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Figure 4. Safety architecture for high-risk AI-supported spine care. The framework includes input validation, model-core uncertainty quantification, refusal or deferral under insufficient or out-of-distribution data, decision filtering, bias monitoring, audit trails, evidence traceability, physician override, and post-deployment monitoring. The central principle is that AI should support clinical decision-making, while final responsibility and action remain with the physician. Created in BioRender. Niu, J. (2026) https://BioRender.com/agwy6nr. AI: Artificial intelligence; HITL: human-in-the-loop; BMI: body mass index; MoE: mixture-of-experts; CT: computed tomography; MRI: magnetic resonance imaging; OOD: out-of-distribution.