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Add the sausage and chopped onion to a large pan. Season with garlic powder, onion powder, Italian seasoning, and parsley. Break up the sausage and cook until browned and the onion is completely soft.
Add the garlic and cook for 2 minutes, then stir in the tomato paste and cook for another 2 minutes.
Add the orzo, diced tomatoes, and chicken broth. Season again with garlic powder, onion powder, Italian seasoning, and parsley. Stir everything together, cover, and cook on medium high for 10 minutes.
Uncover and stir in the heavy cream, spinach, and Parmesan. Cover and cook for another 5 minutes.
Turn off the heat, remove the lid, and let it sit for about 5 minutes to thicken.