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Cook spaghetti in a large pot of salted water until al dente according to package directions. Drain.
While noodles are cooking, prepare the creamy sauce. In a small skillet, heat sesame oil over low heat Add the onions (white parts only) and cook until tender. Add the ginger and cook for about 1 minute.
Increase the heat to medium and stir in the stir in remaining sauce ingredients: peanut butter, soy sauce, water, vinegar, sugar, and pepper. Stir until combined. Remove from heat.
Toss the hot noodles with sauce and garnish with sliced green onions and crunchy peanuts if desired. Store leftovers in an airtight container.