect them to be in commercial hands sometime in calendar 2027. Last but not least, the approval of the CAP24 paddle, which as Jim said, will allow an immediate 30% expansion of our core target market. For me, the most important takeaway from 2026 is the growing recognition across large cohorts of pain physicians around the world that physiological closed loop SCS therapy will become the new standard of care in this space.
Simply put, our technology solves two real-world problems that this space has lived with for decades. A therapy durability problem for physicians and patients, and a profitability issue for industry. With our automated programming, with the assistance of AI, remote pain management for patients, and real-world evidence of a durable and enduring SCS therapy, they were the big topics at the recent ASPN Conference. This is the largest pain-focused physician conference in the world. Saluda solves for all of those problems. We remain excited to provide what I would say is a quantum leap improvement in therapy to patients with chronic pain going forward. We really look forward to a very successful 2027. With that, Sam, thank you.
Thanks everyone for joining today's Q4 update with Saluda Medical. Enjoy the rest of your day. Goodbye.