In order to achieve the goal of effectively utilizing solid waste resources and improving mining stability, it is necessary to incorporate various types of solid wastes in the production of cemented backfill. For investigating the compressive strength and damage characteristics of Cement–Fly Ash–Slag–Gangue (CFSG) cemented backfill under loading, real-time X-ray Computed Tomography (CT) scanning was employed to capture two-dimensional (2D) grayscale slices and three-dimensional (3D) fracture models during uniaxial compression testing. The study quantitatively assessed the evolution of cracks and microstructural damage in CFSG cemented backfill. The results indicate that the specimens underwent four stages of transformation, including compaction, linear elasticity, yielding, and residual deformation, during the uniaxial compression process. The specimens exhibited a measured compressive strength of 3.44 MPa and a failure strain of 0.95%. As the axial strain increased, there was an increase in 2D porosity observed in the CT images and a greater dispersion of crack distribution. A 3D model constructed from CT slices illustrated the feature of cracking expansion, with the fracture volume gradually increasing during the elastic deformation phase and experiencing rapid growth during the yielding and residual deformation phases. The damage variable, obtained from the volume of 3D cracks, exhibited a slow-growth pattern, characterized by a rapid increase followed by a more gradual rise with the increase in axial strain. This study serves as a significant reference for comprehending the micro-mechanisms involved in the damage process and cracking characteristics of cemented backfill mixed with solid wastes under external loading conditions.