Soil salinization threatens global agricultural sustainability and may elevate soil-borne disease risk through coordinated changes in soil conditions and the rhizosphere microbiome, yet long-term field evidence remains limited. Here, a 19-year controlled field experiment with an artificial salinity gradient (non-saline, moderate, and severe) was conducted to characterise salinity-associated responses of soil physicochemical properties, wheat crown rot (WCR), and the rhizosphere microbiome. A 3-year field remediation demonstration was implemented to test whether replacing saline irrigation with non-saline water could reverse soil deterioration and reduce disease severity. The results showed that severe salinity increased soil pH from 7.64 to 8.38 and reduced available phosphorus, total nitrogen, and available potassium by 54.11%, 14.63%, and 37.69%, respectively, while the WCR disease index increased from 10.51 to 32.88. It also reduced microbial richness and diversity, altered rhizosphere community composition, with taxon-specific abundance shifts among halophilic taxa, and redistributed community functional potential, with greater representation of genes associated with compatible-solute metabolism and ion homeostasis alongside changes in carbon, nitrogen, and sulfur metabolism. Remediation reduced soil salinity and pH, improved nutrient availability, and decreased the WCR disease index by 49.17%. Together, our results show that long-term salinization is associated with coordinated deterioration of soil conditions, restructuring of the rhizosphere microbiome, redistribution of microbial functional potential, and increased WCR severity. The remediation experiment showed that reducing salinity improved soil conditions and reduced disease severity. Re-establishing favourable soil abiotic conditions may be a prerequisite for alleviating disease risk in salinized agroecosystems.