In a large soup pot or Dutch oven, heat over medium-high and add crumbled Italian sausage. Cook for about 5 minutes, breaking it apart with a wooden spoon until browned and cooked through.

Next, add the chopped onion to the pot with the browned sausage. Sauté for an additional 5 minutes until the onion becomes translucent.

Stir in minced garlic and optional crushed red pepper flakes, cooking for about 30 seconds.

Pour in the uncooked orzo pasta along with chicken broth and heavy cream. Stir well and bring to a gentle boil.

Once boiling, reduce the heat and leave uncovered for about 10 minutes, stirring frequently.

After cooking, fold in the fresh baby spinach and parmesan cheese, covering for 3-5 minutes.

Season with salt and pepper to taste, and serve hot, garnishing with extra parmesan if desired.