01 -
Form the sausage into 1-inch meatballs (about 1 heaping teaspoon each), wetting your hands with water as needed to keep the mixture from sticking. Place on a baking sheet. You should have about 40 meatballs.
02 -
Heat the olive oil in a medium (about 10-inch in diameter) Dutch oven over medium heat. Add half the meatballs in a single layer, avoiding overcrowding, and pan-fry until browned on one side, about 3 minutes. Flip the meatballs using tongs and brown the other side for 3 minutes. Transfer to a large plate (meatballs may not be fully cooked but will finish cooking with the orzo). Repeat with remaining meatballs, adding a drizzle of olive oil if needed.
03 -
Drain all but 1 tablespoon of fat from the pan. Add the orzo and garlic, sautéing until the orzo is lightly toasted and fragrant, about 2 minutes. Stir in marinara sauce, water, reserved meatballs, and any accumulated juices from the plate. Bring the mixture to a boil, less than 1 minute.
04 -
Cover and reduce heat to simmer. Stir frequently to prevent the orzo from sticking. Cook until most of the liquid is absorbed and the orzo is al dente, about 10 minutes.
05 -
Gently fold in spinach, a handful at a time, until just wilted, about 2 to 3 minutes. Remove from heat and stir in Parmesan cheese. Taste and adjust seasoning with salt and pepper as needed. Serve with a dollop of ricotta cheese if desired.