Bring a large pot of water to a rolling boil. Season with salt. It should taste as salty as the sea.
Heat a large skillet to a medium-high heat. Add the sausage. Use a wooden spoon to break the sausage up as it browns.
Once the sausage is brown, add the garlic cloves. Saute for 1 minute. Stir in tomato paste. Cook for another 1-2 minutes. Stir in tomato puree, vodka, sugar, and salt. Bring to a boil and reduce to a simmer. Cover.
While the sauce simmers, drop the pasta into the boiling water. Stir. Cook until the pasta is just UNDER aldente. It will finish cooking in the sauce.
When the pasta is about 1 minute shy of cooked, stir the cream and spinach into the tomato sauce. Continue to stir and simmer until the spinach has wilted. Use a slotted spoon to transfer the rigatoni to the sauce. Reserve pasta water.
Sprinkle cheese on top of pasta, and gently toss the noodles and cheese with the sauce. Add 1/4-1/2 cup of starchy pasta water to loosen up the sauce. Continue to toss until all the noodles are coated. Season to taste with salt and pepper. Garnish with more parmesan cheese.