Brown the sausage: Heat olive oil in a large deep skillet or pot over medium-high. Add sliced sausage and cook 3–4 minutes per side until browned.
Remove to a plate.
Sauté the veg: Add onion and bell pepper to the pot with a pinch of salt. Cook 4–5 minutes until softened. Stir in garlic and Cajun seasoning for 30 seconds until fragrant.
Build the base: Return sausage to the pot.
Add pasta, chicken broth, and milk. Stir, scraping up any browned bits on the bottom.
Simmer: Bring to a gentle boil, then reduce heat to medium-low. Cover and cook 10–12 minutes, stirring once or twice, until pasta is al dente.
If liquid cooks down too fast, splash in a little more broth or water.
Make it creamy: Stir in heavy cream and Parmesan. Add spinach if using. Simmer uncovered 2–3 minutes, stirring, until sauce thickens and coats the pasta.
Season and serve: Taste and add salt, pepper, or extra Cajun seasoning as needed.
Garnish with parsley or green onions. Serve hot.