•LSTV的主要前入路差异包括血管（主动脉分叉/静脉合流），肌肉（腰大肌）和骨解剖（椎间切线/耻骨联合），与非LSTV相比。•LSTV前路手术偏差增加，但并发症不明显。•进入L45时的血管意识将存在头部更多的ABF和ICC，并伴有L5，而进入更深的L56水平将存在更多的ABF和ICC。
•Key anterior approaches differences in LSTV include vascular (aortic bifurcation/iliocaval confluence), muscular (psoas) and osseus anatomy (inter-crestal tangent/pubic symphysis), when compared to non-LSTV.•There are increased surgical deviations but not significantly greater complications for anterior approaches in LSTV.•Vascular awareness while accessing L45 will be in the presence of a more cephalad ABF and ICC with sacralized L5, and access to the deeper L56 level will be in the presence of a more caudal ABF and ICC in lumbarized S1.
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