Do you manually verify accounts? That's what we have done for a long, long time - it's the best way to stop anything coming through.
That said we don't get many spammers getting in (on our vB4 site) and do not run any of the measures you detail above. We have human verification with custom questions on the subject matter of our forum niche.
We did have a recent explosion however, and they were getting in through Tapatalk where the parameters were initially set to allow people to bypass the manual new account verification. Once we turned that off, they went away immediately again.
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