He missed the first of the live X Factor shows last night, after a nasty fall at his home on Friday.
And despite saying he hoped to return to the talent show this evening, it now looks like Simon Cowell will be missing in action once again.
The music mogul fell down the stairs after a mystery collapse on Friday and was rushed to hospital.
After treatment, it was decided he would not be on the judging panel for the first live show.
The categories were switched around, and judges Sharon Osbourne, Louis Walsh and Nicole Sherzinger went on without him.
It had been hoped that the 58-year-old would be well enough to return to the show tonight – where his category the Groups will compete against Nicole’s Over 25s.
But now it is not looking likely.
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Simon’s doctor visited him at home today, smiling to the photographers outside as he went in.
A source told the Mirror Online: “The decision is not 100 per cent yet but it’s very likely he’ll sit out this one on doctor’s advice.”
Last night, viewers had questioned why Simon’s pal Cheryl didn’t take his spot on the panel.
She had previously joined him to help out at Judges’ Houses, and was in the audience last night to support her partner Liam Payne, who was performing live.
But tonight could see another familiar face step in for Simon – one of his Britain’s Got Talent panel, Alesha Dixon.
“Alesha is ready to step in as a substitute judge as necessary,” added the insider.
Simon will be wary of rushing his return to work. He is believed to be in constant pain since the accident.
And despite carrying out a series of tests, it is still not known what caused the father-of-one’s collapse.
“Simon is suffering bad pains in his neck and is still very shaken,” said a friend.
“He thought he may have broken his back, and he’s told friends it was the most scared he’s ever been in his life.
“However he was given morphine and has improved since coming home.”
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The X Factor continues tonight at 7pm on ITV.