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Yoseph et al. Art Int Surg 2024;4:267-77 https://dx.doi.org/10.20517/ais.2024.38 Page 269

Figure 1. Methodology schematic detailing the three phases of the study design.

Study design and participants
Figure 1 shows the three phases of the study design. The goal of phase 1 was to craft ten commonly asked
questions regarding ACDF surgery. To accomplish this goal, we utilized the following search engines:
ChatGPT-3.5, ChatGPT-4.0, and Google. For both ChatGPT-3.5 and ChatGPT-4.0, the following prompt
was submitted: “Suggest a list of the 20 most common frequently asked patient questions about anterior
cervical discectomy and fusion”. The newly generated 40 questions were again submitted to ChatGPT-4.0
with the following prompt: “Consolidate themes and synthesize 10 questions from the following set of 40
questions: …”. Concurrently, a Google search for “frequently asked questions AND anterior cervical
discectomy and fusion OR ACDF surgery” was submitted, and the first 50 websites meeting our website
inclusion criteria [Table 1] were surveyed. After eliminating redundancies and applying exclusion criteria,
we were able to generate 10 frequently asked questions about ACDF surgery [Table 2]. All searches for
phase 1 occurred on November 6, 2023.

Phase 2 involved soliciting responses to our 10 commonly asked ACDF surgery questions from spine
surgeons and LLMs. In this effort, we conducted interviews with two attending spine surgeons, including
one neurosurgeon and one orthopedic surgeon. Both surgeons were given clear instructions to answer the
questions as if they were answering questions from a patient. Notably, both surgeons were blinded to all
aspects of our study’s design, including the questions themselves, prior to the day of the interview.
Following the interview, a transcript of their answers was produced. We next asked the same questions to
ChatGPT-3.5 and Gemini with the following prompt: “Speak as an expert spine surgeon who is up to date
with the latest scientific research and has years of experience counseling patients with empathy and clarity.
Provide a comprehensive and easily understandable answer to the following question about cervical spine
fusion surgery. Limit your answer to 250 words and focus on the most important aspects to ensure clarity:
…”. The word limit was determined based on the average length and range of our physician-generated