Heat olive oil in a large skillet or saucepan over medium heat

Add Italian sausage and cook while breaking it apart with a spoon

Cook until sausage is browned and cooked through

Add chopped onion and sauté until softened

Stir in minced garlic and cook until fragrant

Add dry orzo and stir to coat it with the sausage mixture

Pour in chicken broth and bring mixture to a gentle simmer

Cook until orzo becomes tender and most of the liquid is absorbed

Stir in heavy cream and Italian seasoning

Add fresh spinach and cook until wilted

Mix in grated Parmesan cheese until sauce becomes creamy

Taste and adjust salt, pepper, and red pepper flakes if needed

Remove from heat and allow to rest briefly before serving

Garnish with extra Parmesan cheese