Brown the sausage: Place a large, deep skillet or Dutch oven over medium-high heat. Add the Italian sausage and cook, breaking it up with a spoon, until browned and cooked through, about 5–7 minutes.
If there’s excess grease, drain it, leaving about 1 tablespoon in the pot. If the pan looks dry, add a splash of olive oil.
Sauté aromatics: Add the onion and cook until softened, 3–4 minutes. Stir in the garlic, Italian seasoning, and crushed red pepper flakes, and cook for 30 seconds until fragrant.
Build the base: Stir in the tomato paste and cook for 1 minute to caramelize slightly.
Add the diced tomatoes with their juice and the chicken broth. Stir well, scraping up any browned bits from the bottom of the pan.
Add pasta and simmer: Bring the mixture to a boil, then stir in the pasta. Reduce to a lively simmer.
Cover and cook for 10–12 minutes, stirring every few minutes so the pasta doesn’t stick, until al dente. If the liquid reduces too quickly, add a splash more broth or water.
Make it creamy: Lower the heat. Stir in the heavy cream and Parmesan until melted and smooth.
Taste and season with salt and pepper.
Finish with greens: If using spinach, fold it in and cook just until wilted, 1–2 minutes. The sauce should be glossy and cling to the pasta.
Serve: Top with extra Parmesan and a shower of chopped basil or parsley. Serve hot.