Bring a large pot of salted water to a boil. Add the orzo and cook according to package directions until al dente. Drain and set aside.
In a large skillet over medium heat, add the olive oil. Once hot, crumble and add the Italian sausage. Cook until browned and cooked through, about 5-7 minutes.
Add the minced garlic to the skillet and sauté for an additional 1-2 minutes until fragrant.
Stir in the cherry tomatoes and cook for another 3-4 minutes until they start to soften.
Reduce the heat to low, then add the chopped spinach, heavy cream, and Parmesan cheese. Stir until the spinach is wilted and the cheese is melted and smooth.
Season the sauce with Italian seasoning, salt, and pepper to taste.
Add the cooked orzo to the skillet and mix until well combined, allowing the orzo to soak up the creamy sauce. Cook for another 2-3 minutes to heat through.
Serve immediately, garnished with fresh basil leaves for a burst of flavor.