Bring a large pot of salted water to a boil. Add the spaghetti and cook according to package instructions until al dente, usually around 8-10 minutes. Drain and set aside.

In a large non-stick skillet, heat over medium heat and add the Italian sausage. Cook until browned and crispy, about 5-7 minutes. Transfer to a plate.

In the same skillet, add minced garlic and cook for about 1 minute. Pour in the heavy cream and bring to a gentle simmer.

Gradually stir in the grated Parmesan cheese into the simmering cream until melted and the sauce reaches a creamy consistency. Season with salt and pepper.

Add the cooked spaghetti into the sauce, tossing gently to coat. Adjust sauce thickness with reserved pasta water if necessary.

Plate the creamy pasta immediately, garnishing with additional Parmesan cheese and serve hot.