Final answer:
The presenting symptom when the hypoglossal nerve is injured during an anterior approach to the spine is a tongue deviation or asymmetry.
Step-by-step explanation:
The presenting symptom when the hypoglossal nerve is injured during an anterior approach to the spine is a tongue deviation or asymmetry. The hypoglossal nerve is responsible for controlling the muscles of the tongue, and if it is damaged, it can lead to weakness or paralysis of the tongue muscles on one side. This can result in the tongue deviating or protruding to the side with the nerve damage.