[Objective] To explore the effect of intermittent cold therapy on occult blood loss after open reduction and internal fixation (ORIF) of thoracolumbar fractures. [Methods] A total of 66 consecutive patients who were undergoing ORIF for acute thoracolumbar frac- tures in our department from January 2021 to November 2022 were included in this study. The patients were divided into two groups by ran- dom number table method, among them 33 patients in cold therapy (CT) group were treated with local intermittent cold compress 6 to 48 hours after surgery, while the other 33 patients in the routine group (RT) not received local cold compress anymore. The perioperative clini- cal and laboratory data were compared between the two groups. [Results] All the patients in both groups had OTIF performed smoothly with- out serious complications such as neurovascular injury or intraoperative massive bleeding. Although there were no significant differences in operation time, intraoperative blood loss and postoperative drainage volume between the two groups (P＜0.05), the CT group proved signifi- cantly superior to the RT group in terms of total blood loss [(608.5±386.2)ml vs (879.2±368.0)ml, P=0.008] and occult blood loss [(334.0± 355.4)ml vs (544.3±283.1)ml, P=0.010]. The VAS score for incision pain decreased significantly in both groups over time postoperatively (P＜0.05), which was not statistically significant between the two groups at any time points accordingly (P＞0.05). Regarding laboratory tests, there was no statistical significance in Hb and HCT between the two groups before surgery (P＜0.05), however, the CT group was significant- ly superior to the RT group in terms of Hb [(112.9±13.2)g/L vs (103.7±15.1)g/L, P=0.015; (117.7±12.7)g/L vs (106.3±12.3)g/L, P=0.001] and Hct [(34.8±3.9)% vs (32.7±4.0)%, P=0.039; (36.0±3.9)% vs (33.3±3.4)%, P=0.005] 3 days and 7 days postoperatively. [Conclusion] Local intermittent cold therapy does significantly reduce total blood loss, occult blood loss, and declines of Hb and Hct following ORIF of thoracolumbar fractures, which might be beneficial to the early postoperative recovery.