In many respects, Tottenham's 2-1 win over Manchester City on Wednesday was a great advert for the Carabao Cup.

Two of the Premier League's leading clubs, both fielding a blend of established stars and exciting youngsters, went toe-to-toe in an entertaining match, lit up by three excellent goals in the first half.

The result eliminated City, who have won the Carabao Cup six times in the past decade, and maintained Spurs' hopes of a first piece of silverware since 2008 in the competition.

While it may have been exciting for supporters, however, this was not an occasion likely to endear either manager to England's secondary domestic cup, as both sides suffered potentially consequential injuries.

Spurs pair Micky van de Ven and Timo Werner were forced off with apparent muscle problems, and Cristian Romero was also substituted out of precaution, while City's Manuel Akanji pulled out of the XI after feeling discomfort in the warm-up and winger Savinho went off on a stretcher in the second half.

Savinho and Van de Ven, who “felt his hamstring” according to Spurs head coach Ange Postecoglou, both appeared in genuine distress as they left the pitch.

City are now down to the barest of bones, with 13 players sidelined and the champions needing to muddle through against Bournemouth, Sporting Lisbon and Brighton before the November international break offers some relief.

“We are in real difficulty,” Pep Guardiola said. “The guys that play, they finish most of them with problems and we'll see how they recover.

“I think when we are in trouble, like we are because in nine years it never happen this situation with many, many injuries for many, many reasons.

“It’s been getting more difficult game by game.”

Guardiola expects to have Kevin de Bruyne, Kyle Walker and Jack Grealish available again after the international break, and said he was hopeful Savinho “just had a knock”, despite the winger being carried off the pitch with his shirt pulled up over his face.

Postecoglou was similarly optimistic on goal-scorer Werner, who immediately signalled to the bench on taking a corner, saying “hopefully it was more fatigue”, even after the German hobbled around the perimeter of the pitch in apparent discomfort.

It felt harder to be positive about Van de Ven's complaint, though, with the Dutchman's face betraying his concerns as he trudged off the field.

Van de Ven, who started at left-back, clutched the back of his right leg after racing back to challenge Savinho but was at least able to walk down the tunnel.

The 23-year-old was sidelined for two months after suffering a hamstring injury at the same stage of last season, and Spurs will desperately hope his latest complaint is not so severe.

Postecoglou is already short of cover at centre-half, where Radu Dragusin and Ben Davies finished Wednesday's game, and there is no like-for-like replacement for Van de Ven anywhere in the world. His ability to sprint back from Spurs high line to make tackles is arguably a factor in his hamstring problems but is also a crucial safety net for Postecoglou's side, often helping Spurs to pull off their high-wire act at the back.

Dragusin will provide cover in the Premier League but Davies and even Archie Gray may also be needed at centre-half if Van de Ven is sidelined for a significant period.

As both clubs waited nervously for updates, the upshot is more evidence of the increasingly unconscionable pressure on players and fresh questions about this competition's place in a packed schedule.

The Carabao Cup is already being squeezed by UEFA's decision to expand its European competitions, in which both Spurs and City are competing this season.

Extra-time has been scrapped before the semi-final stage and the EFL will surely have to cut the two-legged last-fours in the near future, despite managing to maintain the status quo for this season.

While City played like they wanted to win in north London, for Guardiola, who had previously said they would not “waste energy” on the Carabao Cup, the result was probably a relief, allowing the champions full focus on the Premier League and Champions League before the turn of the year.

For Spurs, by contrast, the win felt significant, setting up an enticing quarter-final tie at home to Manchester United; many Spurs supporters would love the club to prioritise the Carabao Cup but it is not entirely clear how the club itself feels about the competition.

Daniel Levy, the Spurs chairman, acknowledged last month that there are “too many games” in the calendar and added that “the particular problem is England is we have an extra cup competition compared to the rest of Europe”, which sounded like a veiled dig at the Carabao Cup.

As the injuries pile up, the Carabao Cup appears to be short of advocates in positions of power, making it easy to wonder about the future of the competition.