Bring large pot of salted water to a boil. Cook pasta according to box directions. Drain and set aside.
While pasta is cooking, place large deep nonstick skillet over medium heat. Spray with cooking spray and add in onion and Italian Turkey Sausage. Break sausage apart as it cooks and browns. After sausage is fully cooked, stir in garlic and tomato paste. Cook 3 minutes.
Add in remaining ingredients and simmer 10-15 minutes, breaking apart the spinach. Taste and adjust seasonings as needed.
Toss with cooked pasta and serve with optional parmesan cheese.