In a large pot of well-salted boiling water, cook pasta according to package directions for al dente. Reserve about 1 cup of pasta cooking water, then drain the pasta.
While the pasta cooks, heat the olive oil in a large Dutch oven over medium heat. Add the sausage and onion. Cook, breaking up the sausage with a wooden spoon, until the meat is no longer pink and the onion is tender, about 7-10 minutes. Add the garlic and cook for 1 more minute. Drain off excess grease.
Stir in the cooked pasta, Alfredo sauce, spinach, sundried tomatoes, pesto, Parmesan, basil, parsley flakes, oregano, and a pinch of crushed red pepper flakes (these are spicy, so use sparingly). Stir until well combined.
Cook over low heat, just until the spinach wilts and everything is heated through. Gradually add small amounts of the reserved pasta cooking water, just until the sauce reaches the desired consistency (you will not need all of the water). Taste and season with salt and pepper, if desired. Divide between individual bowls and garnish with grated Parmesan cheese, extra red pepper flakes, and/or chopped fresh herbs.