England manager Martin Johnson will be poring over his front row options after Phil Vickery was ruled out of contention for the autumn.
Vickery sustained a neck injury in Wasps' 18-13 Amlin Challenge Cup victory over Racing Metro on October 11 and will require three months of rehabilitation.
The 33-year-old's absence has robbed England of their entire first-choice front row - all Test Lions - for the fixtures against Australia, Argentina and New Zealand.
Sale prop Andrew Sheridan and Bath hooker Lee Mears, who have sustained shoulder and knee injuries respectively, were ruled out earlier in the week.
Johnson has just three fit props - Tim Payne, Julian White and David Wilson - in his senior elite squad, while England Saxons props Matt Mullan and Dan Cole are also injured.
Johnson is due to name a revised elite squad next Monday, and there could be promotion from the Saxons group for players like Gloucester loosehead Nick Wood and Saracens prospect Tom Mercey.
The loss of Vickery is the latest in a succession of injury blows to hit England prior to the autumn Tests.
Full-back Delon Armitage, centre Riki Flutey and flanker Tom Rees had already been ruled out of next month's action before Mears, Sheridan and Vickery joined the casualty list.
England tackle Australia at Twickenham on November 7, before facing Argentina seven days later and then New Zealand on November 21.