Exeter Chiefs flanker Tom Johnson has become the latest player to be ruled out of England's autumn internationals.
He has not played since the national team's summer tour to New Zealand and is to undergo neck surgery next week.
"It's one of those awkward ones where there's a balance between waiting to see if rehab sorts it out or operate and try to get some immediate results," said Chiefs head coach Rob Baxter.
The 32-year-old is expected to be sidelined for 10 to 12 weeks.
"Having spoken to the surgeon and then the surgeon having some debates with our medical staff, because it's a relatively straightforward one about trimming a bit of bone to free up a nerve, the consensus has been to get the operation done and give Tom the best chance to be good long-term, so we will do it now rather than wait and see," said Baxter.
Johnson has played 178 game for the Chiefs since joining them in 2007.
|England's 2014 autumn internationals|
|Saturday, 8 November v New Zealand|
|Saturday, 15 November v South Africa|
|Saturday, 22 November v Samoa|
|Saturday, 29 November v Australia|
He is the third England forward to be sidelined this week ahead of the autumn Tests, following news that Northampton Saints prop Alex Corbisiero and Leicester Tigers lock Geoff Parling are facing lengthy spells out of the game.
Props Mako Vunipola, of Saracens, and Dan Cole, of Leicester, are also set to miss England's forthcoming programme, as is Tigers hooker Tom Youngs.
But Baxter believes there is still enough time for Johnson to play his way into contention for next year's World Cup.
"The important thing is to perform with quality and to do that you need to be fit, you need to be strong and you need to feel comfortable with your body.
"It all sounds a negative when you're not playing, but this could work out to be a positive for Tom because he'll be confident going into contact and feel fit, feel fresh and feel strong," he added.
Despite Johnson's absence, the Chiefs have won three of their opening four games of the season and are fourth in the Premiership table.
They return to action on Sunday, when they make the long trip north to face next-to-bottom Newcastle Falcons.