On a recent morning, Dr. Joseph Osorio arrived in the operating room ready to sink six surgical screws into his patient’s spine, and he did not seem remotely nervous that their placement and size had been recommended by artificial intelligence software.

Osorio was the first neurosurgeon on the West Coast to begin using Medtronic’s new “Stealth AXiS” surgical robotic system, conducting a spinal fusion procedure to treat degenerative scoliosis at Jacobs Medical Center in La Jolla by anchoring two small custom-shaped metal rods across three vertebrae in his patient’s lower spine.

The process started with a CT scan, identifying the segment of spine that needed reinforcement. A program analyzed the resulting three-dimensional image, using an AI model trained on information from previous successful surgeries, not just where screws should go, but also the best path for their insertion.

Board-certified with thousands of such surgeries in his past, having completed a fellowship at Columbia University after a surgical residency at UC San Francisco, Osorio is well-qualified to make these calls with zero help from technology. So, why bother using an algorithm to plan these crucial, but routine details?

The utility, he said, is similar to what many are now experiencing when they use AI writing tools. The software can quickly get a person to the neighborhood of what they intend to say.

“You might say, ‘write me a paragraph on this,’ and it’s going to cut down your time, but you might still need to change some words, add a comma, tweak a sentence … that’s essentially what the AI is doing here,” Osorio said.

In this particular case, the AI system’s recommendations for screw length and diameter seemed on point, allowing the army of surgical technicians assisting with the procedure to pull the proper supplies ahead of time. The suggested locations, though, did require minor adjustment.

“It was slight, very slight, I’d say probably, like one or two millimeter adjustments,” Osorio said.

And the AI auto planning feature, he added, is even more useful in situations where a patient’s health insurance company will not pay for a pre-surgical CT scan, meaning that the guiding image must be taken after the patient is already sedated in an operating room on the day of their surgery.

Once a digital surgical plan is created and approved by a qualified surgeon, a surgical robot can use a system of cameras and electromagnetic sensors, registered against each patient’s anatomy with an initial X-ray, to move its arm to each screw location, placing a drilling guide at the exact angle needed to put each anchor in the correct spot. Here, too, AI is at work comparing previously recorded X-rays with real-time sensor data to compensate for any patient movements that may occur.

It is an evolution of Medtronic’s previous “Mazor” robotic spike system, which had already achieved levels of anatomy navigation using sensors and cameras that have reduced the need for X-ray images during surgery. And other medical device companies have launched similar systems, building in AI functions as the entire industry begins to see such augmentation as table stakes to play in a market that has always been as competitive as a high-stakes table in a Las Vegas casino.

Patients may wonder whether this push toward AI guidance is a good thing. After all, this is a technology that has made headlines for its ability to “hallucinate” convincing, but incorrect details.

ECRI, an independent non-profit organization that works to improve patient safety and cost effectiveness in health care, has been watching these systems develop.

In an email, Scott Lucas, ECRI’s vice president of devices, therapeutics and technology, said that the organization does not comment on any individual case or procedure, but has found that AI-enabled systems do have their merits.

“We can say that AI seems to be particularly helpful when it is used to support imaging, planning, navigation and precision in technically demanding procedures such as spine surgery,” Lucas said. “These tools may help surgeons in multiple ways, including tailoring procedures to a patient’s anatomy and improving consistency in implant placement and alignment.”

That said, the executive makes it clear that there is no argument for blind loyalty. In these early days, he argues, AI assistance should be less involved with surgeries, and there must be a clear path that allows surgeons to verify the work that their algorithmic assistants perform.

“Used well, AI may strengthen surgical safety; used without appropriate governance, human oversight, training and monitoring, it could introduce new risks, including overreliance, workflow disruption, planning errors or automation bias,” Lucas said.

Such bias, he added, occurs when a surgeon “fails to recognize when the technology is wrong.”

Osorio said that he believes the checks and balances built into the new system he is now using weekly do give him solid checkpoints to make sure that the machine is not hallucinating. While screw placement calculations will automatically calculate for straightforward placements, those with particularly complicated circumstances, such as anatomy that significantly deviates from the norm, will not proceed.

“If things aren’t lining up perfectly in the image, or they’re getting some feedback, it will just refuse to place a screw in that corridor,” Osorio said. “So, it’s only making recommendations in locations that meet the highest standards, and it still requires the surgeon to validate every level.”

AI is now also involved in the calculations used to move the robotic arm to the correct locations for screw insertions and also to make real-time corrections for any patient movement, Medtronic confirmed by email.

Here too, Osorio said, there are ways to verify that the robot’s calculations are pointing at the correct vertebrae, even though this type of minimally invasive surgery does not expose the target bone before screw insertion.

Surgeons use a bony projection at the back of each vertebra called the spinous process to check the robot’s accuracy, laying a special navigation ring over the landmark to verify that what is showing on the computer’s calculated location screen matches the robot’s arm position.

“A very common statement is ‘trust, but verify’,” Osorio said.

While robotic spine surgery is the latest to begin the process of AI integration, other systems have already made similar moves in knee and hip replacements, urologic procedures, and in some aspects of general surgery.

The Del Mar City Council approved an ordinance May 5 adopting attendance requirements for city commission, board and committee members due to “recent meeting attendance issues.”

The goal of the ordinance is to address “provisions that are somewhat ambiguous and subjective making them difficult to implement consistently.” A Committee Efficiencies Taskforce consisting of Mayor Tracy Martinez and Councilmember Terry Gaasterland were evaluating the issue.

The new rules are scheduled to go into effect on June 4.

“The purpose of establishing committee attendance requirements is to ensure committees function effectively with consistent member attendance and to have a fair and consistent method for handling absences, while recognizing that members may occasionally be absent due to illness or other circumstances beyond their control,” according to a council agenda report.

Previous rules said that if a commission, board or committee member reached three absences within a 12-month period, their term was vacated, according to the report.

“This procedural change will help eliminate redundancy with the Council Policy and give the Council more flexibility to amend attendance requirements in response to the City’s changing needs,” according to the agenda report.

As Mayor Todd Gloria has prepared his budget proposal for the next year, the city says its leadership has factored in a range of considerations for what to prioritize — including the results of a recent survey that led San Diego residents to give their own input.

The survey, which launched in February and closed Friday, asked San Diegans to weigh in on which city services they care most about and which ones they would feel comfortable reducing, especially as the city faces a $146 million deficit for the coming fiscal year.

It was the first time the city conducted a budget survey. But the survey, built by the city’s Performance & Analytics Department, faced some limitations.

There was no set limit to how many times a person could take it, although residents were asked to respond just once. It was technically possible for people outside the city to respond, though they weren’t supposed to. And the city only offered it in two languages, English and Spanish.

Some community members questioned how the results could accurately represent city residents and their different needs.

“Survey data can sometimes be taken as the word, but it’s not necessarily always reflective of what the full community is saying,” said Erin Hogeboom, director of San Diego for Every Child, when the budget’s first draft was released last month.

The budget the mayor proposed last month included cuts to several services, including $11 million from arts and culture and reductions to funding for parks, libraries and youth services. He is set to release his revised budget next Wednesday.

The city closed the survey on Friday. It will share a final report of the responses with the mayor early next week before the revised budget is released, said city spokesperson Nicole Darling.

By the time it closed, the survey received more than 13,000 responses from across the city, and just over 12,000 respondents included their council district. The largest share of responses, at about 2,600, came from District 3 — which covers the neighborhoods around Balboa Park and downtown. It was followed by Districts 2, 7 and 1.

The fewest responses came in District 8, which includes Barrio Logan, Grant Hill, Shelltown, San Ysidro and Otay Mesa, at 572.

Respondents were asked about which city services they most want to protect. They could also identify city services — from parks and open space to homeless programs to graffiti removal — that they would feel comfortable reducing, on a scale of very unacceptable to very acceptable.

The latest results through Wednesday show respondents are most concerned about poor street and sidewalk conditions, homelessness and housing costs. They want to protect street repairs and resurfacing, police and fire-rescue services from funding cuts, according to the city’s survey data.

Responses show that the biggest share of survey takers — 40% — prefer to see a mix of some service cuts and some new revenue to address the city’s financial crisis. Slightly fewer, 37%, said they preferred eliminating some city programs to preserve others.

Over 70% said they wanted to see new revenue come from hotel or tourism taxes. Just 15% said they want new revenue to come from additional parking fees.

The priorities recorded in the survey, centered around the city’s core services, haven’t changed in the months that the survey has remained open, Darling said.

But Bob Lehman, executive director of San Diego Art Matters, says he feels that the survey guided takers toward certain responses and didn’t provide enough context about the impacts of cuts.

The bulk of the questions listed groups of city services that survey takers could rate on whether or not they thought cutting funding for that service would be acceptable.

“It kind of shapes what your response is, when core services are listed alongside arts and culture,” Lehman said. “Without any context, people are nudged towards protecting the obvious essentials.”

The city says the groups of categories were random and that there was no limit to how many times the survey taker could select one of the ratings on the scale for those questions.

Mark Baldassare, survey director at the Public Policy Institute of California, said it’s a good sign that the city has asked for feedback from the public, especially when big financial decisions must be made. But he stresses that analyzing the survey should go beyond the top-line results.

“You have to be careful that it’s going to be representative and … that you’re looking at different age groups, different income groups and different parts of the city, to make sure that you’re not missing any important details about how city services need to be delivered in times when the budget is in stress,” he said.

The city’s survey included optional demographic questions, including a respondent’s age, income level and race and gender. But Darling says the survey wasn’t meant to be a “statistically representative sample, but rather a snapshot of resident perspectives.”

Most of the survey questions were optional. The only required response was a respondent’s ZIP code, though the survey could be submitted with a ZIP code outside of the city limits. In late April, the city said that fewer than 1% of responses were invalid or from outside the city’s ZIP codes.

On its webpage, the city asked respondents to take the survey only once — but there was no way to prevent them from submitting a response multiple times, which the city acknowledges was a limitation.

The city says the survey is just one of several factors informing the mayor’s budget decisions — with others including legal obligations, economic conditions, departmental needs and the city’s responsibility to maintain services like public safety, infrastructure and homelessness response.

“The survey is one tool to understand how residents are thinking about tradeoffs in a difficult budget year,” spokesperson Joya Patel said. “It does not drive decisions on its own.”