Patient perspectives on AI: a pilot study comparing large language model and physician-generated responses to routine cervical spine surgery questions

Aim: The purpose of this study was to elucidate differences in patient perspectives on large language model (LLM) vs. physician-generated responses to frequently asked questions about anterior cervical discectomy and fusion (ACDF) surgery. Methods: This cross-sectional study had three phases: In phase 1, we generated 10 common questions about ACDF surgery using ChatGPT-3.5, ChatGPT-4.0, and Google search. Phase 2 involved obtaining answers to these questions from two spine surgeons, ChatGPT-3.5, and Gemini. In phase 3, we recruited 5 cervical spine surgery patients and 5 age-matched controls to assess the clarity and completeness of the responses. Results: LLM-generated responses were significantly shorter, on average, than physician-generated responses (30.0 +/- 23.5 vs. 153.7 +/- 86.7 words, P < 0.001). Study participants were more likely to rate LLM-generated responses with more positive clarity ratings (H = 6.25, P = 0.012), with no significant difference in completeness ratings (H = 0.695, P = 0.404). On an individual question basis, there were no significant differences in ratings given to LLM vs. physician-generated responses. Compared with age-matched controls, cervical spine surgery patients were more likely to rate physician-generated responses as higher in clarity (H = 6.42, P = 0.011) and completeness (H = 7.65, P = 0.006). Conclusion: Despite a small sample size, our findings indicate that LLMs offer comparable, and occasionally preferred, information in terms of clarity and comprehensiveness of responses to common ACDF questions. It is particularly striking that ratings were similar, considering LLM-generated responses were, on average, 80% shorter than physician responses. Further studies are needed to determine how LLMs can be integrated into spine surgery education in the future.