I'm a Sr. Administrator for a very large forum. There are four other administrators and two moderators for specific sub-boards. At least one administrator is on line all the time. Our members flag problem posts and the notice goes out to all admins and mods. Someone takes them down within a short time. I look at the new accounts at least daily and eliminate those with spam or other violations of our TOC. Very little ever gets into the boards, actually.
We have discussed using captcha and other methods to verify new accounts, but this has worked for us so far. Just takes a little time and effort on our part.
The one difference I see here is that new accounts can start threads. At TMM, they must post at least 5 responses to other threads before they can start one. Most of the spam accounts that are opened have zero posts.