Let's cook.
Heat 1 tablespoon of olive oil in a large skillet or Dutch oven over medium-high heat. Add the Italian sausage, breaking it apart with a spoon, and cook for 5-7 minutes until browned and cooked through. Drain any excess fat and remove the sausage from the skillet, setting it aside.
Add the diced yellow onion to the same skillet and cook over medium heat for 3-4 minutes until softened. Add the minced garlic and cook for an additional 1 minute until fragrant.
Stir in the orzo pasta, crushed tomatoes, chicken broth, salt, and black pepper. Bring the mixture to a simmer, then reduce the heat to medium-low, cover, and cook for 10-12 minutes, stirring occasionally, until the orzo is al dente and most of the liquid has been absorbed.
Stir in the heavy cream, fresh spinach, and cooked Italian sausage. Cook for 2-3 minutes, stirring constantly, until the spinach has wilted.
Remove the skillet from the heat and stir in 1/4 cup of grated Parmesan cheese. Serve immediately, garnished with additional Parmesan cheese if desired.
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