How can one effectively manage and prevent spam registrations in a PHP forum?

Spam registrations in a PHP forum can be effectively managed and prevented by implementing CAPTCHA verification during the registration process. This will require users to prove they are human by completing a simple challenge, reducing the likelihood of automated bots creating spam accounts.

```php
// Add CAPTCHA verification to registration form
if ($_SERVER["REQUEST_METHOD"] == "POST") {
    $captcha = $_POST['captcha'];
    
    if ($captcha != $_SESSION['captcha']) {
        // CAPTCHA verification failed, display error message
        echo "CAPTCHA verification failed. Please try again.";
    } else {
        // Process registration
        // Insert user data into database
    }
}

// Generate CAPTCHA code
$randomString = md5(uniqid(rand(), true));
$captcha = substr($randomString, 0, 6);
$_SESSION['captcha'] = $captcha;

// Display CAPTCHA image on registration form
echo "<img src='captcha_image.php' alt='CAPTCHA'>";
```
Note: This code snippet assumes that a separate `captcha_image.php` file is used to generate the CAPTCHA image.