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Preheat oven to 375°F. Grease a 9 x 13-inch baking dish with nonstick spray; set aside.
Boil penne in a large pot of well salted boiling water according to package directions for al dente. Drain.
Meanwhile, brown sausage and onion in a large skillet or Dutch oven over medium-high heat until the sausage is no longer pink and the onion is translucent, about 5-7 minutes. Add the garlic and cook for 1 more minute. Drain off excess grease.
Stir in the marinara; simmer for about 10 minutes. Add the pesto and crushed red pepper flakes. Taste the sauce and season with salt and pepper, if desired. Stir in the cooked pasta, spinach, and fresh basil.
Spread half of the pasta mixture in the prepared baking dish. Sprinkle with half of the Italian cheese and half of the Parmesan cheese. Top with the remaining pasta mixture. Add the rest of the Italian cheese and the rest of the Parmesan cheese on top.
Bake, uncovered, for about 25-30 minutes, until the cheese on top is melted and the inside is hot and bubbly. Garnish with additional fresh basil, if desired.