Kournikova struggled during Monday practice on grass
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Anna Kournikova has pulled out of the DFS Classic in Birmingham with a back injury.
The Russian will also miss the Hastings Direct International tournament in Eastbourne and is a major doubt for Wimbledon, which starts on 23 June.
Kournikova, a former semi-finalist at the All England Club, has endured an injury-riddled season.
And speculation grew over her appearance at SW19 this year when she was spotted in tearful discussions with her coach Harold Solomon after a practice session on Monday.
Kournikova's injury has been diagnosed as a chronic lumbar dysfunction.
"I'm very disappointed, actually devastated, not to be able to play in Birmingham," she said.
I've been advised not to play this week or next week and I don't know any further than that
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"Grass is my favourite surface and I love playing in England so having to pull out because of my back is the last thing I wanted."
The 22-year-old, who was due to make her Birmingham debut, aggravated the injury last Thursday and had a bandage applied to her lower back.
"I came to Birmingham on Sunday and practised on site and again today. The trainer taped me for the practice but afterwards I knew I had to see the trainer again.
"I've been advised not to play this week or next week and I don't know any further than that. They said my injury was chronic because it keeps coming back.
"It's the same problem I've had since after the Australian Open and it gives me referred pain in other areas but it all comes from my back."