Good afternoon. Welcome to SI-BONE's second quarter earnings conference call. At this time, all participants are on a listen-only mode. We will be facilitating a question-and-answer session towards the end of today's call. As a reminder, this call is being recorded for replay purposes. I would now like to turn the call over to Saqib Iqbal, Senior Director of Investor Relations at SI-BONE, for a few introductory comments. Sir, please go ahead.
Thank you for participating in today's call. Joining me are Laura Francis, Chief Executive Officer, and Aanchal Maheshwari, Chief Financial Officer. Earlier today, SI-BONE released financial results for the quarter ended June 30th, 2023. A copy of the press release is available on the company's website. Before we begin, I'd like to remind you that management will make statements during this call that include forward-looking statements within the meaning of federal securities laws, which are made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Any statements contained in this call that relate to expectations or predictions of future events, results, or performance are forward-looking statements. These forward-looking statements are based on the company's current expectations and inherently involve risks and uncertainties.
These risks include SI-BONE's ability to introduce and commercialize new products and indications, SI-BONE's ability to maintain favorable reimbursement for its products and procedures, the impact of potential economic weakness on the ability and desire of patients to undergo elective procedures, SI-BONE's ability to manage risks to its supply chain, the impact of future capital requirements driven by new product introductions, and risks to the continued renormalization of the healthcare operating environment. Other forward-looking statements include our examination of operating trends and our future financial expectations, such as expectations for surgeon training and adoption, active surgeons, new products, and clinical trial enrollment, and are based upon our current estimates and various assumptions. These statements involve material risks and uncertainties that could cause actual results or events to materially differ from those anticipated or implied by these forward-looking statements.
Accordingly, you should not place undue reliance on these statements. For a list and description of the risks and uncertainties associated with our business, please refer to the Risk Factors section of our most recent Form 10-K and Form 10-Q filed with the Securities and Exchange Commission. SI-BONE disclaims any intention or obligation, except as required by law, to update or revise any financial projections or forward-looking statements, whether because of new information, future events, or otherwise. This conference call contains time-sensitive information and is accurate only as of the live broadcast today, August 7, 2023. With that, I'll turn the call over to Laura.
Thanks, Saqib. Good afternoon, and thank you for joining us. I'm pleased with our performance in the quarter, as we delivered over 30% revenue growth, led by robust demand for our portfolio of solutions, strong surgeon engagement, and favorable reimbursement tailwinds. The US procedure growth trends over the last several quarters give me confidence that we're, we're well positioned to deliver a strong second half of 2023. Furthermore, our strong liquidity position, bolstered by the successful capital raise in May, provides us the flexibility to continue our judicious investments in portfolio expansion and commercialization initiatives. We believe these investments, combined with secular growth factors in the business, will allow us to deliver continued revenue growth and accelerate our progress toward adjusted EBITDA and cash flow breakeven.
Before I discuss our results, I want to thank our employees, as they've continued to demonstrate unwavering dedication to serve our expanding surgeon base and ensure patients have access to our best-in-class solutions. This level of consistent record performance over the last several quarters would not be possible without you. Now, moving to our second quarter performance. In the second quarter of 2023, we generated record worldwide revenue of $33.3 million, an increase of over 30% compared to the second quarter of 2022. The quarterly result was led by record US revenue of $31.2 million, which represents US revenue growth of over 31% compared to the prior year period. This 5th consecutive quarter of record worldwide revenue and improving operating leverage exemplifies the consistency of our execution and strength in the business.
Let me provide an update on our key initiatives as we continue to look to extend our leadership position and drive strong long-term growth. Starting with sales infrastructure, our direct sales team is our biggest asset as we expand our product portfolio and surgeon base. At the end of the second quarter, our U.S. commercial organization comprised 85 quota-bearing territory managers. We complement our territory managers with clinical support specialists, as well as a growing network of third-party sales agents for case coverage. We also selectively place instrument sets at high-volume hospitals to meet demand. We're confident that our hybrid strategies will allow us to further penetrate the surgeon market cost-effectively, accelerate top-line growth, and achieve higher productivity.
At the end of the second quarter, our trailing 12-month average revenue per territory in the US was approximately $1.4 million, representing a 32% productivity gain over the comparable trailing 12-month period. Our strong revenue growth and increased operating leverage over the last several quarters are the results of our investments in building a world-class commercial organization. Moving on to surgeon engagement. We exited the second quarter with approximately 935 active surgeons. This equates to approximately 30% growth in our active surgeons over the second quarter of 2022. This was the 10th consecutive quarter of double-digit year-over-year growth in our active surgeons. Based on the early third quarter trends, we surpassed the 950 active surgeons milestone we set at the end of the first quarter. It's also encouraging to see surgeon overlap across our procedures.
We expect our complementary portfolio to drive deeper engagement and increase procedures per surgeon over time. These trends in active surgeon base reaffirm that our portfolio expansion strategy and investment in education are resonating with our customers. On academic training, we're pleased to see steady adoption of our procedures by surgeons first trained as residents and fellows as they matriculate to independent practice. For example, among the cohort of surgeons first trained as residents and fellows, procedure revenue in the second quarter of 2023 nearly doubled compared to the second quarter of 2022. Turning to products and solutions. With iFuse 3D, iFuse TORQ, and now iFuse Bedrock Granite, the value of our innovative, versatile, and complementary product portfolio has positioned us as the top choice for surgeons looking for sacropelvic solutions.
iFuse TORQ has become a key growth driver for us due to its expanded clearance, covering SI joint dysfunction, trauma, and adult deformity. iFuse TORQ provides a complementary technology to iFuse 3D for our existing surgeons. It's also allowed us to engage new surgeons and successfully convert several surgeons using competitor products when performing minimally invasive SI joint fusion procedures. While we remain strong advocates of the lateral transiliac trajectory as being the gold standard when performing SI joint fusion procedures, in June, we received FDA clearance for placement of iFuse TORQ in the posterolateral trajectory. This clearance provides surgeons, mostly those who are competitor conversions, the flexibility and confidence to use their preferred approach. The use of iFuse TORQ as a second point of fixation across the SI joint in adult deformity procedures is increasing since the product received FDA clearance for the Bedrock trajectory last year.
In trauma, we remain in the early stages of market development and are encouraged by the adoption we're seeing for iFuse TORQ in sacral insufficiency fractures. The trauma opportunity is of strategic importance to us as the sacropelvic solutions leader and is an important avenue for our growth over the long- term. Moving to iFuse Bedrock Granite. We are extremely pleased with the success of Granite in its first full year on the market. This breakthrough device has allowed us to target 130,000 annual cases across long construct adult deformity procedures and degenerative spine procedures to the sacrum, expanding our total addressable market by approximately $1 billion to over $3 billion. Given the positive surgeon reception, we're actively rolling out instruments and implant sets to capitalize on the demand momentum for Granite.
Furthermore, in June, we expanded the Granite implant family with the launch of a closed-head Granite implant. This addition to the Granite family will allow us to drive adoption with a subset of surgeons who prefer implants with a closed tulip head to attach the rod. We believe Granite has the potential to become the standard of care for stabilizing the basal long constructs in adult deformity procedures, and this addition ensures that Granite can address the preferences of surgeons performing pelvic fixation procedures. In addition to the use of Granite in long construct adult deformity procedures, we're encouraged to see that year to date, nearly 40% of the procedures in which Granite is used are actually shorter, multi-level constructs, generally a treatment for degenerative spine disorders.
Given the demand trends and over 100,000 annual procedures involving spinal fusion to the sacrum, we're progressing toward a 2024 launch of another new product in the Granite family. We believe the new product will further accelerate adoption of Granite in these short construct procedures. Along with the growing demand for Granite, we're seeing a consistent trend in surgeons using some combination of our products with Granite to achieve two points of fixation across the SI joint on either side in long construct procedures. This is driving a significant pull-through opportunity for the portfolio and a higher per procedure average selling price. Moving on to clinical evidence. Given the growing interest in the SI joint space, as a market leader with commitment to clinical evidence and patient safety, we launched the STACIE study in June.
STACIE is a prospective study of the use of iFuse TORQ in patients with sacroiliac joint dysfunction. The purpose of STACIE is to work with a select group of physicians and gather post-market information on the use of iFuse TORQ for sacroiliac joint fusion. I'll now turn the call over to Anshul to provide more detail on our financial results.
Thanks, Laura. Good afternoon, everyone. I will focus my comments today on second quarter revenue trends, operating leverage, and liquidity. I will end with our updated 2023 guidance. Starting with our second quarter revenue. As Laura noted, our worldwide revenue in the second quarter was $33.3 million, representing growth of over 30% compared to the prior year period. Second quarter U.S revenue was $31.2 million, increasing over 31% compared to the prior year period. This record US performance was driven by growth in the procedure volumes, which rose by approximately 30% compared to the prior year period. In addition to robust volume growth, for the second consecutive quarter, our US per-procedure average selling price increased compared to the prior year period. International revenue was $2.1 million, reflecting growth of approximately 15% compared to the prior year period.
Across Europe, France maintained strong volume growth, offset by ongoing recovery in Germany and the UK. Moving to gross margin and operating leverage. In the second quarter of 2023, our gross margin was 81%, in line with our expectation. As anticipated, the gross margin reflects the impact of procedure and product mix due to higher total cost of iFuse TORQ and Granite, increase in depreciation from the deployment of instrument trays to support the growing demand for these products, depreciation associated with our second facility in Santa Clara, and higher freight costs. Operating expenses were $38.9 million in the second quarter of 2023 versus $40 million in the prior year period. This 3% decrease in operating expenses is mainly due to timing of certain commercial activities that are scheduled for the second half of 2023.
This was partially offset by an increase in stock-based compensation and higher commission associated with the revenue growth in the second quarter of 2023. We're pleased that we have now demonstrated several consecutive quarters of improved operating leverage while investing in R&D and clinical research, which are crucial to delivering strong and sustainable revenue growth over time. Our net loss was $11.2 million, or $0.30 per diluted share for the second quarter of 2023, compared to a net loss of $18.5 million or $0.54 per diluted share in the prior year period, representing 46% earnings per diluted share improvement. The earnings per diluted share for the second quarter of 2023 were also impacted by the increase in the number of shares outstanding from our follow-on common stock offering in May.
Adjusted EBITDA loss in the second quarter improved 59% to $4.7 million versus $11.5 million in the prior year period. Turning to liquidity. We ended the quarter with a strong balance sheet, including approximately $169 million in cash and marketable securities. Our cash balance includes approximately $84 million in net proceeds from the following offering in May. Our first half cash used in operating activities was $14.3 million, an improvement of nearly 50% compared to $28.4 million in the prior year period. We are pleased with our trajectory of cash utilization in the last few quarters, while continuing our investment in long-term growth initiatives. We are building our instrument tray and inventory capacity to support the growing demand for Granite as we prepare for a seasonally strong fourth quarter. Moving to our updated guidance for the year.
Based on our 2Q performance, we are increasing our full year 2023 worldwide revenue guidance and tightening the range to $132 million-$134 million, up from our previous guidance of $128 million-$131 million. This revised guidance translates to year-over-year growth of approximately 24%-26%, versus the previous range of 20%-23%. We continue to expect the 2023 annual gross margin to be approximately 80%. Based on the updated guidance, we anticipate operating expenses will increase in the mid-single digit % for full year 2023 due to anticipated higher commission and bonus expense from higher revenue. With that, I will turn the call over to the operator for questions.
Thank you. To ask a question, please press star one one on your phone and wait for your name to be announced. To withdraw your question, please press star one one again. Stand by as we compile the Q&A roster. One moment, thanks, for our first question. Our first question will come from Craig Bijou of Bank of America Securities. Your line is open.
Good afternoon. Thanks for taking the questions and congrats on another strong quarter. I, I wanted to start, I know you're typically reluctant to give details on specific products, but I'm going to try anyway. I wanted to see if there's any color that you can provide on, you know, the strength in the first half. Looking at revenue guidance, even with the raise, it implies essentially flat revenue, first half versus second half, maybe, maybe slightly more in the second half. Is there anything on the product level that we should be thinking about that would suggest that, you know, the strong first half growth that you saw wouldn't continue in the second half?
Thanks, Craig. Thanks for the question. What I'll do is I'll, I'll answer your first question on the, on the product side, and then I'll have, I'll turn it over to Anshul to talk a little bit more about the guidance. We're really pleased with, with the quarter that we just exited. 30% growth in the quarter, strong continued momentum in the US, strong momentum with our active surgeon base, improvement in our ASP, a 60% improvement in our bottom line losses. We're, we're really excited about how we performed this quarter, and we just see very strong momentum going into the second half of this year as well, which is why we felt confident with the, the rate that, that we provided in guidance. From a product perspective, we're, we're seeing performance across the board here.
Our core business continues to drive our results. When I say core business, I mean primary SI joint fusion, and that can be with our iFuse 3D products, or it can be with iFuse TORQ. We're also continuing to see momentum in our trauma business with iFuse TORQ, specifically with sacral insufficiency fractures. Finally, we did talk quite a bit about Granite, which has just been a terrific launch for us, and we have a lot of excitement around Granite. We did talk a little bit about the product extension with the closed head Granite that was launched late in the second quarter, and that that opens up some additional opportunity with certain surgeons who prefer that particular product.
I won't, as you said, I'm not going to break down what the growth was, but we're seeing growth in all of the areas that I just mentioned and are really excited for the second half of the year.
Correct, thanks for the question on guidance. Laura has already talked about some of the enthusiasm in the business that we've seen, you know, not just in the first half, but also in the second half of last year. We've had about five quarters now of record revenue, and you know, honestly, this first half of the year is actually the strongest sequential growth and year-over-year growth we've seen as a public company. Feeling really good about, you know, how the business is set up. Some of the assumptions that we had made in our guidance and the last increase in guidance we did at the end of the quarter, you know, played out better than what we anticipated, both in terms of the Granite adoption, the rollout, and the ASP trends.
Now, you know, while all of that's been going on, we also, while being very, you know, confident of the strength and the secular trends in the business, and also want to acknowledge that, you know, there is potential seasonal strength in the second half. We just want to be very thoughtful as we're going into the back half of the year, and that sort of reflected, you know, in our guidance. You know, some of the assumption changes that we had was, you know, we provided some more upside from the Granite rollout in the second half. You know, historically, we've talked about mid-single-digit ASP decline, and, you know, even though we've had 2 consecutive quarters of positive ASP, we're still assuming, you know, ASP pressure in the back half of the year, albeit low single digit now.
We think it's appropriately hedged in terms of getting into the second half of the year.
Got it. Thank you. Then just a, a quick follow-up. Laura, I think you said the new approval for TORQ better positions you to go after some of those competitive cases that, you know, the SI joint fusion that may prefer the screw versus the triangular implant, iFuse. Maybe if you just expand a little bit on that and, and talk about how you are, you know, doing, you know, picking up those competitive cases. Thanks.
Sure, sure. And TORQ, as you know, was primarily launched to focus on the trauma opportunity that we have with sacral insufficiency fractures. That continues to be a long-term opportunity for the business that we're really excited about. Another adjacent market, our best estimate is around $350 million of potential that's there as well. The more immediate opportunity with TORQ certainly has been in the primary minimally invasive SI joint fusion market. We've seen a very significant uptick of competitive surgeons that are converting over to iFuse technology using the TORQ implant. Some of those surgeons have provided feedback where they're actually interested in the lateral approach, but they're also interested in this posterior lateral approach.
What we want to do is we want to be the company that provides sacropelvic solutions regardless of, you know, what the surgeon is, is interested in. While we remain strong advocates of the lateral approach, it's the gold standard. There's a lot of data out there showing the efficacy of the product using the lateral approach. We also want to give those competitive surgeons the solution that they're looking for and the confidence to use it. That, that trajectory is now on label.
Great. Thank you, and congrats again on another strong one.
Thanks, Craig.
Thanks, Craig.
Thank you. One moment, please, for our next question. Our next question will come from the line of Young Li of Jefferies. Your line is open.
All right, great. Thanks for taking our questions, and congrats on a strong quarter here. Was wondering if you can maybe share some more color on the intra-quarter growth. You know, it sounded like the momentum carried into July as well. But, you know, what are some of the expectations for the summer season, sort of seasonality impact? Can you provide some color on the, you know, high-level Q3, Q4 cadence?
Yeah. Hey, Young, this is Anshul. Why don't I take this question? You know, obviously coming out of the 2Q or the first half, we feel pretty good about the business, and some of that is thoughtfully reflected in our increased guidance of 24%-26%. When you think about, you know, quarterly trending, you know, sequentially in the 3Q, historically, you see, as an industry, a sequential dip in the 3Q from the 2Q. It can be somewhere around the low single-digit range. In our guidance, that's what our assumption is, that sequential decline from Q2 to Q3, mainly driven by this, you know, summer seasonality and actually having one less selling day in the quarter compared to the prior quarter.
While continuing to acknowledge that, you know, we've got strong momentum with a new product rollout, and we're going to work hard to minimize the impact of that, but that's not incorporated in the guidance that we've set.
All right, great. Very helpful. I guess, a follow-up question. Just in terms of getting a new surgeon onboarded for core SI joint fusion procedures, you know, is that timeline or process getting shorter, either due to the portfolio effect or just, you know, increased acceptance in the KOL and clinical community?
Yeah, thanks for the question, Young. And this dovetails a little bit with your previous question on interquarter growth in July. We did, we did mention in our prepared remarks that we have actually exceeded the high watermark of 950 surgeons in Q1 already at the end of July. We did see some strong new surgeon growth heading into the month of July, which is very encouraging given, you know, the summer months. I do also believe that, that you're right, that we have seen a decrease in the amount of time it takes for us to bring on new surgeons.
Part of it is just that the procedure is more well known at this point in time, and part of it is the different modalities that we can use in order to reach the new surgeons. It can be a regional course with a cadaver lab training, it can be a local training course in the OR, or it can be with our simulators, which we still are heavily using. And that's on the core primary SI joint fusion business. If you, if you actually look at our Granite business, it's actually quite easy to go in, and we do what we call an instrumentation review, typically in the office of the surgeon, because this is a procedure that they're used to doing already.
They're just going to be using the Granite technology, that's replacing some of the existing technologies that are out there. In terms of adding active surgeons, I do believe that we have a number of different ways to, to engage these new surgeons and that we have, significantly improved our ability to onboard.
All right. Thank you so much.
Thank you. One moment, please, for our next question. Our next question will come from Kyle Rose of Canaccord. Your line is open.
Hi. Great, thanks, everyone, and, and congrats on a, on a strong quarter. wanted to just ask, look, you've, you've had the NTAP out in the market for, you know, over nine months now. I just wanted to see if you've seen any material changes in, you know, the amount of implants being used per procedure. I know there's been a lot of talk of, you know, from going from two to, you know, potentially four or, or somewhere along that path. Secondly, I don't know if I missed it: Did you get the number of CSS reps you have in the field as well?
Sure. Thanks, Kyle, for the question. I will answer the question on the NTAP. Just as a reminder to others that are on the call, we have an NTAP in place that's a little over $9,800 for Medicare cases. It's exclusive to Granite, and it does create a pretty strong competitive advantage for us. That's really combined with the efficacy of the product. The goal here for surgeons is to ensure that they don't have fixation failure in these long construct cases. You know, these cases, on average, can cost $200,000 for the initial case and can cost in the range in total of around $125,000 for a revision, and obviously, the patient impact as well is significant.
What, what the NTAP does is it really, it, it's economically beneficial to the surgeon, to the hospital, and to the payer, and we have seen strong interest in that particular NTAP. We're, we're pleased with that. In terms of our CSS reps, you know, our, our typical pattern in prior years was to actually give out both numbers. It, it became a little bit confusing. Also, given the push that we've had toward agent sales as well, you know, what, what I'll tell you is that the CSS is similar to prior years or a little less than, you know, one CSS to, to one senior, quota-carrying rep. As I said, we're also bringing on additional agents that are helping to increase this productivity that we've seen.
Of, you know, on average, productivity increase of 32% this, this past 12 months, if you compare it to the prior year. It, and it does show that we can really grow the territory rep productivity. In 2021, it was less than $1 million. Last year it was around $1.2 million, and now we're at $1.4 million. Those quota-carrying reps are supported by the CSSs that you asked about, and then also the addition of agents who have been particularly helpful with Granite cases.
Mr. Rose?
Yeah, that's all for me. Thank you for taking the questions.
Thank you. One moment, please, for our next question. Our next question will come from the line of Samuel Brodovsky of Truist Securities. Your line is open.
Hi. Thanks for taking the question. Just the first one, and thanks for the color around the surgeon dynamics to start 3Q. With the new TORQ approach, should we think about a steady cadence of new competitive surgeon conversion through the second half, or is that more of a one-time thing? How should we think about what's contemplated in guidance in terms of new surgeon adds?
Yeah, in terms of new surgeon adds, it's not just the posterolateral trajectory with TORQ. You know, we're really focused, as we have been over the last several years, through education and engagement, to continue to grow that number. And it's, it's really critical for us as we think about the long-term outlook for the business. You know, based on what we've seen thus far in the quarter, we feel pretty confident that we will continue to hit new active surgeon milestones throughout 2023 at the end of each of the quarters. Right now, our expectation is to have that low to mid-teens growth in the fourth quarter of 2023 compared to the fourth quarter of 2022, which, as you may recall, Sam, was a pretty high watermark to start within the end of last year.
We feel very good about that. The other piece that's also equally important for us is, continuing to focus on growing surgeon overlap. Laura talked about the multiple modalities and treatment types that we're engaging surgeons with, and we've had a lot of success there, but we've seen, a 30% growth in this quarter in active surgeon base, but our procedures performed for surgeons sort of stayed flat. You've actually had surgeons moving up the volume scale as well, that have been doing a procedure for a while. Both those metrics, you know, pointing in the right direction for us.
Great. That's really helpful, and I appreciate the other color you've given on assumptions around price through the second half. Just with the Granite launch going so well, does that give you a more positive outlook on how you think about price per procedure evolving through 2024 and beyond? Thanks very much.
Yeah. Yeah, no worries, Sam. On the, on the ASP side, look, you know, we're really encouraged by the ASP trends, specifically in the first half, you know, having had two consecutive quarters of year-over-year ASP improvement. It's, it's driven by two things, right? The first one is the Granite volume that Laura's talked about, where we've seen surgeons, specifically those that do adult deformity procedures, using more than two points of fixation, so more than two SI-BONE implants in their procedures. And to some extent, we are also seeing, you know, a bit more moderated decline in ASP within the minimally invasive SI joint fusion business, even though we've continued to see a move to ASCs. You know, historically, that decline's been in the mid-single digit at the ASC side of service.
With the increase in the fees, in the start of 2023, the team's actually done a great job in working really hard and in several cases being successful in maintaining the pricing on those contracts. You know, we also want to acknowledge it's been only 2 quarters, right? While we feel good about some of the reimbursement tailwinds, the procedure product mix, we just want to be thoughtful and are not incorporating that upside in the back half of the year or, you know, at this point, too premature to talk 2024.
Thank you. One moment, please, for our next question. Our next question will come from Drew Ranieri of Morgan Stanley. Your line is open.
Hi, Laura and Aanchal. Thanks for taking the questions. just maybe first on, on OpEx for, for Aanchal, but you've, you've done a good job year-to-date, leverage is becoming more, of an important part of the story. In your kind of prepared remarks, you talked about continued revenue growth and, and progress towards adjusted EBITDA and cash flow breakeven. I was hoping you might be able to touch on kind of the latter two parts of these and, and maybe kind of what your expectations are for laying the groundwork to eventually achieving these targets, of, of adjusted cash flow and, EBITDA breakeven.
Thanks, Drew, for the question. In terms of the operating leverage, we're really pleased with the trajectory that we've demonstrated in operating leverage. It's been pretty linear to our top line growth, and it's basically driven by the foundation that we've built in making investments that we knew was required to support the level of growth acceleration we're seeing in the business. Now, in terms of, you know, how we see that evolve, we do believe that fiscal year 2023, we will continue to see operating leverage, albeit, you know, the year-over-year comps do become a bit tougher. You are seeing that in last year as well. We feel good about that, and, you know, we're not gonna be giving out guidance on when we believe we get to breakeven from an adjusted EBITDA or cash flow perspective.
If you look at the trajectory that we've been on and, and extrapolate where revenue has been and is potentially going to go, when we provide 2024 guidance and, and beyond, we'll be able to share more.
Okay. fair enough. Maybe second, on, on just the, the Granite instrument trays, I understand that you're continuing to roll this out, and, part of the recent raise was to kind of build up the, the inventory here. For the centers that you're in today, can you maybe just talk to us about what you're seeing in terms of utilization or, or productivity? You kind of hinted at some details, but, any more clarity around, what you're seeing, kind of the early days of, these accounts would be great. Thank you.
Thanks, Drew. On Granite trays, the, the Granite launch really has been trying to supply in order to meet demand. I talked in my prepared remarks about the efforts of our team in order to, to hit the results that we've hit. This, this is a, a particular area that I would say that, that people have gone above and beyond here. Our operations team trying to supply the implants that are needed, the trays that are needed, and then the people in the field trying to utilize the trays that they have. It, it has not been unusual for our sales reps to have to drive hours in order to retrieve trays and actually go to another site.
What we think we're doing here, in the second quarter and in the third quarter, is making sure that we have the inventory that we need, especially for Granite, as well as the trays that we really need, particularly going into the seasonally high volume fourth quarter that's coming here. We feel very confident that we're in that position. It really has been around 12 months of a lot of work in order to make sure to meet the demands that our surgeons are providing.
Got it. Appreciate the color. Thank you.
Thank you.
Thank you. One moment, please, for our next question. Our next question will come from the line of David Saxon of Needham & Company. Your line is open.
Hello, this is Joseph on for David. Maybe a high-level question, looking at 2024. Aanchal, I know you said it was maybe a little early to comment on it, but maybe some high-level details. You know, you'll be facing much more difficult comps in, in 2024, but you'll also be farther along with the Granite TORQ rollouts. And, you know, the assumption that you have the shorter construct Granite launch there going well. But just wanted to hear how you guys are feeling about, you know, sustaining that, that 20%+ growth, even as you start lapping those tougher comps.
Yeah, Joseph, thanks for, thanks for the question. Look, you know, I think our execution over the last several quarters gives us a lot of confidence in the underlying momentum in the business. You know, the foundation of which is built on our differentiated portfolio, which, as you, as you highlighted, is the, the next family of Granite products that we'll launch next year. The favorable reimbursement, both within the SI joint fusion side of the business, as well as the NTAP on Granite, and just the improving operating leverage, right? We're set up really well, and we do believe we're in the early innings of delivering on our long-term growth strategy that we've laid out over the last couple years, and have all the ingredients in place to deliver strong and sustainable, as well as fiscally responsible growth.
That said, we don't want to get ahead of ourselves. You know, I want to make sure we can capitalize and deliver what we believe will be a strong second half before we talk about 2024. You know, too early for me to give you numbers on 2024 at this point, but, you know, we're, we're doing everything possible to deliver on a strong second half and feel good about that.
Okay. Okay, great. Fair enough. Maybe, could we get an update on the marketing strategy? You've had the DTC campaign here out for two years now, you know, maybe if you could talk relatively, wanted to hear how you guys are feeling about consumer awareness now, you know, kind of relative to when you started those activities?
Yeah, I'm happy to take that question. The digital marketing activities have been a focal point for us. We are trying to generate, you know, additional knowledge with patients of SI joint dysfunction and degeneration. We've been quite successful in doing that, whether it's bringing patients to the website, completing our pain survey, or using our Find a Doctor functionality in order to be referred to, to one of our surgeons. We've been quite successful in using search as well as social media in order to drive patients to a, a better understanding of this particular condition. What we're really doing is we're starting to focus a little bit on a little lower in the funnel, for those patients who have actually had an interest in finding a doctor to help to further facilitate that process as well.
Our marketing strategy is evolving here as we continue to develop our digital marketing strategy.
Okay. Thank you very much for taking our questions.
Thank you.
Thank you. Thank you. I'm seeing no further questions in the queue. I would now like to turn the conference back to Ms. Laura Francis for closing remarks.
Thanks, all of you, for joining the call today. The year-to-date performance and the favorable demand trends, they bolster my conviction in a strong second half performance, as well as our long-term outlook for the business. I'm confident that we have all the elements in place to deliver a strong and sustainable long-term growth and progress toward profitability. Thanks for your time today. Goodbye.
This concludes today's conference call. Thank you all for participating. You may now disconnect, and have a pleasant day.