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Heat a Dutch oven or large soup pot over medium-high heat. Add the ground beef and let it cook for 5-6 minutes without stirring, allowing it to brown. Break it up into smaller pieces as it cooks.
Add the chopped onion and continue cooking for another 5 minutes, stirring occasionally and breaking up the beef further. Drain any excess fat if needed, but leave a bit for flavor if using lean ground beef.
Stir in the garlic, red pepper flakes, Italian seasoning, and orzo. Sauté for about 1 minute to toast the orzo slightly.
Stir in the tomato sauce, beef broth, heavy cream, and Worcestershire sauce. Bring the mixture to a gentle bubble. Cook uncovered for 10 minutes, stirring occasionally to prevent the orzo from sticking to the pot. Lower the heat to medium-low as needed to maintain a gentle simmer.
Remove the pot from the heat. Stir in the Parmesan cheese and fresh spinach, then cover the pot for 3-5 minutes to allow the spinach to wilt and the sauce to thicken. Season with salt and pepper to taste.
Serve the dish warm with extra Parmesan cheese if desired. Enjoy your creamy, flavorful one-pot meal!