Heat a large Dutch oven or stock pot to medium high heat. Add ground sausage, diced onions and garlic powder. Cook and stir until meat is fully browned with no pink remaining. This usually takes about 5 minutes. If there is excess grease in the pain, it can be drained off.
Pour in the chicken stock, crushed tomatoes and tomato paste and stir until well combined. Bring to a low boil, then simmer for 15 minutes, stirring occasionally.
After the 15 minutes, stir in tortellini, cream, spinach and salt. Cook until spinach is tender, which happens quickly, usually about 3-5 minutes.
Serve with freshly grated parmesan, red pepper flakes, salt and pepper.