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Roll the ground sausage into 1-inch 'meatballs' and place on a plate. Heat the olive oil in a large Dutch oven over medium heat. Fry the meatballs on all sides, working in batches if necessary, about 10 minutes. Transfer them to a plate and cover to keep warm.
In the same pot (don’t wipe it out), sauté the onion until it begins to soften, about 4 minutes. Add the garlic and sauté until fragrant and soft, another 1 to 2 minutes.
Add the chicken stock and bring to a boil, scraping the browned bits from the bottom of the pan. Reduce to a simmer and add the pasta and browned meatballs. Simmer until the pasta is barely al dente according to the package directions, about 8 minutes. Stir occasionally, ensuring the pasta doesn’t stick to the bottom of the pot.
Add the spinach and simmer until the spinach is dark and wilted and the pasta is cooked, another 1 to 2 minutes. Season with salt and pepper and taste. To serve, optionally drizzle with good-quality olive oil and sprinkle with parmesan cheese.