Background: Social media, particularly Twitter, has played an increasing role in networking and the dissemination of neurosurgical research. Despite extensive study on financial conflicts of interest (FCOI) influencing medical research, little is known about the function of conflicts of interest on social media and the influence they may have. In this study, we sought to evaluate the FCOI of physicians followed on Twitter by the top three neurosurgical journals. Materials and Methods: We analysed the FCOI of United States (US) physicians followed by the top three neurosurgical journals (Journal of Neurosurgery, World Neurosurgery, Neurosurgery) on Twitter. We determined the FCOIs of each physician using the Open Payments Search Tool located at https://openpaymentsdata.cms.gov and summed the data between 2014 and 2021. Results: We examined 2651 Twitter accounts followed by the top three neurosurgical journals on Twitter and determined 705 (26.6%) belonged to US physicians. Of the 705 US physicians, 577 (81.8%) received general payments between 2014 and 2021. After excluding US physicians currently in residency or fellowship (n = 157), this percentage increased to 93.2% (n = 511/548). In total, nearly $70 million in general payments were made between 2014 and 2021. Conclusion: These findings raise questions regarding the interaction between neurosurgical journals and the medical community on Twitter. This study may serve as the basis for