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Bring a large pot of salted water to a rolling boil. Add the pasta and cook according to package directions until al dente. Reserve 1 cup of pasta water before draining the pasta.

While the pasta is cooking, heat the olive oil in a large skillet or Dutch oven over medium-high heat. Add the Italian sausage, breaking it up with a spoon, and cook until browned and cooked through, about 5-7 minutes. Drain any excess fat.

Reduce the heat to medium. Add the chopped yellow onion to the skillet with the sausage and cook until softened, about 3-4 minutes.

Stir in the minced garlic and red pepper flakes (if using) and cook for 1 minute more until fragrant.

Pour in the crushed tomatoes, kosher salt, and black pepper. Bring the sauce to a simmer, then reduce heat to low and let it cook for 10 minutes, allowing the flavors to meld.

Stir in the heavy cream and Parmesan cheese until well combined and the cheese has melted into the sauce.

Add the fresh spinach to the sauce, stirring until it wilts, which should take about 2-3 minutes.

Add the cooked and drained pasta to the skillet with the sauce. Toss to coat the pasta evenly. If the sauce is too thick, add a splash or two of the reserved pasta water until it reaches your desired consistency.

Stir in the fresh basil. Taste and adjust seasoning as needed.

Serve immediately, garnished with extra grated Parmesan cheese and fresh basil, if desired.


Bring a large pot of salted water to a rolling boil. Add the pasta and cook according to package directions until al dente. Reserve 1 cup of pasta water before draining the pasta.

While the pasta is cooking, heat the olive oil in a large skillet or Dutch oven over medium-high heat. Add the Italian sausage, breaking it up with a spoon, and cook until browned and cooked through, about 5-7 minutes. Drain any excess fat.

Reduce the heat to medium. Add the chopped yellow onion to the skillet with the sausage and cook until softened, about 3-4 minutes.

Stir in the minced garlic and red pepper flakes (if using) and cook for 1 minute more until fragrant.

Pour in the crushed tomatoes, kosher salt, and black pepper. Bring the sauce to a simmer, then reduce heat to low and let it cook for 10 minutes, allowing the flavors to meld.

Stir in the heavy cream and Parmesan cheese until well combined and the cheese has melted into the sauce.

Add the fresh spinach to the sauce, stirring until it wilts, which should take about 2-3 minutes.

Add the cooked and drained pasta to the skillet with the sauce. Toss to coat the pasta evenly. If the sauce is too thick, add a splash or two of the reserved pasta water until it reaches your desired consistency.

Stir in the fresh basil. Taste and adjust seasoning as needed.

Serve immediately, garnished with extra grated Parmesan cheese and fresh basil, if desired.
