Controlling Sonic the Hedgehog and his friends Mighty the Armadillo and Ray the Flying Squirrel, the player must escape an island after they are kidnapped by the villain, Doctor Eggman.

The game marked the debuts of Sonic characters Mighty and Ray; both have reappeared sparingly in the franchise.

[c] According to designer Manabu Kusunoki, the idea for trackball controls was conceived after an unspecified member of the development team—who was a fan of Marble Madness—suggested that it would work well with Sonic's style of gameplay.

[4] Both were designed by Kusunoki, who chose their species since he thought they would control similarly to how Sonic did and that they, like hedgehogs, were obscure.

Kusunoki could not recall why it was disputed; however, according to video game journalist John Szczepaniak, Sega of America failed to turn in its paperwork for the trademark on July 13, 1993.

Hackers discovered English-translated dialogue and sprites based on Eggman's appearance in the American Sonic the Hedgehog animated series hidden within the ROM image, suggesting that there were plans to release it in American arcades to promote the series.

[19] Game Machine listed SegaSonic the Hedgehog in November 1993 as being the sixth most popular table arcade unit in Japan at the time.

[12] The French magazine Mega Force compared the isometric graphics to Sega's Zaxxon (1982) and SNK's Viewpoint (1992).

[22] In the midst of a review for Sonic Gems Collection in 2005, GameSpy expressed disappointment that SegaSonic the Hedgehog was not one of the games in the compilation, voicing hope it would someday be rereleased.

[24] John Szczepaniak offered a negative stance in 2018, due to what he called bland level design and imprecise controls that had "an irritating fuzziness".

He compared turning characters with the trackball to feeling intoxicated, and claimed to have watched several individuals try to play but give up.

[11] Hardcore Gaming 101's Kurt Kalata similarly criticized the controls and high difficulty level, but nonetheless praised its break-neck pace and level design, which he wrote were aspects the Genesis Sonic games could not achieve.