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Brown the Italian sausage in a large pan for about 5 minutes.
Add the chopped onion and cook for an additional 5 minutes.
Add the orzo pasta and garlic, and cook for about 30 seconds.
Stir in the chicken broth and heavy cream. Once it boils, cook for 10 minutes uncovered on medium-low heat, stirring often to prevent sticking.
Remove the pot from the heat and add the spinach and Parmesan cheese. Mix until the spinach has wilted.
Serve warm.