Dustin Johnson withdrew from the Saudi International before Thursday's first round with a back issue.
The Asian Tour said Johnson, who won the event in 2019 and 2021, had to pull out after "tweaking his back."
He withdrew from the Masters Tournament in 2017 because of an injury to his back.
It was unclear Thursday whether Johnson would be healthy enough to play at LIV Golf's season opener at El Camaleon Mayakoba Golf Course in Playa del Carmen, Mexico, which begins Feb. 24.
Johnson, 38, left the PGA Tour to sign with the upstart LIV circuit last year. He won the LIV season championship and earned $35.6 million -- money on top of the reported four-year, $125 million contract he received for committing to the upstart tour.
Mexico's Abraham Ancer shot a seven-under par 63 to take the lead after the first day of play at Royal Greens Golf Country Club in King Abdullah Economic City, Saudi Arabia. He was followed by Sebastian Munoz (64) of Colombia, and Spain's Sergio Garcia, Louis Oosthuizen of South Africa and Cameron Young, all of whom shot 65.
All but Young are signed with LIV Golf.
--Field Level Media