PURPOSE: To test the usefulness of a novel performance test, the tally counter test (counter test), which uses a hand tally counter to objectively assess the severity of cervical myelopathy. METHODS: Eighty-three patients with compressive cervical myelopathy (mean age 64 ± 13 years) who were undergoing cervical laminoplasty and 280 healthy control subjects (aged 20-89 years) were tested. The subjects were instructed to push the button of a tally counter as many times as possible in 10 s. The average of the right- and left-sided values in each patient was used for analysis. In the patient group, counter test values were compared with Japanese Orthopaedic Association (JOA) and Japanese version of the 36-Item Short Form Health Survey scores preoperatively and 12 months postoperatively. RESULTS: The average counter test value was significantly lower in patients with myelopathy than age- and gender-matched controls (32.9 ± 10.9 vs. 46.9 ± 8.5, P < 0.0001). The counter test value was significantly higher at 2 weeks postoperatively than preoperatively (P = 0.0014). Counter test values showed a moderate correlation with JOA scores and a weak to moderate correlation with SF-36 physical functioning, role functioning, and role-emotional scores both pre- and postoperatively. The intraclass correlation coefficient of counter test values was high both pre- and postoperatively. CONCLUSION: The tally counter test is objective and quantitative assessment method for patients with cervical myelopathy. The test is simple, reliable, and capable of detecting small functional changes.