High-risk spinal procedures, such as multilevel fusions, revision surgeries or operations involving spinal deformities, often place surgeons in ethically complex situations. Decisions need to be made regarding surgical eligibility, the balance of risks and benefits, long-term quality of life and the patient’s ability to recover. Dr. Larry Davidson, a leader in spinal surgery, acknowledges that while clinical experience is crucial in these decisions, Artificial Intelligence (AI) now plays a pivotal role in supporting the ethical aspects of surgical care.
By processing large volumes of data and highlighting patient-specific risks, AI helps providers make more transparent, evidence-based decisions that prioritize safety and autonomy. In high-stakes scenarios, it supports the evaluation of surgical appropriateness, improves how risks are communicated and helps manage patient expectations—all while reinforcing ethical integrity in spine care.
Ethical Dilemmas in Complex Spine Surgery
High-risk spinal procedures often raise difficult ethical questions. Surgeons must consider whether a procedure will truly improve the patient’s quality of life or whether it might introduce new complications. They also need to assess if the patient fully understands the potential risks and has realistic expectations about recovery.
It’s important to explore alternative, less invasive treatments thoroughly before considering surgery. Sometimes, there may be external pressures, whether from the patient, family or insurance policies, that push for surgery even when the clinical advantages aren’t clear. These pressures can complicate the decision-making process, especially for older adults or those with multiple health conditions.
Ethical choices in these situations require more than medical expertise. They call for clarity, compassion and a structured approach to weighing risks and benefits. This is where AI can serve as a valuable partner, offering timely insights to support thoughtful, patient-centered care.
AI as a Risk Stratification Tool
One of AI’s most valuable contributions is its ability to assess risk at an individualized level. By analyzing patient-specific data, such as age, imaging, prior surgeries, comorbidities, lab results and functional status, AI platforms can generate a comprehensive risk profile for each candidate.
This risk profile helps the surgical team determine whether a procedure is advisable or if conservative management may be more appropriate. In borderline cases, AI assists clinicians in assessing how much risk is acceptable based on the patient’s values, goals and overall health.
Supporting Shared Decision-Making
Ethical spine care centers on informed consent and shared decision-making. AI can generate visual tools and outcome simulations that help patients understand the full scope of a proposed procedure, including best-case, worst-case and most-likely scenarios.
For example, a patient may see how their expected mobility and pain levels compare under surgical vs. non-surgical care. These data-backed visuals help ensure the patient’s decision is informed, realistic and aligned with their values, which is especially important in high-risk scenarios where outcomes are uncertain.
Reducing Bias and Subjectivity
In certain situations, surgeons may unknowingly lean on personal experience or cognitive biases, which can lead to favoring more aggressive treatments or overlooking a patient’s vulnerabilities. AI helps provide a more objective perspective by standardizing risk assessments and minimizing variability in clinical recommendations.
By relying on data rather than intuition alone, surgeons are better positioned to explain and defend their decisions ethically, especially when they choose not to operate due to excessive risk.
Prioritizing Patient-Centered Outcomes
AI doesn’t just predict survival or surgical success; it can model outcomes that matter most to the patient, such as the ability to return to work, independence or reduction in opioid use. These quality-of-life metrics often carry more ethical weight than traditional clinical outcomes.
By aligning recommendations with what patients value most, AI helps steer care in an ethically sound direction that respects individual goals, not just clinical metrics.
Flagging Non-Medical Ethical Concerns
AI systems can also integrate socioeconomic and behavioral data to identify non-clinical risk factors that may affect outcomes. These might include limited access to rehabilitation services, unstable housing, mental health struggles or caregiver availability.
When these concerns are flagged early, the surgical team can coordinate additional resources or adjust the care plan to reduce ethical risks, such as neglecting post-op needs or performing surgery on someone unlikely to complete rehab.
Aiding in Surgical Triage and Resource Allocation
In systems where surgical resources are limited, such as public hospitals or during healthcare crises, ethical decisions must be made about which patients receive priority. AI can help establish transparent triage protocols based on medical urgency, recovery potential and expected resource use.
This ensures that decisions are consistent, equitable and based on clinical logic, rather than emotion or pressure, helping surgeons avoid moral distress and maintain fairness across all cases.
Maintaining Human Oversight and Empathy
AI’s role in ethical decision-making is not to replace judgment but to enhance it. All final decisions must be made by clinicians who understand the patient as a person, not just a data profile. Emotional intelligence, empathy and patient-provider trust remain essential components of ethical care.Surgeons must also carefully consider how they communicate AI-generated insights to patients, making sure the technology enhances rather than complicates the decision-making process.
Training the Next Generation of Surgeons
As AI becomes more integrated into ethical decision-making, spine surgery training programs are beginning to emphasize its responsible use. Surgeons in training are learning how to interpret AI-generated recommendations, weigh them against real-world scenarios and apply them in ethically complex situations.
Dr. Larry Davidson explains, “AI will provide us with the ability to have a total and comprehensive understanding of the patient’s medical history and what sort of spinal interventions would be considered as best practices.” Teaching future clinicians how to responsibly use this level of insight is essential to advancing ethical spine care.
Building Transparent, Accountable Systems
Ethical use of AI in high-risk spine care also requires system-level accountability. Algorithms must be continuously validated to prevent bias, maintain accuracy and ensure they’re grounded in up-to-date clinical evidence. Patient data must be handled with transparency and privacy.
Hospitals and surgical departments must set clear standards for how AI tools are used in surgical approvals, documentation and patient communication, creating a framework that supports both ethical care and technological advancement.
Guiding Difficult Decisions with Confidence
The most challenging decisions in spine surgery often come with no clear path forward. When the risks are high and outcomes uncertain, surgeons must carefully weigh the potential for benefit against the possibility of harm. These moments demand more than clinical skill;they require judgment rooted in evidence, compassion and ethical clarity.
With the support of AI, spine surgeons gain a broader and more personalized view of the patient. These tools synthesize data, highlight risks and offer outcome predictions that help clarify complex choices. When used responsibly, AI strengthens transparency, supports patient autonomy and equips providers to navigate uncertainty with greater confidence.
Ethical decision-making remains a human responsibility. But with AI as a trusted partner, spine care is becoming more informed, more consistent and more attuned to the individual needs and values of each patient.