Abstract: Alkaline mine tailings (pH＞8), predominantly derived from the flotation of iron, aluminum, and molybdenum ores, are characterized by high salinity, nutrient deficiency, low organic matter, and poor structural integrity. These extreme physicochemical conditions impede natural recovery processes and pose long-term environmental and health risks. Conventional remediation measures, such as topsoil coverage and chemical stabilization, have demonstrated limited efficacy in such contexts, necessitating alternative strategies with enhanced ecological compatibility. Sulfur-oxidizing bacteria (SOB), recognized for their metabolic plasticity and environmental resilience, have shown significant potential in the bioremediation of extreme substrates. This review synthesizes recent advances in understanding SOB distribution and adaptation mechanisms in alkaline tailings, including diversified sulfur metabolism, utilization of alternative electron acceptors, stress response to salinity and metal(loid)s, biofilm development, and regulation of functional gene expression. Furthermore, the roles of SOB in improving alkaline tailing physicochemical properties, promoting soil structure formation, enhancing organic matter stabilization, and facilitating metal(loid) immobilization are systematically evaluated. Key environmental factors influencing SOB activity are also discussed. A conceptual framework integrating physicochemical function, nitrogen and carbon fixation, and ecosystem build-up is proposed to support SOB-based mine tailing rehabilitation technologies. Research gaps and future directions for SOB application in ecological rehabilitation of alkaline tailings are proposed.