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Cook the Italian sausage in a large stockpot over medium-high heat until browned, breaking the sausage up and stirring it with a long spoon while cooking. Drain off any excess grease, then transfer the sausage to a separate plate and set aside.
Return the stockpot to the heat and add the olive oil. Add the white onion and saute for 5 minutes, or until the onion is soft and translucent, stirring occasionally. Add the garlic and cook for an additional 1 minute, or until fragrant, stirring occasionally. Add the crushed tomatoes, stock, basil, salt, pepper, and the cooked Italian sausage to the pot, and stir to combine. Continue cooking until the mixture reaches a simmer. Add in the tortellini and baby spinach, and let the soup continue to simmer (reducing heat to medium-low if it starts to boil) until the tortellini is cooked through, stirring occasionally. (This will take a few minutes longer if the tortellini was frozen.) Taste and season with extra salt and pepper if needed.
Serve warm, garnished with Parmesan cheese if desired.