Objective To compare the surgical outcomes of the sequence of screw and rod placement for Lenke type 5C adolescent idiopathic scoliosis (AIS). Methods Lenke type 5C AIS patients who underwent posterior orthopedic fusion and fixation in our hospital from Jan. 2013 to Dec. 2020 were recruited. Based on surgical sequences, 22 cases were assigned to bilateral group (after bilateral screw placement, orthopedics was performed on the convex side and then on the concave side), and 20 cases were assigned to convex group (screws placed on the convex side and performed orthopedics, followed by the concave side). The operation-related indicators (including operation time), imaging parameters, quality of life scores were compared between the 2 groups before and 2 years after surgery. Complications of the 2 groups were analyzed. Results The operation time in the bilateral group was significantly longer than that in the convex group (［232.8±13.1］ min vs ［198.4±16.5］ min, P＜0.01). At the last follow-up 2 years after operation, the Cobb angle and its correction rate in the convex group were better than those in the bilateral group (［8.0±2.3］° vs ［9.9±3.2］°, P＝0.03; ［81.9±5.4］% vs ［77.8±5.8］%，P＝0.02). The rate of pedicle screw breach rate was 5.4% (17/ 312) in the bilateral group and 1.4% (4/280) in the convex group, with significant difference (P＜0.01). At the last follow-up 2 years after operation, the treatment satisfaction of quality of life assessment of the bilateral group was 4.61±1.38, and that of the convex group was 4.50±1.44, but there was no significant difference between the 2 groups (P＞0.05). There were no abnormal electrophysiological monitoring or operation-related complications in the 2 groups. Conclusion For Lenke type 5C AIS, the convex side of pedicle screw placement and orthopedics followed by concave side of pedicle screw placement and orthopedics can achieve better surgical effect.