He was selected by the St. Louis Blues in the ninth round of the 1988 NHL Entry Draft, No. 177 overall. After skating with the Blues for the 1989–1990 season, he played four seasons with the Quebec Nordiques (later relocated to Colorado). He became a free agent in 1994 and returned to the Blues, playing there until July 1999, when he broke his pelvis in a motorcycle accident in St. Louis and was unable to resume his NHL career. Known for his devastating punches, he battered many of the league's top enforcers during his career.
In the Spawn comic book series, Todd McFarlane created a mob enforcer character named Antonio "Tony Twist" Twistelli, whom McFarlane acknowledged was named after Tony Twist. Twist learned about the character through his mother in British Columbia, who had a group of boys arrive to her house with Tony Twist-related Spawn items in 1997. After this incident, Twist viewed the Spawn animated series that had earlier aired on HBO from May to June 1997, he subsequently remarked "I'm in pink thong underwear, smoking a cigar, ordering the kidnapping of a child while two women are naked on the couch making love to each other. I obviously didn't want any part of that. Even if I was a good guy I wouldn’t have participated. You’ve got kids being kidnapped, you’ve got nudity, you’ve got police raping women. It’s nothing I want to be affiliated with." On October 31, 1997, Twist filed an anonymous John Doe lawsuit against Todd McFarlane Productions, and related parties such as HBO, for appropriation of his name without permission. The lawsuit was filed anonymously in order to keep publicity surrounding it to a minimum.
He was initially awarded $24 million by a St. Louis, Missouri judge in 2000. Sean Phillips, a former executive of a sports nutrition company, testified for Twist, stating that he withdrew a $100,000 endorsement deal, only after learning about the despicable nature of the Tony Twist character. However, the $24 million ruling would be reversed in November 2000, with McFarlane joking to journalists "He's got to return that yacht now." The trial continued, and Twist later won $15 million in 2004 when a St. Louis jury found Todd McFarlane Productions had profited from Twist's likeness. The verdict was upheld after two appeals in June 2006. In 2007, Twist and McFarlane settled the lawsuit out of court for $5 million.

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