Brendon McCullum needs an operation on his back and has been ruled out of Middlesex's T20 Blast quarter-final with Northamptonshire on Tuesday.
The former New Zealand captain was suffering with back problems during the month he spent with Middlesex in June.
But his symptoms worsened during the Caribbean Premier League, where he was playing for Trinbago Knight Riders, and he informed Middlesex CCC of his unavailability once his commitments in the Caribbean had finished.
It means Sky Sports viewers will not be able to see the 34-year-old in action on Tuesday as his county go up against the Northamptonshire Steelbacks in the T20 competition, live on Sky Sports 2 from 6.30pm (BST).
Middlesex's managing director of cricket Angus Fraser said: "I have been in regular contact with Brendon whilst he was at the Caribbean Premier League and was aware that he was struggling with his back.
Middlesex's managing director of cricket Angus Fraser said: "I have been in regular contact with Brendon whilst he was at the Caribbean Premier League and was aware that he was struggling with his back.
"The short nature of a T20 means there is always the temptation to play someone when they have an injury but Brendon felt he could not do himself justice and did not want to risk letting the team down in such an important game.
"He has been having regular injections and dosing up on pain killers for some time just to get by, which is not particularly good for you.
"As a club we have not had a lot of luck with injuries in the past couple of weeks. Seven 1st XI players have been forced to miss cricket or play in discomfort for one reason or another.
"But we will travel to Northampton on Tuesday with an excited and extremely capable squad. These are the sort of games we wanted to be involved in when we discussed our goals at the start of the season and we will give it everything we have got."
Resource: skysports.com
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