Wasps lock Joe Launchbury has become the latest player to be ruled out of England's autumn internationals due to a nerve irritation in his neck.
Launchbury, a regular in Stuart Lancaster's second row, will be unavailable for six to eight weeks while he recovers from the problem, immediately ruling him out of Tests against New Zealand, South Africa, Samoa and Australia.
The 23-year-old has been replaced by Leicester's Graham Kitchener.
"It's disappointing but it's important for Joe, England and Wasps that he has the appropriate recovery period. We are confident he'll be back in the new year," head coach Stuart Lancaster said.
Launchbury's injury is the latest in a string of issues to Lancaster's preparation plans. England's forward lines have already been dealt blows in the absence of second-row Geoff Parling, front-rowers Alex Corbisiero, Tom Youngs, Mako Vunipola and Dan Cole with flankers Tom Croft and Tom Johnson also unavailable throughout November.
Centre Luther Burrell is also unavailable for the first Test against New Zealand with a hand injury but is likely to be an option for Lancaster later in the month. Fly-half Stephen Myler is also undergoing treatment for a hamstring problem with hoping of featuring in the series.
England's campaign against the All Blacks gets under way on Saturday 8 November.