Gutter Ballet is not a concept album, but the final three songs ("Mentally Yours", "Summer's Rain", "Thorazine Shuffle") are a conceptual suite dealing with a single character as revealed by the band in interviews.

The title Gutter Ballet finally came from that of a play producer Paul O'Neill had written ten years earlier and which would later make-up the majority of the band's next work, Streets.

Two videos from the album entered rotation on MTV, "Gutter Ballet" (filmed at the beginning of 1990 in New York)[5] and "When the Crowds Are Gone".

The former track became a staple of Headbangers Ball and as a result, both Jon Oliva and Chris Caffery were invited to join host Riki Rachtman for an interview in 1990.

[9] Paul O'Neill was planning a theatrical release under the Trans-Siberian Orchestra name, titled Gutter Ballet, including Savatage's music from this album and from Streets: A Rock Opera.