In a large soup pot or Dutch oven, heat over medium-high heat and add the crumbled Italian sausage. Cook for about 5 minutes, stirring occasionally, until the sausage is browned and no longer pink.

Add the chopped onion to the pot, continuing to cook for another 5 minutes until translucent.

Stir in the minced garlic and red pepper flakes, cooking for an additional 30 seconds.

Add the uncooked orzo and mix well, ensuring it is coated in the sausage mixture.

Pour in the chicken broth and heavy whipping cream, bringing to a gentle boil. Reduce heat and simmer uncovered for about 10 minutes.

Stir in the fresh grated Parmesan cheese and baby spinach, allowing spinach to wilt. Cover and let sit for 3-5 minutes.

Season with salt and pepper as desired before serving.