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North Queensland and Gold Coast are licking their wounds after a number of injuries in a chaotic and error-ridden NRL derby won by the Cowboys.

Justin Holbrook is unsure how long his Gold Coast Titans will be without stars Kieran Foran and AJ Brimson after the two vital members of their spine were injured in a 24-12 loss to North Queensland.

The duo were strong for a fast-starting Titans outfit that enjoyed an early lead in the second Queensland derby in 24 hours but Gold Coast lost their way before the Cowboys clung on to victory in an error-strewn and chaotic final 20 minutes.

Foran went down with a calf issue a quarter of the way through the contest and moments later Brimson was treated for a problem with his hamstring.

Jayden Campbell and Erin Clark replaced them for the remainder of the match.

"How bad? I'm not too sure yet. But they're never easy injuries to come back from in a short time," Holbrook said.

"To have to deal with that for 60 minutes was really tough and it was probably the difference in the end."

Cowboys winger Murray Taulagi was also left the field after suffering a suspected medial ligament injury on the stroke of halftime.

Cowboys coach Todd Payten confirmed Taulagi will head for scans on his right knee.

The 24-year-old was one of three Cowboys to depart the match, with James Tamou hobbling off with a foot injury and centre Gehamat Shibasaki limping out with a hamstring complaint.

"Gehamat's hamstring ... it's hard to get a gauge because he's never done a hamstring before. He couldn't tell if it was bad or not," Payten said.

"James has got a foot complaint but given the way he finished the game I think he's no good for next week."

Despite the loss of Brimson and Foran, it was the Titans who took an 8-6 lead into the break after Alofiana Khan-Pereira scored in the third minute for his fourth try in as many games.

Tanah Boyd added two more points off the tee before the Cowboys finally cracked a stalwart Titans defensive line through Jeremiah Nanai on 35 minutes to trail by two at the break.

Tamou scored shortly after the second-half restart for his first try in Cowboys colours since September 2016, to put his side 12-8 in front before Valentine Holmes intercepted a long cut-out pass and ran 90 metres to score North Queensland's third.

When Nanai was sin-binned for a dangerous tackle, Khan-Pereira crossed for his second soon after and the Titans looked set to fight down to the wire.

But the Cowboys sealed the result with seven minutes remaining when Tom Chester dotted down with his fingertips after a falcon and the ball ricocheting off a number of players.

Holmes was the standout for North Queensland, registering a game-high 225 metres but he was not without his own errors.

Tom Dearden also enjoyed his best game for the Cowboys in 2023 with a number of sniping runs in midfield.

Jordan McLean became the only Cowboys forward to crack 100 running metres in their last two outings, while skipper Tino Fa'asuamaleaui led the charge for the Titans with 174 of his own.

Both teams now enjoy 2-2 records with the Cowboys facing Canterbury away in round five and Gold Coast having a bye.