In a large skillet heat olive oil over medium high heat. Add sausage, garlic, and onion. Sauté until the onions are soft, and the sausage is starting to brown; 5-7 minutes.
Add tomatoes, Italian seasoning, salt, pepper, half and half, and Parmesan cheese. Stir until everything is well combined. Bring to a boil, reduce heat to simmer for 5 minutes. Stir in spinach, until wilted.
Add drained pasta, stirring to combine.
Serve topped with additional Parmesan cheese if desired.
Keyword Dinners, Easy, Easy Dinners, Italian, One Pot Meals, Pasta, Sausage, Simmered, Spinach