Brown the sausage in a skillet over medium heat until fully cooked, then drain excess fat.
Sauté the onion & garlic in the same skillet until fragrant (about 2 minutes).
Transfer to the crockpot and add crushed tomatoes, carrots, tomato paste, chicken stock, Italian seasoning, and salt. Stir well.
Cook on LOW for 6 hours or HIGH for 3 hours until the carrots are tender.
Add tortellini, cream, and spinach in the last 20-30 minutes of cooking. Stir occasionally.
Stir in red wine vinegar just before serving to enhance flavors.
Taste and adjust seasoning, then serve hot.
Pair with crusty bread or a fresh salad for a complete meal!